The Issue of Out of Hours Care Must Be Resolved
Sally Leonards, medical law expert at Hospital Negligence, discusses the issues surrounding out of hours care and how this can impact patients.
The team at Hospital Negligence has handled the full spectrum of cases of avoidable patient injury and we regularly see the devastating impact poor care has on lives.
There are certain issues that arise again and again and it can be difficult to explain to those affected why the same failures in care continue to happen.
One recurring issue currently under scrutiny by all those with an interest in patient safety is the poor standard of out of hours care. Whether it be a lack of adequate GP services or dangerously understaffed A&E units, the NHS continues to struggle to provide safe services in the evening and weekends.
Here I take a look at some of the issues with out of hours care and the impact they can have on patients, drawing on my experience of fighting for justice for those who have suffered preventable injuries.
Lack of family GPs available out of hours leads to reliance on poor private providers and A&E
Last year, I secured an admission of negligence and a six figure compensation settlement for a pensioner who lost a leg after a GP at an out of hours surgery, ran by a private provider, failed to treat a dangerous blood clot. The symptoms of the blood clot were clear, yet in an appalling error the GP sent the gentleman home and advised him to take a bath.
By the time he received the treatment he needed after attending A&E, it was too late to save his leg, which was amputated above the knee. While the compensation I secured for him allowed him to pay for the equipment and adaptations he needs to cope, no amount of money can ever fully make up for the horrendous trauma this man went through.
Poorly trained doctors employed by out of hours providers
His case is just one of several we have handled involving basic errors that were made by seemingly poorly trained and inexperienced doctors employed by out of hours providers. As we all know, patients have no control over the time their illness strikes, so this reliance in some areas on wholly inadequate services is a real concern. Children are particularly vulnerable as their condition can deteriorate rapidly. However, getting them good urgent care out of hours continues to be problematic.
In the not too distant past, family GPs would make home visits to the sick. However, to attract enough GPs to the profession to ensure that no regions were without cover, a previous government developed the opt out scheme. This allowed GPs to opt out of providing cover out of hours, which many did, forcing primary care trusts to rely on private companies. It is speculative to suggest that an organisation that exists to make money may be tempted to use cheaper and poorer quality staff and resources to drive profits. However, clearly the risk exists and only if highly stringent monitoring is put in place will rogue doctors be flushed out. Sadly that has not happened effectively in the past.
Many people feel they have no other option if they or a loved one is taken ill out of hours than to attend A&E. As these services are already stretched to their limits, this pushes them further with an influx of patients, not all of whom require emergency care. Furthermore, the chance of mistakes happening in an A&E unit buckling under the pressure is high when an assessment by a good GP could have dealt with the patient effectively.
It strikes me that with these ongoing and dangerous issues with out of hours GP care, the government could look at incentivising family GPs to work at weekends and in the evenings. Patients need to be able to rely on good quality care whenever their illness strikes and the cost of providing adequate cover could be offset by reducing the number of appalling errors that are made.
Out of hours hospital care suffers due to lack of senior doctors
A significant problem with hospital care in the evenings and weekends that has been highlighted several times in the press in recent times is the lack of senior doctors available. The NHS is heavily reliant on junior doctors at these times to provide critical care to patients who may be in a life and death situation.
While junior doctors are clearly doing an extremely difficult job in highly pressurised circumstances, they often do not have the experience and skills to deal with complex cases on their own. They need experienced consultants to provide them with support and make decisions on a patient’s care or serious mistakes can be made. Currently, for most patients who are not in A&E or intensive care, consultants are not present in the hospital and are on call, meaning they provide advice over the telephone and only attend hospitals in emergency situations - and it could take them some time to make their way in. Add in the higher number of emergencies at the weekend and the result is a recipe for disaster for some patients.
Reducing death rates with adequate cover
There have been several reports stating that providing adequate consultant cover in the evenings and at weekends could slash death rates at these times. It is widely known that the risk of patient death in hospitals is much higher at the weekend. Research by Dr Foster Intelligence found that patients admitted for emergency treatment at the weekend are 10 per cent more likely to die than those admitted during the rest of the week. In addition, we have represented patients who have been left with catastrophic and life-changing injuries because consultants were not available at the weekend or in the evenings.
This is a completely unacceptable situation and one that despite our calls for urgent resolution continues to blight the NHS. Those leading the organisation say that their challenge is to attract consultants to work at the weekend when many feel they should no longer be obliged to do so. However, we believe that if the presence of senior doctors is crucial to providing safe services then it is an issue that must be tackled head on. The legacy of the Stafford Hospital scandal, when hundreds of patients died needlessly due to poor care, should never be forgotten and hospitals must be committed to preventing the same situation ever arising again.
Patients must come first
Clearly, affordability is key and the cost of having consultants available on site at unsociable hours will be high. However again, this could be offset by reducing the number of patients who are needlessly killed or injured due to the unavailability of senior doctors.
It is our experience as medical negligence experts that the unavailability of good quality GP care and senior doctors in evenings and weekends is one of the most pertinent issues that needs to be addressed in the fight to provide safe services in a modern NHS. Patients must come first and finding new ways to ensure their safety out of hours must be a priority.
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