Posted by Mattie
Wednesday, 16 May 2007

Last weekend, I had to call the doctors (Valley Road) out of hours. I hadn't done this for around 20 years so wasn't too sure of the procedure.

During the first call I had to answer endless questions when I really didn't feel like talking.

After an hour or so, a male nurse phoned back, very friendly - and asked all the same questions again!

Two and half hours after my initial call, yet another nurse phoned, asked me yet again to answer many of the same questions and then suggested I drove to Bradley.

Bradley??? When I showed that I had never heard of Bradley and expected to be able to see someone locally, she immediately became quite officious - the last thing I needed when I wasn't feeling well. I didn't feel capable of driving. And it turned out, that Bradley isn't even in Calderdale! It's in Huddersfield. Miles away.

Nearly five hours after first feeling I needed medical advice, I gave up. In my innocence, I thought I could speak to a doctor and get some re-assurance. That they would come round if they thought it necessary. And because I don't bother them unless I really need to I foolishly felt they would know that if I was calling them at a weekend, it was going to be important.

Is that how the system works? They do everything they can to make you give up. Fortunately, I was feeling much better by the evening, but what if I hadn't?

Having spoken with friends, I find that this experience is not uncommon.

We should expect and demand better. It is really unacceptable that after all the NHS reforms, we can no longer get to see a doctor in Hebden Bridge when we need one.

From Joseph
Thursday, 17 May 2007

Our experience of NHS services in Calderdale has exceeded our expectations in every way. From 2 births in Halifax in surroundings that I would have been pleased with in a private hospital to a fantastic standard of care at Valley Medical Centre. Our experience includes everything from immunisation jabs, to post natal to mole removal to lumps on feet to A&E when my Dad's drugs went wrong and many other colds, flu's and rashes that affect a young family.

Without exception the "service" we've received has been fantastic in just about every way, a credit to Valley medical centre, the PCT and the hospital and everyone who works there, and even the govt who have funded the whole thing. Yes I imagine they get it wrong sometimes, as do all of us, but as a whole its pretty good.

From Adam B
Thursday, 17 May 2007

In response to Matties' experience, there are some understandable misconceptions which I would like to address. Also, in light of his unhappy experience, I would suggest that he doesn't let this lie here.

It sounds as if you spoke to Local Care Direct who have offices (among other things) in Bradley. Generally speaking they are good - very good! They try to be very community based, they are open to listening to peoples' experiences of them and you are probably eligible to become a member. Go here to find out more about membership, the organisation and how to feed back to them regarding your less than satisfactory experience. They take such feedback very seriously.

Regarding the long wait for call-backs, there is a huge demand on out-of-hours services at the weekend (especially on public holiday weekends) so regrettably long waits can happen. The time taken for someone to call you back is related to the urgency of your case. There are those who call with serious problems who need an immediate callback and you will be queued behind such cases. Similarly there are many who call with nothing more than a cold or virus and who just need to take some lemsip and lie down for a while - so it is a misconception to feel that they will assume it is urgent because you are calling at a weekend.

If they advised you to attend Bradley then that corresponds with the required clinical urgency. You were probably triaged as 'moderately urgent'; requiring care within approximately 24 hours (in most cases) but not urgently.

Bradley is actually not all that far to go - not more than 20 miles. It feels like a long way if you are not well but if patients are really in need they always manage somehow. It is not the responsibility of out-of-hours services to resolve transport difficulties, logistically it is not possible.

Unless you happen to live near an out-of-hours centre it is not usually possible to see someone locally. An on-call doctor may be sent to you but this is used for urgent or immediate cases. The role of doctors out-of-hours has changed. You will usually speak to a nurse who is qualified to assess your clinical need and offer advice, in some cases she will refer you to a doctor but statistically this is not necessary in the majority of cases.

Regarding the questions asked, they must ask questions to accurately and legally assess your clinical need. It is worth asking them why they felt it necessary to repeat some questions.

You have raised some good questions and I would contact LCD to follow them up however it does sound as though your clinical need was accurately assessed. You were not in need of a doctor or other immediate attention, yours was not an urgent case and you were well enough to travel (however inconvenient and uncomfortable this may have been). It was not by chance that you were feeling better later on; this was because you're condition was not serious and it was treated as such.

I hope this helps with your case. If you have any queries regarding my comments please let me know. I do strongly advise talking to LCD about this.

Best Regards,
Adam.

From Mattie
Friday, 18 May 2007

Thanks for the responses. I wasn't seeking to criticise our local GPs who I know are rightly very highly respected.

I was prompted to write not just because I was fed up with the service I received, but because I don't like to think of anyone else having this kind of bureaucratic, long distant health care (?). I know others share this concern.

My point is that we should expect be able to receive out of hours medical advice and support in Hebden Bridge, or at any rate we should not have to go further than Mytholmroyd or Todmorden. Even the Government have this week been making noises about surgeries outside working hours. We should normally have the opportunity to receive advice from a qualified doctor without waiting 4-5 hours and giving up in dispair.

The other indignity I found unacceptable is being repeatedly asked so many questions when I wasn't feeling like talking. I can understand they would want this information once for someone who hasn't called them for a while, but why repeatedly? Don't they have a computer?

From Adam B
Friday, 18 May 2007

Hiya,

No I know and you're right there Mattie - your out-of-hours (OOH) services are very separate to your local surgery.

