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A faulty production line

Hospital says GPs will manage patients it has told doctors to discharge early

A hospital trust in South West England that is advising its senior clinicians to discharge patients early has said primary care and other services are ‘well equipped’ to manage these patients.

Hospital doctors at Royal Cornwall Hospitals NHS Trust were sent an email by bosses earlier this month, encouraging them to discharge patients before it is clinically appropriate to do so.

The trust admitted, however, that there is ‘proportionate risk’ for patients coming to harm. The email, signed by the trust’s medical director, Dr Allister Grant, said that GPs and community services were ‘well-equipped’ to cope.

The BMA said the 'unacceptable' situation was putting patients and doctors at risk and was a result of pressures facing services.

GP leaders have said GPs could be left with sicker patients, who are beyond their scope of practice.

A spokeperson for Royal Cornwall Hospitals NHS Trust said 'nobody will be discharged if they still need care that can only be provided in hospital' but for many it is 'far better' to be managed in the community or at home.

The email sent by the tust said: ‘One of the mitigations was to look at the level of risk that clinicians are taking when discharging patients from Treliske Hospital [now known as Royal Cornwall Hospital] either to home or to community services, recognising that this may be earlier than some clinicians would like and may cause a level of concern.

‘It was agreed however that this would be a proportionate risk that we as a health community were prepared to take.'

It later added: ‘We discussed the fact that the community services, voluntary services and primary care are well equipped to manage some of these earlier discharges.’

Yaso Browne, GP lead for the Doctors' Association UK, said early discharges was a risk to GPs as well as patients.

She said: 'If premature discharges are indeed occurring, this is not just a threat to the safety of the individual patient but also to already stretched community services.

'It may mean that GPs will have to prioritise managing these sicker patients potentially involving work beyond their scope over patients they routinely manage and have been trained to see.'

Dr Chaand Nagpaul, BMA council chair, said: ‘This example highlights the frankly unacceptable situation doctors are facing on the ground, being pressured to discharge patients earlier than is clinically appropriate – putting both themselves and patients at risk – due to a lack of capacity and unprecedented demand.

'This is a dire indictment of the state our NHS has been allowed to creep into.’

Dr Nagpaul added: ‘We are writing to the trust to express our serious concern and we are ready to support any doctor who refuses to compromise their care to patients. We are also reaching out to the GMC.’

A spokesperson for Cornwall and the Isles of Scilly Health and Care Partnership said on behalf of Royal Cornwall Hospitals NHS Trust: 'Our doctors, nurses and other frontline staff are working exceptionally hard to care safely for the much higher number of older and sicker patients who need our health and care services this winter.

'Nobody will be discharged if they still need care that can only be provided in hospital, but for lots of people it is far better for their physical and psychological wellbeing, and far more convenient for them, to recover at home or in a community setting with the right support, which also means that beds are available for those who need them more.'

Readers' comments (27)

  • Cobblers

    "It may mean that GPs will have to prioritise managing these sicker patients potentially involving work beyond their scope over patients they routinely manage and have been trained to see."

    No. Readmit.

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  • Nhsfatcat

    We’re a health community when it comes to dumping work out into primary care but we’re certainly not in it altogether when it comes to negotiating these plans or helping primary care cope.
    Most of these patients will need more nursing input at home and there are hundreds of community nurses drinking tea and eating hon nobs, aren’t there?

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  • "we as a health community were prepared to take"
    I'm pretty sure the health community includes the GPs.
    And the GPs were not asked about being prepared to take on the increased risk or doing hospital work for free.

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  • Bounce straight back in remember what they did to Dr BG when the system failed her.

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  • truly shocking

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  • Not uncommon to get a discharge letter suggesting patient needs a visit day after discharge. If they need to see a Dr every day then they are in hospital - refuse

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  • A quart into a pint pot will not go.

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  • I would bounce the patients straight back in to hospital as a failed discharge and report it as a SEA

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  • Urgent need for post hospital visit are nearly always an indicator of an incomplete or early discharge. Failed discharge - back to a/e.

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  • Most of the work caring for patients in hospital is done by nurses and HCAs. So if they come out earlier than expected into the community there would need to be a large investment in more community and district nurses. It may actually be a good idea but with a large increase in DN funding.

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