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Serious illnesses 'missed'

31st August 2007

Some serious illnesses in children may be being missed because of a lack of face-to-face care outside normal GP surgery hours.

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Dr Anthony Harnden, a lecturer in general practice at Oxford University, has voiced concerns at the level of reliance on phone consultation and the skills mix in out-of-hours care.

Writing in the British Medical Journal, Dr Harnden said changes in out-of-hours cover has led to the care of feverish children being delivered by an increasing number of professional groups.

He said: “Doctors, nurses, staff working for the telephone helpline NHS Direct, out-of-hours centres and accident and emergency departments may all have different levels of skill and experience.�

He said this was a major concern because the most solid evidence for recognising clinical severity in febrile (feverish) children in primary care is a global assessment by an experienced clinician through a clear history and careful observation of signs, including alertness, activity, colour and respiratory effort.

Research suggested half of children with meningococcal disease were sent home after first consultation, he said.

Out-of-hours GP care changed with the new contract in 2004 allowing family doctors to opt out of evening and weekend care leaving primary care trusts to make alternative arrangements. The public have also relied more on the NHS Direct phone advice service.

Dr Harnden said there should be less telephone advice and more opportunities for prompt clinical assessment to improve care of feverish children.

The Department of Health said patients have access to a skilled GP at all times, through the out-of-hours service and NHS Direct.

 

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