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Gold, incentives and meh

Labour would put GP out of hours under ambulance trust control

The Labour Party wants GP out-of-hours services to be put under the direct control of ambulance services as part of its long-term plan for the NHS.

Unveiling the party’s 10-year plan for the NHS earlier this week, shadow health secretary Andy Burnham said the ‘new future’ for ambulance services would include being able to call directly on GP out-of-hours services so as to be able to end the ‘default’ of carrying patients to hospital.

According to Mr Burnham, the plans, which would be consulted upon, promised to be ‘a substantial answer’ to relieving the crisis of too high demand on A&E departments.

He said: ‘I see [the future ambulance service] as an integrated provider of emergency and out-of-hours care, able to treat people where they find them rather than carry them to hospital. This is a substantial answer to relieving the growing pressure on A&E. It is the lack of integration in out of hours care that often results in carrying to hospital as the default option.’

He announced that, if elected, Labour would launch a consultation into how GP out of hours could be ‘integrated’ into the ambulance service, while NHS 111 contracts would be put under the control of ambulance trusts nationwide.

He said: ‘So just as we call for a single team approach in local care, the same principal should apply in out-of-hours arrangements. This is how we do it: As NHS 111 contracts expire, we will look at ambulance services taking them on, so that in time they can handle all 111 and 999 calls from the same call centres. This will mean more experienced staff on the phone and better classification of calls. But just as with other parts of the NHS we need to ask the ambulance service to work from a default presumption of treatment at home, not  hospital, if clinically safe an appropriate.

‘To do this paramedics must be able to call directly on a wider range of health professionals: GPs, OTs, physios, care assistants, who can settle and support people at home in out of hours times before handing over to local teams. Building a sense of a single team [in which] GP out of hours services is essential, all with the financial incentive to keep people out of A&E. So we will consult on better ways in which GP out of hours can be integrated with the ambulance service. These changes will allow us to build a high quality, highly coordinated response behind the NHS 111 number, that commands better public confidence than it has today.’

The plans follow warnings from emergency medicine leaders that the NHS 111 emergency advice line is putting more, rather than less, pressure on A&E departments in its current form. The Government has also highlighted a problem with too many ambulances being dispatched via 999 and has launched a pilot giving call handlers two minutes extra to decide.

Readers' comments (14)

  • Several ambulance trusts provided OOH in the past to PCT`s. We have come a full circle and spent lots on money reorganizing the same en route.

    What a bunch of muppets the politicians are?

    That said if 111 and ambulance service are run by the same team there is no perverse incentive to pass the buck to another service.

    e.g A hypothetical 111 provider refers lots to A&E as it runs the OOH service (so doesn`t want to overload its OOH service which is capitated payment) but when that is pointed out gladly provides a frontend A&E GP service (apart from the GP OOH for the same area!) on tarrif to send away patientsfrom A&E who were sent there in the first place either by themselves via 111 or those who wanted to see GP OOH but can`t get appointment in the first place!!!
    One couldnt make it up

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  • Stupid and I'll informed. In many areas the 111 service contract is run by the ambulance services already. And many ambulance service do call GPs, oohs etc to see appropriate patients. There is a financial disincentive to taking pts to a+e for ambulance services. In fact perversely this has from experience led to bad decision making by untrained ambulance staff resulting in treatment delays. Eg. Myocardial infarct left at home for the gp to see.

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  • Can we start collecting examples of the general incompetence of ambulance control..with these incentives it will get dangerous

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  • The first time the ambulance service declined conveyance and called me out for "just a backache" my exam showed cauda equina compression, and I had to admit the patient, a second ambulance being called.
    My local orthopaedics agreed with 1st ambulance crew that I was just " a bolshy GP objecting to being given some work to do" and did not operate for 2 days.
    The permanently impotent and partially incontinent patient did include me in the legal action, till his solicitors medical advisor told them they had no criticism of my actions or record keeping.
    The 8 million pound compensation was therefore only split 2 ways to my great relief.

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  • In this area (West Midlands) the ambulance service has taken 111 over from NHS Direct (who ditched the contract after fining they could not run it for the amount they bid!!).
    However it is still manned by substantially the same staff who ran it before with a smattering of clinicians among the many call handlers. Particularly when under pressure (weekends, bank holidays) their default seems to be to pass the call on - to OOHrs or A&E rather than deal with it appropriately
    What happened to the real Traige system - put your best man at the front ?

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  • This is because the ambulance crew have a sterling record accross the country when it comes to patient care one can only assume???!

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  • I have lots of examples of serious misdiagnosis by paramedics and ambulance crew from missed hip fractures MIs PEs etc I have tried to involve WMAS in case reviews for teaching and feedback and hostility and a defensive attitude was my response.I do not blame the paramedics themselves they are put in situations beyond their knowledge and welcome them contacting doctors either in hours or OOH.The problem has always been the management structure of WMAS they should not be allowed to run successful existing GP OOH they basically don't have the expertise

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  • GP Partner 7.37 pm.
    I fully agree with you. Poor decisions by ambulance crew is frequent. I had one today. They cannot be blamed because they are doing a job with inadequate training. The government has to recognise that there is no substitute for a doctor.

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  • Ha, but they have closed GP practices all over, so where are the doctors?

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  • This is an interesting idea but unlikely to have been well thought through. There is a lack of recogniton that Ambulance services are the minority recepient of 111 and OOH case load. Even where the Ambulance service provides these services they almost operate as separate entities. Experience demonstrates that very big providers such as Ambulance Trusts, become inefficient and very hard to performance manage. Ideally CCGs with NHS England should be allowed to assess their local needs and patient flows and determine the service offering that meets those needs. Then any provider, including an Ambulance Trust, could bid to deliver that service. As it stands a Labour one size fits will deliver poor quality if not unsafe services

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