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Replace GP out of hours with GP-fronted A&E departments, Monitor urges

NHS should consider adopting a Dutch system of out-of-hours GPs working within the England’s A&E departments, Monitor has urged.

This would improve care quality, cut rates of unnecessary A&E attendance and enhance GPs’ job satisfaction as a result of not having to be on call, the health services regulator said.

But the GPC said the proposals, from a new report titled Exploring international acute care models, would require a solution to the GP workforce crisis first.

The Dutch system championed by Monitor sees patients who need urgent treatment at night or weekends first contact an out-of-hours GPs based in a specialist clinic that is often co-located with an A&E department. And, according to the report, Holland sees only 120 A&E attendances per thousand of the population per year compared with 278 in England.

The report said: ‘[W]here GP posts are co-located in hospital premises there might be cost efficiencies resulting from shared use of resources and infrastructure, particularly X-ray availability, simple suturing and so on.

‘The Dutch system reports good GP job satisfaction and work-life balance improvement. Average time on call out-of-hours for a GP was reduced from around 19 hours per week to four hours per week when GP posts were introduced.’

But GPC chair Dr Chaand Nagpaul said: ‘Most importantly there is an acute shortage of GPs that has been exposed this year by the 450 vacancies across England for GP trainee positions. Comparisons with other countries, while useful, cannot be taken as like for like, especially when – as Monitor indicates – the UK spends less on its healthcare than other developed economies, a fact that applies particularly to out of hours services.’

He added: ‘This report highlights the compelling case for more GPs and the need for a coherent plan to establish a clear urgent pathway for patients that integrates a range of services, including NHS 111.’

The BMA previously opposed very similar calls made in a report from the College of Emergency Medicine earlier this year, which suggested all A&Es should have a GP working there.

Readers' comments (14)

  • This has been trialled and there are already GPs in many city A+Es.

    The problem is many towns have neither A+Es nor MIU services so we could end up even further away from our patients. Furthermore after a while, GPs near A+E tend to behave more like hospital doctors and feel medico-legally obliged to access things like blood test and scans which rapidly inflates costs.

    With a shortage of 8000 GPs and a primary care budget that has fallen to 8% of the NHS spend, it's difficult to see how this will work well in the UK.

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  • Will MDU/MPS cover us for this extra activity for free? I think the costs would outweigh any benefits that migt accrue.

    I wouldn't rely on NHS Indemnity, assuming it was offered.

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  • My main worry with this system is whether GPs can act as GPs, or would they be expected to follow the same medico-legal defensiveness as an A&E SHO?

    Its no good sticking GPs in casualty and expect them to work like an SHO. Its a waste of resources. Many studies find that clinicians who have the investigation resources available to them in the same building will be more likely to use it. Will the highly cost effective GP resource be worse off?

    Finally will patients abuse this new system? Not only can you see a GP, but with immediate access to bloods, CXRs, and admission to hospital. Would that actually decrease workload for casualty depts?

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  • Why does this regulator get to give its opinion on the best models of care?
    Same with the CQC who get excited about diagnosis rates and opening hours, rather than actually looking at if we deliver a safe service in safe premises.
    It seems that any old numptee can make sure their opinion is widely reported if they write a report some regulator or government body, but grassroots GPs' opinions are worth nothing.

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  • Do Dutch GPs do stupid pointless home visits?

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  • Dear Monitor the Dutch health system is insurance based so Dutch GPS probably don't get the well it's free dross that we get through our doors

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  • What happens to the housebound or who have no transport to travel to the next town ?

    Who looks after the palliative care patients ?

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  • "What happens to the housebound or who have no transport to travel to the next town ?

    Who looks after the palliative care patients ?"

    Good question....but I doubt your average politician, political executive or the 'I'm too busy to see my GP during the day cause I'm at work' brigade would have any idea what you mean, indeed even what a palliative care patient is, or who might look after them.

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  • With what GPs could we do that? Do we have sufficient workforce to implement this? What happens to existing services that GPs provide?

    I think you need to consider a few more factors when comparing systems. How about increasing the A&E minors units?

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  • Can't see how this would reduce 'time on call'- maybe it means could reduce busy-ness / workload on call?

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