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Trusts to have three GPs in A&E streaming service at one time

Exclusive Four trusts are planning to have up to three GPs working in A&E at any one time as part of the Government’s plan to triage patients at the door of every emergency department from this October. 

A Pulse investigation into trust plans for A&E streaming revealed that North Middlesex University Hospital NHS Trust, Maidstone and Tunbridge Wells NHS Hospital Trust, Norfolk and Norwich University Hospital and Taunton and Somerset NHS Foundation Trust will all have up to three GPs seeing patients in A&E as part of their triaging services.

The investigation, which received responses from 29 CCGs and trusts, found that 22 are planning to have one GP working at any one time in A&E, while three are planning to have two GPs on site at once. 

The Government announced the scheme in March, with the intention of easing pressure on A&Es this winter.

But trusts are already struggling this autumn, with four declaring black or red alerts in September and October and GPs have said the strain on A&E will put general practice under even more pressure this winter.

Yet GPs have said winter plans this year miss the ‘vital role’ of general practice and are instead relying heavily on this scheme to manage winter demand.

Trusts have given a variety of recruitment methods for hiring the GPs, with some hired by the CCG and others hired by the trust.

Some trusts plan to recruit through local and national advertising, others will work with local federations to supply the GPs and some are relying on the local CCGs to recruit the necessary GPs.

Taunton and Somerset NHS Foundation Trust, which plans to have up to three GPs in A&E at one time, said they have ‘not had difficulty in attracting GPs to work within A&E’.

A spokesperson for the trust said: ‘GPs tell us they like working in A&E, and enjoy the teamwork and the type of medicine they can practise there.

‘The GPs can work a mixture of GP practice hours and A&E shifts and that is attractive to some.’

However, NHS Brighton and Hove CCG said recruitment at Brighton and Sussex University Hospitals NHS Trust is ‘anticipated to be difficult’ but added that they also expect employment by a hospital to be an ‘attractive proposition’. 

But the Government’s plan is occurring at a time of widespread GP shortages.

Chair of out-of-hours representative body Urgent Health UK Dr Simon Abrams warned that workforce constraints have led to A&E departments appointing ‘quite inexperienced GPs’.

But GPC workforce lead Dr Krishna Kasaraneni has previously warned that a ‘chronic lack of GPs’ means it is ‘doubtful’ that the Government’s plan is feasible, adding that ‘most importantly we actually need more GPs in local surgeries’.

He said: ‘The Government should be focusing on this as a priority because we cannot soldier on with an understaffed GP service that is unable to provide enough appointments to patients.’

The Government’s ‘GPs in A&E’ scheme

Simon Stevens announced in a letter to trusts in March 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.

Health secretary Jeremy Hunt added that the system is working ‘spectacularly at hospitals like Luton and Dunstable’, which were able to admit or discharge 95% of its patients within four hours this winter despite mounting pressures.

But Dr John Ashcroft, executive officer at Derby and Derbyshire LMC, warned that only newly qualified, inexperienced GPs would go for the roles because of an £80 per hour cap on pay put in place by the Government.

The Government has since invested £100m to help hospitals upgrade their A&E departments to allow for the triaging service in three rounds of funding in April, June and September.

However, the scheme came under scrutiny when a patient died after being diverted to a GP streaming service in Bristol.

Readers' comments (17)

  • A/E GP: This doesn't look like an A/E issue go to your GP.
    GP reception: We're full. Go to A/E.
    A/E GP: This doesn't look like an A/E issue go to your GP.
    GP reception: We're full. Go to A/E.A/E GP: This doesn't look like an A/E issue go to your GP.
    GP reception: We're full. Go to A/E.A/E GP: This doesn't look like an A/E issue go to your GP.
    GP reception: We're full. Go to A/E.A/E GP: This doesn't look like an A/E issue go to your GP.
    GP reception: We're full. Go to A/E.A/E GP: This doesn't look like an A/E issue go to your GP.
    GP reception: We're full. Go to A/E.A/E GP: This doesn't look like an A/E issue go to your GP.
    GP reception: We're full. Go to A/E.A/E GP: This doesn't look like an A/E issue go to your GP.
    GP reception: We're full. Go to A/E.A/E GP: This doesn't look like an A/E issue go to your GP.
    GP reception: We're full. Go to A/E.A/E GP: This doesn't look like an A/E issue go to your GP.
    GP reception: We're full. Go to A/E.A/E GP: This doesn't look like an A/E issue go to your GP.
    GP reception: We're full. Go to A/E.

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  • Vinci Ho

    (1) Whether one likes this or not , this is a political directive coming from the last budget statement of the Chancellor. Considering the number of crises currently faced by this fragile government, nobody in Westminster would bother to rethink about how this £100 million should be spent otherwise . There is ,though ,appearing to have some possibilities that the forthcoming Chancellor budget statement may have some announcements on NHS funding ,after what the health secretary said in front of health select committee of House of Commons two days ago.
    (2) There is a question of exactly what these A/E GPs will do ?Pure triaging is arguably a waste of resources and repeating the statement ‘ this is not appropriate for A/E and please go back to see your own GPs’ is not going to help any of us . Yes , it may ‘educate’ some patients and prevent them from going to A/E inappropriately in the future. Equally, if these A/E GPs provide active interventions , you are feeding the behaviour of going to A/E instead . You simply cannot win. My gut feeling is NHS111 might even recommend patients to go to see these GPs in A/E if things get really desperate time to time.
    (3) The prospect of creating more working opportunities for our GP colleagues , perhaps , is presumably a positive one. Some young colleagues may like the idea. But under the atmosphere of surgeries closing and poor recruitment/retention , £80 a hour (presumed indemnity covered) could have already sucked away some potential candidates working in the community.

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  • An employee at 80ph presumably plus pension NI Annual leave Bank hols Study leave Sick leave annual appraisal plus job review, experience increments, paid for mandatory training als/child safeguarding and the rest, perhaps experience increments also and indemnity covered sounds ok. Hand over at and of the shift. Paid break. Doing bloods and cannula and begging other hospital regs to take the pts after begging radiologist to do the scan. Not that efficient really though.

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  • Why aren’t all doctors speaking truth to power?
    My understanding of the research is that if you put GPS in A and E they start to behave like A &E doctors.

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  • Those in power are incapable of listening, understanding and acknowledging when they are wrong and they are out of their depth.
    So we are doomed.

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  • Just Your Average Joe

    GP reception: We're full. Go to A/E.A/E GP: This doesn't look like an A/E issue go to your GP.


    Actually - what needs to happen is - there is nothing seriously wrong with you - go home and rest/recover, and don't come back with self limiting Cr0p please. See pharmacist, or get help from your gran or online etc.

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  • Just Your Average Joe

    The GP in A&E - will start acting like A*E team - due to medicolegal risks - if something goes wrong - 1st question will be why didn't you do bloods/xray when freely available in the department - this would have changed outcome!

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  • The GP will adapt and turn into an A+E doctor. The expectation that one picks up everything demands that one does all the tests under the sun to cover their back.

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  • Pay at our local DGH is £47/hr not £80. You work as part of a team, people are pleased to see you and value your experience as a GP, the work is interesting and you get sent on regular breaks. Is it any wonder there is no trouble recruiting?

    Unsuitable or offensive? Report this comment

  • Cobblers

    A west country GP @£47 per hour.

    Undersell yourself or what!

    The admindroids must be hugging themslevs with glee at getting GPs to work for that.

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