GPs out-of-hours service branded ‘inadequate’ as A&E departments are inundated

Oct 30 2007 by Caroline Innes, Liverpool Daily Post

ACCIDENT and emergency departments are being inundated by patients with minor ailments because out-of-hours service provided by GPs is poor and inadequate, says a new study.

The report by the Royal College of Physicians (RCP) brands Britain’s out-of-hours health care provision as “inadequate and inflexible” and has called for a shake-up of the current system.

The report was last night welcomed by health spokesman and Lib-Dem MP for Southport John Pugh, who earlier this month told the Daily Post he believed Merseyside’s out-of-hours GP service should be brought back under the direct control of Primary Care Trusts.

Mr Pugh, who has raised concerns in Parliamentary debates about the lack of transparency of Merseyside’s out-of-hours provider Urgent Care 24 (UC24), has said complaints would continue and patients would continue to go without GP treatment unless the system went under an urgent review.

Since new GP contracts were introduced in 2004, many family doctors have been allowed to opt out of providing a night-time and weekend service.

The responsibility for those services has shifted to primary care trusts with Liverpool using Wavertree-based organisation UC24 to provide care for its 1m patients.

Now the RCP is calling for another shake-up so that staff delivering acute care can “acquire and maintain the same competencies” as those in hospitals.

The report said: “Patient access to ‘out-of-hospital’ general prac- tice or community-based acute medical care, especially out of hours, is largely inadequate and inflexible. Too often patients pre- sent to acute hospitals because there is nowhere else for them to go to get the reassurance and care they need. An expansion of the range of services, providers and facilities offering unscheduled and acute medical care in the community is required.”

Mr Pugh said: “It is time we review this service. We should revert to a more local and person-alised service where physicians who know their patients carry out face-to-face consultations and have access to patients’ records.”

The report also said people should be directed as soon as pos- sible to a doctor who could diag- nose their condition quickly no matter what time of day, and that they should be supported by round-the-clock diagnostic facil- ities such as X-rays and blood tests.

Christy Millar, a 21-year-old graduate, was in a coma six weeks after a Merseyside doctor diagnosed her appendicitis as a stomach bug. She believes her case is an example of problems with the region’s out-of-hours GP service and that if she had had her condition diagnosed quickly and accurately her condition would not have deteriorated.

She had been preparing to move in with her fiancé when she devel-oped stomach pains and vomiting last May. Two days later, a doctor from Liverpool’s out-of-hours service Urgent Care 24 told her she had gastroenteritis.

Just 48 hours later, she was fighting for her life at Liverpool’s Royal Liverpool University Hos-pital after fiancé Stephen Boyer rushed her in to A&E by taxi.

RCP president professor Ian Gilmore, a physician at the Royal Liverpool Hospital, said changes had to be made.

He said: “For doctors, nurses, managers and all those involved with the care of acutely ill patients, this task will not be easy, but the status quo is not an option if we are to give these patients a consistently high standard of care.”

Shadow Health Secretary Andrew Lansley said: “This report accurately highlights deficiencies in the structure of out-of-hours and urgent care in the community.

“The Government is over a year late in publishing its urgent care strategy so this report is a welcome contribution in designing new urgent care processes.

“I welcome the recognition for the need for rapid access to clinical decision making.

“There is no case for downgrading local A&E departments where alternative local access to emergency care is not available and shown to work.”

carolineinnes