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Gold, incentives and meh

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)

  • Also GP`s can repatriate unnecessary appointments to local MP clinic.

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  • We had a patient attend our A+E with a 'sore knee'. This patient had injured the knee skiing, had already seen the GP 3 days earlier and had been prescribed pain-killers and been referred to an orthopedic consultant.

    All hope is lost unless we re-educate the public AND turn away non-emergency patients AND have more primary care capacity outside 9-5.

    But who wants to be the one responsible for turning away drunks and violent patients at 3am on a Sunday?

    We tried having GPs working next to A&E but it was staffed by OOH service and they sent most of them back to A&E.

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  • Re Anonymous | 07 March 2014 9:10am

    Start charging for appointments and poor people might well die. Still, at least they'd stop bothering you.

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  • Ronald Graves - They dont seem to die in in Australia New Zealand, Canada, France, Germany......................

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  • The BMA want to keep the NHS free. This is far from what i feel the majority of grassroots GPs think. The BMA are so out of touch. There has to be some control the huge demand from the public on the basis of need not want. In an ideal world a free NHS is what we all want but not when it is being totally abused and not when there are financial constraints.

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  • here here 6:06

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  • Just Your Average Joe

    The NHS should be free for medical problems.

    Start charging all Alcohol related attendances £100 and then responsible drinking will be become the norm again within a very short period of time.

    A&E is the place where education needs to be placed to remind ALL attendances - was this an accident - with risk of fracture/burns etc or an Emergency - ie life threatening MI/Stroke.

    No one with a temperature should go to A&E unless sent there by a GP who has seen them first.

    Patients go to A&E when they don't receive the treatment they wanted - though they were given the treatment needed by their GP.

    A&E often are defensive in their practice (Not meant as a criticism) as have worked the sharp end, so many parents do end up with the antibiotic their GP said no to 4 hours earlier.

    Turn all attendances triaged as non urgent back to primary care, and educate parents, temperatures and viral illnesses don't need to be seen in A&E.

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  • The behaviour of A+E and the tarriff need reform.
    We tried re-direct locally but not really successful as very few sent back - except when A+E overloaded.

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  • Hooray at last common sense ! Putting your hand in your pocket for a nominal sum makes you stop and think. When will any party in government be brave enough to do this though ? They care about votes and image far more than joined up thinking.

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  • Works both ways! I wanted my GP to check out my daughters arm, damaged during a gymnastics session. Didn't think it was brokrn but a lot of pain and she couldn't use it without pain. It was an 'accident' so they refused to see us. We waited 2 hours at A&E to be told it was a severe sprain go home and rest it. No x-ray!

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