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GPs buried under trusts' workload dump

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)

  • we have gp front door streaming . costs a fortune and redirects very little . only works if highly experienced gps who are willing to manage risk stream and are able to redirect patients back to see their own gp in a timely fashion. patients come to a&e because can't get gp appointments and gp send patients to a&e as hospital has no beds for direct admissions . absurdly pointless. expensive time consuming steps added . quality added =0

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  • Cobblers | Locum GP | Kent03 Nov 2017 11:01am

    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.

    Whilst I agree, bare in mind most GP partners earn less then 50quid/hr. In fact, most I know are round 40quids/hr when you take out the cost of being a contractor.

    This is the real bit that needs sorting. If the partners are earning 80quids/hr, we'll have enough trainees wanting to be a partner (the most efficient part of NHS provision!)

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  • If u stock A&E with doctors and GPs this will increase demand. Especially if they expect their problem to be fixed in four hours. We’re not A&E SHOs. We shouldn’t be doing this. Would a consultant do this?

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  • Pointless political 'back of a fag packet' thinking. Anyone with a modicum of access knowledge knows this has no evidence base

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  • £300 per hour or naff off

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  • AlanAlmond

    Can I suggest something?
    How about hospitals to have an ‘Alan Sugar’ in every A&E?
    Can we have a news paper with a headline
    ‘Hospitals ordered to put an Alan Sugar in every a&e’
    Maybe a pilot could be run first in Margate.
    Can we pay him £75 an hour? (he isn’t actually medically trained so he could be paid less)
    This has got to help and anyone could see this guy really does sort stuff out ... we need him in a&e

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  • and where are they going find these GP's?

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