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Third of patients presenting at A&E 'could be treated by GPs'

GPs located in hospitals could treat up to 30% of patients currently arriving at emergency departments, claims a new report.

The College of Emergency Medicine report argues urgent care centres run by GPs or other professionals on the same site as their emergency departments could to divert patients away from beleaguered A&E staff.

Only about 10% of emergency departments currently have co-located primary care facilities, said the College, although the proportion of emergency departments with co-located out of hours GP services delivering unscheduled primary care is higher at 36%.

The College makes the recommendation among nine others in a report, The Drive for Quality, calling for a major shake-up in the provision of emergency services and the way they are funded.

Emergency departments are on the verge of collapse because of staffing and cash shortages, the College argues.

The report draws on findings of a survey of 131 UK emergency departments by the College during 2011 and 2012.

The report states: ‘Commissioners and clinicians must work closely together as a matter of priority to better manage workload in their emergency departments.

‘Clear targeted funding strategies and appropriate co-located primary care services are needed to cater for 15% to 30% of the present work in emergency departments.’

Chief executive of the NHS Confederation Mike Farrar said they strongly supported the warning by the College.

He said: ‘The past few months have been the toughest many of us in the NHS can remember, and credit must go to A&E staff who have been working tirelessly to manage patients safely.

‘The key thing is to understand that A&E doesn’t stand alone - pressure in our A&E departments is a visible symptom of a whole system under great strain and tackling it requires a whole-system solution.

‘We urgently need  to look at the alternatives. This includes fundamentally reviewing how we organise and fund our services outside traditional hospital settings, the way staff work throughout the whole week, and how we provide effective alternatives to hospital-based emergency care.’

Readers' comments (13)

  • Im sure there are lots of people turning up at A&E who could be seen and treated by GPs. The problem is getting yourself infront of a GP in a timely manner. By the time you have finally got through on the phone number, avoided been fobbed of by the receptionist with an appointment in 2 weeks time, and got a same day appointment you might as well have gone and waited in A&E. It would be much quicker and less hassle.

    People are fundamentally lazy. As a result they will always go for the easiest route to treatment. What needs to happen is that access to GP's needs to be the path of least resistance for patients, then they will follow it.

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  • Dear Above - this is the most important sentence -"The key thing is to understand that A&E doesn’t stand alone - pressure in our A&E departments is a visible symptom of a whole system under great strain and tackling it requires a whole-system solution". GPs are at bursting point also hence 2 week appointments for non urgent problems.

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  • Anon 12:22

    You've just proven the selfishness of the great British public. Have you considered the strain you are causing the system by choosing what is most convenient for you, rather than what is most appropriate? If the public continues to behave as you do, no amount of restructuring or increasing GP access will solve the problem as people will always see their problem as urgent and important.

    By the way, increasing GP access has never been proven to reduce AED attendance as far as I'm aware. In fact I remember a study done couple of years ago which proved this point

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  • & a 1/3 of those attending the GP didn't need to as nothing wrong with them medically.

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  • There are two types of patients:
    1.The bum:someone who has never worked and has no intention of working but to subsist on state handouts all their lives
    2.The taxpayer:hardworking citizen who is propping up the slobs at the bottom and the super-rich tax evaders at the top

    If you're a bum then you should shut up and stop complaining.You're lucky that you're entitled to any health care at all.Just go to USA and see what happens to folk like you.

    On the other hand if you're taxpayer then you rightly deserve more.This is where a state funded health service like the NHS breaks down because your money is being diverted elsewhere to provide a "free" (i.e:free for the bum) at point of delivery service .So you will get a much superior service in an employee/employer based insurance system as in the States.The only way to do that here in the UK will be to abolish the NHS but as has been discussed before that is one holy cow no politician is going to slay.

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  • 'The key thing is to understand that A&E doesn’t stand alone - pressure in our A&E departments is a visible symptom of a whole system under great strain and tackling it requires a whole-system solution.'

    We were fully booked 3-4 weeks in advance and our on the day appointments filled everyday so additional or urgent extras were making 30% of our daily workload- some real and some unprepared to wait; so we instated minor illness surgeries to offload some work. You've guessed already- they got filled as well and nothing changed to the ordinary and on the day availability; it just fuelled the demand. And the 5m for the minor illness issue was abused very quickly as a simple route in!
    Expectation/damand is too high for what we can provide. As a partner I feel duty bound to leave no time in the day where I can not see patients and thus do paperwork etc at night. I know it's 1755 and I'm replying to a Pulse article but that's because I just can't talk to another patient without a break I haven't paused since 8am, except driving between visits.
    A+E at breaking point- I hope they're ready to thrombolyse me soon!

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  • The hospitals are reluctant to accept GP help. If GPs sat in a room in A&E and saw a third of the patients who were diverted from the triage nurse they would lose a significant portion of their income. The hospital would be unable to claim a tariff for those patients. We suggested this solution locally and had immense opposition despite there being ample room in the department. The best we got was the MRI bus parked outside A&E to consult patients in over the xmas holidays. I'm getting fed up of this moaning, us GPs have been ready to go in and sort out the hospitals problem if they want our help.

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  • Maybe the RCGP should have a conference about GP workload has vastly increased and we are bursting at the seams.

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  • 8:28 Try and at least grasp the situation before you spout such prejudiced nonsense. Attendances at ED are not a cash cow for the hospital.

    ED departments don't even get the money to see the patients. Any increase above the historical baseline (which currently is running at at 150%) is only paid at 30% of tariff. So they are deliberately underfunded, supposedly to stop hospitals greedily hogging all the patients!?! The CCGs (and PCTs before them) were supposed to invest the cash in preventing the rise in attendances. Instead, they've pocketed the surplus or invested it in failed schemes, which clearly have not stemmed the flow

    Meanwhile, the hospitals are drowning in patients and they don't even get the funding they need to provide safe care. I don't pretend to know the solution, but it does not lie in mud slinging at each other.

    As for turning away offers of help, every study putting GPs in an ED shows that in 6 months, they behave exactly like an ED doctor,so there are no savings to be had there.

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  • we had a pilot in our local AE with GPs working there to relieve pressure on Ae. I did about 6 shifts over several months. I did not see one 'primary care' case. All cases were appropriate to AE. The consultants and the out of hours organisation (who provided the staff), pulled the shifts as they were not useful. This is because our local out of hours organisation works effectively with ambulance servicces, AE departments and other local health services. Our system in our area is not particularly 'broke'! If numbers in AE are high, this is for other reasons, including alcohol related disorders, something our government does not have 'the guts' to tackle - easier to blame GPs!!!!!!!

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