NHS direct is 'is more of a hindrance than a help'

Some patients are being wrongly classified as urgent referrals - with minor sprains or temperatures - and so leapfrogging others with more serious complaints, claim doctors and ambulance crews.

There are calls for a review of the NHS Direct phone service amid fears that it is putting extra strain on the system, rather than relieving the burden.

Figures show that two out of three patients calling NHS Direct end up being sent to see a doctor, dentist or pharmacist - half of them classified as urgent or emergency cases. Millions

of patients use NHS Direct as a first point of contact for advice. It receives around 500,000 calls a month.

The 24-hour service is manned by nurses who ask about a patient's condition and make an assessment of whether they should be sent to a doctor, out-of-hours services or accident and emergency.

But doctors and paramedics claim NHS Direct is overloading the system and question whether the £150milliona-year cost provides value for money.

Only 34 per cent of callers are dealt with solely by NHS Direct, while the same proportion are told to contact other services such as GPs and pharmacies. Around one-third of "emergency" cases are sent immediately to GPs or hospital -in line with Government targets.

But Dr Mark Reynolds, a GP member of the Government's advisory group on the formation of NHS Direct and spokesman for the NHS Alliance, said: "NHS Direct is too cautious. They refer patients on as urgent or emergency cases when doctors doing out- of-hours or in A&E would not recognise them as such.

"We have had things like moderate temperatures or diarrhoea and vomiting referred as urgent.

"It puts a strain on the system as it means we have to see the patients quickly, which could be a risk to patients who are real emergencies."

Dr Reynolds, who is chief executive of On Call Care, which provides outofhours GP care to parts of Sussex and Kent, said: "It also means NHS Direct is delaying people's care.

"Half of the referrals we get from NHS Direct are treated over the phone by our nurses. Why can't NHS Direct treat more themselves?"

Jonathan Fox, of the Association of Professional Ambulance Personnel, said its members had had patients referred to them with nothing more than a sprain.

He added: "The number of referrals is too high and in some cases unnecessary."

Dr Hamish Meldrum, chairman of the GPs' committee of the British Medical Association, called for a full independent review of the service.

He said: "It's understandable that NHS Direct should err on the side of safety but it was actually brought in to take the burden off GPs and A&E.

"The evidence it has done so is dubious and there is quite a lot suggesting it has done the reverse, as two-thirds of calls get referred somewhere else."

Helen Young, clinical director of NHS Direct, said the service wanted to increase the number of calls dealt with in-house.

"But we do have some arrangements with GP out-of-hours providers that mean we have to pass on all the calls we get. As we do not see patients face-to-face, we have to operate with a degree of caution."

A Department of Health spokesman said: "NHS Direct will continue to work to ensure that only appropriate callers are referred but it is important patient safety is not compromised."