CHRISTMAS PRESSURE Out-of-hours services will be most tested

Published: 16/12/2004, Volume II4, No. 5936 Page 9

The NHS is bracing itself for a busy Christmas and New Year. With GP surgeries closed for seven out of 10 days, out-of-hours services and accident and emergency departments are anticipating heavy pressures.

GP surgeries will close on the afternoon of Christmas Eve - a Friday - and not reopen until the following Wednesday. They will close again on the afternoon of New Year's Eve and open on Tuesday 4 January, and in Scotland, Wednesday 5.

In many areas out-of-hours services will then be provided by new services without previous experience of dealing with seasonal pressures. Some will only have been in operation for a matter of weeks.

Around 50 per cent of out-ofhours services are now provided by primary care trusts and another 10 per cent by the private sector, with the remainder run by organisations based on GP co-operatives.

NHS Alliance out-of-hours spokesperson Dr Ruth Livingstone said: 'It will be a supreme challenge for all of the new PCT-provided services. I sincerely hope that all co-ops and out-of-hours organisations have got their act together and have got contingency plans to call in extra staff.' Dr Livingstone is also acting medical director of the Lincolnshire South West teaching PCT out-of-hours service, which is putting on double staff for the holiday shifts, plus GPs paid a retainer to be on standby.

National Association of GP Cooperatives chair Dr Mark Reynolds said out-of-hours services received 1 million calls during the Millennium period - which had a similar pattern of closures.

New services that based requirements on previous patterns of calls should be able to cope but, he added, they might run into difficulties if they had 'cut corners and costs, and halved personnel and replaced doctors with nurses too quickly'.

Long holidays also lead to a different pattern of demand, with many unwell people soldiering on until the third or fourth day, he said.

This leads to a dramatic increase in patients who need home visits.

However, PCTs running the services insist they are well able to cope with the Christmas rush.

A Lincolnshire South West PCT spokesperson said: 'We have a comprehensive rota sorted... it is a continuation of what we have in place. It is not going to present us with any difficulty.' In Scotland, NHS 24, the answer service which takes calls for out-ofhours providers, is expecting to field up to 18,000 calls on 27 December - twice the number it would have on a normal busy weekend day. Staff are each working for six of the eight public holidays and weekends.

But those in acute care are concerned messages about appropriate use of emergency services may not be getting through to the public.

British Association of Emergency Medicine president Martin Shalley said he had seen patients last weekend with sore throats who thought GPs were no longer available out of hours. 'It is going to be a very difficult period, ' he said. 'Any problems with the primary care stream will have a knock-on effect.' Wednesday 29 December may be especially busy, with surgeries unable to cope with the pent-up demand for GP appointments, he added.

Royal College of Nursing adviser for emergency care Mike Hayward said the jury was still out on the new out-of-hours system and whether enough had been done to inform the public. 'It will be put to the test over this Christmas period, ' he said.

A&E departments were under enormous pressure to meet the government's end-of-year target of 98 per cent of patients being treated within four hours, he added. At the same time strategic health authorities were pressurising hospitals to limit the use of agency and bank staff to save money - and in some cases trusts were banning their use.

Many acute trusts are reducing or stopping elective work in preparation for Christmas, as well as discharging patients. London emergency bed service manager Graham Hayter said the peak demand for beds tended to be the first week of January rather than the holidays, as hospitals started doing elective work. However, the changes in outof-hours could have an impact if the new providers were inclined to be more cautious and send more people to hospital.

In Swansea, pressure is being taken off A&E departments by a temporary clinic set up in the Kingsway medical centre. The clinic will open on popular drinking nights, and paramedics and A&E nurses will deal with the 'walking wounded' who would otherwise go the Morriston Hospital.

The Department of Health has set up a monitoring system through SHAs for the winter season. A spokesperson would only say:

'SHAs, as always, work with local health economies to prepare for an increase in demand for services, which includes the festive season.' There are two points of hope for the NHS: current forecasts for the Christmas period suggest the weather will not be harsh, and there is little sign of a flu epidemic, which would test the system to its limits.