Ombudsman highlights flaws in night cover for GPs

Fatal flaws in the GP deputising service which provides emergency cover for family doctors at nights and weekends, are exposed by the NHS ombudsman today.

Fatal flaws in the GP deputising service which provides emergency cover for family doctors at nights and weekends, are exposed by the NHS ombudsman today.

One GP deputy lied about his failure to diagnose appendicitis in a 15-year-old boy, another tried to evade inquiries into how he missed a brain tumour in a female patient and a third failed to start antibiotic treatment in a 32-year-old man with meningitis who later died.

In a fourth case, a woman awaiting a coronary bypass operation suffered a heart attack which was missed by three separate deputising GPs whom she saw over one weekend. It was only diagnosed when she returned to her own GP the following Monday.

Responsibility for providing emergency cover for GPs is being transferred to primary care trusts and up to half of family doctors are expected to opt out of all night and weekend work, putting extra strain on the emergency service. A deputising service in Norfolk has had to fly in five German doctors after failing to find British GPs prepared to do the work and a service in Hampshire is considering doing the same.

In the foreword to her latest report, Ann Abraham, the health service ombudsman, says: "In the past six months I have seen a number of serious cases involving GP deputising services. The quality of care, communication with patients and record-keeping in these cases is a real cause for concern."

Ms Abraham describes how the GP in the appendicitis case was called to the patient's home by his parents in the early hours of the morning in September 2000. The boy complained of severe abdominal pain and the GP, employed by the Heart of Birmingham Primary Care Trust, prescribed a powerful opiate painkiller.

The following morning the boy was taken to his own GP and admitted to hospital as an emergency where a burst appendix was diagnosed.

When the boy's mother complained, the doctor claimed he had diagnosed appendicitis but that the boy's mother had been reluctant to take her son to hospital. An independent review was held which found no fault in the doctor's care. But when the ombudsman investigated, the doctor changed his story and admitted he had considered but discounted the possibility of appendicitis.

The doctor, who was severely criticised by the ombudsman, apologised to the patient's family and the trust agreed to work with him to improve his practice, record-keeping and communication skills.

Three other cases highlighted in the ombudsman's report involved GP deputies employed by Healthcall, now called Primecare, the UK's largest commercial deputising service. In one case, Healthcall took more than five hours to respond to a call from the parents of a 32-year-old man suffering from flu-like symptoms which had rapidly worsened.

The ombudsman found the GP had "failed to respond appropriately" to what was a probable case of meningococcal septicaemia and had "failed in his duty of care". Healthcall agreed to improve the handling of emergency calls and standby cover during holiday periods.