Ambulance delays: GPs forced to advise unwell patients to take buses or taxis to hospital

GPs say they have stopped trying to phone ambulances for seriously unwell patients – even advising those with chest pain to take the bus.

One GP said they had been forced to transfer patients to hospital 10 minutes up the road including an elderly patient with sats in the low 80s because their oxygen supply started to run low while on hold.

It had felt unsafe and a huge risk but they ‘couldn’t sit by and watch someone die’, the GP, who wanted to remain anonymous to avoid identifying the patient, said. 

Another GP partner who also works in urgent care said they are managing increasing numbers of critically unwell patients and having to look after them for far longer leaving them feeling ‘unsafe’.

The urgent care centre is not equipped to cope with emergencies yet even a blue light ambulance for a child with stridor caused by an allergic reaction took two hours yesterday, they added.

In one incident Pulse has come across, an out-of-hours GP was called out to provide interim treatment for an elderly patient who ended up waiting 48 hours for an ambulance.

Dr Paul Evans, a GP and chair of Gateshead and South Tyneside LMC, said he has normalised telling patients to get a lift or taxi if they possible can.

Just this week he advised a patient with central chest pain that he could organise an ambulance but it would likely be faster and more likely they would be seen if they took the bus which the patient opted to do.

‘I now only call ambulances for those who are truly bedbound and unable to be thrown into the back of a car, or have literally no-one,’ he said. ‘The same goes for colleagues in and out of hours.’

GPs are now considering ambulances to be a ‘last resort’ option even for very unwell patients, he added.

A GP in York said they’d had to transfer several patients including one patient where after five hours the oxygen supply was running out and another having a heart attack in the surgery.

In one case a patient who had lost all feeling in their legs was refused an ambulance as not enough of an emergency.

Dr Lucy Pocock, a GP in Bristol told Pulse she has taken two patients to hospital herself, one a child needing oxygen and one frail elderly person who was confused and unwell and had no relatives.

‘In my practice, we call a taxi rather than driving ourselves. This is as a result of advice from our indemnity provider who cautioned us against driving, in case we invalidated our car insurance and also in case the patient were to deteriorate.’

She added that the current ambulance delays had altered her decision making when deciding to admit someone at all.

‘I have to weigh up the risks and benefits of admitting someone who is elderly and frail – in the past, if I knew they would be seen and sorted quickly, I may have decided it would be in their best interest, but now I know they may have to wait 12 hours for an ambulance, and then another 12 hours in a queue outside A&E before they’re assessed.

‘I am therefore admitting fewer people and palliating (focusing on symptom control and comfort over cure) more,’ she said.

Dr Lis Galloway, a GP in Surrey said it put practices in a very difficult position: ‘We’ve had discussions around safety, liability and dereliction of duty if we have to stay with a critically unwell patient and the knock-on effect on GP care.

‘I should add, we have the utmost sympathy for our ambulance colleagues. The moral injury must be horrendous.’

Professor Azeem Majeed, a GP and professor of primary care and public health at Imperial College London, said GPs should not be responsible for filling in gaps in urgent care services: ‘I do think we need guidance from NHS England on what the responsibilities of GPs are in such circumstances.

‘If GPs provide care outside their competence, it does raise medicolegal issues that need clarification.’

Dr Clare Bannon, deputy chair of GPC England at the BMA, said: ‘GPs, by instinct, will always want to try and help those in need, but they should not be put in a position where they are having to do things that are above and beyond their skills, outside of their contracted services, or not covered by indemnity.

‘This isn’t safe for them or their patients. It also creates further strain on general practice services, taking GPs away from caring for the rest of their patients. NHS pressures are becoming unbearable, and patients are suffering as a result.’

Dr Caroline Fryar, MDU director of medical services, said they recognised that the current pressures within the NHS are putting doctors a position where they are having to look after patients in impossible circumstances and GPs should use their best judgment as to the most appropriate course of action. 

She added: ‘The current circumstances mean that doctors are being forced to consider whether to provide additional or interim treatment in a practice setting whilst a patient is awaiting transfer. 

‘What additional treatment is appropriate is a matter for the doctor’s judgment and will depend on the experience of the clinician, what they consider to be within the limits of their competence and what they consider can safely be administered in the setting the patient is in.’

GPs should keep careful records of the circumstances that required the additional treatment, as well as a detailed note of the actual treatment given and any advice given pending a transfer, she said.

‘If there are delays in the ambulance arriving, you may decide, based on your own clinical judgement, it is more appropriate to get the patient to hospital in some other way, such as in your own car.

‘However, bear in mind that business and car insurances may have stipulations about this. If you think this scenario might arise, try to look into any exclusions in advance.’ 

The latest figures show more than a quarter of ambulances waited more than an hour to hand patients over at A&E in the final week of 2022 – the highest levels recorded and double the peak from last winter.

NHS England did not provide a comment.