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| Cornwall out-of-hours case study: Eve Tonkin | Cornwall out-of-hours case study: Eve Tonkin |
| (about 17 hours later) | |
| The night of 14-15 February is seared on Bob Tonkin's memory. Eve, his love of 35 years, wife for 27 of them, and mother to his five sons, was terminally ill with cancer. They both wanted her to be cared for at home as she died, and in that their wishes coincided with government policy. | The night of 14-15 February is seared on Bob Tonkin's memory. Eve, his love of 35 years, wife for 27 of them, and mother to his five sons, was terminally ill with cancer. They both wanted her to be cared for at home as she died, and in that their wishes coincided with government policy. |
| But the shunt that had been inserted into her brain to relieve pressure caused by secondary tumours had become blocked. She was distressed, losing movement in her hands and legs and unable to speak properly. Bob says he knew she needed a doctor to come out to them urgently in Leedstown, their village in the middle of rural Cornwall, because it had happened before. He had faithfully accompanied her through every appointment and treatment and understood the stages of her suffering and its symptoms inside out. | But the shunt that had been inserted into her brain to relieve pressure caused by secondary tumours had become blocked. She was distressed, losing movement in her hands and legs and unable to speak properly. Bob says he knew she needed a doctor to come out to them urgently in Leedstown, their village in the middle of rural Cornwall, because it had happened before. He had faithfully accompanied her through every appointment and treatment and understood the stages of her suffering and its symptoms inside out. |
| He remembers ringing the out-of-hours GP service run under a privatised contract by Serco for the local primary care trust at around 7.40pm. He was warned it could be a six-hour wait despite his assessment of the urgency of the problem because it was so busy, but then so was the A&E department a long drive away. | He remembers ringing the out-of-hours GP service run under a privatised contract by Serco for the local primary care trust at around 7.40pm. He was warned it could be a six-hour wait despite his assessment of the urgency of the problem because it was so busy, but then so was the A&E department a long drive away. |
| "We sat and waited and waited. I phoned again to say again how serious it was, and then I waited and waited, and phoned again and kept being told 'they should be there soon'. Then they finally rang to say the doctor was on his way around 2am but coming from the Lizard area. I knew that would take another 40mins or more. He got to us at last at 2.50am. I remember it clearly." | "We sat and waited and waited. I phoned again to say again how serious it was, and then I waited and waited, and phoned again and kept being told 'they should be there soon'. Then they finally rang to say the doctor was on his way around 2am but coming from the Lizard area. I knew that would take another 40mins or more. He got to us at last at 2.50am. I remember it clearly." |
| Serco's logs for the night, seen by the Guardian, show the call was booked at 20.01, the point at which a clinician in the Serco call centre had assessed it, and then Serco set the clock ticking that requires it to meet target times under its contract and national standards. The call was given the lowest priority for home visits of "less than six hours"; and a deadline of before 2.01. The doctor arrived at 2.30 according to the log, half an hour after the limit, or three-quarters of an hour after it, according to Tonkin. | Serco's logs for the night, seen by the Guardian, show the call was booked at 20.01, the point at which a clinician in the Serco call centre had assessed it, and then Serco set the clock ticking that requires it to meet target times under its contract and national standards. The call was given the lowest priority for home visits of "less than six hours"; and a deadline of before 2.01. The doctor arrived at 2.30 according to the log, half an hour after the limit, or three-quarters of an hour after it, according to Tonkin. |
| Tonkin says the doctor who arrived was "first class, very embarrassed at the wait and apologetic that the call had not been given more urgent priority, but explained that he was the only GP in the service in a car west of Bodmin that night", with two-thirds of the county to cover. | Tonkin says the doctor who arrived was "first class, very embarrassed at the wait and apologetic that the call had not been given more urgent priority, but explained that he was the only GP in the service in a car west of Bodmin that night", with two-thirds of the county to cover. |
