I totally agree with your editorial about the new QOF points for reducing avoidable visits to A&E.
A&E visits are beyond GPs' control
These have been brought in even though Pulse's valuable survey suggests overwhelming opposition from GPs.
A&E attendances are beyond our control not only because of the location of the hospital, but also because of the impression that patients can get that service easily due to its quick accessibility.
Making a reduction in A&E visits part of the QOF will not only make it a paper-chasing exercise, but will be futile – just look at the failure of advance access.
Currently, we have raised expectations and a demand-led culture through Darzi centres, NHS Direct, walk-in centres and privately run out-of-hours services which invariably ask patients to see their GP the following day. With further change looming with the 111 urgent care number, which is going to make things worse, who is responsible for educating and changing the culture of these services and the patients who use them?
Our first duty as a GP is to provide quality and treat the patient, not the targets. We should ensure that these decisions are informed by quality and not cost.
I have no doubt that capacity and access to primary care will get more challenging due to lack of manpower and people turned away from A&E departments who are sent to primary care, where we may not be able to see them in the timeframe which may be required.
There may be cases where a patient is sent back and cannot be seen as urgently in primary care, due to a lack of communication from secondary care.
Until our health secretary follows his ethos of ‘no decision about me, without me', goes to the public and explains why they cannot attend A&E, we certainly do not have any control over attendances under the present limited resources.
From Dr Krishna Chaturvedi
Southend-on-Sea, Essex
