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At the heart of general practice since 1960

Ludicrous hub-bub over out-of-hours

During a co-op night shift I happened upon a ludicrous document describing 'criteria for out-of-hours provision'. After the inefficient shambles of NHS Direct we are soon to have ­ wait for it ­ communication hubs.

'A ''communication hub'' is the entity that will receive the technical link with an NHS Direct site. It is envisaged that communication hubs be operationally manned with an appropriate management structure in place.'

Doctors or nurses? Er, no.

I pinched myself. Was this a bad dream? Is this Stalinist central planning gone mad? At this rate the out-of-hours management, administration, commumication and nursing cost per patient will soon be half what GPs used to get for providing a total 24-hour service.

Whatever happened to the concept of: patient calls doctor, callhandler/ receptionist takes details, passes call to doctor who either deals with it (advice, base consultation, visit or to A&E) or passes it to a nurse for simple advice. The call handler can pass it directly to the nurse if appropriate.

We do not need and arguably cannot afford separate nurse advice sites and communications hubs. There are already plenty of GP surgeries and

co-op bases. For a mere £4 per patient ­ that's more than £1million for our 140-doctor co-op ­ we could easily provide an extra call handler and a nurse or two and still have plenty of change. And the patient would get a much better service than NHS Direct currently provides.

Dr John Fitton

Kettering

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