What is the Emergency (Out-of-Hours) Doctors’ Service?

The service is set up to assist patients who have urgent medical problems or are taken ill when their own surgery is closed (i.e. Evenings, throughout the night, weekends and Bank Holidays). The service works together in partnership with the local Clinical Commissioning Group and NHS 111; phone 111 , and comes under the general title of East Lancashire Medical Services. Patient care is provided by a clinical workforce of GPs, mostly drawn from local practices, Nurse practitioners and Paramedics assisted by a team of skilled administrative, technical, reception and driving staff.

How do I contact the Out-of-Hours Doctor’s Service?

Providing your own surgery is closed (i.e after 6.30pm Mon-Fri, and all day at weekends and Bank Holidays) you should ring the Out-of-Hours Emergency Number on 111. Your call will be answered by the NHS 111 operators who will first take some brief demographic details (name, telephone number etc) and brief details of your problem. Please note that this service is not available when your own surgery is available. Even if your surgery has a half-day closing, there will be a doctor available on the phone for emergencies, and on these occasions you should ring your own surgery first.

What happens when I contact the Out-of-Hours Service?

In order to process your call quickly we need to know the full details of the person who is ill.

You will be asked for:

• The number you are ringing from, if not the patient’s own home
• The patient’s full name, address and date of birth
• The name of the patient’s GP, & from which surgery or Health Centre.
• Brief details of the illness / symptoms.

If the patient has contacted the service before the details will probably be available on the computer – for this reason we need to check the patient’s date of birth and confirm the spelling of any names. The details will then be passed to a nurse who has specialised training in telephone triage. By asking certain questions the nurse can decide the next course of action, the most appropriate people to help you, and ensure that your call is given due urgency and priority. Some of the questions may appear irrelevant and “time wasting” – but there are sound medical reasons for each and every question. A few minutes spent at this stage can ensure a speedy response to your problem by the right medical personnel.

What happens next?

Depending on the information you give the nurse, one of four things will happen:

1. The triage nurse may give you the appropriate advice for treating the complaint yourself. In many instances it may not be necessary for you to see the doctor – his advice would be exactly the same as that given by the nurse, and this would take up an appointment needed for more urgent cases
2. The nurse may arrange for a doctor to contact you with more advice or information, or to issue a prescription for you. This will usually be within the next couple of hours. Alternatively they may instruct you to attend the nearest A&E department or, if necessary, arrange an ambulance for you.
3. Arrangements may be made for you to see a member of our clinical team at the Out-of–hours treatment centre. Staff at the centre will then ring you back with the first available appointment time (These are not “drop-in” centres and since there may not be any medical staff on site we may not be able to see patients without an appointment)
4. If your complaint prevents you from travelling to the centre, or if there are other exceptional medical reasons, we will arrange for a doctor to visit you at home.

When I call the Out-of-Hours service why do I not get to speak to the doctor straight away?

Despite being intended only for emergencies, the service deals with many hundreds of calls each day, many of which are about routine complaints and common ailments. If the doctors were to speak personally to all these callers they would never have sufficient time to spend with patients who have genuinely urgent or serious medical problems. For this reason, all calls are “triaged" first – in other words they are assessed by highly trained nurses who can prioritise each call according to its urgency. Whilst we understand that to each patient their particular problem is never trivial, they are often to medical staff that come across these problems every day, and can therefore be dealt with just as effectively by a nurse or paramedic as by a doctor. This leaves the doctor with much more time to spend on more serious or complex cases. If there was any doubt as what treatment you needed, the doctor would always be consulted.

Why can I not have a Doctor Visit me at Home?

• Patients have a right to a consultation with a doctor 24 hours a day – but this does not necessarily mean the doctor will have to come to you.
• These days, demands for doctors out of hours are extremely high, and therefore home visits are made only for patients who are seriously or terminally ill, the very elderly, or the truly bed-bound. Offering home visits for people who have social, financial or transport difficulties would not be an appropriate use of a doctor’s time. Whilst we are here to help, getting to the doctor has to be the patient’s responsibility.
• In surgery a doctor can spend all of his time treating patients, whereas with home visits most of the doctor’s time is spent travelling around from one district to another.
• The Out-of-hours call centres have much better examination facilities than in a home environment, and have the best medical equipment & life-saving facilities on hand. Not only does this make the consultation much safer, it also helps the doctor in making a speedy diagnosis and in providing the best possible treatment.
• All out-of-hours centres are adjacent to, or have direct communications with, local hospitals where the doctor can quickly contact specialists and consultants should the need arise.

