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GPs go forth

GPs to wait 40 minutes for ambulances for critically ill patients under new trial

An ambulance service is piloting longer response times of up to 40 minutes for certain serious health conditions when the patient is already with a GP or other healthcare professional.

The trial, which covers around five million patients covered by the Yorkshire Ambulance Service, downgrades a wide range of serious conditions, including heart attacks, strokes, sepsis, meningitis, an acute exacerbation of COPD/asthma or a blocked catheter where the patient is in severe pain.

The Yorkshire Ambulance Service suggests that an ambulance will only be called ‘immediately’ for somebody who is ‘unconscious’ or who has had a cardio-respiratory arrest, compromised airway, anaphylaxis, suspected leaking/ruptured abdominal aortic aneurysm (AAA) or an obstetric emergency.

The scheme also instructs GPs to fill out a form before dialling 999 – to ensure they have all the ‘relevant information’, such as patient’s name, age, why they need an ambulance and whether there is a defibrillator nearby. This could potentially delay getting hold of an ambulance even further.

Dr Dean Eggitt, a GP from near Doncaster, told Pulse: ‘Whoever has drawn this (pilot) up is either somebody who doesn’t understand medicine or who has no regard for human life. We know now that lives don’t matter.’

He added: ‘This is really, really serious stuff. The only way now to get an ambulance in eight minutes is when your heart has stopped or is about to stop.’

Dr Eggitt points out that while every minute counts with heart attacks or strokes, patients with these conditions could potentially wait up to 40 minutes for an ambulance.

‘This seems to be a move away from patients queuing and dying at hospital A&Es to GP practices where we don’t count the numbers dying. Perhaps we should.’

Dr Eggitt fears that the situation could get worse as the Yorkshire pilot could potentially be the first of a ‘roll-out’ of the initiative to other parts of the UK.

A spokesperson for the Yorkshire Ambulance Service said: ‘We confirm that updated guidance has been issued to GPs and healthcare professionals in the Yorkshire and Humber region which is specific to them making a request for an ambulance when a patient is in their care.

‘GPs and healthcare professionals should be with the patient and have direct knowledge of their condition so they can request an ambulance response for a conveying vehicle to arrive within an appropriate timeframe for their clinical needs. This can be escalated at any time should a patient’s condition deteriorate.’

‘The timeframe for the arrival of an emergency ambulance to convey the patient to hospital has not changed and remains within 19 minutes,’ added the spokesperson. ‘When life-saving assistance is required, the nearest available resource is always sent immediately.

A spokesperson for NHS England said that the Ambulance Response Programme is national, while the work ‘Yorkshire Ambulance Service is doing is separate and part of local arrangements’.

‘The Ambulance service is currently piloting an Ambulance Response Programme, which aims to ensure the fastest and most appropriate response for seriously ill patients, including those suffering suspected strokes, meningitis and sepsis,’ said the spokesperson. ‘

‘The letter from Yorkshire Ambulance Service does not relate to 999 calls made by the public, but is part of locally determined arrangements to transport patients to hospital who have already been assessed by a GP or other health care professional. These local transport arrangements are not part of the Ambulance Response Programme.”

The news comes as Pulse has revealed that very young and elderly patients are dying because of worsening delays to 999 calls. GPs have even been forced to drive patients to the hospital themselves after an ambulance failed to turn up.

Campaign group GP Survival compiled scores of incidents, arguing that patients were increasingly being put at risk due to underfunding of ambulance services.



Readers' comments (21)

  • The pressure should be relieved from the other side ie time wasting calls. We need to look towards charging for 999 calls and potentially refund if it was an appropriate call.
    If alcohol is deemed to be the cause and I mean willful inhebriation by choice as opposed to addiction etc then the person should be charged for all the services used in the NHS. It's outrageous that some patients feel they can get pissed, fall over and let the NHS pick them up all in the name of a good night out. Yes there will be hard choices to make but if we've got to this point we have to consider it.

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  • As a GP, as a patient and as someone who, like most of us I believe, continuously strives to make the future better than the past, this is simply depressing.

