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A&E should 'repatriate' non-emergency patients back to GPs

A&E departments should not be paid for treating non-emergency patients and be told instead to ‘repatriate’ them back to GP practices, says a leading GP.

Dr James Kingsland, president of the National Association of Primary Care and and a GP in Merseyside, said that the only way to reduce the pressure on urgent care was to have a more ‘accessible primary care system’.

He added that he had implemented the idea of a ‘never full’ practice that provides same-day access to all patients, but that this had been undermined by the lack of change in the rest of the system.

Dr Kingsland also argued GPs could save money if they were given the funding currently provided to walk in centres, saying that as ‘50% of all activity in walk in centres are seen with the same condition by their general practice within the same week’.

Speaking at the the Nuffield Health Summit 2014, Dr Kingsland said: ‘We created the “never full” practice. So we are confident for our registered population, same day care, urgent care, immediate care, pre-booked care, is all available.

‘But having got that, the patient flows haven’t changed, even though patients can access our service any time of the day. They don’t have to ring at eight in the morning, they don’t have to wait on the phone.

‘So to change the patient flows, we’ve got to change where they go to. We’ve got to have the appetite to change the duty of care in A&E. So a patient who goes to A&E, who is not an accident or an emergency, could be repatriated immediately to their “never full” practice’, via an IT system. But then tariffs [have to be] changed, I’d be delighted if A&E see a baby with a temperature for three days, but they don’t get paid for it.

‘Unless we’ve got these mechanisms, the patient flows won’t change, even if we’ve got a good accessible primary care system.’

NHS England’s director for urgent and emergency care Professor Keith Willett agreed: ‘That’s just about the offer, isn’t it? At the moment patients don’t see that as the standard offer. They don’t recognise that, and they don’t work, they don’t respond to that. That’s something we have to get right. 

‘The Healthwatch report, despite four out of five people know 111 exists. Only one out of five choose to use it. Fifty percent choose, to go to straight to hospital. We have to build that they can see that they can get something different. You’re right it can all be done [in primary care].’

Readers' comments (29)

  • Ms Webb,

    Sorry, your point is? If it had been broken or suspected to be broken and needed an Xray, you would have had to wait for a few days under primary care. And whilst we can all apply simple bandages, we don't have the time nor the facilities to do more complex bandaaging or plaster od paris. You would have been then told to goto AED. Would you have been happy with that?

    As A&E stands for Accidents and Emergencies, surely it is reasonable to advice one to attend for an accident that cannot be self managed. If not, it should be called Emergency Only Department.

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  • Our practice has always seen all emergencies the same day, regardless of how busy we are,

    We also have a system where patients can be redirected from A+E to the surgery with an appointment the same or next day. However we have only had 2 patients redirected in 4 months.

    Like another posted suggested above, the decision to send a patient back to A+E only seems to come up when the a+e is very busy.... If we want people to learn, they should be redirected whenever possible. I agree that it is a difficult decision to make and the A+E will only get blamed when someone is really ill.

    On a side, my best friend works in A+E - he called me on my mobile because the patient was complaining that she could not get to see a GP today. I had seen the same patient a whole 2 hours earlier and declined antibiotics for her cold. He called me in front of the patient which I thought was quite amusing.

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  • I read somewhere that James Kingsland got extra funding of £30 per patient to create his "never full" practice. I am sure he will respond if this is not the case. If it is, then the cost of upscaling his venture to the rest of us is going to be impossible for the public purse to meet...

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  • I would never use the 111 service, the time it takes to answer so many stupid questions I could have an ambulance on my doorstep and be on my way to hospital.

    Of course I wouldn't use 999 for non emergency situations but when a pleb is told you have a heartbeat of 212 and going in and out of consciousness surely the ambulance should be summoned, rather than wait until they complete their list of questions!

    People will always do what makes them feel safe and cared fro, and that does not include being examained in closed rooms by pharmacists or doing multiple choice quiz tests with 111

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  • nhs 111 is a disaster
    the lunatic internal market is a disaster
    the administrators continue to worsen the flaws of the previous flawed system they created
    suggest we sack them all and put money onto patient care

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  • Does that work in reverse too?
    So all the patients that book appointments to see if we've got the letter from secondary care can now be cancelled. We will no longer have to see patients to to inform them of what the hospital tests are, or tell them what actually went on during their consultation because the doctor didnt explain anything.
    I could probably save 20-25% of my appointments that would more than compensate for the few that roll up at a+e unannounced.

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  • If you feel very unwell and can't get an appointment with a GP, of course you go to A&E.

    It is time GP's took action against the 300+ patients at my practice that do not attend for the appointments that they booked!

    It is time wasting and deprives other patients of the care they need.

    111 is not a service I will every use, once was enough, it was an ordeal I will never forget!

    A pharmacists, do you want to risk being alone, being examined by male staff ... I don't think so!

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  • if you want better access to gp's..just like the only other open access system in the nhs..aed..then like the lattter we need more doctors..better patient education..fines for abuse....the answer is not trendy idiocy like telehealth emails telephone...these are admittedly of minor value but are a way of imposing inevitably inferior consultation modes on general practice as a way of obfuscating yet again the real problem...lack of staff..also a less safe and more risky mode for practitioners.
    ask yourself..why does every other part of the nhs seem happy to limit access by waiting list?pray tell the answer
    colleagues i urge us all to totally reject the tsunami of disgusting criticism of primary care.
    truth is we save the nhs from total collapse.
    be proud of ourselves.
    forgive the tidal wave of people criticising us from their armchairs of absolute ignorance..they know not what they do!...there does seem to be an epidemic of ignorant arrogance in wonder our scottish colleagues rightly want to completely separate from nhs england.
    please tell me where the capacity in primary care is to absorb patients back from aed?...i would love to know..arrant feeble minded pathetic nonsense.

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  • My 76 yr old disabled sister in law had a surgical procedure on her foot yesterday and was told to have it re-dressed by the nurse at her GP's practice on Monday. Nurse only there for 2 hours one day a week and booked-up for weeks. Drop-in centre 4 miles away open 4 hours - and take your chance! Obvious answer A&E (half mile away) but this is now discouraged. Suggestions (polite) please.? NHS or DIY?

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