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. 2000 Aug 12;321(7258):446.

NHS Direct

Doctors may gain time to use their true skills if people start using NHS Direct

Steve Kempley 1
PMCID: PMC1127804  PMID: 10991583

Editor—O'Cathain et al's paper confirming that advice offered by nurses through NHS Direct was useful to callers1 should make us question the generally hostile opinions on this service propounded in free publications that derive their income from pharmaceutical advertising.2

Telephone advice can form an important part of an NHS that needs to meet people's concerns, even if some of these concerns seem trivial to doctors working under pressure. The primary end point of NHS Direct should be whether it meets the needs of its callers for information not whether it reduces work for any sector of the medical profession. If an increasingly information hungry population cannot get information from the NHS it will turn to other sources, which may be less reliable or relevant.

Too often, medical staff see their role as tough gatekeepers of the NHS, excluding a public that would demand too much. This demeans the public and those working in the front line of the NHS. If the NHS develops several different front doors doctors may be freed to use their skills without waging a continual battle to persuade members of the public that they do not need further investigation, treatment, or referral.

References

  • 1.O'Cathain A, Munro JP, Nicholl JP, Knowles E. How helpful is NHS Direct? Postal survey of callers. BMJ. 2000;320:1035. doi: 10.1136/bmj.320.7241.1035. . (15 April.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Hayes D. The case against NHS Direct. Doctor 2000 Apr 13:36-9.
BMJ. 2000 Aug 12;321(7258):446.

Clinicians must be able to provide feedback and evaluate advice given

Kate Farrer 1,2, Peter Rye 1,2, Linda Murdoch 1,2, Murray Bain 1,2, Darryl Hampson-Evans 1,2

Editor—O'Cathain et al report that most respondents found advice from NHS Direct to be helpful and reassuring.1-1 However, mothers of several young children recently admitted to our paediatric department have received advice from NHS Direct that in retrospect was concerning and inadequate. We report one such case here.

The mother of a 6 month old boy telephoned NHS Direct for advice over three consecutive days. He had been unwell with vomiting and increasing lethargy over this period. She was interviewed, and because he was still drinking copious fluids and frequently wetting nappies she was reassured on each occasion. He was subsequently admitted with severe diabetic ketoacidosis.

Although diabetes is rare in infants, lethargy is an important, although non-specific, symptom.1-2 Reassuring information, such as the history of adequate fluid intake and urine output, should not be taken in isolation.

Monitoring and audit of NHS Direct are essential, particularly as the evidence for the efficacy of telephone triage in this population is lacking.1-3 Some evidence of efficacy has been the absence of major adverse events in recent studies, but are these events being reported?

We attempted to give feedback on this case. The NHS Direct website has no facility for clinicians to give feedback. Use of the NHS Direct telephone line to give feedback led to a succession of telephone calls, culminating in the suggestion that we write to NHS Direct care of the NHS Executive in Leeds.

Users are rightly able to provide feedback via the NHS Direct website and telephone, but attempting to give feedback as clinicians was time consuming, arduous, and unsatisfactory. We strongly recommend that a system for feedback from clinicians be provided and made readily accessible.

References

  • 1-1.O'Cathain A, Munro JF, Nicholl JP, Knowles E. How helpful is NHS Direct? Postal survey of callers. BMJ. 2000;320:1035. doi: 10.1136/bmj.320.7241.1035. . (15 April.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-2.Hewson PH, Humphries SM, Roberton DM, McNamar JM, Robison MJ. Markers of serious illness in infants less than six months old presenting to a children's hospital. Arch Dis Child. 1990;65:750–756. doi: 10.1136/adc.65.7.750. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-3.McClellan N. NHS Direct: here and now. Arch Dis Child. 1999;81:376–377. doi: 10.1136/adc.81.5.376. [DOI] [PMC free article] [PubMed] [Google Scholar]
BMJ. 2000 Aug 12;321(7258):446.

Cost effectiveness and effectiveness in terms of health outcome needs to be determined

Bob Bury 1

Editor—It is not surprising to find that patients like to be able to pick up the telephone and obtain advice.2-1 What we need to know is whether the diversion of resources into NHS Direct is cost effective and effective in terms of health outcome.

If the service is used as an additional source of advice by patients who then go along to their general practitioner or an accident and emergency department anyway—or if, even worse, it encourages patients who would have got better anyway to present to their doctor—then all NHS Direct is doing is to give a nice warm feeling to those involved.

No matter how many P values and 95% confidence intervals are calculated, patient satisfaction questionnaires are a soft audit tool and do not constitute scientific inquiry.

References

  • 2-1.O'Cathain A, Munro JP, Nicholl JP, Knowles E. How helpful is NHS Direct? Postal survey of callers. BMJ. 2000;320:1035. doi: 10.1136/bmj.320.7241.1035. . (15 April.) [DOI] [PMC free article] [PubMed] [Google Scholar]

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