Patients wait twice as long for ambulances when they become seriously ill at the GP, investigation finds

‘We had an hour’s delay for a lady with sepsis and respiratory failure, she subsequently died’

Alex Matthews-King
Health Correspondent
Friday 04 January 2019 01:13
Comments
GPs may be called out to home visits for patients with chest pains that turn out be a heart attack
GPs may be called out to home visits for patients with chest pains that turn out be a heart attack

Patients whose GP spots symptoms of serious health problems like heart attacks and sepsis are waiting twice as long for an ambulance as those who call 999 alone, an investigation has found.

After doctors revealed they have had patients “die waiting” and had critically ill newborns put at serious risk, the British Medical Association has said NHS bosses must address long waits.

While GPs can assess a patient’s condition, they only request an ambulance when there is an emergency. They are not equipped to provide emergency treatment, GP leaders said.

Delays have become so severe that some senior GPs admit advising patients to call 999 directly and not to mention there is a doctor present.

Others have resorted to taking patients to hospital in their own cars.

Ambulance services are under significant strain, in part because pressures in hospitals at peak times can leave them queued up waiting for space.

Health trust bosses rejected any suggestion there was a practice of deliberately downgrading emergency responses to patients in the care of a health professional.

But they admitted the discrepancy needed to be addressed.

Freedom of Information requests sent by the magazine for GPs, Pulse, to all 13 ambulance trusts in England, Wales, Northern Ireland and Scotland showed calls from doctors or other health staff resulted in longer waits across the board.

Cases reported by GP surgeries included one where the practice ran out of oxygen while supporting a patient with sepsis, after having waited three hours for an ambulance.

One anonymous respondent told Pulse they ”waited several hours with a newborn who had a critical heart condition and was later advised that the condition was time critical and the baby only just survived”.

Another doctor said a patient had a cardiac arrest and died waiting. They added: “We had an hour’s delay for a lady with sepsis and respiratory failure, she subsequently died.”

Of the 10 services that responded to the Pulse investigation, waits for a GP or healthcare professional were all at least double compared to all other callers – typically a wait of an hour compared to 30 minutes.

While the total wait figures included requests for “planned conveyance” from GP surgeries, for non-emergency transport to hospital, the investigation also found longer waits in the most serious (category 1 and 2) calls.

Ambulance groups said comparisons between trusts are not possible because of different ways of reporting, and local protocols where responders and GPs may agree on a response time target as high as four hours.

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Dr Peter Holden, a former negotiator for the BMA’s GP Committee, who has an interest in urgent care, said these measures used to help stretched ambulance staff prioritise resources but have become routine.

“We are now told it’s four hours – or longer,” he said. “If I am with a patient who needs an urgent ambulance, I have been known to say to the family, “You dial 999 and deny that I am here’. Because effectively there are two responses you get – the general public I’m-having-crushing-chest-pains immediate response, or four hours.”

Dr Richard Vautrey, chair of the BMA GP Committee, said it was vital that when doctors call for support their requests are treated as seriously as those from any other patient, and that delays also kept GPs from seeing other patients.

“GPs are highly trained doctors, often with decades of experience under their belts, but in order to provide the best possible care to patients in emergency situations they may need the equipment and skills of paramedics. We are raising this issue in discussions with NHS England”,” he added.

The Association of Ambulance Chief Executives said many areas are piloting schemes to “improve the parity of response between public 999 and healthcare professionals requests”.

They added: “We acknowledge we do need to do better for healthcare professionals and ensure parity of responses between public 999 and healthcare professional requests, particularly for category 1 and category 2 calls.’

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