Above my pay grade

"71 year old male, shortness of breath"

I don't profess to be a GP, nor do I wish to be or act like one. Like nurses GP's range in quality from helpful and polite, to rude, obnoxious and verging on negligent. Many wasted ambulance hours are spent picking up the slack for GP's not willing to do their bit and simply taking the easy option and clogging up a hospital. This is party due to a lack of GP's available during out-of-office hours and partly, in my opinion due to laziness. One consequence of the opt-out policy, which was part of the new GP contracts which came into effect in April 2004, is that the overwhelming majority of England's 298 primary care trusts were left with a huge gap in their budgets as they take on the burden of the out-of-hour service. A burden that has not been dealt with correctly and one which is causing unnecessary strain on hospitals and the ambulance service. Ask any member of the ambulance service, or any nurses if they wanted to 'opt out' of working crap hours and you'd get a resounding yes. There are 24 hours in a day and unsurprisingly, people are in fact ill, between 5pm and 9am. Shocker! 

In recent years ambulance services have begun to move away from just taking everyone to hospital. In fact, if a patient can be referred and left at home that is preferred. One of the alternate care pathways (ACP) is a GP referral. We assess the patient, if they don't need to go, or refuse to go, we arrange a GP to call or visit. This applies to the out-of-hours GP service too. And in general it works quite well, a GP will ring, talk to the patient and either make an appointment or come and visit. On occasions where we have concerns for the patient we will speak to the GP and politely request / insist they do visit. Like with everything, you get good and bad GP's. Some will come out at any hour, will do the right thing, go the extra mile and be polite and courteous whereas others, won't come out for love nor money, will be dismissive rude and lazy. I mean, it's not as if we should expect them to see ill people at night on a meagre £100,000+ salary. Absurd!

This particular job, was very common. An elderly guy, having trouble breathing, but despite all the advise in the world refuses hospital. I'd imagine it's partly from pride and wanting to not be a burden and partly fear, not wanting to die in hospital. Either way, he wasn't going. We did all of our checks, the full work up, sitting and standing blood pressures, ECG and a advanced respiratory assessment. We arranged a GP referral and said to our control it was imperative that a GP visited this guy. We completed the necessary paperwork and went back to the truck! Not 3 minutes later, and our patient appeared at the door, beckoning us to return. He told us the GP had just phoned, didn't ask any questions about how he was etc and told the patient to make his own way to the local hospital and see a Doctor there. Needless to say, our patient told us he wouldn't be going to hospital.

Steam pouring out of my ears I phoned control and asked that the GP phone me directly on my mobile. I was livid. What is the point? What chance do we have of unclogging emergency departments when the ACP's in place can be abused by the unwilling and lazy. After 15 minutes my phone rang. It was the GP.

"Hello there, I was informed you wanted to talk to me"

"We requested a GP visit for this patient as he has poor mobility and would benefit from seeing someone with the ability to prescribe medication, the patient isn't well but is too scared of hospitals to go. He says he was told to make his own way to hospital"

"That's correct, I assessed him over the phone"

"You didn't ask him any questions about his health, his mobility or reasons for refusing hospital, he uses a frame, has no family and is scared"

"Well if you're that concerned you should have taken him in"

"We can't kidnap him, he has capacity and has refused admission. That's why we referred to you"

"In all honesty love, you are talking above your pay grade, I've made my decision, and you aren't qualified to question me"

Wow! He picked the wrong girl to mess with tonight. Needless to say, an argument in sued. It wasn't an argument I was ever going to win but one that made me feel better. I was able to rant about all the above. I told him exactly what I thought of him and I didn't hold back either! I went to town on him. We exchanged names for counter complaints, I even offered my call sign and personnel number. Pay grade, really? He went there? The arrogance and self proclaimed greatness was enough to make me seethe for hours and I did. It was like a red flag to a bull. My crew mate looked on in fear as I screamed and shouted (off the phone by now) at him about bloody GP's. When will they realise that we are no longer stretcher monkeys. Many have degrees in paramedic science, some have masters, there are Emergency Care Practitioners and in general, we are good at determining if someone is ill. When will we get the respect we deserve? We all work for the same team and the sooner the other medical professionals stop treating us like the kid that was never picked for anything, the better state the NHS will be in. By 'better state the NHS will be in' I mean the happier I will be! Lets be honest, being nice won't make a blind bit of difference to the NHS as a whole other than remove animosity and ill feeling between two bodies of people who are essentially working for the same team!