Triaging

[Loulou1969]

Hi , this is a rant since the NHS has introduced the E Consult forms to see a GP
My daughter is 19 and for the past week has developed an awful chesty cough that keeps her awake at night
She completed the form last night as she had pneumonia last year and was very ill .
I dropped her at the surgery this morning presuming she was being seen by a Dr but in fact it was the nurse .

The nurse examined her chest and said she would prescribe antibiotics as a precaution ( I know that nurses with the correct qualification can prescribe them ) and a pump to ease the coughing
I don’t mean to undermine nurses as they are medically trained but my daughter said the nurse was very sharp towards her , I feel that when Dr’s triage patients and feel it’s not serious they send the patient to the nurse

My daughter isn’t good atall some might say the Dr would have prescribed the same as the nurse did but I would feel more reassured if she had seen s Dr .

what are your thoughts on triaging ? Does it unblock the phone lines for appointments? There is a time frame for GP’s to reply to the e consult but is this putting health at risk ?

E consult has been around for years, and doctors aren't necessary for every appointment!

If it's urgent, phone the surgery, if it's really urgent, go to hospital. GPs don't triage, the admin team does. A cough doesn't need to be heard by a GP, the nurse sounds like she went above and beyond to treat the cough.

I can't remember the last time I saw a doctor, it's always nurse practitioners, paramedics or clinical pharmacists who are more thorough in my experience. Doctors are prioritised for complex cases and for when a patient needs to be referred to specialists in my experience. Not for a cough!

I think half the population currently has a chesty cough keeping them up at night. If you weren't going to be happy with antibiotics (which is the most the GP would have done) she should have gone and sat in A and E. But you weren't concerned enough to actually phone anyone and submitted an evening consult request and got seen the next morning. I think that's bloody good going by the surgery.

The reality is that the NHS is on it's knees and there aren't enough GP appointments. Nurses being able to prescribe means your daughter got the medication she needs today rather than not being able to see anyone so not getting any treatment. I agree ideally you should be able to see who you want, but the NHS is barely meeting clinical need. You not feeling reassured is not a problem they can address.

I think it’s totally outrageous how times have changed it’s playing Russian roulette with peoples health and lives .
i don’t know what part of the world your in but this is a first for us , what medical experience does the admin team have and to be able to judge how seriously ill a patient is ? I was told the duty Dr triages .

All this change at the moment isn’t for the better , Gp’s reducing hours of work demanding more money it’s a joke

In our practice, a GP does the triage of the medical consults that come in. All admin do is weed out the ones for things like sick notes or repeat prescriptions which are dealt with separately but any medical consult with symptoms will be looked at by a GP and then actioned. I find the system works very well and gets the right treatment quickly, especially for routine things like infections. I don’t think a GP would have done any different to the nurse either it sounds like.

DS2 is a nurse who can prescribe. He’s done his degree and is 2yrs into his masters. After Christmas he will be going to work in A&E as an advanced nurse practitioner, and will be seeing patients just like your DD.

At our GP surgery the receptionist asks what’s wrong when you ring in, then we’re triaged and rang back by the appropriate person. Last time I rang I was phoned by an advanced nurse practitioner who prescribed me some medication. It was fine.

Not keen, but then I have a job which doesn't allow me to answer the phone at set times (technically, we get a lunch break, but in reality, I can't say I can take calls between x and y time, which makes it difficult when you can't just phone them). I know a lot of people struggle with the triage system at my GP too.
So my answer is I think the system that used to exist when I was a kid was better-you could phone up or walk in and always see your usual GP. They tended to know their patients and families really well and it meant people didn't have to travel a long way, or use AE except in rare circumstances.

I agree with you 100% my mother in law like a lot of elderly or disabled are struggling
ok you can phone the Dr and they will help but it’s just not the same and she feels a nuisance

I don't understand how having a triage system is the the issue OP? You do realise that A&E, ambulance, police, GP's etc ALL have a triage to sort the most urgent priority? It sounds more like your DD found the person that saw her very sharp rather than it being related to having to be triaged. What if it had been the Dr that was sharp?

