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NHS Direct nurse cuts to ‘put safety at risk’

By Ian Quinn

Exclusive: NHS Direct is drafting in managers with no background in nursing or medicine to run its call centres, in cuts its own staff warn will make it unsafe, Pulse can reveal.

Reconfiguration plans outlined in board papers would reduce the number of nurse managers to just one to every 39 members of staff, with claims the move will ‘significantly compromise' patient safety.

The proposals come as figures obtained by Pulse under the Freedom of Information Act reveal that more than 40% of NHS Direct's current call-handlers have no nurse training, and that nearly a quarter of all callers are directed to their GP.

Scotland's service, NHS 24, is meanwhile facing serious criticism for the lack of expertise of its staff and there are growing calls from GPs for it to be axed.

An NHS Direct board paper reports: ‘Multidisciplinary teams under a team manager will provide management for all team members, irrespective of professional background. This will entail clinical staff being line-managed by non-clinical staff.'

In a statement to the board, NHS Direct staff warn the plans ignore ‘the consideration of the patient and impact on quality of care'.

‘Without sufficient nurse leadership, the efficiency of NHS Direct services and safety of care would be significantly compromised,' it adds, warning of the ‘risk of falling into a management-focused model of generic call-centre services'.

NHS Direct this week opens an internal consultation on the plans, which would see more than 20 ‘senior clinical management' posts axed, saving £3.9m a year as part of a £20m package of cutbacks for the next financial year alone.

Nick Chapman, NHS Direct chief executive, claimed the restructure was intended to free nurse staff from red tape, adding ‘clinical supervision and patient safety is paramount'.

‘We will see after the three months' consultation what the majority of staff think,' he said.

Figures obtained by Pulse also reveal NHS Direct classifies 26% of calls to its 0845 number, and 24% out of hours, as urgent.

They follow a report in February by David Carson, director of the Primary Care Foundation, finding patients calling West Yorkshire Urgent Care Service had been placed at risk of ‘significant harm' by failings including classification by NHS Direct call handlers of 60% of all home visits as ‘urgent or emergency'.

Yet a new report by NHS Direct, entitled ‘West Yorkshire Urgent Care – lessons learned', dismisses the findings as ‘teething problems', claiming that since July 2009 NHS Direct staff had ‘largely achieved satisfactory levels of performance'.

NHS Direct told Pulse the performance of its West Yorkshire call handlers had improved to meet PCT targets, although almost half of calls resulting in a home visit are still classified as urgent.

Earlier this month NHS 24 staff were branded ‘inadequate and incompetent' by a court sheriff, after a 50-year-old patient was told to take indigestion tablets while suffering a fatal heart attack. GPs are now calling for both services to be scrapped, with representatives at the Scottish LMCs conference describing NHS 24 as a ‘huge waste of resources' while motions to this week's LMCs conference in London call for NHS Direct to be decommissioned.

Dr Mark McCartney, a GP in Pensilva, Cornwall, said: ‘I am extremely concerned at any move to reduce clinical training of NHS Direct staff as there are already huge problems, as shown by the swine flu line, which was worse than hopeless and potentially dangerous.'

More than 40% of current NHS Direct call handlers have no nurse training More than 40% of current NHS Direct call handlers have no nurse training NHS Direct in numbers

£123m - budget for 2010/11

41% - non-clinical call staff

22% - patients sent to GP as urgent or next-day cases

12% - patients sent to A&E or put in ambulance

56% - patients dalth with by NHS Direct

Source: Pulse FOI investigation