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GPs buried under trusts' workload dump

Patients will be able to see a GP in 'every A&E' by next winter, says NHS boss

Every A&E department in the country will have to ensure it has a GP triage service in place before next winter, NHS England's chief executive has said.

A letter from Simon Stevens to trusts today clarified that 'every hospital' should implement a 'comprehensive front-door streaming model by October 2017', which he told MPs would require a GP in every A&E.

This followed chancellor Phil Hammond's Budget, which announced yesterday that £100m will be used to support 100 projects to place GPs in A&E departments.

The announcements come as part of a major crackdown by the Government following a winter where a majority of hospitals have consistently broken the target of seeing all patients within four hours.

Mr Stevens and NHS Improvement chief executive Jim Mackey wrote to all CCGs and hospital trusts this morning to let them 'know about the action now needed to turnaround A&E performance in 2017', adding that the NHS has to make 'concrete changes' in order 'to avoid a repeat next winter of this past winter'.

It set out that every hospital should implement 'a comprehensive front-door streaming model by October 2017, so that A&E departments are free to care for the most urgent patients'.

Mr Stevens told the Public Accounts Committee meeting this morning that 'the £100 million capital is to make sure A&E departments can make the space available for GP steaming, the model that has been successfully adopted in places like Luton and Dunstable hospital, one of our top performing A&E departments in the country and have these in place by Christmas'.

'We want all hospitals to have comprehensive front door streaming with GPs by next Christmas,' he added.

The £100m announced yesterday is 'a contribution to that', he said, adding: 'This is probably going to be 50 to 100 hospitals which need a bit of remedial work or extra capacity creation.'

Mr Stevens acknowledged that 'this is only part of the solution' and that 'other things need to change as well'.

He said that 'possibly the most important' would be using the £2bn of extra social care support announced in yesterday's budget - £1bn of which is being made available this year - 'to ensure that elderly and frail people are able to leave hospital'.

He said: 'If we can free up to 2,000-3,000 hospital beds, that’s the equivalent of opening five new hospitals.'

The letter to trusts and CCGs said it was 'vital that, together with our partners in local government, we ensure that the extra £1bn the Chancellor has made available for social care is in part used to free-up in the region of 2,000-3,000 acute hospital beds'.

It added: 'We would ask that you immediately now engage with the senior leadership of your local adult social care departments to discuss how those patients stuck in hospital needing home care or care home places can access those services.'

At the same time, speaking at the Reform Health Conference this morning, health secretary Jeremy Hunt said that 'A&E departments and their performance is a fundamental matter of patient safety' and that it was therefore 'absolutely essential that we do get back to the 95% target'.

He said: 'I expect the NHS to return to that target during the course of the next calendar year and make very tangible progress towards that target through this year.'

In the speech, he welcomed the £100m 'into the GP triaging systems, stream system, which we've seen works spectacularly well'.

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Readers' comments (28)

  • The only way to get this work is by throwing cash at it. I don't know that 100m is enough or not but if they get GPs to fill the breach again it will only sap an already depleted pool. The primary work for a GP lies in General Practice. Bailing out secondary care is not our job. Primary care will suffer but one wonders if the powers that be really care?

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  • I'd probably do it for about 300 quid an hour. I'm not sure 100 mill is going to stretch that far?

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  • Great they see some locum GP rather than some A&E SHO -won't change anything

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  • Sure, as more of these GPs will be ending up with infarctions caused by NHSyndrome.
    NHSE in seventh heaven - plan accomplished; Patients in confusion - Who's going to treat me?
    Book appointments with local NHSE bosses,Hunt,Stevens and Aunty May please. Open 7 days a week 8 to 8.

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  • CENSORSHIP?

    When a general practice patient goes to A&E... it is simply annoying
    When a patient needing immediate 999/ A&E
    Refuses to go in.. or requests a home visit instead..
    or comes into a routine 10 minute appt
    The potential risks and disruptions are huge..

    GP triage of cases sounds good
    Don't simply pass cases needing full investigation to a GP
    who has no access to the testing or any results
    Stop treating the GP like an ignorant middle man
    To bypass a fully worked up admission..

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  • Mr Stevens acknowledged that 'this is only part of the solution' and that 'other things need to change as well'.
    Like - find the GPs in the first place.
    And then if we can do that, why not put them in GP where they can do the job of keeping people away from hospital more effectively?
    Does this really work "spectacularly well"??
    Any comment from the folks in Luton & Dunstable?

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  • To get an idea of the risk involved, just google Gianni Khan Luton Dunstable Coroner. Band 5 nurse left doing triage. A system is only as good as its weakest link. To run this system they had to increase emergency care consultant numbers by 300%. And of course we know that A&E don't have any chronic recruitment problems...

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  • Council of Despair

    1. but seriously - and again we have to ask the question where are we going to get the GPs from?

    - we don't have enough to staff normal hours.
    -we don't have enough staff for 8/8 7 day week service
    - Brexit means losing European staff
    - Tougher immigration rules and immigration costs means less foreign staff
    - It takes 10 years to train a GP and the state has admitted it isn't going to reach the 5000 extra GP target which is an underestimate of the numbers needed for normal hours.

    So where are the GPs going to come from ?

    2. If you are going to use the existing pool of GPs assuming you believe in market forces and are not going to force them - then you need to offer incentives for them to work so;

    - how much money are you going to pay them? is it enough?
    - is it cost effective?
    - is there a better way?

    again so many basic questions but no answers.

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