LMCs are pushing back against ambulance crews who ‘inappropriately’ insist on speaking to a GP immediately when attending 999 calls.
This month, both Lancashire and Cumbria LMCs and Leicester, Leicestershire and Rutland (LLR) LMC have put out guidance emphasising that practices have ‘no contractual obligation’ to give clinical advice to ambulance teams.
Staff at the East Midlands Ambulance Service (EMAS) recently made a complaint to a local authority about a Leicestershire practice when they were unable to get through to the GP, according to the LMC.
LLR LMC executive chair Dr Grant Ingrams said that despite assurances from EMAS management – including a poster and training for staff making it clear that GPs are not contractually required to support them – practices continue to complain about ‘further incidents’.
He has lodged a formal complaint with EMAS, requesting that an apology is issued to the practice reported to the local authority.
Lincolnshire GP practices are facing the same issue with EMAS, and LMC medical director Dr Reid Baker told Pulse that some have reported instances where ‘EMAS colleagues have said they would inform the CQC’ about a failure to support the ambulance team.
Meanwhile, Lancashire and South Cumbria LMC chief executive Dr Adam Janjua told Pulse that two or three practices reach out to him every day to raise this issue – and that in reality, far more will be facing pressure from ambulance staff.
Ambulance crews attending 999 calls have wrongly told GP practices that they are obliged to respond and must do within certain timeframes, according to local GP leaders.
Queries to GP practices usually relate to information such as patient allergies or past medical history, or ambulance teams want a prescription for urinary tract infections or lower respiratory tract infections.
However, some teams want GPs to ‘take over decision and responsibility as to whether a patient should be taken to hospital or left at home’, Dr Ingrams told Pulse.
He said this demand is ‘inappropriate’, and is becoming ‘more often and more difficult to deal with’.
Guidance put out by LLR and Lancashire Cumbria LMCs warned GPs to consider that if they provide clinical advice, it is based on a clinical assessment they did not perform and so they must be ‘confident’ in the technician’s assessment.
‘There may also be numerous indemnity issues to consider when providing advice to clinicians who are not regularly under your clinical supervision,’ Lancshire and Cumbria LMCs advised.
GP leaders have also pointed out that ambulance services have their own senior clinicians who can provide live advice to crews, and that for information held by a GP practice, a member of the reception team should be able to share details rather than the GP.
Dr Janjua, whose LMC area is covered by North West Ambulance Service (NWAS), told Pulse: ‘In some instances, [ambulance teams have] been quite pushy with the receptionist, insisting that there’s a duty and an obligation to do it, and receptionists have been bullied into putting them through to clinicians in the middle of consultation, for example, which isn’t appropriate, because there really isn’t a need for that.’
He said that ‘nowadays’, they are ‘insisting that the GP takes over care’ for patients calling 999, adding to the feeling that general practice has become a ‘dumping ground’.
‘I think there’s a misconception in the whole system about what GPs are meant to do: consultants think that we are meant to do their dog jobs; the ambulance crew thinks that we’re there for taking over the care of patients that they don’t necessarily see as warranting their input.’
Dr Janjua has also suggested to both the ICB and NWAS that if they want to set up an ‘individual ad-hoc service’, this should be arranged as a local enhanced service which appropriately reimburses GPs for their work.
Both Lancashire and Cumbria LMCs and LLR LMC have advised GPs to develop a practice policy on what to do when ambulance crews reach out for support.
LMC advice for dealing with ambulance requests
- Ascertain the reason for the ambulance team’s contact to the practice;
- Provide medical history relevant to support their assessment of the patient;
- Escalate the contact to the appropriate clinician if the practice has chosen to do so;
- Inform the ambulance team of possible timeframes for any response;
- Offer advice if the practices chooses, but may also redirect ambulance team to their own clinical supervision and advice pathway.
In response to these concerns, NWAS said that medical advice required by their teams is provided internally by its own team of senior clinicians.
Any queries to a GP practice would be to gain a medical history or with the aim of managing chronic conditions outside of hospital, the service claimed.
A spokesperson said: ‘We will work closely with LMC to address any specific concerns it has.’
In the East Midlands, the ambulance service said it recognises that primary care colleagues ‘are extremely busy’ and highlighted that training and further support to its staff has been developed with LMCs.
Responding to concerns about the practice being reported to the local authority, an EMAS spokesperson said: ‘We’re aware of a formal complaint to our service and are currently investigating.
‘It would be inappropriate to comment further until we have responded to the complaint.’
Last year, NHS England reportedly asked ambulance crews to review which emergency calls other than those classed as immediately life threatening can be treated elsewhere, including GP practices.
And in January, Pulse reported on GPs in Wales being forced to provide emergency care themselves due to a lack of ambulance capacity.
At our practice we try to accommodate these requests to avoid unnecessary A&E visits. However we are in the fortunate position of generally having the capacity to do so.
Seems ok for ambulance to tallk about gp’s patient to gp.
Paramedics often call the practice to discussed a patient that called 999 because they could not get an appointment with that same surgery. It’s a revenge thing and I can’t say I blame them.
This is UK wide. Whilst in principal I’d don’t have a major issue with helping to keep someone at home, where appropriate, often the quality of information is akin to a fict with the intent to get a specific outcome. Passive aggressive controllers, and paramedics on scene have become an increasing issue as ambulances are stuck queuing at ED’s. I’ve sympathy for them, but it doesn’t make it appropriate to demand speaking to a GP
We always try to respond as soon as possible wherever I have worked, but if I am on a house-call and not in phone signal range, they will have to speak to another member of the team, from ANP to Receptionist (I mean ‘Care Navigator’), so this is a bit ripe from a service that when asked to provide emergency transport, tries to get it downgraded to ‘tomorrow’ or takes 6 hours to show up on an 8-minute target. If a patient inapproppriately dials 999 because Surgery offered a more appropriate response than an appointment at 4 pm on Sunday at paient’s convenience as too busy today because they got friends over, that is fault of the patient, not the underfunded GP surgery short of staff. This could however just be result of someone trying to ‘divide and conquer’ ambulance versus GP services, so watch out and re-unite against the NHSE/DoH warmongerers.
Perhaps if GPs automatically recommended that the ambulance team took the patient to A&E this practice of calling the GP for advice might be reviewed.
These phone calls used to be about clarifying details such the patient’s history or medication. Years ago they gradually morphed into a thinly veiled ploy to request a GP visit instead of taking the patient to A&E. LMC advice to clarify legal and contractual position of GPs would be welcome, but caveats about acting in the patient’s best interest will always result in grey areas.