The wrong sort of triage

I visited our local A&E department recently, where they now have consultant physicians in A&E till 10pm every day. The rationale is simple. More senior people can make better decisions about when to admit people. In contrast, juniors play safe and admit people when admission may not be needed. In a nutshell, experienced staff are better at triage.

Contrast that with what’s going on in primary care. I saw the inside of an NHS 111 call centre on the One Show this week. Large banks of newly recruited staff who had arrived from their previous jobs (beauticians, financial advisors) after just 10 weeks training. If they needed help, they held up a large placard saying ‘Clinician’ and a doctor or nurse would come over to help them out. No wonder hundreds of patients are being funnelled to A&E.

In Denmark, out of hours triage in primary care is done by GPs who man the phones. Better still, they are electronically linked through to pharmacies so that they can send a prescription through to a pharmacy near the patient’s home where a face to face consultation is not needed.

So what do we need – more experienced people doing triage (as in my local hospital) or the least experienced (as in NHS 111)? For me it’s a no brainer. Cheap isn’t always better. It often isn’t cheaper either.

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