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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.

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Readers' comments (24)

  • I sort of thought this was going to happen when I left NHS and emigrated. Not surprised and the same thing is happening out here in Australia. Probably a world wide phenomenon to some extent though I must say the anguish expressed in these posts seems pretty severe! Ouch! I feel for you.

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  • Anon@10.26
    Free at the point of NEED is probably still workable; it's free at the point of "want" that requires a rethink if we want to maintain the former.

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  • neat summation. Lawrence, you forgot to mention the equally awful NHSD, which despite manned by Nurses, used to send upwards of 30% to A & E. Computer decision software cannot replace risky decision amking of complex biopsychosocial presentations and the easy default? A & E!

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  • Our local A+E, has been in the worst 3 performing in country over the winter, yet CQC have just inspected it and given it a 'good' rating (shows you the kind of job they do). But A+E used to phone us to send 'gp' patients back to us for appointments, they stopped doing this 4-5months ago. Seems to be a bit of a political game being played, and almost stoking the fires!

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