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GPs go forth

NHS England pilot area found front-door A&E GPs 'did not work'

An area piloting NHS England’s new care models has said placing GPs at the front door of A&E departments ‘did not work’, and that they were better placed overseeing patient discharge.

The comments, which related to a trial at the Frimley Park Hospital in Hampshire, come after NHS England has told all hospitals they must use GP front-door streaming this winter.

But Dr Andy Whitfield, chair and clinical lead of NHS North East Hampshire and Farnham CCG, which runs a Primary and Acute Care System (PACS) vanguard, told a conference of health professionals: ‘One thing that didn’t work is the national programme to get GPs at the front door in A&E.’

He added: ‘Actually we found putting GPs at the back door more effective, managing discharge of patients. We found this was far better than having them at the front door.’

Dr Whitfield stressed that this was the experience in their local area and the model may have worked elsewhere. Meanwhile, in his CCG area they are recruiting GPs to help with patient discharge from hospital by working with long-term conditions patients in the frailty unit.

A CCG review of last year’s winter pressures at Frimley Park found that ‘performance challenges’ were driven not just by high numbers of patients attending, but also more complex needs of patients who were admitted and delays in discharging patients fit to leave hospital.

According to Dr Whitfield these GPs are 'supporting early intervention and discharge out of hospital in less than 72 hours'.

He told Pulse: ‘We have worked with our local acute provider to create and establish a shared model using the experience gained over years of successful collaborative clinical working, to implement an adapted role to suit local circumstances. 

'We have been able to expand the GP role and we are currently recruiting as a result.’

NHS England has ploughed £100m into its mandate for 'every hospital' to implement a ‘comprehensive front-door streaming model ahead of this winter.

But the plan has been met with criticism by GP leaders due to workforce concerns and a lack of evidence to back up its efficacy.

Are there enough GPs to stretch to A&E?

GP leaders have warned that a ‘chronic lack of GPs’ meant it was ‘doubtful’ that the Government’s plan is feasible, adding that ‘most importantly we actually need more GPs in local surgeries’.

Health secretary Jeremy Hunt praised the model, saying it worked ‘spectacularly at hospitals like Luton and Dunstable’, which was able to admit or discharge 95% of its patients within four hours last winter despite pressures.

However, a Pulse analysis found that in order to roll out Luton and Dunstable University Hospital's model across all trusts in England, between 278 and 417 GPs would need to be working in A&Es on any one day.

A Pulse analysis of hospital plans for GP streaming found some trusts planned to have three GPs in A&E at any one time this winter, with CCGs taking a variety of approaches to recruitment.

Readers' comments (11)

  • So the GPs referrals to A+E are appropriate as we found out.

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  • Wish they would stop trying to reinvent the wheel. GPs are best at doing what they do which is being in THEIR practices seeing patients and not trying to sort secondary care deficiencies !

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  • Look guys we are all missing the point here.

    Mr Hunt and NHS E say is works so there it is. No need to question these fonts of all knowledge!

    PS is Mr Hunt's view skewed by personal experience of A/E use when GP unavailable??

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  • I worked as a GP in A+E in 1994. It is always useful to have an experienced Generalist to help sort the minor problems that are neither accidents or emergencies but are perceived to be by patients. Payment by activity and clinical governance issues changes behavior of clinicians in hospital to be more risk averse and investigate more because it is easier. Patients think they are getting a better service but it lacks the continuity of care. There needs a fundamental redesign of how the service is paid for or the false battle between primary care and A+E will continue to plague the NHS. Patients are not the problem it is the system that confuses them. If we simplify it and only have two places of access that are funded equally for the work, there is a possibility the system can work as one team to sort out the patients rather than making them the enemy.

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  • I have worked several sessions as a GP in A&E last few months, patients are deflected to see the GP instead of A&E doctor for minor illness/ GP related presentations, it does help the service tremendously, reduces hospital admission and unnecessary tests in A&E, A&E workload, patient gets personal GP touch of more than 10 minutes consultations and patients get better educated on A&E use. I don't think this pilot analysis is correct, I feel it works, even if it takes way some GPs needed in practices.... why do I get the feeling they are now trying to create another role for GPs in the hospital....will now be front door A&E GP, discharge GPs, very soon GP on one practice GPs??? I really can't keep up with this people...

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  • Dear All,
    NHSE plan confirms what we already knew.
    Paul C

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  • OHH GP services should be co-located to A+E...
    This isn’t the same as having GPs “at the front door”,

    The separation is an historic construct. If this was done not only would A+E benefit but so would OOH.
    In fact the whole system would benefit.

    And that’s what Taj Hassan has been saying for few years. But no point NHSE listening to someone like him... he’s just president of Royal College of Emergency Doctors...

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  • Vinci Ho

    Ha ha ha
    A/E front door GP
    A/E back door GP
    Porforlio GP
    Locum GP
    GP partner
    Salaried GP
    The list goes longer and longer.
    This merely demonstrates how much this government and its ‘brilliant’ health secretary need us more than we need them.

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  • All over the years successive Givernments have put additional moneys & resources into NHS where they are not needed. They have failed to take advice from GPs, failed to involve GPs and appointed managers with no experience as to how new projecs in primary care work out. Hence the outcomes are already predicted to be doomed failures.

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  • GPs man A+E and look after inpatients in Canada. Specialists just consult on the ward and do outpatients they don't have patients on the ward. Makes sense realy. The GPs who work in hospital are called hospitalists but they are generalists who work in hosp rather than primary care.

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