Emergency care in general practice

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6989.1268a (Published 13 May 1995) Cite this as: BMJ 1995;310:1268
  1. P D Thomas
  1. General practitioner Gipping Valley Practice, Barham, Ipswich IP6 0AS

    EDITOR,—I am alarmed by the number of authors who consider that emergency medicine and the out of hours service are entirely separate from doctors' obligations to their patients. It is a sad indictment of current standards if the pressures of his work as an NHS general practitioner prevent Andrew Dicker from attending and treating acutely ill patients.1 General practitioners seem to have relinquished their raison d'etre to other providers, whether they be paramedics, midwives, or pharmacists, all of whom are employed by trusts or businesses.

    I completed the five day course of the British Association for Immediate Care some time ago and the three day course more recently. I carry a comprehensive set of equipment in my car at all times. This includes oxygen, a defibrillator, and thrombolytic drugs.2 None of the equipment was provided by the NHS, and the family health services authority recently declined to give any help towards the cost of replacement defibrillator batteries at pounds sterling465 a set, yet I have received more than pounds sterling10000 of NHS funds towards computer equipment and other practices have even received television monitors.

    I will willingly attend any medical emergency, but I am seldom called by ambulance control to any road traffic accident, case of trauma, or acute medical or obstetric case within my practice area. I have even been the subject of a complaint by the ambulance service because I considered that I was, and a paramedic was not, the better person to accompany my patient on her journey to hospital because she was still unconscious as a result of the ketamine I had given her during extrication from her badly damaged vehicle.

    After a minimum of nine years of training every general practitioner is qualified and contracted to provide NHS patients with “all necessary and appropriate personal medical services.” It seems, however, that genuinely ill people must now die unnecessarily or languish untreated and in pain for 30 minutes or more while awaiting an ambulance, or possibly for much longer while awaiting a deputising doctor, because early, qualified medical treatment is denied to them unless they live close to a trauma centre.3 One author has even stated that a defibrillator has never been required in her 17 years in practice.4


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