This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

Gold, incentives and meh

Four myths about GPs' role in the A&E crisis

Dr Laurence Buckman explains why GPs shouldn’t be taking the slack

GPs are being blamed for a crisis in A&E that has not been caused by our profession. Managers are expecting us to jump to deal with the problems - for instance by asking us to offer extended opening hours to cope with demand in emergency departments back at Christmas, and in January to step in to staff ambulances to cover striking workers.

But if this carries on, there will be another crisis in the NHS when all of its GPs walk out.

We need to devote more energy to knocking the constant anti-GP rhetoric that’s directed at us by the press and Parliament. So here are some common myths about our role in the crisis, busted.

1 GPs can stop people going to A&E

The only way a GP can stop someone who has already decided to go to A&E from doing so is by lying across the doorway of the hospital and physically preventing entry. It takes longer to deter possibly sick people than it does to see them. This is probably the reason why many GPs who work in A&E are alleged to ‘go native’ if they stay there long enough, and then admit ‘too many people’.

2 GPs keep sending patients to A&E

Critics have repeatedly claimed that that A&E is full of minor and major complaints because GPs are not available at night and weekends (despite a flourishing GP co-op movement). This is clearly not the case. A&E is clogged up with problems that could be dealt with elsewhere for reasons that have nothing to do with GPs.

For instance, NHS 111 was introduced against GPs’ advice and has damaged co-ops badly as well as sending far too many to hospital - as we predicted. This is backed up by the president of the College of Emergency Medicine, who told MPs that the service was responsible for almost the full increase in A&E attendances in the last year.

And effectively closing social services has resulted in the homes that are left sending very sick older people to A&E, as well as them not having enough beds to take back those who are well enough to be discharged.

3 Patients can’t get appointments with GPs, so they go to A&E instead

There is a widely held misconception about our staff and appointment availability. Patients claim that they cannot get timely appointments, but most practices employ staff who fall over backwards to help patients as soon as possible. Indeed, many doctors who work in A&E tell me that when they call practices on behalf of patients who have claimed they couldn’t be seen by their GP, they can almost always get an appointment.

Many patients use A&E because they think it’s the only place they can get help out of hours. We should be encouraging patients to try to contact their pharmacy or us before they make the fruitless trek to A&E for non-emergency matters.

4 The A&E crisis is something new

Around the millennium, it was clear that general practitioners were running out of steam and leaving the profession.

So the Labour government agreed to a new contract, which included a large sweetener in the form of stopping out-of-hours for a pay cut. Almost all GPs jumped at the chance.

The crisis in the NHS was with us then and has worsened, as cuts to per-capita funding, thoughtless imposed ideas, and the decimating of social services have taken hold. Population growth hammered the final nail in the coffin and we are yet again rearranging the deck chairs on the NHS Titanic.

We will all be drowning while the fools who made this happen bask in well-earned directorships of private medical businesses.

You see, we can play the blame game too.

Dr Laurence Buckman is a former chair of the GPC and a GP in north-west London.

Rate this article  (4.73 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (24)

  • Drachula

    We could start turning people away at the doors when they shouldn't be there.....

    Unsuitable or offensive? Report this comment

  • Absolutely correct analysis,

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    Very rarely hear anything from Laurence these days on this platform
    Good arguments to put forward.

    Unsuitable or offensive? Report this comment

  • I can't quite work out if the second to last paragraph is referring to Dr John Chisholm and Dr Simon Fradd or not.

    Unsuitable or offensive? Report this comment

  • Its good to finally hear from a BMA member I respect.

    Unsuitable or offensive? Report this comment

  • Good piece from Bob Gill of NHAP on these issues - "Behind yet more spin of 'more power to GPs', the scary truth is of a profession being steadily dismantled to make way for the unfettered free market."
    https://www.opendemocracy.net/ournhs/bob-gill/what%E2%80%99s-happening-to-my-local-gp-carrots-sticks-and-long-game-of-nhs-privatisation.

    Also Caroline Molloy's piece focussing on A&E on OD well worth a read looking at cuts to services -
    "What's really causing the A&E crisis?"

