Dear All

There have been a lot of comments about NHS Direct and how it has worked, or
not, over the recent holiday period.  I am glad that there is some support
for it, as well as criticism.  I would like to share with the group some of
the history of the NHS Direct as I feel some responsibility for it, having
been involved in some of the development for it before it was set up.  I
still represent BAEM on its National Advisory Group but I am afraid that
does not give me or us very much say in how this highly political project
develops.

NHS Direct was conceived to build on the experience that some A&E
Departments and some GP coops were having with running very successful
"telephone triage" schemes and advice lines.  We also knew that most A&E
Departments take medical advice calls but that they rarely have the
resources to ensure that appropriate staff deal with them.  Advice calls
taken by the first person who answers the phone, answered off the cuff and
unrecorded.   Dangerous.  Medical type advice calls are dealt with by
several other agencies even less appropriately....999 switchboards,
Chemists' shops and Police Stations were quoted, as well as some GP
surgeries without the sophisticated communications of modern Coops.  The
idea of setting up a telephone access line parallel to 999 but for less
acutely urgent problems seemed attractive.  You could get banking and sex
over the phone, why not wider access to health-care.  People may have heard
of the idea of "888", but that proved to be prohibitively expensive.

The project originally was for 3 pilot sites which could be closely
monitored and evaluated before committing resources more widely.  You
probably guess the rest.  Political imperatives took over.  Committment made
by senior politician to roll out NHS Direct country wide, even before pilot
sites operational.  Bang goes the idea of careful evaluation.   A lot of the
professionals involved (there are GPs as well) voiced dissappointment at
this but you can't get a politician to go back on a major public policy
undertaking simply in the interests of good science.  I decided to stay with
the project and try to keep in touch with it.  The need to implement a safe
system of decision making does certainly lead to prolonged questions in some
situations.  I do hope we are not just introducing yet another way to get
health queries not very well dealt with, after you have rung A&E and the
local Police Station!

So, what is my message?  Please don't condemn NHS Direct out of hand or on
basis of anecdotes.  The idea behind it is not all bad, but it is being
extended much too quickly for it always to go right.  Preferably get
involved with the organisation of local sites.  They will all need local
medical input.

Apologies for the long message.  It is what you get round to writing when
off sick with 'flu.
Happy New Year
Jonathan Marrow



%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%