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Independents' Day

GPs not to blame for pressure on A&E, says NHS England adviser

Exclusive GPs are not to blame for the rising pressure on A&E departments as figures show that attendance at emergency departments is ‘stable’, an NHS England adviser taking part in its emergency care review has said.

Dr Agnelo Fernandes, the RCGP’s urgent care lead who sits on NHS England’s Emergency Care Review, speaking in a personal capacity, said that A&E attendance figures have remained flat over the decade, and the reason for an apparent increase in attendance is due to a change in recording figures and ‘risk-averse’ junior doctors.

Health secretary Jeremy Hunt has claimed there is a crisis in emergency care, and has blamed this on ‘poor primary care provision’ created through the ‘disastrous’ 2003/04 contract, resulting in an additional four million attendances at A&E departments.

But the latest NHS England figures show that while A&E performance ‘deteriorated significantly’ in the last quarter of 2012/13, attendance figures were 1.7% lower year-on-year.

The NHS governing body found that there was ‘no single trend or factor’ to explain the deterioration in A&E departments, despite Government ministers’ claims.

An analysis published by the King’s Fund showed that the jump in A&E attendances in 2003/04 was largely due to a change in the ‘data series’ used, smaller walk-in and minor injuries unit attendance included together with specialist emergency departments from that time in official figures.

Dr Fernandes - who is sitting on the review into emergency and urgent care being led by NHS medical director Sir Bruce Keogh that will look at whether GPs should take back out-of-hours care - told Pulse that emergency attendances have remained flat and Mr Hunt’s claims that they are the cause of the problems in A&E departments are wrong.

He said: ‘The fact is that A&E attendance has not gone up. It is stable. If anything, if it has changed, it may have gone up 1% or 2% in England.’

‘It is almost a flat graph over the last ten years. From 2002-03, they started counted the figures differently. What is included in the figures now is walk-in centres, minor injuries units, etc.’

He said that the real problem with the pressure on emergency departments lay with a lack of expertise and rising emergency admissions, and that this was not GP’s fault.

He said: ‘The decision to admit is not a GPs’ decision but the hospital doctors. The crisis is that they don’t have enough A&E consultants.’

‘You have A&E departments run by juniors and locums. What happens then is that they are more risk-averse and they admit.’

Dr Fernandes’ comments come after the chief executive of the NHS Confederation, Mike Farrar, said the past few months had been the ‘toughest many of us in the NHS can remember’.

He also said that GPs were not solely to blame: ‘The key thing is to understand that A&E doesn’t stand alone - pressure in our A&E departments is a visible symptom of a whole system under great strain and tackling it requires a whole-system solution.’


Readers' comments (24)

  • If they haven't had an accident or suffer from an emergency tell them to b***** o** SIMPLES!

    Any more problems to solve?

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  • Surely this is a success story Mr Junt should be proud of. Cas Depts are obviously providing such a good service that consumers are queuing up to use it!

    They should be rewarded for being so popular!

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  • WAKE UP - the politicians are not interested in correct stats -they have an agenda and that is privatisation of the NHS . GP's are an obstacle and this is a great smear story . Wait until commissioners start rationing then we'll see spin like those money grabbing GP's are paying themselves too much .

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  • Patients attedning A&E with minor ailments that do not require A&E treatment should be turned away! It is patients mistreating this valuable service that is causing the problems!!

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  • I recently had to attend an A and E in a town of 60 000 people - to see a gp out of hour.
    How many people were there in front of me? How long did I wait ?
    Answer -- None , 5 minutes
    Why ?
    It was in Guernsey where a small fee is charged
    Thats the solution to the entire problem!

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  • Agree with most of the above and Richard Ansell is right, just await more spin. No danger of our leadership attempting to pre-empt this of course.

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  • A&E Depts need a rapid opinion GP as the first point of contact. The GP's job should not be to treat or advise or diagnose beyond advising whether the patient should continue into A&E or go elsewhere. It would be great fun to do "I'm sorry but this is not an accident or emergency, see your GP within the next so many days or contact them more urgently if such & such occurs, but I am not permitted to give you a diagnosis as you should not have attended here in the first place!"

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  • I wrote a long comment but then deleted it. After all, why bother, since this is a debate prompted to fulfil a financial agenda unhindered by sufficient quantitative evidence to enable a fully-informed decision to be reached that may not be the one that is wanted.
    Unusually, nearly all GPs in Newham (East London) did NOT opt out of out-of-hours in 2003. We have a thriving GP coop that continues to deliver excellent OOH care yet Newham General's A&E statistics are still generally regarded as "problemmatical".

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  • I believe that if politicians were doctors, the GMC would strike them off!

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  • 1. Oh how we would love the "you're not an emergency, go away" option but imagine the first time a turned-away patient dies - the press would have a field day.

    2. GP triage at front door is a great idea, but see 1 above!

    3. A considerable part of the problem is that local Social Services have their own funding cuts to implement, and they are standing on the hosepipe further down the chain blocking beds which means patients in A&E who need to be admitted have no bed to go to, If you were in a supermarket and someone had parked across the exit, opening more tills would not solve the resultant overcrowding.

    Proper joined up end-to-end care, and proper joined-up end-to-end funding to support it is what is needed.

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