    Frankly, UK clinical academics might as well seek other employ for the foreseeable future, because evidence based medicine and best practice are clearly no longer relevant in the NHS.

    MR Hunt, it is apparent that you have no empathy for patients, but be aware that when history is written your everlasting legacy will be to the NHS, what Beeching has been to the railways.

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  • Perhaps rather than rushing to condemn, we should question Pulse and Dr Eggitt first to ensure they have their facts straight.

    The spokesperson says "The timeframe for the arrival of an emergency ambulance to convey the patient to hospital has not changed and remains within 19 minutes"

    So if that is the case then the headline and story are unhelpful scaremongering. If it is not correct then lets know more and hold them to task.

    Either way, lets check the facts before rushing in with emotional accusations.

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  • can you see a scenario when first patient has LVF . we need 15 to 20 minutes to take histry and then write a letter and give immediate treatment. . even if ambulance come as 999, it delays surgery as it is now and some patients walk out. if we have to wait for 40 minutes for ambulance then remaining patient need to be sent home.
    do we have a spare room which we don't use. who monitor the patient.
    i can see gp's telling patient to ring for ambulance from home if quicker response is required. if they say wait for gp to asses then when does go go? AFTER 3 HOUR SURGERY? ambulances want to pass critical care to gp. if 40 minutes is enough then 3 hours is also enough.
    who came up with idea to pass their shortage of funding to pass it to gp?

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  • A month ago, I was called just outside of my premises in emergency for a 84 years old man who felt down from stairs in the street. He was lying on the tarmac, a few people around, who already called an ambulance. A family member told me that he has Alzheimer. I examined him, did not find any deficit, his occiput was bleeding a bit. But definitively he had to be rushed in hospital in case of brain extra dural bleeding...
    As the ambulance after 15mn was still not there, I called again through 999. I explained the case, said that I wanted him to be rushed to the hospital in case of extra dural haemorrhagic possibility.
    Then I was told that because he was conscient we had to wait for the ambulance and that they could not say how long. Just that we were in a queue...
    I said OK, I know that our conversation is recorded, I have told you the case, and the emergency level, so if something happen while waiting, the guy at the 999 will be definitively responsible...
    % minutes later not ONE but THREE ambulance arrived on site!!!

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  • This is appalling. Who's idea is this? Who is the undividual who thought this up? Who designed the form?? What are their qualifications?? Why has the power of life and death over every seriously ill individual in the country seemingly been handed without a murmur to people who's basic job is to transport people to hospital? Why does the opinion of some nameless form designer in an ambulance service trump the wishes of the GPs, Hospital Drs and nurses they service? fill in a form before calling 999-- WTF??? I'm gobsmacked.

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  • There is secondary and primary care [ we do 90 % already on 7.2 % of the budget]
    We cannot provide secondary care for the hospital dependent and needy patient.
    That is secondary care. I wonder what the GMC thinks.
    It is a lot easier if you did not become a GP in the first place. Thank God, I only have to do a few more months.

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  • Apologies to anyone who has already seen this post in September, but it is relevant to this discussion, so I have copied and pasted in it's entirety.

    calling 999 will not necessarily help. I called 999 (earlier this week) after stopping my car to assist (with 2 other health professionals who fortunately happened to be passing) when an elderly man collapsed in the street. He looked very unwell, was objectively severely anaemic and could not stand up without feeling faint. TWO HOURS later neither a paramedic nor an ambulance had arrived, and despite two further phone calls to chase up, the ambulance control room staff were unable to even offer a vague ETA, instead clearly reading a scripted response about "high demand". The patient was eventually transported to hospital by a passing paramedic travelling in his own car. Apparently there are no targets for attending patients triaged as "green" even if they have collapsed in the street. Absolutely shameful.......

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  • who allowed this pilot to go ahead?
    If the CCG commissions this service then the GP members should vote it out, or vote out their clinical leads

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  • an extreme and absolutely unacceptable DISGRACE

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