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GPs buried under trusts' workload dump

GPs urged to use screening tools to diagnose sepsis

GPs are being urged to use screening tools to diagnose sepsis, as the NHS aims to reduce the number of deaths from the condition.

NHS chiefs said these tools form part of a new ‘action plan’ on sepsis, which is currently killing an estimated 37,000 patients each year.

The action plan said GPs are limited by their ‘lack of laboratory services’ in their ’ability to distinguish between sepsis, severe sepsis and septic shock’, but that there ‘are screening tools available to support GPs identify sepsis’.

It raised one such tool, the GP Sepsis Screening and Action Tool Protocol, available to the 30% of practices using SystmOne, which uses patient record information ‘to assess whether a patient has suspected sepsis’.

However leading GPs criticised plans, saying these thools were not suitable as an aid for GPs to reach a diagnosis.

Dr John Cosgrove, RCGP council member and a GP in Birmingham, said the SystmOne tool ‘pops up every time you type in fever, but it’s really not appropriate to measure and record in full every time you see someone with a history of a feverish illness’.

He said: ’GPs have concerns about the way these tools have been implemented. The tools are not suitable for screening or diagnostic purposes but simply to aid communication and audit as to how unwell a patient is.’

He also claimed the UK Sepsis Trust, which helped develop the SystmOne tool, shared GPs’ concerns about how the they were implemented.

Trust chief executive Dr Ron Daniels said: ‘The UK Sepsis Trust welcomes this action plan as a part of the ongoing strategy to reduce avoidable harm from sepsis.

‘We are conscious, however, that tools and processes designed for hospital use may not be directly translatable to primary care, and will continue to work with GP colleagues and stakeholders including RCGP to continually test and improve tools and recommendations.’

Other recommendations in the action plan include a new sepsis education module to be developed by Health Education England; raising public awareness; CQC inspecting hospital implementation of NICE guidance; a new NICE clinical guideline in 2016 and quality standard in 2017; improved coding on sepsis by HSCIC; and looking at refreshing guidelines on antibiotics in treating severe sepsis ‘to ensure antibiotics remain effective’.

NHS England medical director Sir Bruce Keogh said: ’In many cases sepsis is avoidable, and if not, it is often treatable, so we need to ensure that healthcare professionals are supported and equipped to identify and treat sepsis early.

’We have a good idea of what needs to be done and this plan aims to make things happen.’




Readers' comments (17)

  • (1) "Screening": we must consider the ten WHO criteria set out by Wilson and Junger

    (2) "Tools": we might ask if "improvement culture" overuses a mechanical metaphor when it comes to humankind.

    I do appreciate that sepsis may be less complicated than many other issues. However these questions might still be worth some further consideration?

    Dr Peter J Gordon

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  • Medicine is difficult and it's fuzzy.

    Reducing antibiotic prescribing is likely to increase rates of sepsis (I see this is being packaged as one illness as opposed to the hundreds of illnesses that this really is).

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  • Typical. Yet another "tool" to take away our clinical judgement and autonomy.

    Trust, you say? What is that? You cannot trust a doctor these days mate!

    Take away the benefits of being a GP- and then there were none.

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  • It's freaking awesome. It pops up every time you type "not feverish" because there is fever in there somewhere.
    Like NHS fire alarms. Goes off so often in the end you just ignore it. I mean obey rapidly and professionally.

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  • Just Your Average Joe

    Tools are like calculators for those people who can't do mental arithmetic.

    When you can do the simple stuff in your head you don't need a calculator.

    The tools are for those who can't, and essentially for the less qualified army of GP replacements they are trying to foist onto the unsuspecting public as they can't find enough GPs to replace the ones they are forcing out with their constant media bashing and general harassment we all know about.

    Tools are only useful in the right hands anyway - give a 5 yr old a paint brush vs a seasoned artist and see the difference.

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  • I share the views of those who have posted so far.

    I am concerned about the proliferation of "tools" in healthcare.

    A National Lead for Healthcare Improvement Scotland recently suggested, in a public forum, that a tool should be "designed" for "person-centredness". Concerned about this, I wrote the following post:

    I have also made a short film on this subject called "Tools of the trade":

    Dr Peter J Gordon

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  • I agree with Neman Khan. Time to give up if I have to rely on a "tool" to decide if patient in front of me is sick/very sick/needing immediate treatment. Surely this is something for NHS 111 call centre use or is in preparation for cheap doctor-light big health care company-run surgeries.

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  • If you look at most of the sensationalist (albeit tragic) red top headline cases behind proliferation of sepsis 6 campaign, and it's new GP-friendly relative, most of the failings are systemic failings in recognition of sepsis, usually due to poor staffing on a nursing level, lack of equipment, lack of documentation/inaccurate documentation failing to trigger assessment, A&E waiting times etc...not because of lack of clinical acumen of doctors. Still being a lowly registrar and seeing both sides of the coin, GPs are bloody fantastic at recognising the seriously unwell and should be proud of doing it without the benefit of lactate/CRP. But if the patient then gets sent in and have to wait 6-8 hours in a corridor without assessment/timely antibiotics, that's where mortality creeps up.

    Also, false reassurance of a sepsis tool not detecting at risk groups can be lethal - children and young adults can compensate fantastically until they fall off a cliff. Somebody with a rigid abdomen but normal physiological criteria is completely plausible, and wouldn't flag up concerns with a calculator.

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  • I create on-screen templates and protocols like this. They are helpful but they do not replace my clinical skills.

    Is this the best offer they can come up with?

    How about funding near patient CRP testing? Perhaps GPs are expected to fund this themselves.

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  • My GP screening tool says the NHS is septic,but we all knew that anyway by looking at the clapped out car crash waiting for resuscitation.Time to get out if you can,if you can.Is this one worth resuscitating at such a high personal cost!

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