Dr Mary McCarthy: Shropdoc is effective - we must save it

Medical services are contracted to provide 24-hour cover, seven days a week, and this is as true of primary care as it is of secondary care.

Previously, GPs used to do their own out of hours, sitting by the phone on nights and weekends waiting for patients to call. As the volume of work grew, GP practices started amalgamating with other local practices to share the on-call work. Eventually these groups grew big enough to cover a sizeable area.

Regulations came in that required phone calls from patients to be recorded and monitored, meaning that it was no longer possible for doctors to use their home phones to take calls.

The groups of practices transformed into GP co-operatives for out-of-hours work and were managed from a base with expert clinicians answering the phones, a clinical area to see patients in and cars with drivers to ferry the doctors to home visits.

Shropdoc, the locally commissioned out of hours service, grew out of the Shropshire GP co-operative and although it became more formally managed, it retained the ethos that this was a service organised and staffed by doctors.

Its organisation is similar to that of an army in the sense that in combat situations the army medics have a rule that the most experienced, and best qualified person, makes the initial assessment of any injuries and decides on their priority and disposal. Similarly, GP-led systems have GPs deciding on the seriousness of the patient’s medical condition and on whether this requires a home visit, a face-to-face consultation at the base or just advice over the telephone.

The advantage of this expert-led system is that the patients get the right treatment, in the right place, first time around. Those who really need to be seen in A&E, or admitted to a hospital bed, get an ambulance. The rest are either advised over the phone or asked to make their way down to the base to be seen.

Although expert clinicians are more expensive, they prevent unnecessary ambulance journeys and hospital admissions so end up being more cost-effective for the local community.

Shropdoc data has consistently shown that this type of service is safe and effective and this service in Shropshire is a leading example of how this type of care can be well organised.

As a result of this organisation and the ability to filter concerns effectively, if Shropdoc takes a call the ambulance disposal rate for those who call and get admitted to A&E is three to six per cent compared to other parts of the UK where the rate is 12 to 18 per cent.

Shropdoc’s expert clinicians deal with 70 per cent of calls with telephone advice only compared to the West Midlands where the number of calls that are dealt with by phone advice is nearer 20 per cent, with more people unnecessarily having face-to-face consultations.

The Clinical Commissioning Groups are about to put the out-of-hours service out to tender. Local GPs are concerned that a good, locally-focused service may be lost because of financial restrictions.

Patients in the area benefit from this excellent service and it means that we can free up capacity for those patients who really need ambulances and more acute care.

Making savings in the short term can end up costing more money in the long run. While many parts of the NHS may not be functioning well this is one area where we have a highly effective service. It’s important that we hold on to it.

* Dr Mary McCarthy has worked at Belvidere Surgery in Shrewsbury for more than 20 years. She is chairman of the local medical committee and represents Shropshire, North Staffordshire and South Staffordshire on the General Practitioners Committee of the BMA.