Make first call to your own GP

LAST week, Jeremy Hunt, the Health Secretary, apologised formally on behalf of the NHS, to the parents of William Mead, a twelve month old boy, who died in December 2014, from sepsis as a complication of underlying pneumonia.

Despite several consultations over many weeks with GPs both at the family’s own surgery in Cornwall, and latterly the out-of-hours service as well as 111, sadly it appears that William’s pneumonia was not diagnosed, and even more upsetting, that had his mother’s final call to 111 been processed differently, the child may have still be alive.

The purpose of this article isn’t to scapegoat either individuals or organisations, or to suggest a complete restructure of the current system. I am sure that everyone involved in little William’s case will be have been deeply affected by the situation. However, I hope to be able explain how the current service has evolved, as well as practical solutions to help patients get the most given the limitations of this system.

Until 2004, GPs provided out-of-hours cover for their own surgery or perhaps that and a neighbouring surgery as well, so if you rang up between six pm and eight am the next morning, there was a good chance that the doctor on-call knew you personally and had access to your medical history. After 2004, the out-of-hours service was devolved to independent providers, so although the GP would likely be from the local area, they might not be from your surgery. In addition, they would not have access to your full medical record, adding to any ambiguities. Due to the spiralling demand on the out-of-hours service, which has increased by 25 per cent in the last year alone, non-medically trained call handlers were employed, and by following an algorithm designed by qualified doctors and nurses, they would hopefully be able to select those cases which required a doctor’s attention, prioritising so that those situations deemed most urgent were processed first.

Sadly, like every system it does have its draw backs. The volume of calls to the out-of-hours service seems to be rising exponentially, perhaps as some patients now see it as an extension of the normal day time service, rather its designated role for emergencies. It is not immune to inappropriate requests, consultations that could have waited until the next day, and astoundingly even prank calls. In addition, it is sometimes used as a second opinion for an individual who has disagreed with their own GP’s assessment.

Thankfully, I am very pleased to say most people recognise and are able to use both the routine as well as out-of-hours services responsibly and hopefully to their benefit. My advice to anybody in doubt would be as follows; if you think you, or your child, have a complaint that needs urgent attention, please try and see your own GP within the same day. They will have full access to your notes, and most surgeries are flexible enough to see emergencies on the same day. Ask your doctor what to expect in terms of how long the symptoms may last, and what should prompt you to seek immediate repeat medical advice. If a symptom persists longer than you have been advised, or you feel yourself deteriorating, first try to see the same GP who assessed you initially, or failing that a GP from your own surgery. If you are worried about a particular diagnosis, mention this to your doctor. Most will be pleased you have aired your fears, as it will give them a chance to explore this with you.

If your symptoms or those of a family member develop after routine hours, firstly ask yourself if they can wait until your own surgery opens. You will get a much more complete service from a doctor who has access to your full medical record. However, if it is an emergency, then do not hesitate to contact the 111 or out-of-hours providers promptly. Try to answer questions providing the maximum amount of information you have available. Be sure to highlight the severity of your symptoms as well as how rapidly they have developed. If you have had similar symptoms before, be sure to mention this as well any diagnosis and course of action at that point. In addition, as the service will not have access to your medical records, don’t forget to brief the call handler of relevant major medical problems, for example heart disease. Keep a list of your regular medication handy as this will often be asked about. If you feel that your situation merits a face-to-face consultation, do not be shy about asking for this, especially for children or the frail elderly.

In conclusion, although nothing will bring William Mead back to his grieving parents, hopefully greater vigilance by healthcare professionals and patients together, will prevent such a tragedy recurring.