A Calling for Care
21 January 2008
Out-of-hours care for patients changed when a new contract was brought in four years ago, sparking widespread controversy. The poor handling of the contract is reported to have cost the Government £1.8bn more than expected. In the North-East, fears have been voiced over access to out-of-hours healthcare for rural patients. Health correspondent Audrey Barton spent yesterday shadowing the team at Northern Doctors Urgent Care who look after out-of-hours care in the region.
IT is 11am on Sunday and we are on our way to our first urgent home visit.
The call has come into the Northern Doctors Urgent Care (NDUC) call centre staffed by doctors and nurses at Gosforth Business Park, Newcastle.
A woman with a history of cardiac problems has phoned in with gastric pain and breathlessness and due to the nature of her symptoms, is logged as a priority.
We head off in a clearly-marked response car complete with green light.
My team is led by Dr Billy Hunt with driver Ken Higgs. Clinical executive Dr Mike Harrison sits in the rear with me to explain the system.
As we make our way to the Newcastle address, more jobs are fed into the satellite navigation system from the call handlers, with brief details of each case.
“Chest pain is the one everyone dreads as it can be so many things,” explains Dr Harrison.
“The only way to exclude a heart attack is to do tests in hospital.”
After spending time with the patient in her home, Dr Hunt makes a judgment call and refers her to casualty for checks.
“In some respects out-of-hours care is more exciting as you always have something new come in,” says Dr Harrison.
“There are different elements which come together.”
The service, which pre-2004 was covered by daytime family doctors, covers from 6.30pm to 8am during the week and 6.30pm Friday to 8am Monday.
Now under the control of the primary care trusts, our service is run by NDUC which employs 250 doctors and covers Northumberland, Newcastle and North and South Tyneside from its Gosforth base.
It brings together a range of skills and elements that in-hours GPs do not experience.
Triage over the phone is the most significant difference between the two.
“The most difficult job is the triage, taking the person’s history over the phone,” said Dr Harrison.
“It is the most important part and it is better to have someone senior dealing with it.”
The call initially comes in to a handler at the centre who is trained to pick up key phrases or words and prioritise the call.
The patient is then phoned back by a doctor to carry out the triage.
“You don’t know the patient, you are doing it over the phone so you don’t have any visual clues, it is all audio.
“If you see someone in surgery you can see they are in pain or limping. It all hangs on the triage.”
The doctor will decide whether the patient can be dealt with over the phone, needs a home visit or should see a GP at one of the seven centres across the patch next to accident and emergency departments.
The details are then put through the system to reach the cars and logged as jobs for them as a call handler phones to flag them up.
All four calls we respond to during the four-hour session are elderly patients and two are referred to hospital for further checks. Treating the elderly is a trend during the daytime as children will be more inclined to be taken to one of the centres by their parents. But calls to attend children do come in at night.
“All the population is getting healthier but each year the calls into GPs increase as there is a lot more we can do nowadays,” explains Dr Harrison.
“So despite the fact that everyone is getting healthier and living longer, the demand for healthcare goes up and up.
“It’s a bit of a paradox really. The more elderly patients we have, the more ill they get in their lifetime and the more care we have to provide.
“We work with the PCTS to help minimise admissions to hospital.”
Two jobs are for patients in care homes who have chronic conditions and have contracted an infection. Dr Hunt, a Rothbury GP by day, is able to deal with them and prevent hospital admission.
Over 90% of the GPs working for NDUC are local with many working as GPs in the patch during the day but doing two or three sessions each month in out of hours.
The service has been criticised by Berwick MP Alan Beith for its coverage of rural Northumberland after midnight when the centres are closed.
Dr Harrison, a daytime GP in Bedlington, is quick to defend the service.
“We do take into account rurality as we started off as a rural co-operative in Northumberland so we know how to run services and meet all the targets.
“We are constantly changing the number of doctors we have to respond to demand. Every call is dealt with in the same way, no matter where it comes from.
“But for every one rural call we get, say in Rothbury, we probably get 20, 30, or 40 down in Newcastle.”
He puts this down to deprivation in urban areas which is known to be associated with ill-health.
“There are a lot more calls in urban areas and most of our work centres around deprived urban areas.”
A massive 20% of the work across the patch is home visits – higher than most areas.
“That is mainly because it is a large rural area and also quite deprived and we have the lowest car ownership levels in the North-East.”
Dr Hunt returns to the base shortly before 3pm, after seeing six patients, when he has time for a swift, albeit late, lunch.
His shift ends with entering notes from each patient into the computer for the next time they may call.
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Weekends and bank holidays busiest
Home visits carried out in a four to six-hour period yesterday –
South Tyneside: 12
Alnwick: 6
Berwick: 2
North Tyneside: 25
Ashington: 16
Newcastle: 20.
Typical reasons for the home visit during that time:
Call from terminally-ill patients with palliative care needs.
Elderly people with chronic conditions such as lung disease who have an infection.
Diabetic woman feeling sick.
Calls relating to children tend to come in at night as they can visit the centres during the daytime.
One in three home visits is urgent, two in three are routine.
The service usually receives 1,000 calls during a winter Saturday.
Busiest times are weekends and bank holidays such as Christmas.
