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Out-of-hours GPs 'should be based in A&E departments'

GP out-of-hours services should be based in every A&E department, according to joint recommendations from the College of Emergency Medicine and three other royal colleges.

In their Acute and emergency medicine: prescribing the remedy report, the colleges say it’s ‘unreasonable’ to expect patients to determine whether their illness is a serious or minor condition and co-locating A&E and OOH would allow patients to attend one facility and be ‘streamed’ to the appropriate service following triage.

However the BMA has said the scheme could overwhelm an already overstretched GP workforce, and prevent patients getting ‘care they need in the community’.

The report states: ‘It is unreasonable to expect patients to determine whether their symptoms reflect serious illness or more minor conditions. Co-location enables patients to be streamed following a triage assessment.

‘This also enables collaborative working including sharing of diagnostic facilities, reduces duplication of administrative tasks and permits patients to be easily re-triaged should further assessment require so.’

This is one of 13 recommendations by the Royal Colleges of Physicians, Paediatricians, and Surgeons, which also calls for an end to the four-hour A&E target, and for seven-day delivery of community and social care services.

However, GPC chair Dr Chaand Nagpaul explained that, although the scheme could have benefits, the priority should be to ensure there are ‘sufficient’ numbers of GPs coming through general practice’s doors to prevent A&E admissions.

Dr Nagpaul said: ‘Strengthening the link between GPs and hospitals could deliver real benefits to patients by ensuring that they get fully joined up care.’

‘However, general practice is suffering from severe workforce pressures.’

The president of the College of Emergency Medicine, Dr Clifford Mann, said it would be a ‘scandal’ if these consensus recommendations were ignored by policy makers.

He said: ‘If we are to avoid an annual crisis and build a resilient system it is vital that the 13 recommendations within this unique document are implemented.’

‘No plans for acute and emergency care should be developed without reference to these consensus recommendations. It would be nothing short of a scandal if these recommendations were not acted on. The time for action is now.’

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Readers' comments (25)

  • They realised that pretty quick, didn't they!!!

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  • Many A&E have such systems, but GPs will ONLY accept such a situation from a position of professional equality and NOT subservience to Emergency Medicine (or any other specialty). In other words GP with CCT equals opinion of (EM) Consultant . Period. Non negotiable

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  • This is a very silly idea

    Of course hospital based medicine wants to do everything around their inefficient expensive hospitals.

    Primary care , community paeds needs to be based where it is delivered - at some level.

    Hospital based solns only work in big cities

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  • Vinci Ho

    Chinese saying:
    When the lips die , the teeth are exposed to cold.
    It would be nothing short of a scandal if the number hence funding of GPs is not substantially increased. The time of action is now.
    Who is supposed to act, ladies and gentlemen?

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  • local AE was very short of staff and asked for GP help - plenty of offers but became clear that they only wanted GP registrars / newly qualified GPs - presumably so they could be treated like SHOs.

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  • The usual Londoncentric view. How far do patients have to travel in London to the nearest A & E 2-3 miles with good public trasnport. In many rural areas the distance is 20-30 miles and if there is still a bus service 1 or 2 buses a day. One size does not fit all.

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  • Oh dear guys - why not lose the inferiority complex, its so demeaning to you all.

    There is no suggestion of subservience here - quite the opposite, the report is talking about working in partnership to ensure the patient goes to the right professional first time, be that a GP or ED.

    This is a pragmatic solution to a real issue, which is that we know that 15% of all ED attendances would be better dealt with in primary care, but if patients are turned away, everyone complains. Triage and co-location are one very sensible solution. Remember that the income follows the patient, If they don't attend ED, then the GP gets the payments.

    Its time to grow up and start behaving like mature professionals if you want to really solve these issues. Partnership isn't a dirty word, it can be the way forwards, and hospitals are not the enemy

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  • OOH GP`s/service should be paid per patient seen from A&E- eg if patient goes to A&E and is triaged to OOH- the A&E gets £15 triaging fee and the OOH GP /Service gets paid the rest of the cost.
    The problem seems to be 111 is diverting many simple problems that can be seen in primary care to A&E and self limiting illness to OOH.

    The 111 service was setup to be a cheap and cheerful service and they got exactly that.
    You pay peanuts...

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  • Anon at 111.40 p.m
    You are partially right -on the idea of collaboration
    (although with time this becomes one way street!) but DEAD wrong on payment.
    GP`s are not paid per consultation but £60-£75/yr irrespective of attendences unlike hospital.
    Same with OOH- It paid mostly on population served (£5-15 /per head in most places) and for meeting some arbitary targets for urgent and routine waits ( or money docked) much like 4 hr target for A&E.
    The problem GP`s feel will be A&E sends lots of work around to OOH who dont get paid anything extra and some of them will have to go back to A&E ( there is bound to be some which are tricky)
    Income DOES NOT follow the patient in primary are at present hence the issue...
    Also medical indeminity for this should be borne by NHS and not individual GP`s.
    At present the Medical defence fee for a GP doing OOH >6sessions/week is approx £12,000 (why would any GP want to do this unless he makes much more to cover this)

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  • I was part of a pilot to have GPs in A&E in Somerset some years back.

    I saw pretty exclusively acute minor illness.

    They were paying me quite highly for my time (better than the average OOH locum)

    I wondered if it actually made sense for a highly trained, relatively expensive GP to be seeing sore throats in casualty rather than an SHO / nurse practitioner.

    Presumably someone must have done the maths though...

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