Campden Health has recently carried out and published the results of a survey showing a worrying level of risk taking in GP practices in relation to the screening of patient phone calls. These findings fit in with a number of recent issues that our clinical negligence team has been dealing with.
For many people calling their GP practice for an appointment is the first step to managing their health concerns – with increasing concerns about A&E resources being stretched to capacity and out of hours services such as NHS 111 not working effectively. There is a difficult balance to be found between managing as many people as possible at a primary care level and the ability of practices to deal with huge volumes of patients and enquiries. Campden Health’s research has revealed the level of anxiety amongst GP’s about the number of patients attending appointments where there is no medical benefit to be achieved (as opposed to seeing a nurse or pharmacist or simply requesting a repeat prescription through reception).
One in eight practices admitted letting receptionists decide which patients need urgent treatment when they call in to make an appointment. Increasingly in the last few years, many have been using a ‘telephone triage’ to decide how soon a patient needs to be seen. In many cases this is a system managed by trained nurses who make an assessment and document the call and advice given. This can be a very effective way of ensuring that patients who need to be seen urgently get priority whilst dealing with minor queries that may not need a GP at all – or for patients who need directing straight to A&E.
However, the Campden Health survey of 1200 GPs, nurses and practice managers found that 13 per cent of surgeries are allowing such calls to be taken and assessed by receptionists without medical training – in some cases without any input from a medical practitioner. Almost half of the GP practices who were triaging patients by telephone were not providing any significant training in how to assess patients or in the spotting of ‘red flag’ symptoms.
Philippa Luscombe, partner in the clinical negligence team at Penningtons Solicitors, said: “The findings of this survey highlight the difficulties GPs have in allocating their time according to medical need and resources available. However, whilst the idea of the ‘telephone triage’ is a good one, and in many cases works very effectively, we have seen a number of problems arising whereby receptionists have either not taken the right information required to recognise the urgency of a case or had the information but not appreciated its significance.
“Our team has more than one case at present where by the time a patient has got a GP appointment and been referred on to hospital their condition has become so advanced that they cannot be saved – incidences of bowel obstruction and meningitis for example. We have recently settled another case where incomplete information was taken from a mother about her child which resulted in erroneous advice being given. Due to the practice in question not having a system for calls being logged and reviewed the problem was not picked up until the patient was seen a couple of days later. In this instance the child ended up with significant loss of vision due to a progressive condition. We therefore have real concerns about telephone triage as a system if it is not operated by trained medical staff with clear recording and review systems. Unfortunately this survey shows that this is not happening in a worrying number of cases.”