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Independents' Day

Government to expand GP streaming service as '10%' of A&E patients diverted

The Government is planning to expand GP streaming services in A&E departments after claiming that it reduced pressure on urgent care services, a minister has stated.

Baroness Blackwood, the Department of Health and Social Care's then-minister for innovation, said that 10% of all patients visiting A&E are now seen by a GP.

Since 2018, acute trusts have had to ensure they have GPs on site at all times to divert and treat patients who do not need hospital care, backed by a £100m investment.

Addressing the House of Lords last month, Baroness Blackwood said: 'We need to improve access to community care to make sure that people are diverted away from inappropriate visits to A&E. We have said that we will recruit over 6,000 doctors in GP practice, and we are working on that as we speak.

'We are also increasing the number of GP[s] within A&E so that people can be diverted into appropriate care when they go to A&E inappropriately. The evidence is that already around 10% of those attending A&E are streamed [via] those GP[s], and we are currently trying to increase that provision.'

The Government, which has yet to publish any official evaluation of the scheme, told Pulse the 10% figure comes from internal analysis, which it declined to share in full.

The DHSC and NHS England also told Pulse they had no central data for how many GPs are currently working in A&E streaming as this was managed at a local level.

GP leaders argued that the scheme should not be expanded, as the streaming services create a 'perverse incentive' for patients to go to hospital rather than their GP practice and threaten continuity of care.

Dr Fay Wilson, CEO and medical director at Urgent Health UK and GP out-of-hours cooperative Badger, told Pulse: 'Patients are not thick, it will simply result in more and more people going into A&E. It ends up giving patients a perverse incentive to go into A&E with minor ailments, we need to stop treating them in A&E. It’s a really, really stupid idea.

'I’m fed up with politicians not looking at evidence, creating kneejerk reaction policies and not responding to the patients’ needs. It is much more sensible to use GPs in general practice, rather than put them in hospitals.

'I’m sick of the NHS spending £70, £80, £90 to see a single patient in A&E when they are not prepared to properly fund general practice.'

Dr Krishna Kasaraneni, BMA GP committee executive lead for workforce, said: 'One of the key solutions to addressing the pressures on access to services in the NHS is to invest in expanding the primary care teams in GP practices. With investment to increase the number of GPs and allied health care professionals, the care provided to patients in general practice will continue to improve.

'This, in turn, should then address some of the pressures on the NHS as a whole. There is no substitute for continuity of care and spreading the already stretched GP workforce even more thinly is likely to further fragment care.'

Early evaluation of the scheme saw researchers on the fence, with one study claiming GPs saw patients 'quicker' using 'fewer resources', while another failed to show any impact on overcrowding issues.

Meanwhile, a Pulse survey a year into the scheme found that a quarter of GPs were finding it more difficult to employ locums as these were being booked up to work in A&E departments.

Baroness Blackwood resigned as a health minister in last week's cabinet reshuffle. Meanwhile, Helen Whately, the MP for Faversham and Mid Kent, was added to the DHSC team as a minister for care.

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Readers' comments (18)

  • Much is written about problems meeting the 4 hr A/E target, but is the target the problem? Everywhere in the NHS care is delivered according to a balance of need, resource and evidence. Suspected cancer cases are seen before the obviously benign. Suicidal patients are seen urgently by specialist led teams whereas the chronically mildly anxious might be directed to on-line treatments. A 35 yr old man’s 3 week itchy crutch ringing my surgery for an urgent appointment will offered a routine appointment a few days later. But not if he were in A/E, uniquely, there he is expected to be treated in the same timeframe alongside patients with suspected heart attacks, blood clots, pneumonia or broken bones. There are other unintended consequences, attempting to meet the 4hr target leads to perverse distortions in the allocation of resources and funding, sucking up money that could go to community care. The target was introduced in 2008 by a beleaguered SOS wanting to avoid adverse headlines, not after any research, studies or objective assessment. A/E should now be freed of this political whim and allowed to respond to clinical need. Does our newly emboldened government have the courage to do so?
    Dr Paul Cundy
    General Practitioner,
    Wimbledon

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  • A total and utter waste of f******g time. For once I agree with the BMA comments.

    Speaking as someone with # ankle and currently back at work on crutches as no locums!

    Interestingly 3rd time in medical career worked with POP applied, maybe valuing all NHS staff, especially Primary Care a bit better might help.

    6 weeks let

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  • Cobblers

    Latest brain fart from her maj's gummint.

    The fly in this ointment? Not enough GPs.

    And as Fay rightly says we should be heading these patients away from AEU unless your idea long terms is to abolish GP.

    I'll leave you with that thought. If you believe that is their aim then some of what they do makes sense.

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  • "Please do not go to A&E for things that your GP could help with"
    "If you come to A&E you can see a GP"
    I may need the help of Big Brother to think both of these things at the same time.

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  • doctordog.

    Modification of help seeking behaviour?
    This doesn’t help.

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  • Utter utter genius.

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  • Having worked extensively on/off as a GP in A&E (before service stopped as seemingly it worked but those damned GPs expected to be paid...) the main problem I see is UK A&E generally staffed by very junior and inexperienced Drs who manage one case at a time from admission to d/c with middle grades hiding away or "supervising." A&E should be highly paid and therefore fully staffed at all times.

    No one else is trained to manage risk, high foot fall and demoralising time constraints with no breaks - if primary care was REALLY wanted as an NHS service it would be properly supported and made appealing to our brightest young.

    Why would anyone choose to go to A&E with usually minor ailments when we all have access to 24/7 GP and OOH access.

    The big question most of the time in A&E waiting rooms is the game of actually identifying who the patients are and who are simply their friends or family!

    I agree in the irony of don't go to A&E but if you do you'll see a GP!!!!

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  • I remember a shift I did (to help pay for car loan) where the consultant in dept had arranged full bloods and paging the Pads consultant in for a child. As I walked past with him very flustered I saw smiling child sitting there with obvious Molluscum.
    Real battle after that to cancel all his great plans and just send family home with simple reassurance and advice.
    "but you're only a GP"
    Did point out we see an awful lot of stuff and rarely bleed and scan everything before making a clinical decision.

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  • What remaining GPs the NHS has are being forced to do appraisals, SARs, GDPR, CQC preparations etc.

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  • The problem is. I one making these decisions seems to see the overall picture. GP stuff is going to A and E as they can’t get to see there GP for two weeks. This leads to increased A and E attendance but rather than sorting out GP land with better pay, less stress etc so people stay, they take GPS away from this into A and E. someone is very very dumb

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