A man posing as a heart patient who had run out of medicine has exposed a potential gap in the NHS Direct telephone advice service that could put lives at risk.

A man posing as a heart patient who had run out of medicine has exposed a potential gap in the NHS Direct telephone advice service that could put lives at risk.

An investigation into the 24- hour nurse-led helpline by the magazine HealthWhich? has found that while potential emergencies are being missed other patients are being unnecessarily sent to accident and emergency departments.

The magazine's investigator posed as "Michael", a 55-year-old who suffered from angina. He said he was away from home and needed a repeat prescription of the Tinitrate spray he used to relieve the attacks.

He made 10 calls to NHS Direct numbers around the country but in only four cases spoke to a nurse. The other six were taken by call handlers. Despite clear cues that he was using his spray more frequently, eight of the nurses and call handlers failed to notice this or explore the reasons behind it and dealt only with his need for a repeat prescription. Experts asked to comment on the case said Michael should have been asked about his history, which would have disclosed that he had had a heart attack and that his angina was getting worse. They said he should have been referred urgently to his GP.

In another scenario, a researcher called the helpline claiming to be a woman with a five-year-old daughter who had been vomiting and had diarrhoea. Experts said the woman should have been told to care for her daughter at home, making sure she drank plenty of fluids and took painkillers if necessary. But one nurse told the woman to take her daughter to A&E - advice that experts said was "inappropriate".

NHS Direct was set up in 1998 to increase convenience for patients in need of immediate health advice. It covers two-thirds of the country and is due to be available nationally by the end of the year. The speed of its growth has drawn protests from the medical profession, which claims it has not been adequately tested.

Sally Williams, the principal researcher with Health Which?, said: "Our biggest concern is where there are gaps in the system, as reflected by Michael's experience. We would like to see NHS Direct take a close look at the way it deals with calls about repeat prescriptions to make sure that potential emergencies don't slip through the net."

A spokeswoman for the Department of Health said there were "major flaws" in the way the magazine had investigated NHS Direct. She said: "We know through continual independent evaluation that NHS Direct has a very high level of caller satisfaction and has safely delivered healthcare advice and information to more than three million callers and on many occasions has acted as a lifesaver."

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