Who do you call in an emergency???
With increasing access to health care professionals these days, along with parents who are better informed and more aware of childhood illnesses, it is no doubt that there is some confusion about who to call when your child is unwell.
Whether you are fortunate enough to be able to fund private health care (through work or self funding) or whether you only use NHS services, I discuss my thoughts on who to contact.
Before I begin, this post is aimed at parents who use the UK health system as this is the only system I have worked in.
I will touch on the main differences between NHS (National Health Service) care and private care first of all.
NHS hospitals are understaffed and under-resourced (trust me, I work for the NHS) BUT in an emergency, in my opinion, the care is the best.
This is because we prioritise emergencies. We are taught how to deal with emergencies extensively during training and throughout our working lives and for this reason, there are dedicated ‘emergency teams’ for most scenarios eg trauma team, cardiac arrest team, obstetric haemorrhage team, paediatric emergency team etc. You or your child will be triaged instantly and if a true emergency is at hand, EVERYTHING is available to you, nurses, doctors, pharmacists, investigations such as scans if needed, medications. All disciplines come together and offer their expertise to work together to address the problem.
During these times, I truly feel proud to be a part of the NHS. We are a ‘well oiled machine’ in an emergency, where we all have our roles and work together.
In private hospitals, if the relevant staff are present at the time you need them, your child will receive the same care. I say this because, most health care professionals have a duty to provide most of their time to the NHS. When their NHS duties are finished, they can then offer their skills to the private sector. Usually this is infrequent. When you attend a private hospital, you will be triaged and if the hospital is not equipped to deal with your emergency, you will be directed elsewhere. You will most likely be seen initially by a nurse and then he/she will assess the level of care your child would require. If you and your child do get turned away or told to go to another hospital, in my opinion that is a waste of valuable time…time that could have been spent with someone examining your child and arranging necessary tests.
If you are kept in the private hospital, you will often be seen first by a nurse or similar health care professional who will then take you straight to see the specialist in that field. That’s where private care may be viewed as better. You are most likely to see the specialist straight away with little to no waiting time. Some are reassured that they will be seeing the specialist who deals with that particular field and therefore their children are in the best hands. The SAME people who work in the NHS also work in the private sector. The myth that better doctors work in the private sector while the less able ones work in the NHS is just that, a myth. The very same doctors work in many other locations. If you already have a private paediatrician or specialist, you may be lucky enough to have their direct contact details and hence may be seen sooner by him/her directly should an emergency arise (I’m not sure if this also includes calling them at 3am!). That is not the case for the NHS. You will tend to see a different member of staff each time and may have to go through the history and details each time you go to hospital. If your private specialist has a commitment in his/her NHS hospital and cannot see you when you need him/her, he/she may direct you to somewhere else and in this scenario, one may perceive it to be the same as going anywhere else.
The other obvious difference is that you don’t have to pay to use services provided by the NHS while for private services you do and that is why (some people may have private insurance through their work), many consultants/specialists give you their direct contact details and more of a personal consultation.
The bottom line here is that private hospitals remove waiting times and you are more likely to directly see the specialist (if they are available that is!). These services are paid for by yourselves or through private medical insurance. In NHS hospitals, you will have to wait to be seen (sometimes hours) but will have access to ALL healthcare professionals, scans, treatments and services. You do not need to pay anything directly (if you work in the UK, part of your tax contribution goes towards funding the NHS).
The QUALITY of care in both sectors is the same. For true emergencies (see list below), I would strongly advise you to take your child to your nearest NHS A&E.
Let’s now move on to not so urgent matters. If your child has a symptom that you would like to be addressed and a consultation is all that you really need (eg onset of a cold, ear pain, nappy rash etc), you could see your GP who would and should be your first port of call, but if you are referred via the NHS, your wait to see a specialist will be at LEAST 6 weeks. By that time, your child may have gotten worse or the issue resolved on its own. This can be frustrating. GP surgeries offer same day telephone or face – to face consultations for children so utilise this service.
In the private sector, a consultation can even occur the very same day with the specialist and your questions may be answered straight away.
In order to get referred to see a specialist under the NHS, your GP (NHS GP) has to refer you. Some people get referred with no problem but some are told by their GPs that there is no need to be referred and the child can be dealt with in the community without the need for specialist services. This may not be what you wanted but sometimes it is the GP’s clinical choice to make that decision. If you have a private GP and you want to see a paediatrician for your child, it is very easy to get referred to see someone. You may only get asked if there is anyone in particular you would like to see.
Children can deteriorate very quickly and so any change in symptom or persisting problem (eg fever), should be checked again. No one will tell you off for taking your child to the doctor 10 times! What doctors cannot do is predict if something will get worse or turn into something more sinister. You may have taken your child to see the doctor for a fever that has persisted. The doctor can only examine and tell you what they think is going on AT THAT MOMENT in time. They cannot tell you if the child will develop a rash the following day or if they will start vomiting the following day etc. It is your duty to take them to see someone again if things change. If you can’t get a same day appointment and you are worried, go to the emergency department.
