Newspaper reports this weekend quote potential earnings for out of hours GPs that show the serious problems that face manning the health service.
Has the Government and NHS England been oblivious to the true cost of running out of hours services.? Has it not twigged that come 6.30pm on a Friday night GPs switch off their responsibility for the treatment and care of their NHS patients. It falls to the highly paid few who have no long term responsibility.
My recent experience of GP and community care was that on a Friday morning in late October a GP decided that palliative care should be initiated in the form of a Rapid Response Team for a dying relative. By 5.30pm that evening there was no sign of a team and after enquiry of the surgery a prescription had been issued and left at a pharmacy to collect. So the wife of a dying man had to go by car to collect a prescription which she could not administer as a syringe driver was required. The Rapid Response Team only contactable via a message taking service arrived at 8.00pm. They administered morphine by injection. But not the main drug prescribed to calm the patient. No syringe driver was fitted.
At this time the question arises as to whether the 111 service knew about a new palliative care patient. There was no promise of a return visit. Over the next two days the Rapid Response Team responded only to calls that the patient was in distress. The syringe driver was not fitted until 3.00am on the Monday morning. Overheard conversations suggested that the nurses were unclear as to what the GPs instructions were. But surely he was not contactable over the weekend. It would have been a case of contacting ‘111’. Again after the 3.00am visit there was no promise of a return visit. The patient died 7 hours later not seen again by a GP or nurse.
Insult was added to injury when the GP would not visit to confirm death. Legally he does not have to. The nurses on the Friday night also flustered about asking that the patient signed a consent form to apply for funding. Apparently this was a reward for keeping a patient out of hospital.
The lack of coordination and management of care once a GP is off duty is astounding and needs addressing by NHS England as a matter of urgency. I wonder how many more incidents there are like this where a dying patient suffers dreadfully in their dying days and final hours. Yet out of hours doctors earn a fortune. Perhaps the money that is being spent on locum GPs could be redirected at Palliative Care.