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At the heart of general practice since 1960

GP study doubts lung Ca advice

We read with amazement Dr Choudary's scathing attack on casualty units (Letters, November 8).

In his letter he says excessive hospital referrals 'may have something to do with the quality of care given in casualty units'. He goes on to say: 'Patients who have not been adequately investigated and treated will need to be referred back.'

Does he mean referred back to A&E? The role of A&E is to treat patients who have suffered recent injuries or who have emergency conditions that require emergency assessment and treatment.

The role is not to take over the care and investigation of chronic problems. However, it is inevitable that more chronic problems will present at A&E. It is difficult to assess these patients without access to their full past medical history and access to previous outpatient letters and so on.

It is therefore often the case that these patients are assessed and investigated to ensure there has been no deterioration or development of a new problem and then referred

back to the GP, who is in a much stronger position to continue long term management, which may include referring to an appropriate specialist.

If it is apparent from the A&E attendance that outpatient referral is necessary and the A&E staff feel there is sufficient background information, then in our experience, that referral is made from A&E.

Dr Choudary later makes the point that 'we already see many patients who should have attended casualty but because of excessive waiting time insist on coming to the surgery instead'.

With the new four-hour target, it is rare for a patient to have an excessive wait. If a patient is well enough to attend A&E but decides the wait is too long, and so leaves A&E and books an appointment to see their own GP, I wonder if this may be a more appropriate place for the patient in the first place?

On the other side of the coin many patients attend A&E saying they couldn't get an appointment with, or didn't want to bother, their GP!

There is always going to be an overlap between general practice and A&E, and we have to accept that A&E-type patients will attend their GPs' surgeries on some occasions, just as patients with primary care-type problems will attend A&E.

A&E and local GPs need to understand each others' strengths and weaknesses, and work together acting in the patients' best interests. Creating (or reinforcing) a them-and-us situation will only be detrimental to patient care.

Dr A Pountney,

A&E SpR

Dr R Pountney,

salaried GP

Yorkshire

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