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GPs go forth

Pulse 2019 review: GP practices face ambulance delays

Pulse FOI reveals GPs are better off pretending they are not there. Allie Anderson reports

Patients will probably think that, if they’re going to have a medical emergency, there are worse places to have it than the GP practice.

Surrounded by doctors, you’re in safe hands until an ambulance arrives. Paramedics will surely get to you quickly because, with a trained GP deciding you need an ambulance, they’ll realise this is serious – right?

Well, wrong, as Pulse discovered back in January.

Rather than being at the front of the queue, patients who have the misfortune of needing emergency medical assistance while at the doctors will, in fact, face longer waits.

Because ambulance trusts across the country are deliberately delaying sending blue light assistance to GP practices.

Pulse’s investigation found that, on average, ambulances take more than twice as long to get to 999 calls placed by surgeries than those made by the public or other services – the assumption being that GPs are able to handle things until help arrives.

But that’s not always the case. One GP told Pulse that they’d waited with a patient with sepsis for three hours, during which time the oxygen being administered had run out. In another case, a patient who’d waited 90 minutes for an ambulance had died.

As BMA leaders pointed out, GPs can spot when emergency care is needed, but they’re not trained to provide it.

Yet, from October this year, all healthcare professionals requesting emergency help will have to score a patient’s medical need based on an assessment of six vital signs: respiration rate, oxygen saturation, systolic blood pressure, pulse rate, level of consciousness or new confusion, and temperature.

Understandably, there’s deep concern that this could put patients at risk.

If ambulance trusts are already downgrading calls from practices as standard – the presence of a GP and a defibrillator is sufficient to meet some government targets – then it’s hard to see how scoring a patient’s vital signs will speed things up.

Not to mention the burden that places on GPs, as they find themselves in the unenviable position of sitting in the consultation room with their seriously ill patient, watching the minutes tick by as their condition deteriorates.

Now they have to justify their decision to call an ambulance.

This was illustrated poignantly by Kent GP Dr Mark Ironmonger, who’d witnessed a life-threatening emergency at a restaurant and sprang into action. Despite telling the ambulance dispatcher that the patient was possibly in the midst of a third MI, there was an 80-minute wait between the first 999 call and the paramedics arriving.

‘In the meantime, I’d been left in charge of a life-threatening situation unsupported, equipped only with a set of cutlery, drinking straw and my fingertips,’ Dr Ironmonger said.

‘Despite doing my best to reassure the patient and his relatives throughout, this was a highly distressing scenario all round.’

It’s no surprise that some GPs have resorted to having the patient’s relative call the ambulance, believing they’ll get a speedier outcome.

In a life-or-death situation, asked whether there’s a doctor in the house, it seems the best response is a firm ‘No’.

Readers' comments (9)

  • one area i locum in has sent round a memo stating GP calls for 999 will be made lower priority than 999 calls that have not been see by a GP. so if i feel they need an urgent 999 i tell the patient to call direct as seeing me will put their life at risk. this is the consequence of such a policy. its not the ambulance service fault, they are short staffed and often stuck in A^E trying to offload patients. the NHS is broken. this is the results of 10 years plus of chronic underfunding and pushing staff out of the NHS with poor working conditions. yet we get the blame. until we as a GP service no longer exist because we have all left. who you gonna call then.

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  • Cobblers

    This has long been the case in SE Kent. SEKAS would 'delay' attendances to surgeries and a GP call from a patient's home. Inevitably this brought the response that the patient or a relative would be asked by the GP to call and, if asked, to state no doctor in attendance.

    I even recall surgery staff 'pretending' to be the patient's friend when calling an ambulance.

    J*** effing C***** why can I get a take away in 10 minutes and an ambo in 60 (if I am lucky) minutes? WHY?

    COI I left mainline practice in July 2016.

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  • DrRubbishBin

    "J*** effing C***** why can I get a take away in 10 minutes and an ambo in 60 (if I am lucky) minutes? WHY?"
    Genius!! we need to outsource the ambulance service to deliveroo

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  • No such problems here. I had a chap in complete heart block a few weeks ago and the ambo crew were here before I had unplugged him from the ECG machine. I’m sure the $800 cost has nothing to do with things. Most walking wounded here call an Uber to ED.

    Systems fail slowly, then all at once. Good luck people.

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  • I cover local minor injuries unit as part of on call walk in with chest pain previous mi told 4hr amb wait due to workload pressures but if worsens can escalate
    I work out of hours as well and at busy times find up to half my visit workload is from 999 calls retriaged to home visits by gp which to be fair are normally infections but have been cva angina and sepsis previously

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  • Cobblers

    DrRubbishBin 30 Dec 2019 7:49pm

    Ping! Light bulb moment.

    Pay As You Go App? Suggestions?

    JustED

    DeliverAEU

    DoorGash

    GoDuff (Obs Probs)

    Migps (Men In Green Pyjamas)

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  • Working in Kent my phone calls with 999 are always like this:

    First question: "Is the patient breathing?"

    Second question: "Is the patient conscious?"

    Third question: "Can I confirm a doctor is present with the patient"

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  • This is really interesting because I thought that the ambulance service was now prioritising GP patients with the same urgency as those calling from the community - clearly not the case. It would be interesting to get FOI figures about how frequently 999 or cat 1/2 calls are requested by GP practices and the time between the call and arrival of paramedics. GPs are not emergency docs or Intensivists and we only have quite basic equipment. More importantly, there is not national training for GP teams to manage emergencies in the surgery and this is also an unacknowledged need that must be urgently addressed.

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  • "I thought that the ambulance service was now prioritising GP patients with the same urgency"

    Dear Dr Maloney,

    The difference between the reality of how the NHS is run and what the general publics' idea of how it is run is so large it is quite astonishing.

    Her Majesty's Government is fully aware of how shockingly bad the NHS is run but refuses to let the general public know exactly how it is run. It would much rather prefer the GMC protect the public from this harsh reality by putting doctors in jail.

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