Monday 6 September 2010

Tories closing NHS Walk-In Centres

Your easy access NHS Walk-In Centres and out of hours Primary Care Centres are actively being dismantled by the UK Coalition Government. They will be history in a year or so.

Back in the 1990’s the Dept of Health renegotiated the funding contracts with the General Practitioners. These independent contractors, who do not have contracts of employment with the NHS, were suddenly earning a lot more money for less hours and no longer provided out of hours coverage.

The responsibility for out of hours coverage fell on the Primary Care Trusts, who had to suddenly contract Doctors to provide out of hours coverage, where the GP’s had previously covered. Another increase in the health funding bills. In many cases the newly recruited out-of-hours doctors also for a GP Practice – Ho Hum more money for the new Volvo SUV.

The public were finding that the GP Surgeries were only available during the working day and even then it could be many days before they could get an appointment to see a GP. Sickness and injury does not wait for the limited GP availability hours, so the public took the only course open to them and went to the local accident and emergency department of the local hospital. Many of these attendances could easily have been dealt with by a skilled general practice nurse of a GP. As a consequence waiting times extended at the A&E and the price tab for handling these minor ailments skyrocketed.

The Government of the day reacted by setting up Walk-In Centres (and NHS Direct) in clinics around the country. There the patient could walk through the door with no prior appointment 364 days a year from 7 am to 10 pm and be seen by a skilled medical practitioner reasonably promptly. Often the medical practitioner would be a skilled and highly trained Nurse Practitioner with many years’ experience and medical post graduate degrees. Any serious case would be referred to medical specialists or A&E departments. Many of the people who attend the Walk-In Centres went because they could not get an appointment with their GP or had indeed been sent there by the GP Surgery staff. The consultation cost at a Walk-In Centre worked out at approximately £25 per session. A similar consultation at a GP surgery would cost the public purse around £40. Someone attending the A&E department would be a minimum of £110 per consultation even for a simple sore throat.

The Walk-In Centres are normally nurse-led. That means a senior nurse usually with 20 years or more experience would manage the service, even employing Doctors to act in a GP mode where necessary. The independent GP’s contractors around the country hate this loss of power, status, (and potential income) to the nurse led services. The senior nurses are required to follow formal medical protocols in respect of treatment, to keep detailed computer records of the reasons for their diagnosis of any patient. They have long training before they are allowed to prescribe medicines. The quality of treatment is at least as good as you would find at the GP Surgery. Many of the independent GP contractors hold positions of power in the governing committees in the local NHS Primary Care Trusts and use this power to thwart to central Dept of Health push for Walk-In and Urgent Primary Care centres.

With the proposed dismantling of Primary Care Trusts by the Conservatives/Lid-Dem Coalition we will see the closure of nurse led Walk-In Centres. They will be hived off to be run by GP Practices or attached to Hospital Trust A & E Departments. Neither the GP’s nor the A&E Departments have a sparkling record when it comes to cost efficient services. The well trained nurses will be frittered away and replaced by GP’s who are paid at least three times the cost of the nurses they replace. It is GP’s who have the ear of the Health Minister and are making sure that the “aberration” of nurse led Walk-In Centres are wiped from the services available to the public.

If you think this doesn’t happen, take a look at the case of the SE London Walk-In Centre based in New Cross. A building was fitted out as a Walk-In Centre Clinic with consultation rooms and an admin area. Almost £1,000,000 was spent on the development and set up. There used to be team of about 12 nurses providing coverage 364 days a year from 07:00 to 22:00. Now the clinic building has been handed over to an independent GP contract practice. The Walk-In centre nurses have been moved out and have a room or two working for another GP Practice. Only three nurses remain.

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