A DOCTOR who helped set up health service phone line NHS 24 is demanding its call centres are "dismantled".
Dr Vijay Sonthalia, who was on the advisory committee behind the helpline in the late 1990s, will speak out at a major GP conference about concerns that nurse advisers dealing with cases are too cautious and refer too many people to GPs.
At a time when out-of-hours medical centres are already under pressure from rising demand and staffing shortages, he is accusing NHS 24 of making medical appointments for people who could manage their problem themselves.
Members of the British Medical Association's Scottish GP Committee are expected to back his call for the 111 helpline to be radically reformed and the nurse advisers sent to work alongside doctors in the community.
Dr Sonthalia believes this way the nurses will improve the way they "triage" - or make decisions about - patients because they will find out what ultimately happens to the people they speak to.
He said: "There is a huge amount of pressure on out-of-hours services and a lot of this pressure is coming from the way NHS 24 staff are trained.
"Personally I feel this hub (call centre) model is not working and the reason it is not working is the nurses do not get any feedback on their triage. "They really should be working in the clinical areas along with doctors and learning on the job. They are working in isolation."
Doctors are supposed to attend house calls marked urgent by 111 staff within an hour, but Dr Sonthalia, who is chairman of the Lanarkshire GP committee, said in his experience they were only reaching 70 per cent in that time frame.
"A lot of the patients which are triaged to be seen within one hour are inappropriate triage," he added. "We have been feeding that information back to NHS 24 again and again."
Before NHS 24 was launched, Dr Sonthalia said at least 50 per cent of patients who called GPs outside surgery hours were given self care advice, but this has now dropped to less than 30 per cent.
It was originally envisaged that call centre nurses would be given feedback on the journey of each patient they spoke to, he added, claiming the technology to do this was never fully developed.
He admitted NHS 24 is not the only reason out-of-hours centres are struggling, saying: "Staffing levels for out-of-hours are not as good as they used to be."
It is the second time this week concerns have been raised about NHS 24. On Monday The Herald revealed its medical director Dr George Crooks had warned the board there were signs the pressure on staff was affecting the way they dealt with patients.
The phone line struggled to recruit the number of nurses they wanted for the busy winter months and is dealing with 20 per cent more callers since a free 111 phone number was introduced.
Scottish Labour MSP Dr Richard Simpson raised this issue with First Minister Nicola Sturgeon in Holyrood.
A review of the care available when GP surgeries are closed was announced by the Scottish Government in January.
The motion being put to the Scottish GP Committee conference in Glasgow next Friday says the present structure of NHS 24 is not working and requires radical reform. It also raises concerns, not shared by Dr Sonthalia, about call handlers without clinical qualifications triaging patients.
In a statement, Dr Crooks said: "NHS 24 works with a group of senior independent clinicians from across Scotland, when developing our triage support tools and designing our clinical processes. These are subject to regular review to guarantee safety as well as clinical effectiveness. The results of our triage are subject to internal and external peer review to ensure they reflect the needs of individual patients who contact the service.
"NHS 24 has nurses co-located in many health boards across Scotland working alongside GP out of hours colleagues and receives on average 4000 calls per day, from members of the public requiring our assistance. The increase in call volumes since the introduction of 111 in April 2014, demonstrates public confidence in the service and patient satisfaction rates in January 2015, stood at 94 per cent."
A Scottish Government spokesman said: "A national review of primary care out-of-hours services is under way. This comes more than a decade after the 2004 UK GP contract, which transferred responsibility for delivery of out-of-hours primary care services to the management of health boards.
"This review, which was commissioned by the Scottish Government is on-going and will address issues such as recruitment and retention of GPs, staff availability, especially during peak holiday times, consistency of service and the public's expectations of the service."
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