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Ambulances routinely delaying treatment to emergency calls from GP practices

Patients who need an ambulance at a GP surgery are routinely facing waits twice as long as patients who call 999 from elsewhere, a major Pulse investigation has revealed.

Freedom of information responses from 10 of the 13 ambulance trusts across the UK show that, without exception, the average wait for patients who are with healthcare professionals is far longer than for members of the public (see map, below.)

GPs have claimed under-pressure ambulance services are delaying their arrival due to the mistaken belief that patients are safe if a doctor is present.

They say the practice needs 'stamping out' by NHS England and the Government 'immediately'.

GP leaders point out they have expertise to determine the patient’s condition, and that they would not request an ambulance unless it was entirely necessary. They are also not equipped to provide emergency treatment, they said.

GPs have told Pulse of examples including cases where they have waited for more than an hour with patients suffering from myocardial infarctions, or sat with patients who had suspected sepsis for over 60 minutes. In one case, a patient with sepsis was made to wait three hours and the GP ran out of the oxygen they were administering.

Some have resorted to advising patients they should not tell 999 call operators that they are ringing from a GP practice.

The GPs say they don’t blame the ambulance trusts, who are having to cope with rising demand and dwindling resources.

The ambulance trusts argue they do not have policies to delay care to these patients, but they do acknowledge they 'need to do better for healthcare professionals' and can improve on their responses to calls from healthcare settings.

They also say that the figures received by Pulse may be skewed, as many trusts have implemented local protocols that allow the call operator and the GP to agree on a one, two or four-hour response time. But Pulse’s analysis of some trusts’ data shows discrepancies in almost all categories of call.

Dr Peter Holden, a former negotiator for the BMA’s GP Committee, who has an interest in urgent care, says that while agreed protocols used to work, the waits for ambulances are now so long that one or two-hour responses now seem a ‘luxury’. ‘We are now told it’s four hours – or longer.’

He adds: ‘If I am with a patient who needs an urgent ambulance I have been known to say to the family “you dial 999 and deny that I am here”. Because effectively there are two responses you get –the general public I’m-having-crushing-chest-pains immediate response, or four hours.’

Dr Richard Vautrey, BMA GP committee chair, said: ‘Whilst GPs and their team members respond to clinical emergencies that they encounter, it's vital that when called for help and support, ambulance services should treat calls from surgeries as seriously as they do from any other location.

'GPs are highly-trained doctors, often with decades of experience under their belts, but in order to provide the best possible care to patients in emergency situations they may need the equipment and skills of paramedics.'

He added: ‘In addition, if ambulance services are deliberately downgrading calls to GP surgeries, or when GPs are with patients on home visits, this leaves GPs unable to respond to the many other important clinical situations that they face each day, which could put other seriously unwell people at risk. We are raising this issue in discussions with NHS England.’

Dr Matt Mayer, BMA GP Committee workload policy lead, added: 'This is a practice that is putting patients at mortal risk and needs stamping out by NHS England and the Government immediately.’

The Association of Ambulance Chief Executives, representing services across the UK, says it ‘categorically refutes’ allegations that calls from GP premises ‘are being deliberately downgraded’.

However, it added: ‘We acknowledge we do need to do better for healthcare professionals and ensure parity of responses between public 999 and healthcare professional requests, particularly for category 1 and category 2 calls.’

An NHS England spokesperson said: 'Anyone in a life-threatening situation is treated as a priority and response times to the most seriously ill and injured patients have never been better, with an extra £36 million funding to help areas deliver even more improvements.'

ambulance response times by region 1000x1324px

ambulance response times by region 1000x1324px

Readers' comments (13)

  • I think I am correct in saying that calls from GPs for ambulances are excluded from ambulance targets and published response times. Correct me if I am wrong.

    Ambulance managers have made the mistake of putting targets above actual care of patients, which is clearly wrong. In mitigation for them as individuals, it is probably ultimately the fault of those higher up the chain, who would replace ambulance chiefs if they are missing targets without actually taking time to understand the cause.

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  • When GPs call 999 it usually means the patient is genuinely very sick and although we have defibrillators it would be better if the patients were treated intensively before they arrest!

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  • Am I the only person in the universe who attributes the deterioration in ambulance response times to the introduction of NHS 111? This pernicious system has algorithms which seem to fail across the board. On the whole, they are so risk averse that 999 ambulances are dispatched even when the patient specifically states that this is unnecessary. More dangerously, they miss serious disease. And it is not as if NHS 111 is cheap. A recent BMJ article costed the service at £12-13 per call. Would that such resource been put into primary care.

    And yet NHS 111 seems to be above criticism. When we express concerns about individual cases we are fobbed off with a corporate speak response to the effect that the algorithms directed the patient appropriately. NHS 111 does not need re-configuring, it needs to be abandoned.

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  • Tom Caldwell

    I'd always assumed this was the case anyway. It is thus important to use buzz words like sepsis, stroke, heart attack, respiratory distress etc in describing your patient.

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  • I waited for over 90 minutes, in the rain, on the seafront, in winter, with a young child going into shock with a shattered femur. As I had stopped to help when I heard them screaming the ambulance control said I was ‘taking clinical responsibility’ so they prioritised other cases. I got very cold as I had to put most of my clothes over the child to stop them getting hypothermia. I saw an ambulance arrive and then divert away only to stop 50 yards away at a hotel. Another van had to come 20miles to reach us.
    Lesson learned. If you are a doctor wanting an ambulance...do not declare your occupation. I had wrongly assumed that saying I was a doctor and that the patient was at immediate risk would prioritise the call when in fact it added to the delay.
    First aiders brought us umbrellas blankets and coffee.
    Ironically if I had just walked on by they would have got to hospital an hour earlier

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  • yes all true
    recent 999 calls from practice for pulmonary embolism, obstetric haemorrhage and severe asthma - all told 2 to 3 hours because patient in " a place of safety" FFS

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  • Calling 999 is now an unpleasant experience. Recently I had a patient with a suspected AAA. I was given the third degree by the ambulance control who made me repeat that the patient was conscious and breathing twice and got very cross when I said I was not going to stay with the patient. They said they would be 4 hours! I responded ok if you really want a complaint and an expensive lawsuit and probably disciplinary action.
    The ambulance arrived 10 minutes later. But why does I t have to be so difficult?

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  • The NHS is great if you're on deaths door or with an otherwise chronic life shortening condition requiring frequent specialist input.

    For everything else it's useless.

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  • common guys, whats wrong with yous?

    Whey are we fighting with our respected fellow colleagues.

    is it, should it, be any surprise when all this was foreseeable by the government own admissions of austerity cuts in the public sector and in the NHS as we already know.

    Also, we have one of the the lowest,if not the lowest,level of GDP contribution to heath amongst most European industrialized nations

    Really, do we need reminding of this!

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  • There are far too many ambulances in London.
    This is totally unfair.
    Some must be moved immediately from London to Wales!

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