Fatal childhood illnesses 'missed by inexperienced' staff covering for GPs out-of-hours

Dr Anthony Harnden says the failure to spot childhood fevers is partly the result of the lack of experience of people providing care outside working hours.

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He says half of children with the bacterial form of meningitis, the most severe form of the disease, are currently sent home undiagnosed by GPs and nurses after the first consultation.

Dr Harnden says the lack of availability of a GP is forcing many more to ring the telephone helpline NHS Direct, which was far less effective at spotting evidence of serious illnesses than a face-to-face consultation with a doctor.

In 2004, a new contract enabled GPs to opt out of their responsibility for patients at weekends and outside the hours of 8am to 6.30pm.

More than 90 per cent of doctors took the Government up on its offer - in return for a pay cut of £6,000 - leaving it to primary care trusts to find alternative cover, such as in-house agencies and private firms.

In fact, many patients are having to rely on NHS Direct, while an increasing number are turning up at A&E departments.

Complaints over out-of-hours care have soared since GPs stopped working evenings and weekends.

In March, MPs condemned the shake-up as a "shambles", with only one in 50 services meeting performance targets.

Dr Harnden, a lecturer in general practice at Oxford University, says the NHS might be missing cases of meningitis, pneumonia, septicaemia and a fever known as Kawasaki disease.

Writing in the British Medical Journal today, Dr Harnden says: "Changes in NHS policy have led to the primary care of febrile [feverish] children presenting outside office hours being delivered by an increasing number of professional groups.

"Doctors, nurses, staff working for NHS Direct, out-of-hours centres and A&E departments may all have different levels of skills and experience.

"This is a major concern because the most solid evidence for recognising clinical severity in febrile children in primary care is a global assessment by an experienced clinician."

This assessment should involve careful observation of the child's alertness, activity, skin colour and breathing.

He added: "To improve the care of children with feverish illness in primary care we should be offering less telephone advice and more opportunities for a prompt clinical assessment."

Dr Harnden criticised guidance from the National Institute for Health and Clinical Excellence, which he said was not sensitive enough.

It encouraged GPs to send too many children to hospital specialists, "while children with a serious illness are sent away", he said.

Meningitis is an infectious disease which can kill within hours and leave sufferers with severe after-effects including brain damage, deafness and loss of limbs.

Meningitis kills more children in the UK under the age of five than any other infectious disease.