Prognosis for NHS24 is that it will simply waste away

LAST Thursday, the annual conference of Scottish general practitioners voted NHS24, the National Health Service call centre, a huge waste of taxpayers’ money. The verdict was scarcely surprising. The real surprise is that the project has been allowed to develop as far as it has.

The idea, copied from a similar service south of the Border, is that instead of telephoning your local out-of-hours service when you want medical advice in the evening, during the night or at weekends, you contact instead one of the NHS24 call centres. Here, your query will be answered by a trained nurse, equipped with all the latest computer technology, to enable him or her decide what advice to give you. This will range from simple advice over the telephone to a recommendation that you see a doctor immediately. In the latter eventuality, the call will be passed to the out-of-hours centre for action.

Future plans are for this service, as its name suggests, to work round the clock. Eventually you will probably have to go through NHS24 before you can get a surgery appointment to see your doctor.

Hide Ad
Hide Ad

To enable nurses to deal with the wide variety of problems that may come their way, they have access to algorithms covering just about every eventuality. For example, if someone telephones complaining of abdominal pain, the nurse will be led to ask a series of questions about where in the belly the pain is, if there is associated vomiting or diarrhoea, how long the pain has been present, if it is made worse by eating etc. It is not possible to be more specific because the algorithms have been purchased under licence from an American company, are commercially confidential and cannot be divulged, even to family doctors.

The service is due to be rolled out this month in West Lothian and will cover the rest of the Lothians by autumn. Soon, NHS24 will be the out-of-hours emergency point of call for all Scotland.

So what are the criticisms? The first, and most obvious, is that this new service is an expensive use of scarce financial and human resources. NHS24 cost the health service 40 million last year despite its limited availability. And wherever one of its call centres is established, the result is a haemorrhage of trained nursing staff from local hospitals and GP surgeries. This has happened in my health centre already and these skilled professionals cannot easily be replaced.

Many say that the money and staff could have been put to better use strengthening existing local out-of-hours centres which already answer calls for help and advice from people living in their areas.

Then call-centre staff will be responsible for a large geographical area and cannot possibly have the personal knowledge of local circumstances acquired by locally-based out-of-hours organisations. All the Lothians will be served from South Queensferry, for example. There is a worry that a natural instinct to play safe combined with this lack of local knowledge will result in unnecessary out-of-hours consultations and home visits. This concern is not academic. Medical colleagues practising in communities served already by NHS24 claim that their workload has increased as a consequence. When a person who has already had extensive dealings with NHS24 staff, and been led to expect a visit, is put in touch with the doctor who will be responsible for that visit, it will not be practical to suggest another way of dealing with a problem. The decision has already been made.

This will soon not be the concern of the ordinary GP. It is expected that by 1 October, all out-of-hours services will be the responsibility of the Health Board, not individual GPs. NHS24 will feed into this new service, indeed planners are relying on NHS24 to deflect many of the requests for advice from the service they are setting up. So confident are they that this plan will work that they are drastically reducing the number of out-of-hours centres and number of doctors on call.

No-one doubts that the nurses of NHS24 will filter out the inappropriate calls that presently have to be fended by duty staff, supposedly leaving them free to attend to those who really need out-of-hours medical attention. But if it is true that they will also increase the demand for evening consultations and home visits then there are real doubts as to the ability of a truncated emergency service to cope.

Let us hope, for all our sakes, that GP critics of NHS24 are being unduly pessimistic. For once, I wouldn’t mind being wrong.