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Independents' Day

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)

  • Drachula

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

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  • Absolutely correct analysis,

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  • Vinci Ho

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

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

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

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  • 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."

    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?"

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  • 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.

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  • 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.

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  • Brilliant analysis ! Accurate ! Superb !

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  • Excellent reflection, and 100% true.

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