Yes – we can tick the right boxes!
A light drizzle has commenced on a cold grey October morning. Mr Smith has struggled up to his GP’s surgery, at the insistence of his wife, feeling decidedly off colour and wishing he could just go home, curl up on the settee and hope he’ll feel better tomorrow. The duty GP ushers Mr Smith into his consulting room and after a short history and confirmatory examination decides that Mr Smith would be better off seeing the local medical registrar for further investigation. The med reg is in agreement and the GP duly has the receptionist book an ambulance to run Mr Smith down to the local hospital.
All in a day’s work for the ambulance service. These are known as ‘doctor’s urgents‘ and are usually completed within 2 to 3 hours following the initial request. They are (or should be) non-life threatening cases and merely involve us pitching up, getting Mr Smith comfortable in the back of the ambulance and having a little jaunt down to A&E or MAU. Easy jobs. No brainers and a great chance to chat to patients and meet some wonderful characters.
And so today Control got a call from a local surgery to book an ‘urgent‘ journey – 2 hour delay. The morning was pretty busy and ambulances were out and about all over the place. A 2 hour delay was looking tough and the job was ‘going out of time’. Control rang the surgery to see whether the patient’s condition was deteriorating – it was. So no chance of an extension then? In these circumstances the call gets upgraded to a 999 call, and is coded accordingly – this time the new AMPDS system came up with an ‘A’ cat code – a life threatening emergency and only 8 minutes to get there. So now we need to dispatch the nearest ambulance which is 12 miles away. No way to meet the 8 minute target there so they send me as well as I’m nearby, though we all know that I’m not going to be able to ‘do’ anything for the patient, I’m just sent so that we can ‘stop the clock‘ and tick the right boxes.
You may consider that this is all very sensible. We have a patient who needs to be seen in hospital; who’s condition is deteriorating; and who has already been waiting nearly 2 hours for an ambulance. Now consider that the ambulance station, where I was, is only 200 metres from the surgery – so I could even walk there and meet the 8 minute target. In addition, the ambulance station is only 200 metres from the hospital and the hospital, surgery and ambulance station are positioned such that they form a triangle.
Result: the surgery is only 200 metres from the hospital!
Mr Smith made his own way to the surgery. The GP wants him transported 200 metres to the hospital and has, as a result, caused him to wait 2 hours to get there because he has to go by ambulance. Then, because the service has had a busy time, we dispatch a blue light ambulance and a response car so that we can tick the right boxes as well as take him 200 metres down the road.
Is this all a sensible use of NHS money and ambulance resources? Could he have walked? Or gone by taxi? Did Mr Smith really need a blue light ambulance? Could someone have walked down the road and got a wheelchair from the hospital? I don’t actually know as a crew ‘greened up’ at the hospital and barely got the ambulance out of 2nd gear before picking him up – no need for me to go.
The whole thing seems to be a long distance runaround to me.