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GP-led centres to take on 50% of A&E work under Darzi plan

By Gareth Iacobucci

New GP-led urgent care centres will be asked to take on up to half the workload of A&E departments under radical plans to shift the patient burden from secondary to primary care.

The proposals, unveiled this week under Lord Darzi's NHS review, are set to create a new 888 urgent care number for primary care as well as a major shake up of out-of-hours provision.

They also suggest Lord Darzi's controversial proposals to reshape the NHS in London will be used as a blueprint for national change, despite the health minister saying it will be up to each SHA to decide how to structure primary care.

The move could spark yet another national tendering process, pitting NHS providers against the private sector - this time to run a network of new GP-led urgent care centres based alongside A&E departments. The new tendering scramble will run alongside that for the polyclinics Lord Darzi has already ordered for every PCT.

The BMA has expressed fears that the urgent care centre plans could destroy the traditional ‘gatekeeper' role of the GP practice.

East of England SHA - the first to unveil its detailed plans under Lord Darzi's next stage review - is proposing a network of the new centres to divert 50% of patients away from A&E. Its proposals, published this week, also say out-of-hours services could be integrated into the new centres.

The centres will act as a gateway to emergency and urgent care, assessing patients and diverting them to the most appropriate service and treating those with minor injury or illness. Dr Robert Winter, clinical leader for Lord Darzi's review for East of England NHS, said urgent care centres would ‘allow A&E departments to provide better care for true blue light patients'.

Simon Wood, programme director for service reconfiguration for the SHA, said the first eight sites had been earmarked in Hertfordshire and the tender process would start this autumn. ‘The key thing is who is best placed to run them.' He said. ‘It could be PCTs, acute trusts or the private sector.'

Mr Wood added that the centres, like polyclinics, would house a mix of GPs, specialists and community staff but he added: ‘The link with out of hours is really important. We need to make sure servicers are as streamlined as possible.'

The SHA's report admitted shifting half of all patients away from A&E would be 'very challenging' but added: 'Experienced GPs will be our front line. They have the right skills to reduce the number of unnecessary referrals.'

It said a new three-digit urgent care number, provisionally earmarked as 888, would be used.

Plans for urgent care centres alongside A&E have already been proposed in London as part of Lord Darzi's NHS shake-up, with NHS managers in the capital suggesting up to 80% of A&E patients could be treated in primary care.

The BMA warned that the centres had the potential to sideline GP practices from the delivery of urgent care, adding that ‘ removing the urgent care element from general practice will lead to the traditional gatekeeper role being lost, which in turn could lead to an increased demand on healthcare services'.

It has also criticised plans for a single urgent care phone service, also mooted for London, saying it could cause confusion.

East of England SHA's move suggests that like polyclinics, Urgent Care Centres are set to roll out nationally, although Lord Darzi conininues to deny London is being used as a model, telling Pulse at the East of England launch it was up to individual SHA's how to meet his targets.

However, the Tories accused the Government of conducting a top-down review which would lead to the closure of A&E services.

Shadow Health Secretary Andrew Lansley said: 'There's no doubt that these changes aren't being driven by local communities; they're coming straight from Whitehall as a direct result of Lord Darzi's big top-down review.'

Dr Brian Balmer, chief executive of Essex LMCs, who was at the launch, said: ‘The principals are all fine but its rather idealised and secondary care driven.' Dr Brian Balmer, chief executive of Essex LMCs, who was at East of England NHS launch, said: ‘The principals are all fine but it's rather idealised and secondary care driven.'

Lord Darzi: plans to shift workload from A&E to GPs Lord Darzi: plans to shift workload from A&E to GPs East of England plans: BOX:

GP-led urgent care centres to take up to 50% of A&E workload

PCTs to develop incentives for GP practices to improve access

pilot introduction of patient-held budgets for people with long term conditions

GPs to take on more diagnostic work and be able to refer directly for

GPs to take on new pre-conception support role to help vulnerable groups of women, such as those with mental health problems or heart disease tackle childbirth issues, with proposal to make it part of GP national contract

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