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BMA survey finds vast majority of A&E doctors blame GP contract for their rising workload

Out-of-hours move hits A&E

By Christian Duffin

Accident and emergency doctors blame changes to GP out-of-hours services since the new GMS contract for their spiralling workload.

In a BMA survey, 95 per cent of A&E doctors said their workload had increased since January 2004. Of these, 89 per cent said the fact many GPs had given up 24-hour responsibility was a key reason.

Four in 10 of the 476 doctors surveyed said an increase in

direct referrals to A&E by GPs had also contributed to the extra workload.

Martin Shalley, president of the British Association for Emergency Medicine and co-

author of the Emergency Medicine report, said A&E doctors blamed PCTs for shortcomings in out-of-hours services rather than GPs.

He said: 'There was a perception among emergency medical doctors that many PCTs had

not provided adequate out-of-hours cover for their local communities.'

Don MacKechnie, BMA A&E committee chair, said: 'The real issue is one of education. There have been many new services

introduced to treat patients with unscheduled medical problems – walk-in centres, new out-of-hours arrangements and NHS Direct. Everywhere is so different so it is no wonder that there is confusion.'

GPs said the rise in the numbers attending A&E was down to a lack of public information about the availability of primary care out-of-hours services.

GP out-of--hours services mostly worked well with A&E departments, they added.

Dr Prasad Rao, a GP in Stoke-on-Trent with a special interest in out-of-hours care, said the government should fund TV

advertising campaigns advising patients of alternatives to A&E.

He said: 'People should stop blaming GPs. Maybe we should not publicise the fact that waiting times are lower than four hours at some hospitals. It encourages patients to go there – they are not stupid.'

Dr Jeremy Lade, a GP and medical director of WestCall out-of-hours service in Berkshire, said out-of-hours services based in hospitals could help A&E. WestCall is based at Royal Berkshire Hospital, Reading.

Dr Lade said: 'There is no evidence here that increased A&E workloads are down to out-of-hours services. We have an agreement to help A&E when they are busy. We would not

see patients with, say, acute chest pains or fractures. It works well – we send patients to A&E sometimes.'

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