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Provide same-day advice to reduce A&E attendances, GPs told

GPs need to make sure they see or speak to patients seeking urgent advice on the same day that they receive the request, NHS England says as it lists how GPs can reduce A&E attendances.

The directive is one in a long list of ‘best practice’ guidance for GPs that has come out of NHS England’s major review into how urgent care services can be reorganised so that fewer people attend A&E departments and are admitted to hospital in an emergency.

Others include asking GPs to prioritise urgent home visit requests, do morning rounds with patients in community care beds, participate in regular meetings of the local ‘system resilience group’ - the multidisciplinary groups set up to improve urgent care planning locally - and risk-stratify frequent users of mental health support services.

The Transforming urgent and emergency care services in England document said that ‘the overall aim should be that no patient should have to attend A&E as a walk-in because they have been unable to get an urgent appointment with a GP’.

For example, it said GPs should offer ‘a range of options’ to patients seeking urgent advice.

The report said: ‘These may include telephone consultations, e-consultations and walk-in clinics, as well as face-to face appointments. Channelling patients into a single, rigid process inevitably disadvantages some, can lead to ‘gaming’ of the system and may lead to inappropriate use of emergency departments.’

It further suggested GPs hold a telephone consultation with hospital doctors before patients with complex health issues are discharged, that GPs must be informed every time a patient is admitted to hospital for a condition that was ‘preventable with good quality primary care’ and that GPs carry out reviews of care home residents and always discussed with the patient’s care team before any patient is admitted from a care home.

The report also says GPs should provide early morning appointments for children who have deteriorated in the night ‘to avoid parents attending A&E because of anxieties and doubt they will get an appointment’.

But Dr Richard Vautrey, deputy chair of the GPC, warned practices would need investment to expand services  in order to offer any greater same-day access.

Dr Vautrey said: ‘We know practices are under massive pressure and have not had the investment into their services in the way A&E has had the investment in recent years and hospitals have had this with extra staff – we’ve actually seen the reverse happening.

‘So if NHS England are serious about reducing the pressures they need to be serious about finding the solutions, which is about identifying proper resources for the longer so practices can expand services, provide the extra staff and meet the growing the needs of the population.’

Dr Vautrey also questioned whether the same-day appointments would help to cut A&E attendance.

He said: ‘The evidence suggests it’s little to do with the GP appointments  - many practices have excellent access in terms of getting appointments and being able to get through on the phone, yet patients will still got to A&E because they perceive that is the right place for them.’

The report follows a list of urgent care advice given by NHS England to CCGs in May, including stipulating that no patient should attend A&E because they could not get a GP appointment.

 

 

Readers' comments (47)

  • Did they also look at how much general practice time is taken up dealing with hospital work? If not, can that be the next "how doctors should do their jobs" from these people?

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  • surely NHSE should be stating

    "physician associates should...."

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  • More obvious old ideas as usual with no resources from a totally out of touch useless quango
    Instead of wasting time with these feeble stale platitudes we need an action plan to strengthen primary care
    All we get is words while they waste resources on their tsunami of non evidence based nonsense
    Wish they would all resign and transfer their resources to patient care... and pigs might fly
    Still this is typical of their autocracy which is doing a great job in reducing GP numbers

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  • So now we know what physicians associates will be doing.

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  • There is only one reason why NHSE wants GPs to take on more work and that is because it costs NHSE nothing.

    Wait until they book patients directly into our surgeries from a central call centre

    We need our contract changing to payment per consultation / problem / inch sutured, as in Canada

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  • There needs to be a change in the way we get paid for any of this same old bull waffle to happen.There needs to be an increase in the workforce,a ten minute consultation on email,face to face etc. is still ten minutes.You cannot put more time in the day.This still will not be good enough as the "I want it now" client base will still go to A&E when they cant get what they want immediately.After all they go to A&E they get a 'proper dr' in a white coat and scrubs,all the investigations under the sun and get seen within 4 hrs.The hospital wins under payment by results getting the sixty quid through the door payment+paid for there investigations+ procedures.While in lowly GP land we get paid per year roughly what the hospital has been paid for this one consultation.Dear NHSE (the people who do the dirty work for HMG)your going to need more than the extra 8 billion pounds a year your 'promising'to put into the NHS to fill the hole your digging.I was always taught when your digging a hole know when to stop.Then again when your digging a hole for the NHS it has to be mighty big.

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  • No politician would dare stop paying A&E for seeing non urgent cases.

    Until they are not paid to do this work, they will continue to cream off the profits from each attendance - and feed the demand by giving almost every child with a fever antibiotics for ''Chest infections'' the GP is missing with no evidence on the costly xrays they took.

    Stop the payment by results and let hospitals do this work altruistically and see how long they continue to see them patients, and how their behaviour changes.

    Otherwise the only other way to stop some patients going to A&E would be to build a moat - and only drop the drawbridge for the real Emergencies.

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  • Vinci Ho

    Everything it said was so politically correct , wasn't it? But can you feel how dangerously flawed this is as this is so out of touch with reality.
    GMC has guidance for us. NICE has guidance for us and now f*c*ing Ministry of Plenty has guidance for us? We must have been doing our job so so wrong !!
    Bottom line : this kind of directive is despotic , judgemental based on one political view with an underlying agenda to wipe out the current form of general practice , and more importantly 'brainwashing' the following generations of our colleagues.The government cares no less about what old fart like me would say but will create a 'new army' for the 'New NHS'(whatever it is going to be called) with all these guidances. The new General Practice soldiers will be 'value for money' , 'obedient' and 'serve well'. Remember this thing called 'Universal Soldiers' in Hollywood movies?
    And don't tell me Harvey Dent , the 'Messiah' , is not involved in this report while he was enjoying his attention telling how much he cared about the general health of NHS staff and will ensure help was there for people burning out . There is a reason why Harvey Dent is called Two-Face.
    Once again,(you are bored of me now !):
    There is only a fine line between politically correct diplomacy and dangerously flawed hypocrisy........

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  • 'They will be coming for our appointments next'

    Then they will find out how few are left ! We do so much triaging to fit those patients in that really need to be seen. What we cannot do is see those that WANT to be seen.

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  • "GPs need to make sure they see or speak to patients seeking urgent advice on the same day that they receive the request"

    I can't see what is unreasonable about this. Good practice I would say

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