to expect an out of an hours doctor to coma and see my doctor when...

[pinkdolly]

My dh is serving away with the forces. I dont drive and even if I did, I am ill with bad flu and a chest infection and 27 weeks pg so cant take anything for it (I haven't slept for 3 days!). I have 2 other young children, 1 of which also has flu.

My poor dd1 (6) has blood coming out her ear and is crying in pain despite having calpol and nurophen. She has flu and I think (tho I am not a doctor myself) she may have perforated her ear drum. She hardly slept all night due to the pain.

Now I know it's not life threatening stuff, but come on you'd think they'd come out and see her. Nope, I have to ring around trying to to find someone to drag her out for me while I stay here looking after myself and my other sick dd. Grrr...!

NBM, good! i think it is good to hear people getting treatment and being satisfied; it reduces my worry about getting ill. I think people often tend to repeat their bad experiences, but there are loads of positive stories that don't get heard as much as they should.

It's not too bad around here. Called an ambulance when DS2 broke his arm badly and needed analgesia in order to be moved to hospital. Crew totally lovely, gave him gas and air, and took him into A and E, and then even came to see him and say hello when they clocked off.

OOH a bit patchy but they will come to see you if it's clearly a bad idea travelling in (it can take 45 minutes/£15 taxi fare each way and there's no transport on Sundays). Examples of this would include diarrhoea, vomiting, pneumonia, having other young children at home asleep and being the only adult in the house, that sort of thing. We tend to go to A and E, but then it's usually with good cause anyway, having been advised by NHS Direct to do so, so not an issue for us.

I do think it would be great to have OOH at hospitals though, instead of obscure GP surgeries in wierd places that are hard to get to. Hospitals have loads of public transport nearby.

I do think some of the comments here about doctors and GPs are rather harsh. All the doctors and GPs I know are very committed and hardworking.

I have never requested a home visit for anything and can only recall using an out-of-ours service once.

We actually got a home visit once though, without requesting it! Dh had just had a hideous d&v bug - he still says it is the worst illness he's ever had and I was tired caring for him. Then I started with it. ds1 was still very tiny, 2-3 months old I think, and still exclusively breastfed. I phoned the clinic and asked to speak to the GP [this was in the days before NHS Direct or mumsnet!] just to ask whether I should continue to bf or use bottles for him. The GP said she wanted to call in and check on us that we were all OK while she was doing her home visits later that morning, and she did.

if my kid had blood comng out of their ear, i might think it was quite serious actually.

deffo a flaw in the system

If you can't walk / drive to the GP (who would want to in the best of heath in these conditions!), call an ambulance, get on a bus, or even get a taxi to the GP (agree if anyone of you are going to need a/bs it's not much use to just get a GP to you if you'll need to go out again anyway).

Sympathies, hope you get better and some sleep soon,

you should not call an ambulance just to get to the GPs. they are an emergency service, not a cab service.

Poor you - it sounds like you are really struggling .

If you can get yourself to an out of hours service in a taxi though you shouldn't be asking for a home visit as that's just not what they are for. NHS direct might be worth a call for their advice?

OOHs GPs can give you an antibiotic jab to keep you going - I had this for a postnatal infection once. Or a voltarol shot if you have done your back in and can't walk, so you can get to hospital later on. That kind of thing.

I think the service is for people with non-urgent conditions, but who shouldn't really be moved. Anyway, sometimes a cab won't accept you if you are obviously really ill with something contagious or messy. And clearly there are times you shouldn't be driving or getting an entire family of small children ready to leave the house in the middle of the night, for something like a second opinion on a bad virus. Similarly GPs do a lot of palliative care work in people's homes as well.

Really I do think this is what GPs are for.

I agree the OOH service should not be used for social needs - like for people who "can't afford" a taxi, for example. It should only be used for medical needs.

I have deliberately avoided GP salary bashing thus far, but a key factor in the need for OOHs centres around here is the fact that GPs have recently reduced their surgery hours since the introduction of the new contracts, and many of them have gone part-time because they don't need to work a full week any longer financially.

I go back to my earlier point about location of OOHs GPs. Ours is not in the nearest city centre, but on a little known housing estate to the north of the city. For people further out it could easily mean an hour's drive each way, and taxis are not readily available in rural areas around here, nor are there buses at the weekend. Even during the week they only run until 8 and you might have to walk 2 miles to a bus stop to get one, because some villages have lost all their bus stops now.

I think key part of the planning brief for OOHs centres ought to be how the hell people are going to get there, and they need to liaise with transport companies and taxi firms to ensure this is possible. Just telling people in rural areas to learn to drive and buy a car is not the way forward.

I am not suggesting that GPs/NHS staff are lazy.

