Posted by: Tony Copperfield
14 March 2017Ah, don’t you just love it when that happens? ‘Patients will be able to see a GP "in every A&E" by next winter, says NHS boss’ v ‘GP appointment waiting times to be published under new access drive’.
Glorious. Both statements from the same department, each deeply flawed and the one at odds with the other.
So. The GP in every A&E thing. I really don’t think you need me to highlight the issues. But just in case: off the top of my head, we have the potentially eye-watering defence subs, the funding of £100m not buying that much for that long, the possible inadvertent encouragement of patients to attend A&E (to see a GP, yippee!) and the fact that a more logical but equally ambitious aspiration would actually be to have a general practitioner in every general practice.
And the GP appointment publication thing? Ho hum. For one thing, appointment access is a very complex issue - and you can bet that whatever instrument they end up using to measure it will be about as blunt as the weapon they beat us over the head with when that data is misappropriated by the likes of the CQC.
And for another, while I’m not even slightly surprised that NHS England’s line on the new investment is, ‘...it’s reasonable to expect, on the back of that, improved access,’ I don’t even slightly agree. That funding was needed just to cope with the workload dump, and I am running out of time, energy, will and space to magic up appointments. It might get us off our knees, but we’ll still be barely mobile.
Which leaves us with that delicious contradiction. Just to savour the absurdity of it, I would absolutely love to work in my local A&E just to triage one of my own patients back to an appointment with me at my own surgery which he won’t get because I’m triaging patients like him at A&E who are there because they can’t get an appointment with me.
Hilarious, but infuriating, too. By the time you read this blog, the typo made by Pulse about this ‘GP streaming’ will have been corrected. Shame. Because I think they had it right first time. GPs will be steaming, and so will their patients.
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield
Readers' comments (16)
Angus Podgorny | GP Partner/Principal14 Mar 2017 8:57am
Hopefully with that sort of thinking the Tories will eventually all disappear up their own bums.
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Healthy Cynic | GP Partner/Principal14 Mar 2017 10:05am
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Ivan Benett | Salaried GP14 Mar 2017 10:14am
Actually, the idea is to reduce admissions. It won't do that either. By the time the sick-enough-to-admit turn up it's too late. If they turn up with a Primary Care problem it will get charged as an A&E attendance anyway.
Extended hours has reduced Primary Care type attendances at A&E, but at a cost. I have argued that the cost is reasonable for opening a service 8-8 during the week and 3 hours Saturday & Sunday. I know others don't agree.
But the main problem is the high acuity attendees at A&E who need admitting. When they attend it's too late to turn them away. Many of them have COPD, heart failure, diabetes, or are elderly frail people with dementia, or any combination of the above.
For each of these there are evidence based interventions that prevent acute deterioration. They need interventions early in that deterioration e.g. Rescue packs for COPD, diuretics for heart failure, antibiotics s for UTI in dementia. All of these are Primary Care interventions. So we need GPs to be proactive and anticipatory with these interventions early.
For that you need good same day access to the practice. Not an appointment in 3 weeks once you've got past the receptionists.
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GoneIfIHaveToDoAnotherAppraisal | Salaried GP14 Mar 2017 1:07pm
"Rescue packs for COPD, diuretics for heart failure, antibiotics s for UTI in dementia" -
BUT - antibiotic stewardship instructs us not to use antibiotics and we have to stop drugs that have the potential for acute kidney injury during acute illness - resulting in unintended consequences of more seriously ill patients presenting to A&E, as GPs are frozen into inaction by impracticable policies and guidelines.
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Patrick Ryder | GP Partner/Principal15 Mar 2017 9:06am
As a profession we have to move away from the us and them syndrome , GP v Consultant and integrate to streamline our approach to patient care especially in acute illness. Why do we need a GP in every A/E department? at a time when the severe shortage of Gp's are forcing GP surgeries to close.
~ Why are patients who do not require A/E attend and secondly why are they not simply turned away at the gate to the appropriate service? Gatekeeper Role
My view is as follows:
Access to GP services for patients with acute illness at the moment is appalling with patients waiting on average 3-4 days and longer and many patients so frustrated they don't even try to get an appointment. A constant backlog of missed opportunity to hear, see or treat. That is the root of the problem and will not be solved by putting even more GP's in A/E departments. This will further divert GP's to A/E and exacerbate the shortage of the GP workforce in the community, the official gatekeepers of patient care and appropriate hospital referrals for acute illness. Serious acute illness, excluding 999 cases which are clearly defined develops and early diagnosis / management is the key to preventing complications and significant poor outcomes. The sticky plaster approach to our failing NHS
will never work and be honest Is not been addressed by the guardians of our services.
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watchdoc | GP Partner/Principal15 Mar 2017 1:59pm
Why do patients end up in A+E
1) getting older
2) 111 protocols
3) public expectation
4) fear of litigation
5) lack of social care
Very little can be done about this next year or the year after. Admissions will rise GP or no GP.
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George Paige | GP Partner/Principal16 Mar 2017 10:49am
Just think about the number of "borderline" cases you see every day. In the surgery you can say if it gets worse call back or go to A&E. They will usually go home rather than make the trek to A&E now. If you are in A&E many will decide to stay in hospital (be admitted) rather than go home possibly to go back again later. Human nature - path of least resistance.
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Othimalai Velusami | Locum GP17 Mar 2017 7:32am
Everyone is talking and commenting of NHS mostly in negative sense.All of them are about the service providers.Can any one say how the service user can help or use NHS the way it must be used? i.e. self sensible healthy living not to live in the world of "state will take care of me"
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Yve | GP Partner/Principal17 Mar 2017 1:28pm
Othimalai Velusami.
You have hit the nail squarely on the head.
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Truth finder | GP Partner/Principal20 Mar 2017 11:19am
Well said Copperfield!Rising older population=more admissions. It is the funding cuts that have caused this, not GPs or any flawed "innovations".
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