Stupid GPs (Again)

Stuart Moore found this little gem on the BBC website, essentially about GPs planning to dial 999 for non-emergency calls.

Ambulance bosses say a threat by GPs in Swansea to dial 999 for non-emergencies would bring the service to a standstill and risk peoples' lives.

Doctors say ambulances are over-stretched and non-emergency patients who need to be admitted to hospital are left to wait.

Ambulances have to respond quicker and within a guaranteed time to 999 calls.

GP’s are upset that ambulances spend their time stuck outside A&E with no beds at the hospital to offload their patients onto.

The Morgannwg Local Medical Committee, made up of doctors from the region, has put forward a motion to the Welsh LMC conference on Saturday calling for members to use the 999 system rather than pre-book vehicles.

Swansea based GP Dr Ian Millington, secretary of Morgannwg LMC, said: “It's really a way of using the system to guarantee that patients get appropriate care.

“What we are trying to arrive it is where we can guarantee a time for a patient to arrive at hospital. Increasingly that's becoming difficult if we use the normal control room number.

These non-emergency patients are the patients who can wait for an ambulance, as their condition isn’t immediately life threatening.  People who are believed to have a DVT, a chest infection, or a urine infection are the typical non-emergency calls we go on.

Stuart asked my thoughts on the subject, these are –

Short answer : “GAAAAHHHH!”

Longer, more sarcastic answer: “Don’t GP’s do that anyway?  Especially for the patients that they haven’t actually seen, just diagnosed over the phone”.

Sensible answer : “Why do GPs think that abusing a system will help patients?  If they carry out their threat then ORCON (Government target) will be hurt, the ambulance services involved will be slated for poor response times and will get less funding, this will result in a worse service.  This only leads to patients getting a worse deal than before.”

I’ll leave you with these comments, so you don’t just think it’s just us road crews who think it is a bad idea.

But Don Page, Chief Executive of the Welsh Ambulance Service NHS Trust, warned if the GPs carried out their threat it would have dire consequences.

“To undertake the threatened action will result in the emergency ambulance service coming to a complete standstill and unable to respond to real emergencies and life threatening calls,” he said.

“It would be unprofessional and negligent of GPs to take such action which would clearly put the lives of people at risk.

“I understand the concerns of GPs but I would urge them to step back and consider the dangers that such action would cause.”

18 thoughts on “Stupid GPs (Again)”

  1. If they do it, the Ambulance staff should get their home numbers and call every 5 minutes through the night complaining of a runny nose and asking for some advice. They'll get the message soon enough…

  2. How hilarious that the services which fail to meet their targets are the ones that then receive less funding. Who exactly is it that is incharge of such a financial plan?Maybe they should try that in those schools where there is a shortage of teachers. “You boy, you are going to fail your Higher Mathematics. As a consequence, we're deciding to give you fewer lessons, so that Mr Hepworth can concentrate on the Grade A students who really need the attention.”

  3. At a day center near me today…An elderly lady (80+) falls over, staff can't lift her, (Health & Safety), so they phone the two phone numbers they have for family etc. One is her daughter an alcholic who lives over thirty miles away, only visits when she wants money, the second is someone across the road from the old ladies bungalow, who it seem she pays to put her to bed at night.

    Finally, they phone the GP & ambulance service, the ambulance crew come round, get her up & check her over, no damage done & she refuses a trip to hospital.

    The GP says he will visit her on Monday…..

  4. Plus if GPs did that they'd actually have less ambulances availible to them as a fair number of services have some intermediate tier vehicles that are crewed by staff that only do Drs “prebooked” urgents.

  5. Blame the whole idea of 'internal market forces'. When politicians realised that you can't reduce everything down to market forces, the world will be a better place.

  6. These are the same GPs who are so concerned about their patients' welfare that they are now refusing to provide out of hours home visits! Result is that now some paramedics (and nurses) are being trained as ECPs to provide the out of hours services that the doctors are paid to do.As for the GPs threatening to call 999 for non-emergencies, I can't speak for Swansea, but it already happens where I live and work. I've lost count of the number of red calls I've had to GP's surgeries at around 6 pm – just as the surgery is due to close…usually given as chest pains, or breathing difficulties – and arrive to find a patient sitting outside a locked surgery saying “they told me to come out and wait for the ambulance”.

    Oh…and while I'm still in rant mode – how will adding to the queues of ambulances waiting outside A&E provide a better service for their non-urgent patients? It's about time that the public (and GPs) had it drummed into them that arriving by ambulance does not give you priority at A&E.

