>What benefits are those?
>
>1. Current wisdom is that the best person to triage is the most
>competent. ?experienced GPs or Nurses to be trained.
Actually current evidence is that trained nurses triaging with computer
lead algorithic systems are as good as the best GP on his best day and
rather better than the worst GP on his best day. How many GPs have
triage training and why should we spend our time OOH sifting through the
dross to find the real cases which need our expert care.
>2. NHS-D, by using Nurses rather than Doctors, tacitly suggests that it
>is now OK for OOH non-emergency contact. If so then the GPs' contract
>needs amending.
I agree, OOH is changing and these changes need to be looked at in
relationship to our contract
>3. If Nurses are theoretically better than GPs because of a protocol,
>then why not offer that protocol to GPs. Or is the problem already
>addressed in (2).
Yes using the same system with the same training a GP would be as good
but no better than a nurse, but why? I would much prefer to have all my
triaging OOH done for me and leave me proper time to see the really ill
people rather than rushing through to get the next pile of flimsies
triaged in case there is a real problem hidden in it.
>4. What possible need is there for a separate NHSD service in an area
>which is already serviced by GPs in the day and a GP co-op OOH. The only
>evidence so far is that a replacement of the co-op receptionist by a
>nurse, or 4 - while the other 3 are giving advice for non-urgent
>matters, may lead to about decrease in GP workload - but - this will be
>stuff the GP is already competent in answering and dealing with
>appropriately, i.e otherwise.
Because without one point access to all OOH, Coops, A&E, Dentists etc
you doing your own triage would then get all the GP appropriate A&E etc
contacts passed to you, adding to your already busy work load, who
called NHS-D. Without your dross being removed by NHS-D for you. GP
workload will only decrease if the NHS-D is across the OOH board.
>5. The NHSD funding will most likely come from GP funding after the
>pilots - so once again change is being forced with no real evidence for
>its benefits. I cannot see this as an addition of services without new
>funding.
The evidence so far from the 3 pilot sites, and from Europe and USA, is
that the people who need selfcare are removed from the OOH system by
triage, appropriate patients go to GPs, A&E etc, etc, the people who
only rang for advice but have serious illness get much better care and
overall outcomes are improved. With the benefits in care to all NHS-D
will be hard to fault on clinical grounds alone
>6. Perhaps rural areas are different.
>
No, works the same everywhere, people are people.
>Personally I would be happy it all OOH was taken away from me but these
>'suck it and see' changes are getting beyond a joke. Of course I will
>continue to work under the new standards but only because I have to, not
>because I want to. Not the best way to manage people resources.
>
See above re: clinical outcomes. Not suck it and see. Used for years in
USA and pilot evidence is mirroring that.
If new standards are clinically better for patients then should we not
embrace them?
Peter
--
Dr P.S.Fox
Consett Medical Centre
74 Medomsley Road E-Mail: [log in to unmask]
Consett Tel: 01207 502266
Co, Durham DH8 5HR Fax: 01207 506077
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|