Senior community nurses are to be sent as “first responders” to some 999 calls in part of the North East, after problems with long waits for ambulances over the winter that have left older people lying on the floor in pain.
Under the plan, community matrons and GPs will be sent to offer support and pain relief to older patients who have fallen and who cannot be reached by an ambulance in less than an hour.
“No clinician wants to think of an elderly person lying in pain like that”
The move is expected to come into effect at the end of this week and will apply to community and primary care staff in areas under the control of County Durham’s two clinical commissioning groups.
Dr Stewart Findlay, chief clinical officer for Durham Dales, Easington and Sedgefield Clinical Commissioning Group, said the idea was not about replacing ambulances with nurses and doctors and would only be used in “a fairly rare number of cases”.
The scheme is being introduced because of the huge pressure that the ambulance service in the North East has come under recently, he told Nursing Times.
“This year we’ve had issues around ambulance response times,” he said. “We’ve had a few cases of elderly people lying on the floor waiting three, four or five hours. No clinician wants to think of an elderly person lying in pain like that.”
The ambulance service had to prioritise the most urgent cases, Dr Findlay noted. The new scheme would apply only in non-life threatening cases when an elderly person has a fall at home and the ambulance cannot get there in under an hour, he said.
Instead a community matron or GP will be first on the scene to do an assessment, offer pain relief and provide support until the ambulance arrives, he added.
“The use of nurses as frontline staff may cause further pressures on an already stretched NHS”
A separate email from the CCGs, which outlined the plan, said: “We have had some tragic cases where people have been left lying on the floor at home with a serious fracture and no pain relief.”
The email blamed slow ambulance response times on “inappropriate 999 calls” and vehicles having to queue outside A&E because of a lack of capacity to move patients into hospital, according to The Independent.
As a result, the emails said senior community nurses and nurses specialised in supporting elderly and vulnerable patients would now “act as first responders for patients who have fallen in their own homes or residential homes”.
It added that GPs would also be asked to “provide analgesia on rare occasions” and included advice from an A&E consultant on what pain relief could be safely administered to patients with a fracture.
But Dr Nichola Ashby, professional lead for acute and emergency care at the Royal College of Nursing, warned that using nurses in such a way might increase pressure elsewhere.
“Whilst the established ‘first responder’ initiative supports rural areas throughout the UK, the use of nurses as frontline staff may cause further pressures on an already stretched NHS,” she said.
Dr Ashby noted that specific trained skills would be required in patient assessment, medicine prescription and administration to “ensure patient care was delivered appropriately, safely and in a timely manner”.
“The implementation of nurse support for the first responders is indicative of a service which is already reaching its capacity and it would be more appropriate to address the trained staff deficit within it,” she told Nursing Times.
“Nurses are already working to maximum capacity within their community and NHS places of work – this would increase the stress on emergency care through a reduction of trained staff available,” she said.
She added: “Patient care is paramount to NHS staff and this supports the need for further employment and training to increase staff availability and support for urgent care within the community.”
In contrast, the British Medical Association welcomed the idea of using nurses as first responders when ambulances were slow to arrive. But the body questioned the idea – mentioned in the email – that morphine could be used to treat elderly people on the spot.
“It should only be done with full facilities for continuous observation and respiratory support should it be required,” said Dr Andrew Green, who leads on clinical issues for the BMA. “This is unlikely to be available so safer alternatives should be considered.”
Labour health spokesman Jonathan Ashworth reacted by saying the NHS was being forced into “desperate measures”.