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A faulty production line

Offer more same-day phone consultations for urgent patients to reduce burden on 'creaking' A&E, GPs told

GPs should offer more telephone consultations for urgent patients to ensure ‘faster and more consistent same day, every day access to primary care’ and help alleviate the intense pressure on A&E departments, a major NHS England review has concluded.

A report published today by NHS England medical director Professor Sir Bruce Keogh, which sets out plans for two-tier A&E services and a wide-ranging overhaul of urgent care, says GP surgeries provide ‘variable’ responses to patients with urgent care needs. It urges GPs, out-of-hours services, community health teams and NHS 111 to work ‘together and differently’ to ensure patients receive prompt advice and care ’24 hours a day, seven days a week’.

As part of this, the report suggests GP practices should provide ‘prompt telephone consultations’ for more patients, in order to free up additional time to spend with patients who would benefit from face-to-face advice.

Today’s report marks the first phase of Sir Bruce’s review, with the next stage due to ‘develop the tools’ for implementation of his proposals, which is expected to take three to five years. The review was launched in June in response to the perceived crisis in emergency care in England, which health secretary Jeremy Hunt said had been caused by four million extra patients attending A&E as a result of the ‘disastrous’ 2004 GP contract negotiations.

Today’s report proposed a range of new measures to alleviate the burden on A&E services, which Sir Bruce said were ‘creaking at the seams’. They include:

- a revamp of A&E departments to create two levels of emergency department: ‘emergency centres’ and ‘major emergency centres’

- increasing the use of self-care by providing greater information

- improving access for GPs to specialist advice.

Under the proposals, GPs will be expected to provide telephone advice for a ‘significant proportion’ of urgent care work in an attempt to free up face-to-face appointment slots.

The report warned: ‘At the moment, patients contacting their GP’s surgery with an urgent problem receive a very variable response, and may be directed elsewhere.’

The report said NHS England’s aim was to ‘provide faster and consistent same day, every day access to primary care and community services for people with urgent care needs.’

‘This is likely to mean general practice, out-of-hours services, community health teams and NHS 111 services working together, and differently, to ensure that patients with urgent care needs can receive prompt advice and care 24 hours a day, seven days a week.’

‘There are many innovative options to explore. The evidence for prompt telephone consultations is compelling, and can free up appointments to spend with those patients who would benefit from face to face care.’

Other innovations to free up time included GPs leading ‘integrated multidisciplinary teams to manage whole pathways of care including the exacerbations of those patients with long term conditions’, and improving GPs’ access to hospital specialists. The report also identified wider problems around GP access, warning that ‘even the simple task of ringing a GP practice to request an appointment can result in a frustrating assault course on a telephone keypad’.

Professor Keogh said that there is a feeling that this winter will be difficult.

He said: ‘We’re here, really, because A&E is creaking at the seams. It’s not broken, but it is struggling.’

‘When A&Es become busy, it means other parts of the system are creaking, that they’re under stress. It’s against that background that there’s a feeling that this winter will be difficult.’

Professor Keogh added it will take three to five years to enact the change necessary, though NHS England expect several key changes to be in place within six months.

Professor Keith Willett, national director for acute episodes of care and co-author of the report, said: ‘The public tell us there’s a lot more we can be doing out there, to improve access to primary care, that means we need to work with GPs to create the headroom for them to be able to respond differently, to give better access to primary care and to community teams.’

However Dr Agnelo Fernandes, the RCGP’s urgent care lead and a GP in Croydon, south London, said more resources were needed in order to increase capacity.

He said: ‘The workload of GPs has gone up and up. There are over 300 million consultations a year. It is by far the most used part of the NHS. However, we also know the resource of general practice has not kept pace with that. There has to be additional resource to increase the capacity.’

‘One way of increasing the capacity is by increasing consultations on the phone, but that requires adequate numbers of GPs to do that as well. You can’t do everything on the phone, you do need GPs to see people too, so you need resources to do that. There is good evidence that you can increase capacity by increasing telephone consultations but there are only so many hours in the day.’

Readers' comments (47)

  • The first thing that needs to happen is for us to say "NO!!"

    Only then will we be able to have a proper debate to reform access to health care, instead of the ridiculous deck shuffling by know nowts that we have had up to now. .

    If that doesn't happen then like many others I am off.

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  • home visits have tripled in the the last 3 years - nearly all to care homes and nursing homes.
    Our CCG directs any one who falls should be assessed within 4 hours. It is hard to take requests to work harder seriously when 2 of our youngish partners have just resigned citing unreasonable expectation at a time we are also told to bolster recruitment!

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  • Una Coales

    Every telephone consultation I have taken ends with just to be on the safe side, come in and see a GP. Can't possible see or examine a patient over the phone?

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  • Keogh is NOT a front line GP---To anyone - if ever you do a phone consultation ensure you finish it with a full legal disclaimer( and record it) that protects you from a complaint. Telephone consultation will merely encourage out of hours or a/e attendances as when told 'if' worse seek further advice and face to face consultation - diarrhoea, temperatures abdominal pains etc usually get worse and may have an underlying rare cause - e.g meningitis, aneursym ectopic etc - the bottom line is avoid telephone consultation this is not safe or quality care. avoid an unexpected serious cause or death and a complaint. Koegh will not be there to support you in this event.

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  • Bentley-driving bastards.....Daily Mail.....all GPs drive Bentleys and live in a house like Downton Abbey paid by the tax-payer..........

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  • "prompt" Mrs Jones you dont mind your consultation being interrupted by Mr Nosensewhatsover do you?

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  • I would disagree with some of the comments on here. We have been running the telephone triage system in our practice for over a year now and have found it has reduced WIC and A&E attendance and reduced DNA's.

    I have found that it works well for our practice population (busy, inner city) however its very hard work on the GP's.

    I feel that it does have a role for ALL aspects of healthcare and when done safely it works well, but there are limiting factors on all things, and without investment in primary care so we can get more Dr's on the gournd to deal the rising demand im not sure how long it will be sustainable.

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  • Hardly an original idea, my practice was doing GP telephone triage 20 years ago. It can be done safely,
    but saves little if any time. However, what a pity that with all the energy going into easing pressure on A+E departments, so little energy has been expended on easing the intense pressure on general practice.

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  • 'The evidence for prompt telephone consultations is compelling, and can free up appointments to spend with those patients who would benefit from face to face care'
    I'd like to see this so-called evidence. My experience is that phone triage is only useful for a selected number of consultations. You cannot examine someone over a phone and the clinical risk is massively increased.
    Ultimately it doesn't matter if the what the government want because we are already working at full tilt and reality is about to bite. The only logical solution is to charge patients for minor health problems and properly fund serious acute and chronic care. I actually feel patients would come away more satisfied if they were charged for some services as it would unleash the power of consumerism and open up new and profitable markets in a truly free mixed health economy.

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  • Can just see - it will a list of the usual ringing up for their 4th chat of the week "because you can't be too careful can you doctor?" . At least with the phone they can't see me hitting my head on the desk, And no and I am not going to Skype

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