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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)

  • It would not be unreasonable if "urgent advice" was truely urgent.

    I was on-call yesterday, and I had many worried well and other motives - needed to see a GP for travel cancellation insurance, reassurance on low grade dyskariosis, stress at work as told off by manager, confirmation of chickenpox, etc etc. All of which patients insisted were urgent and could not wait for routine appointment the next day. On top, patients who were unwell for several days calling at 5pm asking to be seen before 6:30 - I'll let you guess why they chose that time.

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  • 'Others include asking GPs to prioritise urgent home visit requests, do morning rounds with patients in community care beds................................
    They will soon be teaching GPs how to suck eggs. Do these guys think that GPs are robots?
    My whole job is about prioritsing everything and dealing with them appropriately. I do not need any NHSE person to tell me how to prioritise.
    Grossly stupid guidance.

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  • Time to get some guidance for the NHSE from grassroot GPs.

    I am sure we can give proper advice to NHSE how to improve.

    Do they have any real doctors at all in NHSE?

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  • the sinister NHSE ... watch out, I did have a few meetings with some NHSE bods regarding drug budgetary issues.

    I did not tell them I was an ex GP and although they were reasonable nice people, the degree of ignorance about basic NHS issues was frightening.

    They did not understand how medicine management teams can increase GP workloads, they have no idea about why there are drug shortages in the UK and how that impacts on GP and pharmacy time!

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  • Above,In the kingdom of the blind the one eyed man is king.Scarey

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  • For every action there is an equal and opposite reaction:

    Therefore:

    Stick it up your jumper, NHSE told by pig-sick GPs.

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  • I'm sick of this. If all the powers that be can do is wag their uninformed fingers at us they can expect to be ignored. They haven't the first damn clue what is happening to our profession, and increasingly give the impression of not giving a damn either. Same day access? Seven day access? Tell it to the people of Harbottle in Northumberland, who'd be happy for ANY day access now their surgery is closed. GP's are dropping like flies and there is no goodwill left. The coming crisis will be ugly and people are already positioning themselves to avoid the blame. We should not let them off the hook. This is entirely the fault of policy, was endlessly predicted, and is coming to pass. The public who elect these clowns are entirely disinterested and misinformed, so stuff 'em, they'll miss us when we're gone.

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  • Cue Maureen, you're on love, what this crisis needs is big old dollop of matronly hand-wringing.

    Altogether now ; " We welcome this report...."

    And we wonder why we're in such a mess.

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  • I should have said NHSE do not accept there are any issues or concerns about GP recruitment or retention.

    Everyone in NHSE i talk to sees it as a cyclical issue or a non-problem

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  • Patient Access data strongly supports telephone consulting, but there are clearly too few doctors for this, and the patient without chronic issues does not need to speak to 'their' doctor. Remote consulting is the answer. Maybe private services have a role here? @DrMortons we certainly hope so. Why not join us?

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