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Consultants, not GPs, to blame for Shipman?

Your report of Weston Area NHS Trust's policy with respect to A&E discharge information raises some crucial issues which reflect wider aspects of the interface between emergency care and primary care (News, March 19).

UK emergency departments deal with some 200-250 patients per day, and the clinical data that constitutes the 'GP discharge summary' is captured at the point of disposition (ie, discharge or admission to an inpatient facility).

Faced with an average 9 per cent year-on-year rise in the attendance rates at emergency departments ­ all of whom must be assessed and managed within a nationally imposed time window ­ the amount of data that must be captured, coded and disseminated to primary care is relentlessly increasing.

The majority of emergency department patients present with straightforward, self-limiting problems that require little or no follow-up. A balance must be struck between failure to provide GPs with pertinent clinical data and information overload summarising even the most minor of presentations.

A dialogue is essential in every local health economy between the emergency department and the primary care team in order to establish a sensible compromise in relation to discharge information.

The role of enhanced IT is crucial here: secure shared web-based information holds promise, where GPs can access online hospital-generated summaries and paste any particularly relevant data into the patient's primary care notes.

As a matter of comment, Pulse's liberal use of the outdated term 'casualty department' bears little relation to what we try to be about in the 21st Century ­ the rapid assessment, stabilisation and early management of the critically-ill patient, with due care to those of lesser priority. What we cannot hope to do is to adequately manage the increasing proportion of out-of-hours primary care-related attendances that fill our waiting rooms at lunchtimes and evenings.

Dr Darren Kilroy

Consultant in Emergency Medicine, Stockport NHS Foundation Trust

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