Potential emergencies may be overlooked by the NHS Direct system according to a survey published Tuesday by the Consumers' Association.
Health Which?found that in three test cases based on everyday medical problems, a dangerous amount of inconsistent advice was given over the helplines. Nurses manning NHS Direct were found incapable of listening properly to the patient's problem, being over-reliant on computer cues and failing to detect life-threatening situations.
"There must be a balance between drawing on the skills of nurses, and ensuring that advice is consistent and sound," says Sally Williams, principal researcher for Health Which?.
In one of the test cases a 60-year-old woman called Margaret was suffering from chronic stomach pain almost certainly caused by pills she had been taking for neck pain. Seven times out of ten she wasn't advised to stop taking them, and one nurse was criticised for seeming 'obsessed' with checking that Margaret wasn't suffering from a heart attack.
Only three times out of a total of 30 calls did NHS Direct ask for the name and address of each researcher's GP, and not once did they actually go on to contact that GP. Dr John Chisholm at the British Medical Association (BMA) argues that "it is vital that a nurse from NHS Direct speaks to a GP and doesn't rely on email or telephone messages -- this is no substitute for person to person contact".
The NHS Direct Web site does not contain a prompt for directing a patient to the option of consulting a GP.
The Department of Health is adamant that NHS Direct is not intended to replace doctors, but rather to provide another point of access to health information. It accuses the Health Which? study of being seriously flawed.
"Independent research shows that it is successful and working well," says a spokeswoman. This claim is backed up by the director of Southampton University Health Care Research Unit Steve George.
"A serious flaw in methodology in the Health Which? article is that it fails to compare the consistency of advice offered by NHS Direct with the advice available from other services," he says.
The NHS Direct hotline launched in 1998, with the Web site following in December 1999. It was widely hailed as Tony Blair's first step towards the rollout of his e-government venture. It is planned to put all government services online by 2005.
The site receives over 100,000 hits a day, providing advice to two-thirds of the country's population with the national rollout planned for October.
"The jury is still out," says Chisholm. "The place of NHS Direct is yet to be proven -- we need to carry on evaluating the appropriateness with which people use it. Older people are wary of using the service and would rather take the traditional route, as they are intimidated by the new technology."