My child is poorly – won’t it be better for him or her to stay indoors?

We understand that parents are often very worried when their child becomes ill, and it is natural to want to keep them safe and warm. However, most childhood symptoms such as high temperatures, coughs, earaches, diarrhoea, vomiting, and throat infections are not dangerous and their condition will certainly not worsen if they venture outside. In fact, exposure to fresh air will in most cases reduce the temperature and ease the symptoms – it is not uncommon for the child to feel a lot brighter even by the time they reach the surgery! And on the rare occasions that the child has something serious, the sooner they can be seen by the doctor in a fully equipped surgery the better.

How long will I wait at the Out-of-Hours Centre?

Provided you arrive by your appointment time, we will endeavour to see you as quickly as possible. However, there are times when patients with more serious conditions have to be seen first, or a consultation takes longer than average. Inevitably, this means that the next set of appointments can be delayed slightly. There may be two or more clinicians on duty dealing with different problems, and for that reason someone who arrives after you may be called in first. And sometimes a doctor may need to consult and discuss a case at length with a specialist, or maybe arrange a hospital admission, which can take a little longer. Patients are asked to bear with us on these occasions, and not to shout or remonstrate with the reception staff. (The service operates a “Zero Tolerance Policy” towards violence, aggression and verbal abuse, and anyone demonstrating these acts will be asked to leave the centre by security staff).

The Doctor told me I had an infection – so why was I not given Antibiotics?

Antibiotics are not a cure for all minor illnesses. A large majority of infections are Viral, not Bacterial. This means with proper precautions they will clear up themselves, and antibiotics are not helpful. Too much reliance on antibiotics also decreases your resistance to Bacterial infections later on in life, so it is important to take them only when absolutely necessary. If you are given antibiotics you must always finish the course, even though your symptoms may have cleared up after a day or so.

Why did the Emergency Doctor refer me back to my own GP?

The Out-of-Hours service is set up to give immediate assistance to patients until their own surgery re-opens. You may be prescribed a first course of treatment, pain relief etc, but is not there to take over from your own GP. Medicine is rarely “black or white” and may take some time before a definite conclusion can be reached. Many illnesses cannot be immediately recognised in their early stages, but this does not mean that the first doctor who sees you is in any way less competent.

Similarly, the Out-of-hours doctor should not be used for a second opinion. Your own GP knows much more about your background and medical history, which may have a bearing on your complaint. The Emergency team have not got access to this information. For this reason we ask you not to call on the Out-of-Hours service just because it is inconvenient to get to your own surgery.

What happens after seeing (or speaking to) the doctor?

Your own doctor will be notified that you have called the emergency service, and details of your illness, treatment and follow-up instructions will be sent through to your own surgery. Should you need to use the service again before your surgery re-opens, tell the doctor about your previous call so that he can refer to the appropriate notes. As in all health matters, all the information we process is kept completely confidential.

How can I help the doctors at the Out-of-hours service?

• Ask yourself “Is this really an Emergency? Do I really need a doctor today?” - Common ailments such as coughs, colds, sore throats, flu, tummy upsets, earache and hay fever can be treated effectively without prescriptions. Advice on over-the-counter medicines is readily available from your local pharmacist.
• Keep a medicine cupboard regularly stocked with essentials such as Paracetamol, Calpol for young children, throat lozenges, antiseptic cream, plasters and anti-histamines.
• If you take regular medication, ensure that you have sufficient supplies for the weekend or the holidays when surgeries are closed.
• Keep an “Emergency Fund” handy to cover the cost of a prescription, or a taxi to the out-of-hours centre should you need one.
• Have a list of any medication you are taking readily available when contacting the service – this may assist the person triaging your call.
• Keep any appointments you are offered and arrive as near your appointed time as possible. If you start to feel better and decide not to attend – please let us know. Hundreds of hours are wasted every year by patients not keeping their appointment.
• Do not expect the doctor to visit simply because it is inconvenient to attend the surgery, and arguing with the reception or control room staff would not be helping your case. They will assist you where they can, but do not have the authority to arrange a visit for social or financial reasons.

Suggestions & Comments

Because we are constantly striving to improve our service, your suggestions and comments are always welcome.

Alternatively, pass your written comments on to us via your own doctor. If you are dissatisfied with the treatment you received, or have a particular complaint about the service you received please inform your own doctor who will investigate on your behalf.