| Sources have told the Guardian that because several shifts were unfilled that night, the clinician and car that should have been covering Penzance home visits was also having to cover other areas across the county for part of the evening. He was covering clinics for the Penzance and Camborne/Redruth areas for some time, as well as covering for the Helston and Truro cars. Several calls that had been given more urgent priority than Tonkin's, needing a home visit in less than two hours, also missed their target times that night. Sources also allege that it is not the only time in the last year that only one or only two doctors have been left covering most of the county. | |
| Serco denies that there have ever been occasions when only one or two GPs were available to cover the county. It says that while the clinic for Camborne was closed that night, there were four GPs covering west Cornwall until midnight, and that the area was also fully staffed after this time until 8am the next morning. Serco said that while there are fluctuations in demand, it meets its contractual requirement to respond to patient's needs in set timeframes as measured monthly against national standards required by the Department of Health. | |
| The primary care trust that awarded the contract to Serco for out-of-hours services in Cornwall said: "We are confident the service is adequately resourced and meeting the required national quality standards." Patient surveys show a high level of satisfaction with the service, the trust added. | The primary care trust that awarded the contract to Serco for out-of-hours services in Cornwall said: "We are confident the service is adequately resourced and meeting the required national quality standards." Patient surveys show a high level of satisfaction with the service, the trust added. |
| Tonkin, a probation officer and professional international rugby coach, is however appalled by the contrast, as he sees it, between the NHS, "which was superb throughout, I don't believe we would have got better treatment anywhere in the world", and the privatised out-of-hours service. The family GP insisted after that night that the Tonkins contact him direct on his personal mobile when they needed help day or night. But Tonkin felt so angry he went on Radio Cornwall to complain. | Tonkin, a probation officer and professional international rugby coach, is however appalled by the contrast, as he sees it, between the NHS, "which was superb throughout, I don't believe we would have got better treatment anywhere in the world", and the privatised out-of-hours service. The family GP insisted after that night that the Tonkins contact him direct on his personal mobile when they needed help day or night. But Tonkin felt so angry he went on Radio Cornwall to complain. |
| "How is private better, I just don't get it? It was a really harrowing time those last weeks, and that night and the Serco thing really bothered me," he said. A month later on 15 March, having written long letters to each of her boys about her hopes for their futures, Eve died at home, aged 51. "She died in my arms," Tonkin said. "I spray her perfume on my pillow each night … I haven't picked up her ashes yet, I can't face it." | "How is private better, I just don't get it? It was a really harrowing time those last weeks, and that night and the Serco thing really bothered me," he said. A month later on 15 March, having written long letters to each of her boys about her hopes for their futures, Eve died at home, aged 51. "She died in my arms," Tonkin said. "I spray her perfume on my pillow each night … I haven't picked up her ashes yet, I can't face it." |
| Also waiting for Bob to find the strength for, in papers that have piled up since her death, is a letter from Serco, addressed to Eve together with a questionnaire to fill in about the standard of her service. "We are very keen to maintain a high quality service and we ask randomly selected patients for comments about the way their call was handled." Tonkin laughed as he read it out, because otherwise the pain would be just too great to bear. | Also waiting for Bob to find the strength for, in papers that have piled up since her death, is a letter from Serco, addressed to Eve together with a questionnaire to fill in about the standard of her service. "We are very keen to maintain a high quality service and we ask randomly selected patients for comments about the way their call was handled." Tonkin laughed as he read it out, because otherwise the pain would be just too great to bear. |
| • Have you been affected by changes to out-of-hours GP services in Cornwall? Contact felicity.lawrence@guardian.co.uk to share your experiences | • Have you been affected by changes to out-of-hours GP services in Cornwall? Contact felicity.lawrence@guardian.co.uk to share your experiences |
| • Are NHS services where you live being put out to tender? Help us build a picture of what's happening to the health service by filling out this form | • Are NHS services where you live being put out to tender? Help us build a picture of what's happening to the health service by filling out this form |
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