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Independents' Day

Same-day GP appointments don't stop patients from going to A&E, research shows

Patients go to A&E even when offered a same-day GP appointment, a joint report by the Patients Association and the Royal College of Emergency Medicine has shown.

In a survey of 924 A&E attendees, they found that almost half of all patients who had sought a GP appointment before attending A&E had been offered a same-day appointment.

The report concluded the reasons why people attend A&E included convenience and the strength of the A&E ‘brand’ and that it was therefore ‘futile’ to try to discourage people from going.

It recommended that all hospitals move to co-locate GPs to work within A&E departments.

The survey found that nearly a quarter of attendees - which excluded those arriving by ambulance - had tried to see a GP first.

Out of these, almost half (45%) were offered an appointment within three hours of the telephone call; 36% were given a three-day wait; 17% two weeks and 2% ‘over a month’.

The report, titled Time to Act - Urgent Care and A&E, referred to data suggesting 43% of A&E departments currently have a co-located out-of-hours primary care facility, concluding its survey supported a national rollout of such arrangements.

The report said: ‘Such a facility allows patients to choose the A&E brand, decongests the emergency department and makes the best use of currently scarce out-of-hours GP resources.’

Dr Cliff Mann, president of the Royal College of Emergency Medicine, said: ‘Co-location of primary care services has previously been supported by many national organisations and the Keogh Review of Urgent and Emergency Care, but RCEM’s work has shown that in 60% of systems no such co-location exists. Co-location now needs to be implemented.’

The report comes six months after Monitor suggested GP out-of-hours services should be replaced by GP-fronted A&E departments.

In calling for co-location in a report released last summer, the Royal College of Emergency Medicine alongside three other colleges had argued that it was ‘unreasonable’ to expect patients to determine whether their illness is a minor condition or a serious or requiring an A&E visit.

NHS England has also backed the move, with many CCGs using their allocated winter money to place GPs in A&E departments.

However, NHS England admitted that the GP workforce crisis stood in the way of such initiatives, as GP co-location had meant there were not enough to staff out-of-hours shifts and NHS 111 call centres.

Readers' comments (10)

  • Err we've been saying this for ages.

    The hilarious thing is that many patients wait longer overall (3-4h wait), see someone more junior (ED SHO/ST2) and end up being sent away without the appropriate management that they would have received if they had seen the correct speciality (=GP).

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  • This is fundamentally about the value system we want to build the NHS on.

    HMG would love to co-locate us, hey, we could even become employees of the acute trust, perhaps under a single capitated financial model. And we could move to 7 day working and if we make it even easier to get seen at the hospital, and drown the GPs in more work too, both the acute and primary ends of the system will fall over at once and we can privatise it all in one big commercially tendered lot.

    oh, hang on a minute - they're doing all that sh*t to us anyway.

    If you want less people to turn up, rename your WIC/MIU as A&E and shift everything down the chain - make it harder to get in, not easier to get out.

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  • Vinci Ho

    Literally , 'you' need us 'everywhere'.
    A lie cannot be disguised as the truth and,
    The truth cannot be condemned as a lie .....

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  • Charging patients (administrative charge of even £10 per visit) who attend A&E could make a huge difference.

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  • Educate patients what A & E is actually for. A=accident E=emergency...doh...
    ...or are we changing the definition ?
    Tail wagging the dog springs to mind.

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  • shock horror, who would have known that. its not like we haven't told the ivory towers this numerous times. but any patient attending A+E is the GP's fault. baby seen yesterday in gp surgery seen in a+e in the evening and by peads later in the day. no change to management. Whose fault? the GP's, never the patients who have access to all things as and when they want it.

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  • Give people an all you can eat free at the point of access buffet and people gorge themselves until they are vomiting or until the buffet is gone.So be it.

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  • I recently had a very bad personal experience. I contacted the emergency out of hours GP after becoming acutely ill at the weekend. I made an appointment at my local emergency centre following a double consultation by telephone. I arrived for my appointment on time and 2 and a half hours later I was still waiting to be seen. In the end I left and went to A&e not because I was fed up with waiting but because my condition had rapidly deteriorated. I was rushed straight through at A& E due to my physical presentation and immediately received treatment including pain relief that I seriously needed. I was not the only patient at the GP centre that had deteriorated whilst I was there. One poor individual spent all of his wait going backwards and forwards to the toilet to vomit.Not once was he offered a sick bowl and I didn't witness any infection control procedures being followed. I was very ashamed to be a health care professional at that time. Therefore, we cannot always blame the patients. The service has to maintain it's accountability and professionalism.

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  • It is like this in NI - we GPs see over 90% of face to face consultations on 6% of the budget, and 25% each day are people waiting for months for secondary care appointments 2 years for Orthopaedics, 8 months for neurology.
    We GPs do far too much for the money. Next patient waiting on a waiting list goes straight to A+E.

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  • Seems sensible to have GP OOH located in A&E.With good triage at door. When I worked in WIC some of the problems were anything but minor.
    Both should be able to turn away things trivia and direct back to own GP.
    Otherwise will soon be swamped. Why does A&E not turn anything away?

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