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GPs go forth

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.

Readers' comments (18)

  • I would love an experiment where old levels of APMS/WIC funding was given to some bog standard gms/pms practices for 3 years guaranteed with the only stipulation being ‘improve your patients’ care’, and no expectation of care plans, KPIs or reporting.

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  • Why is A+E expensive? Case: A+E consultant did PSA test which was raised on a 98 year old (uncertain why it is an emergency test) and told the GP to refer to urology. Sent to Urology and the urologist told the GP off as an inappropriate test as most 98 year olds would have prostate cancer and it makes no difference to life expectancy.

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  • Dear All,
    I'd suggest there are two problems here;
    "
    Why is A+E expensive? Case: A+E consultant did PSA test which was raised on a 98 year old (uncertain why it is an emergency test) and told the GP to refer to urology. Sent to Urology and the urologist told the GP off as an inappropriate test as most 98 year olds would have prostate cancer and it makes no difference to life expectancy".

    1) the A/e consultant doing unnecessary tests
    2) a GP doing what the A/E consultant tells him.
    The word "No" is a completed sentence. GP 2) should have said what a waste of time and moved on to the next patient.
    Regards
    Paul C

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  • 1.Most governments over the years are bad at making "realistic" plans. This has been poorly thought through; very unrealistic.

    2. The government needs to listen to the relevant professionals (GPs).

    3.There should be a £10 fee for all Minor Illnesses in the NHS (GP and hospital sectors).

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  • 1) Patient makes stupid decision to attend ED with trivia
    2) Government- how do we accommodate this foolishness better?
    3) Government drain only highly efficient part of NHS

    Absolute morons

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  • Problem with saying no is There is the implied or often explicit threat of complaint and resulting paperwork. For which we have no time if you value your sanity. There is too much regulation which hopefully the Americans will insist on paring back if there is a trade deal.

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  • Almost as good as "truth finder" and yes its true. Implanon fitted by a very well known company. Inserted too deep so told patient couldn't sort it. Patient rung 111 who said see GP. Patient interpreted 111 advice as go to A/E immediately who did ultrasound scan to confirm presence of Implanon and advised patient to see GP.

    Minor issue is GP not trained as Implanon fitter and what the f**k am I expected to do to sort out other peoples problem/mess?

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  • its a GP walk in centre. still get paid more than the local GP practice. QED.

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