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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)

  • We simply cannot do any more without a huge injection of resources.

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  • ‘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.’

    Isn't this why Darsi centers closed? Hugely expensive and hardly any benefit to AED.

    Of course NHSE are fully aware of this. It is just another ploy to ensure non survival of primary care.

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  • 'GPs need to make sure'..
    If this is a commissioning intention I fully expect that the fund to make this happen will flow seamlessly from central NHS to co-commissioning CCGs to practices.
    A mere £250/patient should suffice.

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  • This is pie in the sky. We cannot give this standard of care unless we drastically reduce the number of patients each doctor cares for.

    In America they are proposing 5-600 patients/doctor so that each patient will have enough time spent on them.

    In the UK each full time GP has at least 1800 patients to look after. That means that even if he works for 8 hours a day, five days a week, for fifty weeks a year i.e. no lunch break and very little holiday,then he has only 66 minutes per year for each patient to do everything for them - appointments,visits,lab results, referral letters etc.

    The politicians have not grasped how under doctored we are.

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  • Lovely place that would be - in reality not achievable.

    Decreased funding, no staff, roll from crises to crises.

    Not sure when we have to see pstients. Interestingly no responsibility on patietns to access care properly

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  • I agree.a lot of a &e attendances are mostly problems that need to be solved by GPs.

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  • Yes, but only if there are enough GPs. Retain and recruit more GPs. That is the cost effective answer.

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  • Until A+E depts are incentivised to turn patients away (appropriately rather being paid to see everything no matter how trivial or ridiculous) then things will never change. So things will never change then.....just more useless ideology from NHSE.

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  • Did they mention one easy way to reduce unnecessary A&E attendances? Stop MPs and the media repeatedly giving the impression that there is no OOH general practice.
    It may surprise NHSE that we cannot safely increase workload further - something will have to give. Reducing A&E numbers, while possibly admirable in intent, is not something that drives my working day. General practice is more than this.

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  • Read the whole thing from cover to cover. It is pretty poor tbh. Nothing new to see here.

    Reading this and listening to Tim Kelsey's e-cult sermons it is obvious that they are coming for access to our appointment books next.

    A very, very foolish idea.

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