Patients ring alarm bells

From December 1 patients seeking help outside normal surgery hours were referred to a central call centre run by the private medical firm Primecare.

Callers first speak to a Primecare operator who takes their details and, if deemed appropriate, passes them onto a doctor to ring back.

The new system has also meant that patients or carers ringing or calling at minor injury units at community hospitals were turned away and told to ring Primecare instead.

Despite repeated requests, the Kennet and North Wiltshire Primary Care Trust was unable to tell the Gazette before we went to press yesterday the number of practices within its area that had signed up to the new system.

It also failed to answer our request to know how many doctors' surgeries had pulled out of the system since its introduction last month.

In Marlborough, its launch caused such an outcry that on Monday doctors decided to pull out of the Primecare service with immediate effect and apologised to patients who had "experienced excessively long delays".

Patients had complained the system was long winded, inefficient and denied them the speedy access to the minor injuries unit at Savernake Hospital that they had previously found invaluable.

Doctors at Ramsbury's surgery decided not to change over to Primecare on Monday as planned because of the problems experienced by their colleagues in Marlborough.

Ramsbury practice manager Andrew Fletcher said: "There is no point in us joining Primecare until issues raised by the Marlborough practice have been resolved."

But elsewhere in the trust area the changeover has gone smoothly. Dr James Flood of Littleton Panell Surgery, near Devizes, said: "The system seems to be working all right so far. Some patients have found it a little bit confusing being put through to a company called Primecare and talking to a doctor.

"The vibes I am getting is that patients who have rung Primecare have been getting appropriate advice and if nurses and GPs at Primecare think a patient should see their GP during the night they call out the on-call GP."

Dr Barney Williams, of the Marshfield Road Surgery, Chippenham, said Primecare was providing an adequate service for the few patients who needed out-of-hours care.

"We haven't had any problems," he said. "Very few patients need seeing out-of-hours but the ones who have needed it have been all right."

Patients' out-of-hours calls are fed to one of Primecare's two national call centres, in Birmingham or Sheffield. Operators at the call centres take basic details about the patient's problems and arrange for a doctor to ring back.

When the Primecare doctors call back the patient they have to conduct an over the telephone consultation.

The consultations, Primecare confirmed to the Gazette this week, take place without the benefits of any case notes.

Based on their telephone consultation, the Primecare doctors have a choice of options. They can prescribe drugs, although the prescription has to be collected from an appointed pharmacy. Or the Primcare physicians can refer the patient to their nearest minor injuries unit, if it is open, to see either a nurse or a doctor.

The Primecare doctors can, if they feel after their consultation that it's warranted, arrange for the local on-call GP to make a house call to the patient.

In what they believe to be emergency cases the Primecare doctors will contact the local ambulance service and arrange hospital admission.

Primecare has been in operation for about 40 years and is the only national out-of-hours call system in Britain. More than 10,000 GPs in about 3,500 practices make use of the system.

In a statement issued on Tuesday, the Kennet and North Wiltshire PCT said the year's contract with Primecare had been arranged in preparation for the introduction of new GP contracts in April, although the new contracts do not come into force until December.

It said: "Since the commencement of the service on December 1 we have been experiencing some initial problems.

"These are to be expected when implementing a very complex new system and we are in active discussion with Primecare in order to rectify them.

"The PCT, Primecare and the practices are all working hard to ensure this is a good and safe service for the people of Kennet and North Wiltshire."

Mother tells of anxious hours waiting for a doctor to ring back

West Overton mother-of-three Gillie Roberts called Primecare on December 27 when her seven-year-old son Henry developed a high temperature and was in severe pain when breathing and coughing.

Earlier that day Henry had been prescribed antibiotics after his mother spoke on the telephone to a GP at Marlborough.

She said that by lunchtime, when the surgery had closed, Henry was still in agony and screaming that he had pain under his rib cage. Fearing he might have pneumonia, Mrs Roberts called the surgery and a message advised her to call Primecare.

She explained Henry's symptoms to a Primecare operator who said a doctor would phone.

More than 90 minutes later at 3pm and still anxiously awaiting the doctor's call, Mrs Roberts rang Savernake Hospital's Minor Injuries Unit to be told that she had to wait for her call from Primecare.

At 4.30pm a nurse from Savernake rang Mrs Roberts to say Henry could attend the MIU at 5pm where a doctor diagnosed his rib pain and painful breathing were caused by bruising from his coughing.

Mrs Roberts said she had no criticism of the doctors or medical staff involved but was concerned about the system. She said: "I am concerned that the situation could have been much more serious. Say a child had meningitis, a long delay could prove critical."

Mike and Linda Bedford's four-year-old son Douglas was suffering with an ear infection when they called Savernake's MIU on December 7 to be told they should contact Primecare.

Mr Bedford, of Beckhampton, wrote in a letter of complaint to the health authority: "When the call was taken by the Primecare operator it was clear that they were not particularly well trained.

"I find that having to explain where Wiltshire is when you have a sick child does not instil confidence in the system is this call centre even within the UK?

"We were informed that a doctor would call us back shortly but after an hour we gave up waiting and called Savernake again and asked if we could simply bring Douglas in to be looked at.

"Again we were told this was not possible and we were referred back to Primecare."

On their next call to Primecare they were told the doctor was busy but would call them back.

Twenty minutes later the Primecare doctor called to say ear infections were no longer dealt with by antibiotics and Douglas should be given something for the pain.

Mrs and Mrs Bedford had held back giving Calpol to their sick child in case it reacted with any drugs he was prescribed.

Mr Bedford said: "Douglas was left in unnecessary pain for over an hour."