Criticisms of NHS Direct ignore its good points

I read Dr Chris Lancelot's piece on NHS Direct with interest and a sense of recognition.

However, I was sad to see his ignorance of what NHS Direct is and does (GP, 7 March).

He is not alone in that, and I have been pointing out the lack of engagement (or even PR) with GPs and others in the NHS front line for the five years I've worked as a part-time medical adviser to NHS Direct (and part-time GP).

I hope that the proposed extension of GP training to include exposure to the workings of our service will do for future GPs' knowledge of NHS Direct what the foundation year two in general practice will achieve for future hospital consultants - an understanding of what colleagues in another part of the NHS actually do and the responsibilities they bear.

NHS Direct has two functions, both complementary to primary care: firstly, it provides a comprehensive source of information about health and health services via digital TV, the website and the telephone.

Secondly, it acts as a telephone advice service for symptomatic callers, which is how most GPs think of it.

What GPs don't know is that the majority of health advice calls end with self-care advice - with 7 million calls a year, it would be worrying if '70 per cent' were sent to see their GPs as Dr Lancelot claims.

Some callers need urgent attention, and their needs are dealt with by direct transfer to the ambulance service without the delay of formal nurse assessment.

The goal of an NHS Direct nurse assessment is not a diagnosis, but the best advice for the patient on what to do next.

Patients may not want to struggle to speak to a GP or out-of-hours doctor about what may objectively be a trivial matter, but is important to them.

Likewise, they don't necessarily know what constitutes a genuine medical need and value a source of advice on how to deal with their problem.

NHS Direct nurse advisers are nurses first and foremost. They are trained to use their expertise to decide the right outcome for a call, sometimes overriding the advice offered by the software - a bit like GPs sitting at their consulting room computers and not mindlessly doing whatever the screen tells them however inappropriate in the particular consultation.

Please don't belittle a hard-working and dedicated group of fellow toilers in the NHS.

Dr Ewan Gerard, national adviser in public health, NHS Direct.

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