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Phil Peverley:Scary walk-in wounded

Each and every walk-in centre costs your PCT an average of £1 million a year to run. That's £1 million a year that would otherwise be going to fund proper primary care services. It would cost more if these centres were staffed by clinicians who had decent arse/elbow differentiation skills, but as it happens, in my town at least, they aren't.

Each and every walk-in centre costs your PCT an average of £1 million a year to run. That's £1 million a year that would otherwise be going to fund proper primary care services. It would cost more if these centres were staffed by clinicians who had decent arse/elbow differentiation skills, but as it happens, in my town at least, they aren't.

I think we are justified in asking, given this level of outlay, what exactly these centres are doing for our patients. Judging by the evidence of my in-tray today, the answer is absolutely nothing.

There are five letters from the walk-in centre today. By a heroic effort, our local centre has managed to get its letters down from five pages of A4 to only two, and I thank them for it. Eighty per cent of the letter still consists of random items of bureaucratic and demographic information that I either already know or have no interest in, but we'll let that pass.

The clinical bit is the last couple of paragraphs. And all five of the letters describe absolutely no clinical intervention whatsoever.Two of the letters are about patients with simple, self-limiting conditions that require advice only, and other than the fact that it took two nurses to offer the advice, I have no problem with them.

But one of the other letters is a shocker. A patient I know well was walking through the town centre, heard someone call her name, and on turning her head had a severe, disabling vertigo attack that put her on the deck for 20 minutes. When she felt a bit better, she went to the walk-in centre. They took a detailed history (how her obstetric history and immunisation status might have impacted on the problem escapes me, but they documented it anyway), examined her, and told her she had hypertension.

Her blood pressure was 164/88, and that's what caused her problem apparently. She had to go and see her GP tomorrow 'to get her blood pressure sorted out'.

Slice it any way you like, this is just bloody-well wrong. Not only wrong, but stupid, incompetent and ignorant. And anyone who thinks a mild (and in the circumstances understandable) degree of hypertension could cause these sort of symptoms has no right to be consulting independently.

There is no way on earth my patient's BP was responsible for her symptoms, a first-year medical student would have known that, and I was horrified to think that my patient had been treated so incompetently, by two 'professionals' who gave the impression that they knew what they were doing, but who were fundamentally, incontrovertibly, unutterably, plain wrong in their diagnosis.

They obviously had no idea. And yet they told her, with all the gravitas that their spurious position of authority gave them, that she had a chronic long-term health problem that required the immediate intervention of her GP, and my patient believed them.Walk-in centres are apparently here to stay. On this evidence, there is trouble ahead.

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