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At the heart of general practice since 1960

Nein, Nein, Nein

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My partner reckons that Pulse should be running a campaign against the DOH’s latest fab wheeze designed to up GPs’ PHQ scores another notch: NHS 111? Nein, nein, nein!

Having just received my first ever ‘NHS 111 pathways report’, I have to agree. It takes up a large chunk of clinical notes’ space, comprises 49 lines of text and is around 500 words long. And some of those words bear repetition, in the exact order they’ve been presented to me. Such as:

  • The individual was breathing and conscious at the time of the assessment.
  • Heavy bleeding had not occurred in the previous 30 minutes.
  • The individual was not fighting for breath.
  • An illness or health problem was the main problem.

And so on, x 49.

The actual health issue? Ah, it’s buried there in line 15, ‘Skin rash’. Yep. The patient, a young adult, had experienced a rash for less than four hours but was otherwise well. I know this because of lines like

  • Severe illness was not described
  • There was no fever at the time of assessment or within the last 12 hours
  • Skin was not coming off in sheets

Conclusion? The patient should see a GP within 12 hours, and if the practice is not open within this period then he/she should be seen by the OOH service. No, really.

You’d think this should make us weep. But actually, it makes me deliriously happy. Because it’s one of the strongest arguments I’ve ever seen for appreciating what GPs do and how it’s dangerous, expensive and insane to try to deconstruct our role. That ‘assessment’ must have taken a good half an hour, prolonged the problem rather than resolved it, and increased dependence, cost and inconvenience. Any halfway sentient GP would have sorted it out within 30 seconds flat, no messing. And we can do that, over and over again, with only a tiny chance of making a ricket, for just about any symptom you care to throw at us.

All I can say is that the politicians are fast getting the NHS they deserve. May their skin come off in sheets.

 

 

Readers' comments (5)

  • Mark Struthers

    I've just read this article,

    http://www.huffingtonpost.co.uk/francesca-martinez/hands-off-our-public-services_b_2951098.html

    Copperfield is right: stop being nice, we need a revolution and nothing soft or velvet.

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  • We've had 111 for 2 months. Initially we used the printouts as toilet paper, but then decided even that was too important a role for the content, so stopped printing, stopped reading and politely advised any patient to make appointments using the normal systems!

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  • Copperfield read and weep
    111 Assessment read and sleep!!
    What a farcicle waste of money

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  • nein, nein nein. that;'s what we thought about the csa exam

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  • re above, i work for the 111 service and we are told that gp's dont want a short summary. also in my experience rashes are very unlikely to result in anything except home care, if a gp feels the patient is over triaged they need to feed this back, it will be taken seriously and looked into, i realise this is time consuming and i know the system is far from perfect, but its the only way things will improve. the commissioners appear to want the cheapest possible service hence most calls are dealt with by call handlers, not nurses, you get what you pay for......NHS Direct was too expensive

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder