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GP-in-A&E scheme will not be sustainable in the longer term, hospital leaders warn

Hospital bosses have warned that they will not be able to sustain the new 'GP streaming' services in A&E beyond next winter unless the Government puts more cash into the scheme.

NHS Providers, the representative body for trusts, said that the likely continued cost of the scheme will between £500,000 and £1m per hospital, each year - resources which NHS trusts simply do not have to spare.

The Spring Budget pledged £100m to set up the service across England before next winter, but the Treasury has made no mention of ongoing funding for the scheme, which NHS bosses hope will reduce unsustainable pressure on emergency departments.

The report said: 'Many trusts currently do not have this kind of surplus to support this initiative, and it will require funding from commissioners.'

Simon Stevens, chief executive of NHS England, has previously said that every A&E should have a GP streaming service in place ‘by Christmas’ in order ‘to avoid a repeat next winter of this past winter’.

But NHS Providers said even with £100m being allocated this year, this was unlikely to be used ‘quickly enough to make a tangible difference this winter'.

Dr Richard Vautrey, deputy chair of the BMA GP committee, said: ‘The best way to support patients this winter is to invest properly in general practice and community services, as well as developing a much better self-care programme to empower and give confidence to patients.

'Not [by] spending even more money on setting up a service in A&E that simply acts as a magnet to draw in more patients to hospital-based services.’ 

The report also noted the ‘substantial workforce constraints’ limiting trusts’ ability to roll out the GP streaming service ‘when there are already shortages in core primary care services’. 

A Pulse investigation in April found that the NHS would need to find an extra 400 GPs to deliver the plans and Pulse revealed earlier this month that NHS England has instructed hospital trusts not to pay GPs more than £80 per hour.

The NHS Providers report also included a survey of hospital bosses, which found that more than nine out of ten (92%) of them expect the lack of capacity in primary care to impact their hospital’s ability to cope with winter demands.

NHS Providers chief executive Chris Hopson said: ‘Last winter NHS staff responded heroically to extraordinary pressures. But safety and standards of care were compromised.

‘In too many places the NHS was overwhelmed for short periods of time. We must not allow that to happen again.’

The Department of Health has so far allocated £77m out of the pledged £100m funding to 97 trusts for the GP-in-A&E scheme.

It comes as last winter a majority of hospitals consistently broke the national target to treat patients in A&E within four hours.

Readers' comments (18)

  • Get Physician assistants.it will be sustainable. I think we dont need 6 years of medical school just 2 years.

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  • 100% of GPs believe that lack of hospital capacity will impact on their ability to manage the workload in primary care this winter.

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  • It is necessary to get the basics right before introducing schemes like this. As we know, the basics are far from right. Scrap this and focus on making GP an attractive, sustainable career option .

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  • Put some NHSE Managers in A&E and everything will work - Ask Hunt, if you don't believe me!

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  • Apart from the obvious (not enough GPs and should be invested into primary care), wasn't this scheme meant to liberate capacity and hence improve efficiency? i.e. cost of having GP service should be serviced by saving they make on not seeing inappropriate patients.

    100m this is year should be for transformation (make changes happen) rather then paying for service

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  • The real problem is the threshold to request a consultation, whether from a GP, nurse, hospital doctor or whoever. Of course work load will increase because of the larger numbers of elderly and more that we can do. However an increase in patient demand is not tenable without a massive increase in resources. And that is not going to happen.

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  • We need more IT--give them all ipads, more managers, more blue sky thinking, more thinking out of the box, more colours for alerts to solve the clinician vs patient ratio. It is really difficult maths.

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  • Another sticking plaster...

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  • When I climbed to the top of the 1008 steps of Chamundi Hill in India I was rewarded by some enterprising traders selling me cold drinks from their stall.

    In real economies a demand can be satisfied by increased supply. Money, a delayed store of value, changes hands to enable this to occur.

    In centrally planned economies everything is backwards as money is banned or controlled. Thus a demand is met by rationing, pay restraint and general dissatisfaction for all participants.

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  • 12.48, yes, but poor health is obviously a driver of inequality (sick therefore can't work etc) and the cost of modern healthcare is so massive that the only way to effectively address the health needs of a population is by pooling the risks. Even insurance based models recognise this. The advantages of a state run risk pool such as the NHS are that there is no profit motive, there are huge economies of scale and it is very equitable. Sure, people get frustrated about their ear wax being a low priority but most people would accept that the benefits outweigh these disadvantages.

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