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NHS Direct nurses pass on half of service's calls to GPs as urgent

Out-of-hours co-operatives piloting links with NHS Direct say the nurse triage service has failed to cut GP workload.

The claim casts fresh doubt on Government plans for NHS Direct to provide a single 'one-stop' gateway to out-of-hours care by December 2004.

Dr Malcolm Ridgway, chair of Blackburn and District Medical Co-op, said the service was passing on half of calls as urgent and needing GP attention within one hour. The figure compares unfavourably with between 5 and 10 per cent at co-ops where GPs triage calls.

Dr Ridgway said the co-op would fail to meet Government standards for accreditation as an out-of-hours provider unless NHS Direct improved this figure.

'If I was another co-op outside the exemplar I would want NHS Direct triage to be running very slickly before taking it on,' he added.

The Department of Health last week refused to give details of its plans to integrate remaining co-ops with the service, but insisted its December 2004 deadline remained.

Dr Peter Seavers, chair of Burnley and Pendle Medical Co-op, a second-wave exemplar site, said GPs working out-of-hours shifts still had to re-triage calls passed on by NHS Direct: 'This creates extra work for doctors. These calls include things like earache, back pain and medication advice. We are not getting much of a reduction in workload.'

NHS Direct was only managing to triage 30 per cent of calls as nurse advice, compared with 50 per cent completed with doctor advice by the co-op before integration, he said.

Dr Prasad Rao, vice-chair of the National Association of GP Co-operatives, predicted integration would go ahead regardless of the problems. He said most primary care trusts had plans to help out-of-hours providers integrate with NHS Direct: 'If it's a must do then it's a must do.'

GP co-ops in the North West met last week to draw up recommendations for the out-of-hours review implementation team based on their experience of working in the exemplar programme.

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