BUT surely services should be accessible and focused on the end user and part of that equation is taking into account how people with small children will access the service esp in the middle of the night.

It's a bit like public transport as well really - providers should consider how their uers will access the service - disabled and those with young children are often in the greatest need rather than single fit people IYSWIM.

My experiene of out of hours was that I allowed myself(against my better judgement really) to be fobbed off by a GP who said my 7month old son was teething (he had been hospitalised the week prior for a respiratory infection) and who then went on to become dangerously ill with bronchiolitis, needed one week hospital stay three days in HD unit.

Had I taken him straight to A and E it might not have got so bad as they could have started treatment sooner.

That GP was subsequently struck off for failing to diagnose (in person) pneumonia in a small baby.

Our out of hours is south of the borough and only driveable whereas hospitals alot nearer and more accesisble via public transport.

OK so, the issue seems to be getting people there, who, like the OP are genuinely struggling.

What about a transport service then? A nominal charge for petrol? They pay people to ferry the doctors from visit to visit. Maybe a small proportion of that money could be allocated to a patient transport service? I don't think this will be taken the piss out of, because most people will have their own transport anyway, but it would help the section of society for whatever reason don't have access to transport.

I still think that in the circs, the OP should have had a home visit as it would have been better if she could have spoken to the doctor but her condition prevented this.

I don't think GPs are lazy either - far from it - but I would hesitate to say that their services are always responsive. That's altogether different. For example, our surgery used to have a one-hour emergency clinic on a Saturday morning, but closed it after the new contracts came in. Because they did this, the local pharmacy also started closing on a Saturday, because they said there wasn't enough business for them. So that meant people couldn't even consult the pharmacist for advice. We were all thrown on the OOH service, which for most of us now really means a call to NHS Direct and a visit to A and E for most things. Nobody is happy with this turn of events, and we are asking for the Saturday morning surgery to come back. It's not a lot to ask.

A bit of me thinks in overall terms it would actually be cheaper overall to do that than have people paying £25+ per person in transport costs, which amounts to an indirect subsidy of the service that never appears in any accounting column. Not to mention the carbon footprint argument.

There are more options for getting to an out of hours service or to hospital than public transport or ambulance though. You can go by taxi and reclaim the cost from the NHS if you are on benefits. This is more efficient than the doctor coming to you.

Our system is based around people travelling to the doctor and not vice versa. So for example even when there has been a serious traffic accident, a doctor would not normally go out to it, it would be the paramedics who would bring the injured back to the doctor.

Again, this assumes a taxi will take you. And you have the money upfront to shell out up to a week's benefit for said taxi. £50-£70 is a great deal of money.

Is this really efficient? If people get iller as a result? It's funny how every other walk of life is moving back to an earlier model whereby businesses and services often come to you, rather than vice versa, eg grocery shopping, internet shopping, car repairs, haridressers, etc. Yet doctors seem to expect the reverse.

Boffinmum

A lot of this is driven by the government rather than GPs.

Also I belive that the concerns that GPs have about the quality of healthcare possible in a home setting via a well equipped health centre are real.

I think that it is only the UK that has this model of service. I dont know if there is any other country where you can get an emergency visit from a GP to your house without having to pay £££ for it.

But why wouldn't a taxi take you, Boffinmum?

Also an out of hours service would normally be within 5 miles. The vast majority of people live in towns and cities.

I think it is certainly easier to get the doctor to come to you, and sometimes better for your health, too. The problem is that (1) we don't have enough doctors and (2)their hourly rate of pay is so high. Personally I think we should train twice as many doctors and cut their pay by 50%. If GPs earn between £100k and £200k pa I think this should be feasible. And then the existing GPs wouldn't be as stretched and stressed because they would only have around half the work to do.

But in the meantime, contact with doctors is effectively rationed - ideally we would hope according to medical need - so we cannot expect as much contact time as we would like.

if you phone out of hours, and the doctor does not need to see you, they can fax your prescription to the nearest open pharmacy, which in my case is 20 miles nearer than the OOH service.

if the doctor does come to your house (which has happened to me) then they do carry some common prescriptions with them, and they just gave me the medication and didn't expect me to go out for it.

So it does not hold true that you need to get the prescription so you may as well travel to the doctors as well.

It was in the papers this week that a child has died because OOH would not come out and the mother had no way of getting the child to A & E. There is an investigation into OOH as a result.

I thought it was illegal to prescribe without seeing the patient? genuine q

My mil frequently uses the OOH service. She uses it as her out of hours socialising service (I kid you not).

Anyway, she rings nhs direct first, and they organise transport for her. Maybe the OP could/should have done that. I feel the OP has a legitimate reason for doing so, unlike other people I could mention.

Is isnt illegal. They have to adequately assess the patient, but it may be possible to do this over the phone.