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The waiting game

Runaround at the walk-in centre

Yet another sorry saga at the local walk-in centre has got Phil going again on his pet topic

Yet another sorry saga at the local walk-in centre has got Phil going again on his pet topic

Sometimes I feel like I'm always banging on about walk-in centres and I wonder if I'm boring you. Then I think I should be banging on about nothing but walk-in centres, because each day's mail brings its crop of horrifying garbage about them.

Did I tell you about the woman with a rash on her bum? She rolled up to one of our local walk-in centres with an erythematous itchy rash on her arse. A couple of nurses checked her blood pressure, examined her chest, and told her with ineffable authority that she was suffering from ‘slapped cheek syndrome'. Open-mouthed incredulity is the only realistic reaction.

That story is worrying but comical. Another saga that landed on my doorstep recently is merely deeply worrying.

To be fair, the walk-in centre was not clinically at fault this time, but its very existence was what made the scenario possible. My patient, a 35-year-old skinny chain-smoker, woke at 3am with a pain in the side of his chest. He couldn't breathe in without severe discomfort, and his girlfriend drove him to A&E.

So far, so sensible. However, our A&E is one of the busiest in the country, while our walk-in centres are overfunded and underused, and it would seem that someone somewhere is trying to redress this imbalance via protocols to divert the punters.

At A&E, my patient was interviewed (but not examined) by a nurse, who told him all soft tissue problems should be seen by the walk-in centre, so off you go. And off he went in his girlfriend's car, a four-mile trip. Once at the centre, the nurses were horrified that an acute chest pain had not been seen in A&E, so (without examining him) they packed him back off there, this time in an ambulance.

Back in A&E, a doctor (apparently; he didn't actually say) listened to his chest but didn't X-ray him – and told him he had pulled a muscle, it was all basically down to smoking, and he should see his GP the next day for some Champix. And so he ended up in my surgery, holding the side of his chest and gasping, asking for tablets to stop him smoking.

‘We might talk about that later,' I told him. ‘First, I'd like to exclude a condition called spontaneous pneumothorax. I'd like you to go back to casualty for an X-ray.' And off he went, for his fifth medical consultation in the space of 12 hours.

From pillar to post

Now it would be nice to say that my diagnosis was correct and that he was eventually investigated and treated. But life is not that neat, and when I phoned him the next day to find out how he had got on, he admitted, with a certain amount of chagrin, that he had not gone back to A&E, on the grounds they had not done anything for him before. He had instead gone home to bed with some of his mother's painkillers, and that's where he was going to stay if that was all right with me.

Over the next week, his pain got better and now he's fine again. Maybe he did pull a muscle. Maybe he had a small spontaneous pneumothorax and it resolved. We'll never know.

What I do know is that he was mucked about by a system that refused to engage with him and potentially put his life in danger.

It's inevitable, once there is more than one point of access to the health service, that each point will try to limit that access. It's entirely possible my patient could have expired of a tension pneumothorax in the back of a car somewhere between these reluctant saviours, and it's inevitable that someone, eventually, will do just that.

I don't believe this scenario could have occurred in the days when you could only go to A&E or your

GP. I think there will be a lot more stories like this, and I think there'll be tragedy and expense – and the latter (but probably not the former) will eventually make the Department of Health very sorry indeed.

Dr Phil Peverley is a GP in Sunderland

It's entirely possible my patient could have expired of a tension pneumothorax in the back of a car

Pev leans forward

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