I can understand the fact that you were fed up with the way things went and that you wanted facilities locally. In an ideal world we would have NHS Walk-in-Centres (WiC's) within a few miles of every town and village but that isn't ever going to happen. As I mentioned, there are on-call doctors available but these are a precious resource and as such they are used only when necessary. GPs were offered such a good deal to opt-out of OOH care that they left in their droves the whole service became nurse-based (which is a god thing) and less localised (which can be a problem).

I disagree with your comment that we should be able to expect advice from a doctor because this just isn't necessary in the majority of cases. Nurses are highly qualified and as such are able to provide both medical advice and treatment in these situations. In the case that a doctors' specialist knowledge is needed, a doctor can be involved in a number of ways.

Regarding the questions that were asked; you must expect this. Even if you go to see your GP they will ask questions, this is even more necessary for a nurse over the phone who cannot see you and examine you in person. Your answers provide them with information on your medical condition and subsequent medical need. I know that if you are ill you don't feel like talking but if you are phoning an OOH advice service then you will have to talk over the phone - it's the only way.

I don't know why they repeated questions - it may have been to clarify your previous responses. I think you should ask them (maybe 3 times ;-) )!

One thing I don't really understand are your timings - I may have missed something. I think you say that an hour after your initial call someone called you back, 90 minutes later you were called a second time. That is 2.5 hours, where does the 4-5 hours come from?

I would like to repeat my advice that you contact Local Care Direct to discuss your experiences with them. They do take comments (negative and positive) very seriously, they are always looking to improve their services and they will listen to what you have to say.

From Rebecca L
Monday, 21 May 2007

I too have recently had cause to use the out of hours GP service. I called a doctor out to see my three week old son last week. I have absolutely no criticism of the service I received once I'd actually got through to the local office that deals with our out of hours GPs, but I resented having to waste time explaining the situation first to a glorified receptionist at NHS direct, and then one of their nurses who called back and asked me all the same questions over again. I had called about a pre-existing problem so already knew quite clearly what was wrong and what might need to be done. Despite this I was asked numerous irrelevant questions, the most ridiculous of which was 'has your son stopped breathing or have his lips turned blue'... I think I would have been calling an ambulance if this were the case! In the end someone in an office in Huddersfield called me, asked all the same questions a third time, and arranged (thankfully) for a GP to come and visit us within the hour.

Overall my experience of Valley Medical Centre has been exemplary. I moved here from North London three years ago, and I am staggered by the difference between healthcare provision in London and here in Hebden. However, the use of NHS direct as a filter for out of hours calls is both irritating and a waste of time. It would make far more sense for callers to be put through direct to the offices in Huddersfield.

From Adam B
Wednesday, 23 May 2007

The whole system of NHSD within OOH health care has huge question marks over it. The service was very badly implemented and there have been problems ever since as a result. The first contacts at NHSD are often receptionists, I do not know what guidelines they work under but some of the information which is passed on from them is useless, quite frankly. I believe that they are not medically qualified themselves so do not always know what information a nurse requires.

It seems that the questions asked are causing some raised eyebrows and from the point of view of a caller I am not surprised! However, they are necessary from a clinical and / or legal point of view.

Bear in mind that the person asking the questions has only your answers to go on so they may ask questions which seem stupid. Also, consider what happens if a nurse does not ask a seemingly obvious question and the patient dies.

You may be surprised how many people actually call an OOH call-centre when they should have dialled 999, although it is still not as many as those who call with nothing more than a headache and expect urgent medical attention! :-)

Cheers,
Adam

Posted by Tom Standfield
Friday, 25 May 2007

This issue is all over the news today. The BBC news site reports "Gordon Brown has admitted the NHS needs to improve night and weekend GP cover after the system was criticised by an inquiry into the death of a woman."

Mattie and Rebecca have raised a very important concern.

Reading the comments so far, and having experienced the out of hours service myself mainly on behalf of my partner, I think we really need some answers.

1. Why does the extensive questioning have to be repeated three times? Both Mattie and Rebecca mentioned this, and it fits with my experience.

2. If the banks and Inland Revenue can have highly confidential information on computers, why can't local GPs? After all, I can access all my bank information within a couple of minutes.

3. Why can't we have this service in Hebden Bridge. We always used to have.

On Any Questions this evening, a panelist pointed out that if she needed a vet for her cat, one would be with her within half an hour. Why can't we do the same for people?

From Adam B
Saturday, 26 May 2007

I think I can offer information towards answers to some of these questions.

1 - As I said, I think this question should be raised with the OOH service. I can understand that they may wish to verify earlier answers but not why they would wish to ask the same questions 3 times, if you have an experience such as this I would encourage you to raise the question with the service involved.

2 - GPs and OOH care services can (and do) have highly confidential patient information on computers.

3 - As I mentioned, ideally there would be a WiC (or alternative) in every town and village but this is not economically viable. There are still doctors on-call available to visit you in Hebden Bridge just as there have been before. The service is significantly different, however, because GPs were offered a huge incentive to leave OOH care and they left in their droves so many of the services which we used to have no longer exist. Unfortunately the replacements are not fully adequate.

Regarding the case on the news recently, this has been rumbling on for some time (the incident occured in 2005) and does highlight many of the weaknesses in the current service. This particular service has taken significant steps to prevent such a tragedy recurring.

Hope this helps,
Adam.