Friday, September 12, 2008

The N'octor* will see you now...

Last night I was at a meeting where the new GP Out of Hours Provider company were making their pitch. They have been awarded a contract to offer night and weekend GP services to the citizens of Borsetshire starting this October, and so are in the final run up to their takeover.

The mouthpiece for their organization is a tall, chiseled type, with blond and elegantly coiffed locks, in a shiny suit with a lavender shirt and tie. He just oozes “Used Car Salesman”-ness. And his pitch is flawlessly reassuring. Patients making contact out of hours will first be answered by expert call handlers who will speedily ascertain the patients ID and contact details before passing them on to a clinician. If all clinicians are busy and they do not have an over-ridingly urgent problem, then their details will be held until the first such clinician is available to call them back, and their target will be to return these calls within x minutes, where x is a vanishingly small number. Once they have spoken to a clinican, those that need to be seen will be offered a speedy appointment at the nearest centre, or visited at home if housebound.

The new providers are committed to training, and to staff development. They will even help little old ladies to cross the road, pop in at night to fix them their tea and biccies, and tuck them in and read them a story before bye-byes. (Well o.k. I might have slightly embellished the last few points.)

Over all though, an impressive performance by a polished (almost literally so) performer. That is, until we get the specimen rota for the service they are offering. In retrospect (having had the chance to sleep on it I suppose) it should have been obvious from Mr Smooth’s choice of words. Like Humpty Dumpty before him (and I believe as I have also said previously like myself in my turn) Mr S’s words mean what he chooses them to mean. To you and I, hitherto, I suspect the word clinician would have conjured up the image of a proper professional. Probably a Doctor, or, at the very least, a Nurse Practitioner with a higher level of expertise that the standard nursing qualification. It appears to this hallowed band of guardians of the common health and wellbeing we must now also admit the ECP.

“?” you ask, as well you might, and as we all did…

“ECP” says our lad, undaunted. “That’s Emergency Care Practitioner”.

“??” we chorus.

This brave new breed will be at the forefront of our overhauled out of hours services. Without wishing to in any way denigrate this noble calling, the ECP job description is essentially written for a paramedic with a bit of extra training in emergency care—perhaps 2-3 years training after school / college as a minimum, compared to the eight years required of GPs in training.

So, the best advice I can offer the citizens of Ambridge, is to try not to get ill out of hours anytime this winter, as instead of a guaranteed encounter with a GP as we used to offer they are now faced with a one in three chance of being left in the, doubtless entirely capable, hands of an ECP n’octor.


*N'octor-- increasingly accepted contraction for the phrase "Not-a-doctor"

12 comments:

Elaine said...

Frightening!

Anonymous said...

At last you have been brought into modern times. next year it will be the same in the daytime via the Darzi clinic

Z said...

When a friend who was pissing blood and whose wife can't drive was told, at 11 at night, to drive to the nearest all-night centre 12 miles away, he rather lost faith in the new service. My husband (we live a further 7 miles away) drove over to take him.

Everyone in my family who has been suddenly extremely ill has needed a doctor in the middle of the night. If it ever happens again, I won't bother with a doctor, I'll dial 999. Which I don't suppose is the intention.

ageing student said...

When I win the lottery the first thing I will invest in won't be an expensive car or an exotic holiday; it will be private health insurance!

Doctor Jest said...
This comment has been removed by the author.
Doctor Jest said...

elaine-- indeed!

anon-- sorry you didn't feel able to leave a nom de plume. I'd be more than willing to debate with you the relative merits of the "noble" lord's vision for primary care. the original conception of the "darzi" polyclinics in metropolitan areas in fact has a great deal of merit and i'm sure deserves support from patients, professionals, managers and politicians alike. sadly the "darzi" on offer in Borchester is of a very different stripe-- namely a walk in centre open 8.00-20.00 7 days a week, but with a complement of 3 Docs and 12 nurses only, no add on / outreach services proposed, and with fewer than 40% of the 350 or so people who bothered to respond to the public consultation saying they would envisage ever making use of it.

Now whilst i am sure once opened it will attract folk through the front door, i fear it will not be resourced to do much of any value for them, and for this not very much our health economy in the county will be £1,000,000 the poorer. seems a pitty somehow.

z-- i understand the sentiment, but would urge you to reconsider. if at all possible restrain the impulse to call the nines unless there is a genuine and urgent need. the ambulance service is already groaning under the existing strain, and one bad experience will not, i hope, speak to the general level of service in your locale.

a.s-- regretably private insurance can do very little to help you with any medical problem requiring genuinely urgent attention. that's not what it's for. insurance in Blighty will allow you to chose when and where you would like your op' , and give you slightly speedier acces to certain key investigations, but out of hours, and for GP services in hours, it could never cope with the burden or bear the cost. sorry to disappoint, but there it is...

Anonymous said...

We have a daytime walk in centre near to where I live. Doubtless like other walk in centres it costs more per consultation than a GP. I attended a meeting at which a nurse responsible for it said "We can do anything that a doctor can do." Pretty impressive without going to medical school and qualifying as a doctor. I'll stick to seeing my GP and if I really can't, I'll go to A&E.

orchidea said...

The situation in this country is that there is a threatening shortage of GPs, especially in rural areas. General medicine is no longer considered an attractive choice because despite higher-than-average salaries (amongst the specialisms) GPs are obliged to share in a rota of out-of-hours care with their colleagues; something which, apparently, younger doctors are no longer prepared to do.

Doctor Jest said...

anon the second-- or so I presume, thanks for stopping by and sharing your comments. I love this topsy turvy world where we have Nurses employing Doctors and not t'other way around. It remains to be seen how it will work out, but as with z above I do urge you to reconsider pitching up with a primary care problem in A&E. Seeing a rushed junior doc 18 months into his/ her career is no substitute for a proper GP consultation, and is a sure fire way to get a dozen tests done you didn't need doing if you're not very careful. With a bit of luck the Docs in your drop in center will be UK qualified and trained and should give you a half decent service if they are allowed to practice with the traditional GP freedoms...

orchidea-- they're trying to get us to reconsider our out of hours opt out, but after four years of evenings and weekends being a "proper" Dad, I'm not that tempted I must say. And we don't even have mountains to contend with...

Z said...

I wouldn't call any doctor out, let alone in the middle of the night, without urgent and genuine need, honestly. On each occasion we have, the doctor has made the decision to call an ambulance anyway. And that's what I said what I did - on the rare and necessary occasions I have called a doctor out of hours, I expect, having described the situation, to be taken seriously.

orchidea said...

I don't blame you, Dr J. It'll be interesting to observe how the Swiss GP Council solves the problem. We are a bit set in our ways here (spoilt, I guess, too) and I can't somehow envisage that patients will find it acceptable to be seen by a n'octor out of hours.

Doctor Jest said...

z-- sorry fo rthe delay responding, I've been out of the loop rather lately, but I do understand what you're saying. If you know you have a trebble nine problem then you absolutely should go for it. If on the other hand you think you would be better off keeping out of the clutches of the hospital then the OOH srvice really should be there to serve you and I too would expect them both to listen and to take every patient seriously.

orchidea-- vide supra, and if the Swiss GP council is anything like our own beloved GPC then I would porbably worry, but being Swiss I am sure they are not and that therefore you need not...