APPENDIX 17
Memorandum by the Royal College of Paediatrics
and Child Health (GP23)
INTRODUCTION
The Royal College of Paediatrics and Child Health
welcomes the opportunity to submit written evidence to the Health
Committee's Inquiry into GP Out-of-Hours Services. The College's
response was developed following consultation with its Health
Services Committee and Clinical Directors' Sub-committee. Our
response is set out below:
READINESS OF
PRIMARY CARE
TRUSTS
We have concerns about the potential additional
costs to the health economy of the new arrangements.
THE ROLE
OF NHS DIRECT
NHS Direct appears to be referring more children
to A&E departments than general practitioners did in the past.
We have received many reports of NHS Direct not returning calls,
and therefore families taking children to A&E departments.
Why can NHS Direct not arrange an urgent appointment with a GP
for a child for the next day?
POTENTIAL IMPACT
ON OTHER
NHS SERVICES
The potential knock-on effect for acute paediatric
services of more children being seen in A&E departments (many
of whom do not have experienced paediatric practitioners) is considerable.
POTENTIAL IMPLICATIONS
FOR QUALITY
It is essential that a quality assurance process
be implemented alongside any change of provision, in particular
Out-of-Hours Services.
SKILL MIX
WITHIN OUT-OF-HOURS
SERVICES
The potential for nurse practitioners, paramedics,
and other emergency practitioners is considerable. Current training
appears not to prepare them for paediatric practice. Ensuring
the confidence of practitioners working with children and families
is essential and needs to be a high priority.
ARRANGEMENTS FOR
MONITORING OUT-OF-HOURS
SERVICES
There appear to be insufficient arrangements
for monitoring the impact of changes to Out-of-Hours Services.
This is a major issue and confounded by multiple changes in service
provision concurrently. It is essential for the impact of major
changes in service provision to be evaluated fully.
IMPLICATIONS FOR
URBAN AND
RURAL POPULATIONS
Having single general practitioners available
out-of-hours for home consultation in rural areas, when travelling
from one boundary to another, may take up to two hours. This creates
unnecessary delays or alternatively unnecessary emergency department
consultations.
June 2004
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