Post by Focus on May 13, 2013 6:57:12 GMT
* Care provider Harmoni uses nurse practitioners to work eight-hour
overnight shifts when they cannot recruit GPs to do the shifts
* Whistleblower, who works for Harmoni, claims situation is like a 'loaded
gun'
* Said locum doctors fly from Europe to work back-to-back shifts
* Claimed terminally-ill cancer patient had to wait eight hours for pain relief
* Said foreign doctors with poor grasp of English being used to plug rota
gaps
Britain's biggest out-of-hours care provider is using senior nurses to cover up to a quarter of a million patients when they cannot recruit GPs to do the shifts.
The firm, Harmoni, regularly employs advanced nurse practitioners to work eight-hour overnight shifts covering districts of up to 150 square miles.
They have a greater range of expertise than a nurse, but critics say they cannot be expected to replace a fully-trained family doctor and attend emergency callouts.
Harmoni, Britain's biggest out-of-hours care provider, is using senior nurses to cover up to 250,000 patients
At times of staffing pressures, there has been just one advanced nurse practitioner working overnight in North Somerset, which covers 250,000 patients.
The revelations come from a whistleblower – a GP who worked for the firm in Somerset – who has made a number of other startling allegations about how the firm is routinely jeopardizing safety to cut costs.
They include :
Locum doctors flying in on easyJet from Europe, or driving from elsewhere in Britain, to work back-to-back shifts round-the-clock without sleep.
Terminally-ill cancer patients made to wait eight hours for a doctor to visit them at home and administer pain relief.
Foreign doctors with a poor grasp of English being used to plug gaps in the rota
Staff accused of fiddling figures about the length of time patients wait to see a doctor or speak to them over the phone.
The whistleblower said that working for Harmoni was like ‘taking a loaded gun and sitting with it because at some point it’s going to become so unsafe it’s going to go off.
'My personal feeling is that at times it has been unsafe. It’s a dereliction of duty. Everything is secondary to meeting budget. Patient care is compromised, employee care compromised.
'It’s an edict from on high. They have thinned rotas down to a bare minimum.’
Harmoni has contracts in London, Berkshire, Sussex, Dorset, Hampshire, Milton Keynes, Stoke-on-Trent, Suffolk, Surrey, Warwickshire, Worcestershire, Essex and North Somerset. It is responsible for the care of millions of patients and makes £100 million a year from NHS contracts.
A whisteblower said on one occasion a terminally ill cancer patient had to wait eight hours for pain relief (file picture)
Many of its services are now accessed by the controversial 111 service which effectively acts as a call centre when patients try to seek advice if their local surgery is shut.
But the Harmoni whistleblower revealed that when shifts cannot be filled with on-call doctors, advanced nurse practitioners are drafted in instead.
They are senior nurses earning up to £70,000 who have had extra training in advanced medical practice that allows them to carry out some tasks normally done only by a qualified doctor.
Harmoni has admitted they are used to cover out-of-hours shifts elsewhere in the country when it is unable to find doctors.
The firm claimed there would always be a GP on call at home to provide ‘covering support’. But the whistleblower, who has requested anonymity, said he was once telephoned by a nurse who was desperate for advice on treating a patient with a complicated condition.
In March, he said, Harmoni was forced to draft in a nurse from Stoke-on-Trent to cover a night shift in Somerset. The whistleblower said many family doctors no longer volunteered to work out-of-hours shifts for Harmoni because of the intense workload.
Instead, less experienced locum doctors drive down from London and do blocks of shifts spanning several days.
Incredibly, the firm also relies on several European doctors who fly to Bristol by easyJet from Spain and Austria – and some ‘clearly struggle’ with the English language.
The whistleblower said Harmoni assumed the English-speaking abilities of foreign doctors had been tested by the NHS trust.
Last year, according to the whistleblower, a man dying of cancer waited eight hours for a doctor to give him pain relief. He also alleged that last month a manager instructed a junior official to change the figures on a spreadsheet for waiting times so they were more ‘favourable.’
A spokesman for Harmoni said: ‘On very rare occasions, and only after consultation and agreement with our commissioning colleagues in North Somerset that the service remained clinically safe, we have run an overnight shift with a very experienced advanced nurse practitioner providing the first point of contact with a GP available on-call to support with any advice needed.’
Harmoni relies on several doctors who fly from Spain and Austria and some 'clearly struggle' with English
When asked if this happened elsewhere in the country, Harmoni added: ‘Advanced nurse practitioners do have certain limitations on the care they can provide such as with very young children and palliative care.
‘Therefore, on the occasions when they are the first point of patient contact, we ensure there is always covering support available from a GP. For Harmoni, and indeed virtually all out-of-hours providers, there are some occasions where filling all the planned GP rota slots is a challenge.’
When asked if staff were ever asked to change performance figures to make them look more favourable, the spokesman said: ‘Our performance figures are accurately recorded in line with national guidelines and, again, carefully scrutinized by our commissioning colleagues.’
The Department of Health said: ‘It is a legal requirement for the NHS to make sure the right, high quality out-of-hours services are in place for patients in their area. If this is not happening, it is totally unacceptable.’
How in God's name did the NHS system end up in this mess?? - Utter mismanagement and total abuse of the system are just two reasons that come to mind!! - Fx
