The nurses don't ... use their nursing clinical skills as much as they should

Dr Richard Parry, Preston Primary Care Centre

They said 44% did not need to be transferred and could have been dealt with by NHS Direct advice, or been told to see their own GP in normal surgery hours.

This could have been worse, said the GPs, as in some areas NHS Direct assesses all GP out-of-hours calls for them.

They said the patients' own GPs were contacted, and said that the out-of-hours service's re-assessments had been correct in all but one case.

Dr Richard Parry, chairman of the Preston Primary Care Centre, claimed that if they used that system, the GPs would have a 36% increase in workload.

'Confidence'

He told BBC News Online he felt NHS Direct nurses relied too heavily on a computer system to guide them as to what course of action is best for a patient.

Callers can be advised to care for their complaint at home, to see an out-of-hours GP, go to A&E or call an ambulance, or make an appointment to see their own GP during normal surgery hours.

Dr Parry said: "I think the nurses don't have the confidence to ignore what the computer says and don't use their nursing clinical skills as much as they should."

He said the NHS Direct nurses should be based in the out-of-hours centre so they could consult GPs over decisions.

But Dr Richard Fairhurst, medical director of NHS Direct in the area, criticised the doctors for releasing the figures of what was a joint survey.

He claimed the numbers quoted were wrong, and said the GPs should have waited to release the information.

"I don't believe you can draw those conclusions from the figures.

"None of the data has been validated and its not completed."

He said during the month's audit, NHS Direct handled over 1,000 calls from patients covered by the out-of-hours service, 500 of which had been given advice to care for their symptoms at home.

"There are 48 calls which are subject to a degree of doubt as to whether the advice given was correct or not."

He said the next stage of the study was to look back at the each of those cases and check the advice given by both sides.

A spokeswoman for the Royal College of Nursing said: "The findings of NHS Direct and the Preston GP co-op diverge because each was using different assessment criteria."

She said a new computer decision support system was due to be introduced nationally in the next few months, which would act as a reference point for NHS Direct sites and GP co-ops.

The spokeswoman added: "This sample is small, representing the calls received over several hours by one call centre, and could not be extrapolated across the whole of NHS Direct.

"The NHS Direct nurses erred on the side of caution in their assessments, which is the prudent thing to do."