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OOH, what a mess

Another ridiculous referral from the out-of-hours centre leads Phil to despair of the system

Another ridiculous referral from the out-of-hours centre leads Phil to despair of the system

I have a punter in front of me, referred as urgent by the out-of-hours boys. They've sent me a fax which, unusually, has arrived before the patient. This letter stinks so badly I want to pick it up with tongs. These are the salient details.

A 23-year-old woman with a history of migraine rocks up to the walk-in centre with a headache on one side, feels sick, black spots in front of her left eye. She complains of a bad migraine attack.

Having no other details, and not having seen the patient, I am sort of getting the impression it might be migraine.

The staff at the walk-in centre feel differently. They check her blood pressure and it is 180/100. They send her three miles to the out-of-hours centre where some dumb excuse for a GP diagnoses hypertension and gives her captopril (captopril!) and a note to come and see me as an urgent appointment the next day to get an ECG and 'some blood tests'.

I don't know what to say to this girl. I can't possibly collude with the rubbish she has been sold so far. She has been told she has high blood pressure and will be on medication for life. She has been told her high blood pressure has caused her headache, when the converse is glaringly obvious.

I am frankly ashamed of my primary care colleagues, and angry too. What happened to clinical governance? When did they decide to ignore the suggestion we don't diagnose essential hypertension without three separate elevated BP readings?

Who the hell thinks having high blood pressure gives you a unilateral headache? And who (and this is rhetorical) is expected to pick up the pieces?

I know I'm not perfect. I get things wrong all the time. But I am ruddy Sherlock Holmes compared with some of the clowns who are trusted with the care of my patients once I have gone home.

Sometimes I get the impression that, once we have closed our doors and gone for our tea, an amateur circus rolls into town, throws its doors open, and engages in free-form random medical diagnosis and treatment.

There's a devil-may-care insouciance about their pronouncements, a 'what-the-hell' air to their casual diagnoses and life-altering annunciations. It is crass to blame the Government for everything, but it is justified in this case.

Before the new contract, GPs were responsible for out-of hours care. We didn't like it but we did it well. GP co-ops and private providers, employed by us, kept the lid on demand. The premise was simple; identify genuine emergencies, deal with them, and divert the rest to appropriate care the next day.

Out-of-hours care is basically triage. Many GPs still provide good out-of-hours care but many have passed on the opportunity, and those non-medically qualified practitioners who (barely) fill the gap have missed the point. They want to do stuff, despite the fact the proven maxim of out-of hours care is not to do stuff.

You get the feeling these people have to justify their jobs by making referrals, providing diagnoses and creating work, whereas all they are meant to be doing is minding the shop.

Our society needs a safety net at night, not these insecure silly buggers with their hair-trigger alarms and highly developed arse-covering skills. It is almost as if the whole system was designed to undermine our general practice ethos. But that couldn't possibly be true, could it?

  • Phil Peverley is a GP in Sunderland and PPA and MJA Columnist of the Year

elementary

I'm, ruddy Sherlock Holmes compared with these clowns

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