    Unsuitable or offensive? Report this comment

  • We GPs in NI see 90% of all face to face NHS consultations on 6% !!!! of the budget.
    Of course they want us to see 100% - it would only cost 6.67% of the current budget.
    Joking aside , how much do these people want? We already see patients 6.9 times a year for £ 59.
    Actually, 25 % of my daily appointments is people waiting fro secondary care experiencing problems that should have been dealt with long ago.
    To add insult to injury 5% of my consultations are people who should be at A+E but aren't because of having to wait 12 hours.
    To be blunt, they can blame away. They are not getting any more for 6%. In fact, they may have to pay a lot more in the future if we find our testicles, which the spineless GPC may eventually do, for they know GP land is on the brink of disappearing.

    Unsuitable or offensive? Report this comment

  • eventually the straw will break the camel's back, and the max exodus we all know is coming will be upon the UK. I wonder then will the Government finally admit they haven't got a clue.

    Unsuitable or offensive? Report this comment

  • Brilliant analysis ! Accurate ! Superb !

    Unsuitable or offensive? Report this comment

  • Excellent reflection, and 100% true.

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    You see . (3) was well stirred up by Agent *unt when he admitted taking his children to A/E without attempting to see his GP. The act was deliberate and provocative . Not picking up a fight with GPs? Kiss my ****!

    Unsuitable or offensive? Report this comment

  • For instance, NHS 111 was introduced against GPs’ advice and has damaged co-ops badly as well as sending far too many to hospital - as we predicted. This is backed up by the president of the College of Emergency Medicine, who told MPs that the service was responsible for almost the full increase in A&E attendances in the last year.

    You can't blame GPs for this crisis when the real culprit is the government, but they will never stand up and admitt their mistake!
    NHS 111 staff work hard every day/night, but they can only work with the system they have got!
    NHS Direct gave self care advice to encourage people to stay away from services when appropriate and safe.
    NHS 111 directs people to services and sometimes gives self care if you are lucky enough to get through to a nurse!

    Unsuitable or offensive? Report this comment

  • Come back Laurence, we need U.

    Unsuitable or offensive? Report this comment

  • Very good analysis, NHS England will be short of GPs soon if it carries on like this.

    Unsuitable or offensive? Report this comment

  • I have been threatened by some patients, that if they cannot get an appointment TODAY, they will go to A&E. These are patients who:

    Have had the problem several days or even weeks.

    Have not kept previous appointments for e.g. an asthma review, then complain they are an emergency because run out of inhalers.

    We, in my view, need someone in A&E telling these people what is what is not an emergency instead of leading the general public to believe that everything they want they should get, even when they clearly abuse the system and that the are "the centre" of care and the Universe.

    It all reminds me of advanced life support in disaster event training when we should go to the quiet ones first because those that shout the loudest are at least alive.

    In our present system, it seems those who do not push the right buttons do not get the care and those that threaten do.

    Unsuitable or offensive? Report this comment

  • Took Early Retirement

    Unfortunately, though I am sure he is a nice chap, his tenure at the BMA was punctuated by the same spinelessness that we have now.

    Remember when Gordon Brown imposed additional hours with no extra money? The BMA's response was the (in)famous ballot whose questions were, "Are you unhappy with this or VERY unhappy with this?"

    Unsuitable or offensive? Report this comment

  • Introduce charges and watch the workload crisis vanish overnight.

    Unsuitable or offensive? Report this comment

  • I appreciate Laurence's analysis, but he misses the issue of scale. It is alleged that 40% of our local ED attendances could have been managed in primary care. That's 200, amongst 120 practices. 1-2 patients per practice. Even if you PAID patients to go GPs rather than ED, it would scarcely dent these figures.

    This is nothing new. Patients will always go where the lights are on. Whatever offers the path of least resistance form their perspective.

    I have always apposed patient co-payments as being an inefficient way to fund healthcare, but now wonder whether this should be reconsidered in view of managing / influencing spiralling demand?

    Unsuitable or offensive? Report this comment

  • @3.21pm - you're absolutely right. Charges for A&E and GP would make the punters value the service just a bit, reduce frivolous abuse of the system, and prevent the NHS collapsing under the weight of demand. But no politician would have the cohones to deal with the sacred cow.

    Unsuitable or offensive? Report this comment

  • One minute we're campaigning FOR the free at the point of use model and that we need to keep the NHS out of the hands of the nasty Private companies greedy little hands and the next minute the "privatised" General Practitioners are saying lets charge the masses for their care that will stop them coming.

    Cake and eat it springs to mind!!!!

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say