I have always mentioned in previous posts that YOU know your child the most and your instincts should always be given priority. If you feel something is not right and you have just seen the doctor, make another appointment or go and see someone else. This scenario more commonly occurs in children who have persistent fevers despite the usual measures to reduce their temperature. Subsequent visits to GP’s or even emergency departments, often see children being diagnosed with bacterial infections and being started on antibiotics. Diarrhoea and vomiting lasting longer than 5 -7 days usually gets most parents worried in the same fashion. It is advised not to take them to hospital due to risk of spreading the infection.
I will also touch on medical websites and apps. There are a number of apps where you can arrange an appointment to see a doctor at your convenience. I have personally never used any of these websites or apps but it is worth noting that usually all of these doctors are GP’s by profession and will offer the same service a private GP will. As far as I am aware, you cannot get for example an Orthopaedic Surgeon to come and see you at your home via these apps.
So who do you call in an emergency???
NHS Direct (dial 111 in the UK) is a good place to start if you just want some general advice where someone can help decide how urgent the matter is. They then usually advise you who to see to address the problem.
If your child has any of the following, take them straight to you nearest A&E (I would suggest NHS hospital A&E) or call 999 and wait for the paramedics to take you via ambulance:-
Drowsiness/poor body tone (floppy)
Non-blanching rash with fever
Head trauma followed by any change in behavior, personality or vomiting
Any kind of trauma/risk of broken bone
Difficulty in breathing (gasping for air)
Foreign body in ear, nose and throat
Any other symptoms would have to be based on individual cases. But I would suggest calling NHS Direct in the first instance and making an appointment to see your GP. If you cannot be seen within 24-48hours and you are still concerned, go straight to the emergency department. If you have the financial means to see someone privately and you think it can’t wait, try and see a specialist (via referral from a GP). If you have seen a specialist and are still concerned, go to your nearest emergency department. Seeing a doctor in a clinic, may not always be the most thorough of consultations and having the services of a hospital could be advantageous in some scenarios. Although the waiting times may be long, your child will be seen by several sets of eyes where anything that one person may have missed or not looked into, is more likely to get picked up.
If your child has an infection that is highly contagious eg chicken pox, conjunctivitis, diarrhoea and vomiting etc, please do not take them to hospital unless they are very unwell with it.
Below is a flow diagram which I have created in an attempt to try to simplify my babble. The left side of the diagram is the NHS route whilst the right side is the private route.
*You can also go to your nearest private hospital which have urgent care centres (similar to A&E) running until certain times, some may even be 24 hours but remember the limitations I discussed above.
The last topic I would like to mention is about going into hospital on weekends or if you happen to already be an inpatient in hospital over the weekend. With the NHS becoming a 7-day service, staff, resources and general services continue to operate as normal. However, if you are admitted to hospital on a Friday and are not discharged, there is a high chance you or your child will need further tests or perhaps an extended period of monitoring. Many specialized tests only occur on a Monday-Friday basis eg MRI scans, non-urgent endoscopies etc. This may mean that you have to stay in hospital over the weekend with nothing moving forward until the following Monday. Once that particular test is done, the next step is to wait for the test to be formally reported (usually happens later that day) and then the doctors will discuss the results with you the following day. If then, they would like to do more tests based on the previous test, this may mean another 24 hours in hospital at least. So you see, one could easily spend 5-6 days in hospital but only have 2 specialised investigations. To some patients, through my own experience, this makes it feel like a waste of time but via the NHS, several processes are occurring for things to move forward. It is slow and you are not the only patient. If you find yourself in this situation, be prepared for a slightly longer stay.
If you are only being monitored for a certain period of time and do not necessarily need any more investigations done, doctors who work over the weekend can review you or your child and there is a possibility of discharging you over the weekend (only if the doctor you see is senior enough to have the authority to discharge a patient).
If you are waiting to be seen by a paediatric gastroenterologist for example not just a general paediatrician, and you arrive in hospital late afternoon on a Friday, you may have to wait until the following Monday to be seen by the designated person. Not ALL doctors work ALL weekends. We operate in a shift system and if you are lucky enough to be admitted when that particular doctor is ‘on call’ then you don’t need to wait 48 hours to be seen and you may even be discharged that day or within 24 hours.
On the other hand, if you were admitted to a private hospital, you would generally be seen by the specialist straight away and they would arrange your hospital admission along with any necessary tests. These tests however would usually occur straight away, be reported straight away and you would have your answer in a few hours (delivered to you by your specialist). If you had to stay in longer than a day, the specialist would come in especially to see you or your child every day (regardless if it is a weekend or very late in the evening) as you will be under their named care. This is obviously a better process because the necessary tests occur in a more timely fashion and you will have continuity with who you are seeing. One may regard the obvious disadvantage being that if a bigger team is needed or if an emergency develops while you are in a private hospital and a specialised team is needed, you would then be rushed off to an NHS hospital as those specialised teams rarely exist in private hospitals. You will also be paying for each night’s stay, blood test, scan, medication, operation etc. It can amount to tens of thousands of pounds.
So here, I have shared with you a few insider bits of knowledge that I have learned over the years. As a patient and mother, I too face similar situations when my children are unwell and knowing the system makes it much easier for me. I try to help my friends and family by informing them of the above too and thought, why not share it with you, you too are my friends! Hopefully, this has helped a little when you are faced with the need to obtain health advice for any particular reason.
Let me know what your thoughts are, speak very soon in my next post!