Kyle Robert Brown

However given the important fact here that Miss Thomson in her call clearly indicated that the rash was of a bruising nature, that is to say involving comparatively large areas, rather than small spots, and given Dr Freeman’s evidence that concerned callers were likely to speak of bruises rather than rashes if that is what they looked like, I think further consideration should be given to altering the routing tool to recognise this.

While I can see that in certain circumstances there will be present a key symptom which is effectively the governing one, I think that consideration should be given by NHS 24 to provide for situations in which a combination of symptoms, each of a lower significance, elevates the gravity of the call.

What one has to bear in mind, I think, is that the call handler should be provided with a tool which as near as possible puts him in the position of a general practitioner seeing a patient face to face from the point of view of recognising not necessarily a particular illness, but certainly its potential gravity.

I did not really understand why this should be so and consider that it is appropriate that further consideration be given by NHS 24 to this matter.

As well as additional training, which in my view was clearly necessary, the question was also raised as to whether or not nurses in Miss Nisbet’s position should be encouraged to seek a second opinion from a team leader if they are not going to take immediate action.

I consider that it is appropriate that this should be included in any training.

However I think it important that NHS 24 if it has not already done so, should consider which illnesses which are likely to be reported and the significant indicators which properly arouse suspicion to such an extent that emergency treatment is appropriate and that the result of such consideration is that the routing tool is made to reflect this.