Nurses' listening skills weren't always up to scratch

Sally Williams, Health Which?

It also said it had found evidence that advice given out by nurses varied greatly in different parts of the country.

Health Which? has questioned whether the nursing staff who run the helpline are properly qualified to take vital decisions about treatment.

NHS Direct was launched in 1998 and now covers two thirds of England, with the rest of the country expected to be included by the end of this year.

Referrals from NHS Direct

Access to a GP within 48 hours for non-urgent matters is one of the helpline's targets Nearly two thirds of people got an appointment within two days A fifth had to wait four days or more

The idea of the helpline is to provide patients with easily accessible medical advice, so they do not have to turn to hard-pressed GPs or accident and emergency departments.

The Health Which? researchers gave a number of scenarios when they phoned through to ask for medical advice.

One scenario involved adopting the guise of a patient with angina, a potentially serious heart condition.

The "patient" told NHS direct staff that he was away from home and running out the spray he used to relieve symptoms because attacks had become more frequent.

A panel of experts said nurses should have asked enough questions to discover he had already had one heart attack and that his attacks were becoming more frequent, and then told him how to get a repeat prescription while away from his usual GP.

But in only one out of 10 calls was the researcher asked enough to discover whether the patient's condition was becoming worse and given the appropriate advice.

Serious questions

Six calls were not even passed to a nurse but instead taken by call handlers - and in five cases the researchers were not even asked for their names.

Steve George says the study is flawed

Principal researcher Sally Williams said: "Our research raises a number of questions about the role of the NHS Direct call handlers, the remit of the nurses, and about the protocols they use.

"There must be a balance between drawing on the skills of nurses and ensuring that advice is consistent and sound.

"There are also training implications - conducting a consultation over the phone is a skilled job, and the nurses' listening skills weren't always up to scratch."

She added: "Our biggest concern is where there are gaps in the system.

"We would like to see NHS Direct take a close look at the way it deals with calls about repeat prescriptions to make sure that potential emergencies don't slip through the net."

A spokeswoman for the Department of Health said that the way calls about repeat prescriptions were dealt with would be reviewed in the light of the report.

But she said that there were "major flaws" in the way the magazine had investigated NHS Direct.

She said NHS Direct had "a very high level of caller satisfaction" and had often proved a lifesaver.

Dr John Chisholm, chairman of the British Medical Association's GP committee, said: "NHS Direct is a new service which still needs to prove its cost effectiveness and value.

NHS Direct has a very high level of caller satisfaction

Department of Health

"Clearly in some circumstances it can do a good job - but the research from Consumers' Association reveals worrying and potentially dangerous discrepancies."

Steve George, from the University of Southampton who developed one of the safeguards for the helpline, criticised the study.

He dismissed it as "poorly designed" and "sensational in its writing".

"If you take a group of people and subject them to simulated patients over the telephone you always get variations.

"We are trying to compare NHS Direct with a mythical gold standard that doesn't exist."