A sweeping generalisation, I guess, but it strikes me that GPs have been
struggling for years to shed the OOH workload. Always, though, the
powers-that-be (TM) would play the professional responsibility card (or
similar). Now that non-doctors are in charge of OOH the notion that a doctor
needs to be available 24/7 seems to have been dropped like a steaming turd.
This, from the BBC news website...
Patients denied GP out-of-hours
Nurses will run the service
A health authority has said it can no longer provide a GP out-of-hours
service during the night.
Nearly 200,000 patients in Lincolnshire are no longer able to get direct
access to a GP between 11pm and 8am. Instead they will speak to a nurse.
Lincolnshire South West Teaching Primary Care Trust says it has been forced
into the position because of the introduction of a new GP contract.
Since April, GPs have been able to opt out of out-of-hours care.
Despite losing nearly £6,000 in NHS payments, many have done so,
transferring responsibility for out-of-hours care to the local health
authority.
This has meant that some PCTs have struggled to find enough GPs to staff
out-of-hours services.
Nurses are highly skilled, but no-one can pretend that they are as highly
skilled or as highly trained as doctors.
Micheal Summers
Under the Lincolnshire scheme - which covers Stamford and Grantham -
specially trained nurses, called first contact practitioners, will assess
patients, and decide whether they should be admitted to hospital.
It is believed that many other health authorities are likely to adopt a
similar policy.
Derek Bray, PCT chief executive, said the new scheme had the support of
local GPs, and high levels of patient satisfaction.
He stressed that the nurses had been properly trained, and had support from
medics, and the local A&E department.
"We are very happy with the development. We think there are many advantages
in having the service being led by nurses. Many jobs that in the past were
done by GPs, are now done by very experienced, specialised nurses."
Safety fears
However, the Patients' Association says patients would rather speak to a GP,
and has expressed fears that lives could be put at risk.
Michael Summers, the chairman, said: "We are very worried about it. Nurses
are highly skilled, but no-one can pretend that they are as highly skilled
or as highly trained as doctors."
Mr Summers feared that nurses would inevitably refer more patients to
hospitals - increasing pressure on already hard-ressed services.
Dr Hamish Meldrum, chairman of the British Medical Assocation's GP
Committee, also urged the PCT to review its policy.
"I'm not saying that patients will be put at risk, but it may be that
patients will unnecessarily have to go to hospital, partly because the
people who are advising them may not have the experience to make the
decision that might avoid the need for that."
Dr Meldrum said even allowing for the new contract, there should be enough
GPs around to provide a service to patients out-of-hours.
New guidelines
We are talking about a very specific part of the middle of the night where
a properly trained nurse, I think, is quite as adequate as a GP to make
decisions.
Dr Mike Dixon
In a statement, the Department of Health said: "It is for the PCT to
organise suitable out-of-hours services, and this should include appropriate
access to GPs.
"The Department will shortly be setting out new national standards that will
clarify and put beyond doubt the importance of securing proper involvement
of GPs in delivering those services."
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