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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)

  • what is actually happening to A&E and GP attendances in the past 10 years?
    In NI attendances at A&E iis down 5% in past 10 years where GP Consultations iare up 58% over the same 10 year period. There is extra money is going to A&Eservice but funding has been reduced to GPs. It does not make sense. Why do they not look at the attendance figures and divert the funding accordingly.

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  • When telephone consulting only focusses on urgent care it becomes a higher risk 'triage' system.
    Our own experience confirms that using telephone consulting on follow ups and long term patients is where particular gains can be made that unlocks time for the acute demand.

    However, telephone consulting without the full capacity to meet demand breaks down.

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  • How about differentiating between demand and pseudo-demand??!! No OTC prescribing, No Med3s, No GP appointment unless triaged by a good nursing team.
    If your nan can fix it then do not bother you GP unless you pay through the nose for it. That should fix it.

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  • 'How about differentiating between demand and pseudo-demand??!'

    This can be extremely difficult to do safely, thus the use of the most trained person - GP - for 1st contact can be useful, rather than pseudo triage via reception or barriers re waiting times, as per the current model.

    Of course if patients paid the GP for an attendance then a queue at the door would be seen as a good thing, not some kind of failure!

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  • It's hard to see what's not to be 'prioritised'. Prioritising everything = prioritising nothing.

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  • I routinely work 13 hour days without a break. On a busy day I am too tired to think straight by the need of afternoon surgery. Letters and results are usually checked at home after a meal and a rest as there is no time to do this at work.

    When do NHSE think I will have time to do all this extra stuff? If this is forced upon us it will be the final straw for me, already started doing some serious planning for life beyond NHS general practice as clearly nobody has any intention of resuscitating the dead donkey that this career has become.

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  • @12:57pm
    Frankly it is amateurish and kind of ignorant to have people commenting on issues they have no understanding of.
    When you pack your things and leave work by 5pm, a lot of us will still be 'prioritising' to ensure proper patient care.
    You have no idea and I do not blame you for your ignorance.

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  • I agree we need lot of resources in terms of man power and finical help from the Gov.It is very easy to impose on the GPs by NHS England .We GPs have very little power in this country..
    What is said above will be accepted by GPs as we are very weak and helpless.

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  • It strikes me that A&E attendances will rise significantly as the result of GPs seeking medical assistance to have the brush removed?

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  • In NI, we see over 85% of all NHS face to face consultations on 6% of the NHS budget.
    But they want us to more - more ward rounds, phone calls, home visits.
    The fault of the GPC really for doing nothing.
    The LMC voted this year for payment per appointment, but Chaand and the GPC still want patient based pay such that here in NI, as pointed out earlier we get £60 for 6 consults [ £10 /consult], but we used to get £80 for 4 [£20].
    If we are stupid enough and dumb enough to continue to do more for less, then of course we will be asked to more and more, and the stupider we get.
    Serves us right for being as daft as that.

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