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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)

  • Phone consultations take as much time as face to face consultations with the disadvantage of being unable to see the patient . More consultations need more clinicians. The demographic dictates that more consultations are necessary no matter in what form these encounters take place. The highest needs are those elderly patients who are least likely to use Skype.

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  • Always good to have a trauma surgeon and a cardiac surgeon leading restructuring of primary care!

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  • They keep moving the deck chairs as the Titanic keeps sinking.

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  • Due to being rather shortsighted some years ago my patients already have "open access" to phone calls with myself. My predecessor refused to speak to anyone on the telephone saying that if they needed an appointment they had to see him face to face. The net result was that a lot of people just couldn't be bothered and their self-limiting problems resolved themselves. I thought this was slightly mean so agreed to call anyone back who wanted to talk to me. Unfortunately the initial 5 calls per day has grown into an unstoppable monster - at least 20 calls a day that often take me well past 8pm (record = 10:30pm to complete all contacts). These are often pointless conversations with the worried well (tagline jingle "If you're sat around at home, talk to your GP on the telephone on 0898....." etc) which take time away from those who really need it.
    Bottom line - the easier it is to access a free service, the less it will be held in regard.

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  • yet another directive from the centre i tend to think of these comments as "King Canute" directives politicians are very good at them as are brainless surgeons

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  • Let common sense prevail

    I'm so pleased that the great brains employed by NHS England have managed to find the elusive solution to the problem of an overburdened NHS....
    ...get GP's to work harder.

    Now why didn't we think of that?

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  • 8:46 - They dont move the deck chairs, they just expect more people to sit on less of them as the Titanic sinks

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  • Straplines from the NAPC Conference last month:
    GP services are provided on 7.47% of the NHS budget!
    Over 90% of patient contacts take place in general practice!
    There are more hospital consultants in England than there are GP's!
    General Practice cannot cope with any more without funding to support the extra work.

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  • Obviously most GP's spend their days twiddling their thumbs!
    It does appear everyones solutions to all problems are to dump the workload on us. We need to recognise there is no rational debate going on, just politically minded soundbites.
    There is a major need for hospital re structuring but the politicians are too cowardly to undertake this.

    We need to be strong gate keepers but this function is being undermined by trying to improve access in many cases for inappropriate reasons.
    We have several partners within 3 years of retiring, its scary to think what will happen in terms of workload once they retire

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  • Hang on, Ive got another idea - more telephone consultations from hospital consultants. After all, I've only got a 3 week wait for a routine appointment with me whilst a hospital OPA is averaging 3 months at present.............
    I think the local cardilogists would be delighted for any of their patients to ring them at any time for "a bit of a chat".
    Just applying the same logic...........

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