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Good communication between GPs and the out-of-hours service is vital if good care is to be offered and patient complaints avoided, says Dr Karen Roberts of the MDU

A National Audit Office report reveals that just 39 per cent of out-of-hours service providers in England were able to send details of all consultations to the patients' registered practices by 8am the following day1.

The report, which achieved a 95 per cent response rate from PCTs in England, raises concerns about risk management. It means a significant number of practices could experience delays in receiving information about patients who require follow-up care.

This could be a contributing factor to the rising number of complaints about out-of-hours care notified to the MDU. The MDU was notified of just over 200 complaints relating to out-of-hours care last year, accounting for 7 per cent of all GP complaints notified. This represents an increase from 2002 when GP members notified the MDU of 120 complaints relating to out-of-hours care.

Case histories

The following fictitious examples, based on cases from the MDU's files, illustrate the kind of problems that can occur when there are problems with communication between out-of-hours providers and patients' own GPs.

The first case involved a 34-year-old man with a chest infection who was prescribed antibiotics by his GP. The following evening he was having difficulty breathing and called the out-of-hours service. The GP who saw him doubled the dose of antibiotic and said he would ask the patient's own GP to call the following day.

The request for follow-up was not passed on to the patient's GP and the man was found dead the following night. The postmortem showed he died from pneumonia and the patient's family made a complaint and later a medical negligence claim.

The second case involved a terminally-ill patient who was seen by her GP and prescribed analgesia for pain. The GP gave the patient and her family details of how to contact a GP during the day and out-of-hours and said he would pass on details of her condition and medication to the out-of-hours service in case an assessment was needed during the night.

Unfortunately the GP forgot to inform the out-of-hours service about the patient and when the patient's family called the service the nurse on duty gave them advice over the telephone, not realising the seriousness of the condition and that a home visit might be required.

The following day the family called the patient's own GP, who visited and prescribed stronger analgesia. The family made a complaint about the out-of-hours assessment and the difficulties they had had trying to explain the patient's condition to the nurse.

Follow-up care

These cases show that it is vital for patient safety that there are reliable and consistent communication links between GPs and the out-of-hours service.

Out-of-hours services should report back to GPs as soon as possible about any treatment given or follow-up that is required. In turn, GPs may wish to tell their out-of-hours provider if a patient is likely to need care outside working hours ­ for example, a terminally-ill patient who needs pain relief.

The MDU would also advise doctors seeing patients out-of-hours to bear in mind the importance of keeping a clear record, made at the time of the consultation.

Good communication is vital in out-of-hours care and it is important that both GPs and providers have robust systems in place to exchange information about patients and ensure continuity of care.

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