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Nurse out-of-hours triage ‘driving up complaints’

Exclusive Cuts to out-of-hours funding and increased use of nurses for triage are putting patient safety at risk and fuelling a spate of serious complaints, medical defence experts are warning.

The Medical Protection Society has provided information to Pulse on a series of incidents leading to formal complaints, including a leaking aortic aneurysm mistaken for routine back pain, and a failure to recognise second-degree burns.

The MPS's concerns came as the GP leaders warned the Government was set to further raid funding for out-of-hours to pay for the rollout of its 111 urgent care service and that some of the pilots were experiencing ‘operational issues'.

The Department of Health has set NHS managers a deadline of Friday to state when they will go live with 111 – ahead of rollout across England by April 2013. But the GPC said more time was needed to evaluate pilots amid concerns some are ratcheting up pressure on the existing out-of-hours service.

Dr Stephanie Bown, MPS director of policy and communications and a former GP, said out-of-hours providers were using cheaper alternatives to GPs: ‘Increasingly out-of-hours services are using nurse practitioners to provide care and there is no doubt this move comes with significant risks to patient safety.

‘Short-term savings will translate to long-term expenses because if you are not providing safe care your risk of claims will increase and indemnity rise.'

The MPS told Pulse it had handled a number of cases recently where nurse-led triage out of hours had led to complaints, also including failure to refer a scalded baby to hospital to prevent scarring, and glandular fever managed as a simple viral sore throat.

Dr Chaand Nagpaul, GPC negotiator on out-of-hours, said: ‘Triage requires high-level competency, and should not be delegated to lowest-cost personnel.'

GPC chair Dr Laurence Buckman, said: ‘It looks like NHS 111 does not save money and our concern is this money will come from out-of-hours care. In parts of the country GPs are happy with the pilots, but in others they are very unhappy and there have been operational issues.'

Chris Locke, secretary of Nottinghamshire LMC, where one of the four Government 111 pilots has been running, said locally the scheme was causing an increase in out-of-hours workload: ‘Many more calls are coming through than would have been triaged under the old system. The out-of-hours workload is going up when it is expected the DH will use it as an excuse to cut out-of-hours funding.'

A DH spokesperson said: ‘There is no evidence NHS 111 will cost more than existing services. Funding will be determined at a local level.'