I get where you are coming from with some envy, however I think you
missed the point.

I would hope that any UK doc would do the "trying my best for the
patient who pitches up at the surgery with a medical emergency" thing.
However, the question was not about that but about how you get a
receptionist with no medical training to  safely advise a patient with
a potential MI (insert any medical condition you like here) to either

a) call an ambulance or go direct to A&E
b) come immediately to surgery for assessment (always assuming theres
a dr in the house)
c) have some sort of phone triage which may may direct them to a less
urgent consultation

My answer is you don't.

24/7 phone assessment and triage = NHS direct, or a dedicated OOH service

UK GP except in remote areas is not commissioned or contracted to
provide an emergency service and will therefore normally not be
ready/available/experienced at providing it.

I don't ask my receptionists to take on the job of trying to assess
urgency, they simply tell the patient when they can next see the GP
and we ask the patient to decide if they feel the problem can wait 30
minutes, 3 hours, 3 days whatever it is and if in the patients opinion
it cannot wait they need to go to the emergency service.

I could provide an emergency service of course, in the same way that I
can put in chest drains, and could probably do a C section under
ketamine sedation, but thats not what I'm contracted to do in NHS GP
in my locality, and with a perfectly good emergency service that is
contracted to do such things 20 minutes down the road, it will be a
rarity that I will be the best suited doctor/organisation to do so.

On 21 April 2010 21:22, Jel Coward <[log in to unmask]> wrote:
> On Wed, Apr 21, 2010 at 12:57 PM, Geoff Schrecker
> <[log in to unmask]> wrote:
>>
>> The problem with this is getting the doctor, do you pull a doc out of
>> consulting every time you get a call and someone says they have a
>> chest pain. What if the docs are on visits?
>>
>
> Ah, sorry, I had forgot about the visit thing in the UK ;-)
>
> I guess what I was thinking about is what we do here.  If someone
> comes in with chest pain, we see them - the same way that we deliver
> their babies if they come in in advanced labour, or resuscitate them
> if they have suffered major trauma (or try to at least ;-)
>
> .....and our days are booked with 30 patients.  Sometimes some have to
> be re-booked - it happens (we have no access targets and virtually no
> complaints).  What we try to do (rather than run complex complaints
> procedures, or count meaningless points from recipe based medicine, or
> fight with a PCT, or have our computers run by others) is to provide
> care at all levels to all people (well - perhaps not _all_ levels,
> wasting huge chunks of the day doing social work visiting patients,
> whilst working out how to deflect someone who turns up with acute
> coronary syndrome at the office, is not a level that gets provided ;-)
>
> What I fail to see is why I would want to deflect some of the most
> important (and often 'fun') medicine.
>
> I am not being critical of anyone.  I am bemoaning what I think has
> been some de-skilling (and now non-skilling) of primary care docs in
> the UK, in some (many) areas of medicine.  I think it is sad for the
> docs and for the profession.
>
> We have had a few UK VTS trained folks through here, and I have been
> embarrassed by the level of training in anything acute, and some,
> somewhat reticent to shoulder the responsibility for complex
> management.   They are _better_  at the soft skills than their Canuck
> counterparts, that is true (on the whole), and quite good at chronic
> disease management and non-acute psychiatry.
>
> I have also been surprised by a notion of 'I'm not trained to do that,
> so I won't (must not) do it' .......even when not doing that thing
> endangers life.....and a willingness to write that in the
> notes........ and then an expressed entrenched belief that that action
> was correct.....after all the GMC told them so.    Something has
> become disconnected in allo that.
>
> I must also say that I am not talking about current company - in case
> anyone knows who is working here :)
>
> Rant over :)
>
>
> jel
>