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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)

  • 'No patient should have to contact their GP as a result of hospitals not completing the 'package of care' or not following up their patients appropriately and safely'.
    Might help.

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  • "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"

    Does that include those patients for whom the GP has decided that an urgent appointment is inappropriate?

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  • Why shouldn't patients go to A&E after all, Jeremy Hunt admits he takes his kids there because it is quicker than seeing a GP?

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  • I thought the Tories were desperate for Patient choice - what they want when they want it? Therefore if I want to go to A&E with a 5 minute sneeze that is my choice surely?
    In fact stop funding A&E for every presentation and have a decent clinician triaging at the front door and suddenly the problem will be solved in a couple of days - you don't need A&E go to WIC / OOH / own GP / supermarket to buy your own paracetamol. Take some responsibility etc.

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  • Ivan Benett

    Improving in-hours access is possible under the current system using methodology such as provided by the PrimaryCare Foundation, we did it in Central Manchester. In addition, further demand can be taken up by extending current hours. We've done it in Central Manchester and so are the PMCF practices across the country. This seems to reduce A&E attendances by about 8-14%. Note there is little impact on unplanned admissions, which needs much more and whole system change - which is happening in Central Manchester and reduced unplanned admissions so far this year (early days).
    In the end we do need more doctors and nurses.
    I would suggest that average list size per WTE (9sessions a week) GP should be reduced to 1,500 or less. As well as urgent care, there is a lot of proactive and anticipatory care to be done that currently can't be done. Also for new models of working and integrated care, we need a smaller case load. And we need to recognise the value of relational continuity of care.
    So having fewer patients to look after, and better must be right.
    Before anyone says it, no this can't be done tomorrow, but we should aim for it by 2020. Indeed we should hold the Government to account on this.

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  • Is that the same aed attendance reduction and successful Manchester scheme David Cameron announced BEFORE the scheme actually started?

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  • This proactive and anticipatory care malarky is based on false premesis. Care of chronic conditions involves good access and continuity in order to update the care as conditions and symptoms evolve. Care planning is an active semi acute process, not a once a year paper excercise.

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