If your daughter felt her treatment was under par and not acceptable, she could always pay and go privately- but they too would triage! I previously worked for a private GP and they also had a nurse practioner.

And this is why primary care staff are leaving in droves folks. Its reduce hours or quit completely, and many are doing just that.
GP’s can see all the coughs you want, but then those with several multiple complex co morbidities will wait even longer for an appointment.
People talking about what used to be is laughable, yeah maybe when we didn’t all live to 110.
Out next year thank God!

Well, the antibiotics will work whether prescribed by a nurse or a Dr so I wouldn't mind.

I do hope so as last year my dd had very strong antibiotics with pneumonia the usual Amoxicillin didn’t touch it

I guess we are all entitled to our own opinions and your responses have all been interesting .

It won't just be a nurse it will be a nurse practitioner.
I have complex medical conditions but a chest infection is a chest infection and I'm happy to see an ANP for that. They will do the same as a doctor and prescribe first line antibiotics. If that doesn't resolve it she should go back.
I would expect to see a GP for something more unusual/ undifferentiated.

Quite honestly I don’t believe what I’m hearing from you , but that’s my personal opinion if you have trust with seeing somebody that isn’t a Dr with a health issue that you might think is minor .

Go back if she’s not responding to the treatment given..

You are being very unrealistic and rude about highly skilled, highly qualified clinicians.

Your daughter was seen, assessed and treated without being charged and without having to wait for 2 weeks for an appointment.

Just because the nurse wasn’t as fluffy as your daughter would have liked, doesn’t mean she didn’t get safe efficient care.

Maybe stop moaning and be happy she can now recover from her (minor) illness.

Actually your response is very rude , keep your thoughts about how you feel about my concerns to yourself please ?
When I said the nurse was sharp , fluffiness doesn’t come into it she’s probably got her work load now due to a lot of patients being sent to her with what the Duty Dr assumes is minor by reading symptoms .

Also What do you mean without being charged ? We’re in the UK , I do appreciate that the nhs is stretched and that nurses do a terrific job but I feel that my daughter should have been seen by a Dr due to the fact that she had complications last year with Pneumonia
Im not by no means putting clinicians down !

@Loulou1969i presume your surgery has just started the triage system ? Would she not have been seen by a nurse prior to the new system as well ? Our minor illness nurse at the local practice has always dealt with chest infections, nothing to do with the new system .

Previously we was able to book an appointment with a Dr , this is all new . The nurse is going to be very busy with patients being triaged to her . We have so many GP’s at our surgery as well . As previously mentioned my daughter was very ill last year , I’m hoping that the antibiotics help .

If they don’t , you can mention that on the next triage form and you might get a Dr next time .

I completely understand that change us difficult, and that allocation of a patient to a professional on the basis of clinical need does not take into account the ‘emotional reassurance/ comfort’ that the patient or their carers may also be seeking from the interaction.

Previous serious illness in your child does ‘sensitise’ you as a parent, especially when they develop the early symptoms of what could develop into the same illness. Of course you are anxious about what might happen again, even if your child has received exactly the right treatment for now in a very prompt manner.

However, it’s not reasonable to want clinical resources to be allocated on the basis of that parental anxiety and emotional need for reassurance, where that resource is then being taken away from someone who needs it more.

If this prompt, first stage treatment doesn’t work, then I know that you and your daughter will be alert to it and will submit a new form, and then you will benefit from the availability of the ‘next step up’ professional that has been freed up through triage.

I would say if your daughter is no better or worse after taking the antibiotic then take her to AE or phone NHS24 given her previous history. You don’t want it to get worse like before.

If it doesn’t get better after the course of antibiotics, surely the first step is to re-contact the GP for the next step treatment? (Obviously unless critically ill)

You do realise that this person you keep calling a nurse is an advanced nurse practitioner who has spent years at university, has a masters in advanced practice, will have years of experience and will have done multiple other courses, don’t you? If they thought your DD needed to see a doctor they would have called one through.

And fwiw, DS2 was treated by a nurse his whole life after getting pneumonia at a year old. It was an asthma nurse, she knew more about asthma than any GP we saw.