    OK…rant over… feel better now…breathe normally…

  7. Went to a green at a GP surgery, mid morning, for a female with abdo pain. Just as we got on scene we got shouted up and the job had been re-prioritised to a red. Went in and the receptionist told us the patient had been in the waiting room but was currently in the toilet. When she came out the receptionist gave us the GPs letter and I asked why they had phoned back for a regrade. She said the GP must have thought it was getting worse.The patient had a history of abdo pains (psyche related) and was on numerous things for “the problem”. Yet that was regraded to a red after we were on our way and we didn't see the GP once.

    Got an urgent to an elderly female with acute SOB. Shouted up and said are you sure this is an urgent and they said to run with it while they contacted the GP cos they thought it was a bit suss. GP said she wanted the lady in A&E ASAP as her breathing was quite bad. She thought urgent meant do it now, urgently. You just can't educate some people.

  8. This is probably a stupid question but what the hell. If it's not an emergency, why can't they just send the patient to hospital in a taxi?

  9. …..why can't they just send the patient to hospital in a taxi?Who pays for the taxi?

    The GP ain't & the punter, (client, or whatever is the latest buzz word), has no money. OR! feels they should not pay. The system should provide.

    I knew this bloke with a blind daughter, got every allowance he (or she) could get & then, refused to pay for transport for his daughter to go to a day center!!!!

    Payed much of the money to his partner (live in lover), who he claimed was his daughters “nurse”, denied that any one else helped him!!!!!

  10. This is so typical. It also happens frequently in Australia where non-urgent cases are referred by local GPs to ED. What should really happen is that GPs should do the job they are being paid to do instead of handballing it to other already overworked sectors of the public health system. Really, how hard is it to treat the sniffles, or strap a sprain…or [fill in minor ailment/complaint here]?Grrrrrr….

    punkclown ~ punkclown daze

  11. Of course the alternative solution is to continue to chuck funding at underperforming services. In short rewarding those who fail whilst witholding funding from those who show they can use the money to good effect. I've been in the LAS for a while and the improvements under the current system speak for themselves.DSO

  12. I think that there needs to be a……I can't believe I'm going to say this…

    “Third Way”.

    Instead of relying on market forces, when the NHS _isn't_ a market (we want less 'customers', rather than more, and to achieve this would be the greatest success) – we might better be served by roving troubleshooters, who understand the unique pressures and can better allocate resources to ease pressure.

    Otherwise, in a few years time I can see the NHS dividing into two – the elite establishments, and the rest. Look at the difference between the Chelsea and Westminster hospital, compared to (for example) Newham General.

    It doesn't help that the targets that we are supposed to meet have apparently been plucked out of thin air and have little if anything to do with clinical excellence.

    Or that the allocation of funds often has more to do with politics than with how well a trust performs (I seen it happen to other trusts, where the inspectors have wandered in, said in effect ' you can't improve that much wothout cheating' and left leaving no increase of funding).

    The simple answer is that we need more resources, at least until we can start teaching people the correct use of the NHS, and start correcting some of the assumptions and attitudes that they have about the NHS. I think we need experts to allocate this, rather than deciding that whoever gets the most Cat A's under 8 minutes 'wins'.

  13. Well why aren't I surprised.I can count the no of decent GPs I have met in 30 years of work in health related fields on one hand, and even that could be an exaggeration

    It always amazes me that people who are supposed to be so clever and have been at uni for such a long time to qualify never seem to have learnt very much, nor to have one iota of common sense . Neither do they have any idea of how to treat people

  14. I really think one of the biggest problems with the NHS these days is that the general public abuse the service, and that this is because as a society we no longer remember what things were like before it existed. It's taken for granted that clinicians are at our beck and call now, and all the targets and patients' charters reinforce this view.I'm not suggesting that people should be charged the real cost of a night visit from a GP, or a 999 ambulance call (I'm not naive enough to think it's that easy), but if they were, I'm sure there would be less abuse of the system.

    I absolutely agree that one of the best ways we could save the NHS money would be to educate the public in how to use the system responsibly.

    Regarding GPs, I used to be a doctor's receptionist and I think the problem with them is that they are independent contractors to the NHS, not employees. Thus their main priority is making money, not patient care (although admittedly, 'patient care' is their main method of making money, but only in a roundabout way). My experience is that they won't take part in any initiatives unless they are paid to do so (directly or indirectly), however much it would benefit the patient, and only use 'patient care' or 'patient confidentiality' as a front to hide behind when it looks like they will end up either losing money, or getting sued.

    See for example all the recent publicity over the Choose and Book service – surely a benefit to patients – but from a GP's point of view, making a booking at the point of referral means more time taken per patient appointment = less patients seen = less money; or alternatively it means more administration = more staff required = less money.

    PS you must be sick of hearing it, but thanks for the great blog, and deepest respect to all paramedics and EMTs, keep up the good work.

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