Patients to be blocked from phoning GPs

A REVOLUTION in the way patients gain access to medical care is being planned by ministers, reducing the pressure on the NHS by encouraging more people to treat themselves at home.

The controversial scheme involves replacing GPs with nurses as the first point of contact for patients by routing all calls to family doctors and hospitals through a single NHS telephone number.

Callers to the number would receive advice on treatment from the nurses, who would also book appointments where necessary. It would mean the creation of a new gateway to the NHS, which patients would pass through to get to their GP, traditionally regarded as the gatekeeper to the service.

The shake-up, which would have a bigger impact on patients than all the NHS reforms of the past decade, will involve a huge expansion of the existing NHS Direct helpline, which is staffed by nurses who provide advice to patients 24 hours a day. Instead of running in parallel to the existing GP and hospital service, the plan is to use NHS Direct as a filtering system to ensure that only those patients who need the attention of a doctor get it, while the rest are helped to look after themselves.

Frank Dobson, the Secretary of State for Health, told The Independent that the plan, which is to be tested in Northumberland, was still in the early stages of development and would have to prove its effectiveness before it was introduced nationally.

"If it works and it works well, it could be the biggest change in health care the country has ever known. It would mean a different form of access to primary and community services which, if it works, would be more satisfactory for patients, professionals and the health service," he said.

The plan was welcomed yesterday by the British Medical Association and patients' organisations but opposition MPs warned it would threaten the personal care provided by GPs. Alan Duncan, Tory health spokesman, said: "Such a scheme would be a highly centralised, impersonal system. The local link with the GP practice is very valuable. That is what primary care is about. To route everything through an enormous call-centre would be a backward step."

Ministers have been encouraged by the success of the NHS Direct helpline, which was introduced in three pilot areas last year to give patients instant advice and help to ease pressure on hospital accident and emergency departments. An unpublished survey by Sheffield University showed 97 per cent of callers were satisfied with the help they received.

The survey also showed that while 20 per cent of callers were advised to seek more urgent care than they had planned, such as by calling an ambulance, 40 per cent were advised to do less than they planned, such as going to bed with a hot drink rather than calling out the GP.

NHS Direct is being rolled out nationally from April, a year earlier than planned, but in Northumberland, one of the three original pilot areas, it is being pressed into its new role. From July all out-of-hours calls to GP deputising services will be routed through NHS Direct and all daytime calls are planned to follow at a later date.

Dr Kevin McKenna, the medical director of NHS Direct Northumbria, said that a lot of time and resources were being wasted in the NHS treating patients with coughs in casualty departments while patients with life- threatening conditions did not get the care that they needed.

The aim of the scheme was to direct patients to the best care for their situation.

"Work is under way by the NHS executive and the Cabinet Office and it is very much in the development stage. If it goes as it should it would change the whole of health care. That is why we have to be very tentative and ensure people have tools they can use."