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Out-of-hours GPs are keeping hundreds of thousands of patients out of A&E

Exclusive GPs working all hours of the day and night are keeping hundreds of thousands of patients out of A&E departments, with just 5.6% of contacts made to GP out of hours being sent on to hospital as an emergency.

Analysis of data from eight out-of-hours providers by Urgent Health UK, who represent around half of GP urgent care providers, found that out of roughly one million patients seen in a 12-month period, just 74,334 were referred to A&E or 999.

Scaled up to the total population of England this amounts to 6.3 million calls, with 4.3m patients being kept in the community and just 370,000 referred to emergency or ambulance services.

It comes after Prime Minister Theresa May provoked the ire of the profession by ordering GPs to open their doors seven days a week, telling national newspapers that practices were blame for the crisis because they were not opening during evenings and weekends.

But the Urgent Health UK figures show across eight providers, with a total population of 8 million patients:

  • 65% of contacts were seen in primary care, with 23% being given information only, and 2.5% being referred to community services.
  • Providers received 118 calls for every 1,000 patients in their patch, of those calls, over 80 were received from NHS 111, 29 were direct from patients and 9 were bounced back from A&E.
  • 45% of patients were dealt with over the phone, 42% of patients were seen in a treatment centre and 12% received a home visit

Out-of-hours leaders said recognition of their track record in keeping patients in the community was important when the NHS commissioned services in future.

They added that since the introduction of NHS 111 there has been a decrease in calls reaching out-of-hours, but this was countered by ‘increased clinical complexity’ and flat-line funding creating workforce pressures.

Chair of Urgent Health UK, Dr Simon Abrams, told Pulse: ‘The pressure felt on emergency services over the winter period has been well documented, but it is important attention is also focused on services such as out-of-hours, and that they are given recognition for their track record at reducing pressure on the acute system.’

It comes as a Pulse investigation last month found changing working patterns and national GP shortages have out-of-hours services running on a knife edge – with providers feeling they had been ‘airbrushed’ out of NHS England’s thinking.

One in 10 areas said there were occasions in 2016 where they had been forced to close centres or run shifts with no GP cover because of workforce shortages.

Last month Department of Health ministers admitted they had no idea how many GP patients attended A&E because a timely appopintment was not available.

GP leaders have repeatedly urged the Government to focus on sufficiently funding urgent out-of-hours services before rolling out seven-day routine services - a Conservative Party manifesto commitment in 2015.

NHS England said it was reviewing the workforce data it collects to better understand the pressures on the urgent care system, a spokesperson told Pulse: 'We recognise and appreciate the vital urgent care delivered in and out of hours by primary care staff.'

Readers' comments (12)

  • They added that since the introduction of NHS 111 there has been a decrease in calls reaching out-of-hours, but this was countered by ‘increased clinical complexity’

    Is this really true? There are, I am certain, many very complex cases that reach the OOH setting. And I truly believe that the individual clinicians there do an amazing job.

    However, 111 seems to send an awful lot of their workload to hospital. A lot of their moderately difficult workload (like wheezy children, headaches or severe abdominal pain) used to be triaged by the OOH GP service and then (in many cases) seen by the OOH GP service. Now they are commonly sent an ambulance.

    To have flat line funding with a lot of the clinical workload being taken away is a pretty good deal.

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  • Vinci Ho

    From Day 1 when NHS 111 was born , we know all the way it was a Rosemary's Baby. It was created by Cameron's government as an even cheaper version of NHS Direct( still remember that ?). As a result , OOH is allowed to wither as funding is drained further and further(indemnity rising higher and higher) . The media spin misled the public to the impression that there was no GP working after half six in the evening , Monday to Friday and the whole weekend .Then the seven days GP opening protagonists waved their flags and slogans criticising how much we were responsible for the A/E crisis because we could only open 5 days a week trying to preserve the invaluable core value: Continuity(Close my eyes , saw the word 'Quisling').It is now too obvious what the original ,clandestine agenda was in Cameron's mind: punish these expensive GPs who were doing f**k all.

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  • doctordog.

    Of course they do, it's blindingly obvious .
    Rather than fund this stupid unfocused 'routine ' 7day working, OOH is where the funding needs to go.

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  • 1. Patient is very unwell and needs to be in A&E
    Delaying these patients through the maze and delays of NHS 111, wait for call back...wait for GP call back... wait for appt... fobbed off home to re attend or recall later ....is just dangerous
    I find it insulting to expect the Doctors to place their license to practice at risk
    So as to allow an underfunded service to cope
    Remember a lot of A&Es were closed in order to centralise to fewer ones
    Surprise Surprise Fewer struggling to cope

    2. None urgent cases which do not and should not need A&E
    Absolutely right should be managed via the OOH
    But actually even these ...if they can wait should contact their own GP's

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  • How many medicolegal cases has OOH needed to address due to patients inappropriately managed in the community when they really needed investigation and prompt management.. anyone doing this research???

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  • Enjoy Out of hours, even as a trainee, and the patients are same except might be more acutely ill.
    But just cannot afford the indeminity costs.
    Definitely a lot of patients go home, but it is true complex cases are rising and it hard to know details as there is no system of shared records yet at least where i work . Its a conveyor belt of cases, so we do not have luxury to talk to hospital specialist or A/e consultant in a normal evening, or vice versa. Also there is a high alert to spot sepsis so rightly such patients need to go to A/E.Still a large percentage stay at home due to OOH who are regular and expierieced Gp working outside their normal practise hours,ANPs and paramedics on roads.Yes we need funding not more critisism or political agendas

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  • Vinci Ho

    As I said before :
    Destroy OOH , destroy us all.
    Sort out OOH if you tell me the 'new' contract is not a Trojan Horse......

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  • this is a function of the complete nonsense that comes through that is filtered out. The incidence of serious pathology as a percentage of the volume of calls is very low. But yes, that is the whole point of the system.

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  • I worked ooh from 1978 to 2001 when I reached 60 yrs
    Average was 20 hrs per week
    Out of 90 calls overnight on weekends maybe 1 admission or none and 6 home visits.
    It is hard risky work and cover can be for 200-300000 patients ,depending on other doctors in adjacent areas .
    There is no need for 7 day working as good ooh work can cover well.
    The problem is poor ,slow or defensive work.
    Looking back, I would advise against adding this to ft GP work.

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  • Issue with defensive work is one mistake and your career is finished, unless government give crown indemnity, I am dreaming!!
    My advise to all OOH GP- work slow and defensively.

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