Posted by: Witch Doctor | September 14, 2008

Dumbing-down has tumbled from the gutter into the sewers

OK. I have just about recovered from The Swoon.

I can understand a community might become very resilient in times of drought, floods, famine, volcanoes, hurricanes, plagues etc.

And the powers at be may well encourage such resilience.

I grasp that.

However, it seems the Highlands of Scotland have more problems to worry about than a young surgeon who swears alongside his peers and some skulkers on a closed forum.

Kinloch Rannoch residents are being asked to provide the funding and manpower for a volunteer service formerly undertaken by a GP.

These new age “GP’s will have one weeks training and will have neither medical nor paramedical qualifications.

“First Response”, presumably an NHS partner seems to be involved.

Read what Allyson Pollock has to say in “The Herald”

OUT-OF-HOURS BATTLE THAT WE SIMPLY MUST WIN

“Now the health board has come forward with its preferred solution: “community resilience”. The policy involves a company, First Response, supplying local volunteers to fill the gap the GPs have left behind by manning services with local residents/volunteers funded largely through community and charitable donations. Residents were told: “The company will operate a 12-person volunteer scheme with set-up costs of £15,000 funded through community and charitable donations”. So local people are required not only to raise the funds, but also to provide the people to run core services provided by the NHS in most of the rest of the country.

But there is no evidence that a local volunteer with five days’ training, and neither medical nor paramedic qualifications, can substitute for GP care. Indeed, the testimony of the ambulance men present at the meeting was that such volunteer services should be additional and not a substitute. In any case, how will a company supplying local volunteers deal with an acute subarachnoid haemorrhage, status epilepticus, anaphylactic reactions, the small child with meningococcal meningitis, the baby with acute bronchiolitis, the acute myocardial infarction of the acute trauma – the rare but life-threatening conditions that require swift diagnosis and intervention? Just how is the local forestry worker and petrol pump attendant volunteer with five days’ training going to manage, and who will be liable when they fail to make the correct diagnosis and provide appropriate treatment and care?”

What a crazy place this country has become.

This is why we witches hate Creep in any shape or form.

This is end-stage Creep!

And of course there are members of The Medical Profession somewhere in Scotland who are nodding away agreeably totally unaware that their minds have crept into oblivion.


Responses

  1. 1. First Response is an NHS Partner however as a charity it does not profit from the work it does – http://www.first-response.org.uk/ . There are also other providers of Community First Responder Schemes to the NHS.

    2. Community First Responders are not GP replacements, nor are they “New Age GP’s”. They are trained to either Basic or Intermediate First Person On Scene level. This course is approved by The Institute of Health Care Development (IHCD from Edexcel) and is clinically endorsed by the Faculty of Pre- Hospital Care (Edinburgh). Details of what Community Responders are trained to do can be found at http://www.edexcel.org.uk/VirtualContent/31799.pdf

    3. Community Responders are only called on in support of Paramedics and are controlled by the Scottish Ambulance Service (in Scotland). They only get called to situations to which an Ambulance has already been dispatched and are not in any way a replacement for a paramedic or a GP. There are a number of situations to which Community First Responders are not qualified to attend, multi-vehicle accidents or violent situations for example.

    4. Community Responders provide treatment that where possible maintains life and will provide that treatment until they are relieved by qualified medical professional (usually a Paramedic). They are not qualified to make a medical diagnosis but base treatments on the presenting conditions. They very often provide immediate life saving treatments in the form of oxygen therapy, through the use of an automated defibrillator and/or CPR and other simple first aid treatments as taught in the FPOS course. The early use of these simple but effective treatments can significantly increase the chance of survival in such situations – as any medical professional will tell you.

    5. Community Responders reside in the community which they serve and as such when on call are sometimes able to arrive to an incident faster than an ambulance that may have to travel some distance to attend, particularly in geographically remote or smaller communities. They provide the level of treatment to which they are trained to until such time as the despatched Ambulance arrives.

    6. Whatever you may think about why there is a need to use Community Responders and why there has been an increase in the use of the schemes, please do not criticise or undermine those people who give up their free time for no material re-numeration, often putting themselves in unpleasant, dangerous or emotionally distressing situations in a effort to make the communities in which they live safer places to be.

  2. Many thanks for your measured comments on this important matter.

    It seems that Community Responders or other equivalent voluntary services are not intended to replace an existing or pre-existing NHS service but to support it.

    The problem here is whether rationing of local GP out of hours cover should be formally introduced. The concept has been made clear in today’s Herald by Sandy Wilson, Chairman of Tayside Board that a population of 650 does not qualify for a local GP out of hours service. This suggests that Community Responders will be the only local service. ie they are replacing the local GP.

    http://www.theherald.co.uk/features/features/display.var.2446997.0.Correcting_misconceptions_about_outofhours_medical_services_in_Tayside.php

    There has always been rationing of health care. So the question then is: “what is the minimum number of patients that should qualify for a local out of hours GP service? “ Is it 1000, 5000, 10,000? Or will we try to manage without out of hours GPs completely?

    What happens if a patient dials 999? Does a member of the Community Response team come first and decide whether an ambulance should be called or not? They will then need to make a diagnosis. Or will NHS 24 make a telephone diagnosis also without examining the patient, and the volunteer service follow their directions.

    What Allyson Pollock I think is addressing, is “creep.” Good, well-intentioned ideas that gradually metamorphose into something that was never intended. It happens all the time and it can be very dangerous – and good people get caught up in it.

  3. In response to your question regarding what happens if a patient dials 999.

    A Community Responder ONLY gets called once an Ambulance has been dispatched to a situation; the decision to dispatch Community Responders lies with the Scottish Ambulance Service (in Scotland). Community Responders do make medical diagnosis but provide treatments based on the presenting conditions. They will continue to provide that treatment until a qualified medical professional relieves them.

    Community Responders do not decide if an ambulance should be called or cancel an Ambulance that has been dispatched to an incident – they are not qualified to do so. Community Responders would not normally liaise with NHS 24 in the course of their duties. They have been trained to a specific level and for legal, insurance and practice purposes cannot provide medical treatments beyond that level of training.

    If a Community Responders happens upon a medical emergency they will call 999 in the same manner as any member of the public.

    The ultimate purpose of the Community Responder is not to diagnose a condition but endeavour to keep someone alive until a medical professional that is qualified to diagnose the condition arrives on scene.

    My final point and probably not too dissimilar to the one you are making – It is a community decision to instigate a Community Responder scheme, not the NHS or local GP. It does not a replacement for any NHS services – the NHS do not do what Responder schemes do. While Responder Schemes are NHS partners, they are not the NHS. The responsiility of provision of the out-of-hours GP services lies with the NHS and with local GPs who decide to ‘opt out’.

  4. Thanks for clarifying these points.

    I’ll watch with interest how this develops.


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