> I do telephone triage daily (as all GPs have done since the invention of
the
> telephone). You are right it is not 100% safe which is why the systems
are
> designed to over triage (a common criticism). However, the alternative is
to
> tell everyone to go to hospital which is the ultimate in over-triage!.
Well said Robbie - and apologies for the cheeky post Doc - I was remembering
your enthusiasm for the service! I was a bit daunted at Charles statement
though - if you think telephone triage isn't much good.......how come its
now being pumped all over the world? It originated in the States and we
thought you loved it!?
Currently NHSD algorithms are oversafe and refer too many punters to A&E.
Not surprising really, as the foundations are from the states where there is
little in the way of OOH Primary Care - seeing GP same evening was never an
option. However, as a foundation it is very very safe - 15 years in US with
no successful litigation. Software company provide 100% indemnity....they
are confidant. What we need to do now is develop the service by bagloads of
feedback, audit, monitor....and decide what next. We should be able to
gradually knock it into shape for the UK systems - but it will still take
time.
So where should patients die? The poorly worked up chest pain, missed due to
an extra busy surgery because our surgeries are overwhelmed with dross? The
LVF who dies waiting during the night because they don't want to disturb the
doctor? The mum who doesn't report a sudden deterioration in her child,
because the doctor just saw him an hour ago? People think twice (allegedly)
before ringing a doctor - NHSD is saying "please call me"!
It is also fair to point out that there are at least 13 out of hours
operators - up til now working completely independently, and at times
antagonistically! (GP's doing own cover, Healthcall, GP Co-ops, Commercial
telephone advice lines,A&E, Ambulance Services, District Nursing Services,
Samaritans, Mental
Healthlines, Pharmacies, Social Services, Health Information Services, A&E
Advice lines, Family Planning - who should the patient contact first?
Whichever it is more than likely a game of pin-ball will ensue as they are
bounced around different agencies before any will listen to what is wrong.
Once reliable advice is forthcoming - all across the country, then surely
government can accurately pump OOH cash to where it is needed? A frightening
thought?
Damn - long post, and I promised not to waffle - sorry Darren!
Jeremy
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