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GPs urged to ring vulnerable patients over weekend in attempt to cut A&E attendance

Exclusive An NHS England area team urged GP practices to call vulnerable patients on Friday night and over the weekend because the ambulance trust was unable to cope with unexpected winter demand, Pulse has learned.

In an email sent to practices via CCGs on Friday 12 December, NHS England’s (West Yorkshire) emergency preparedness, resilience and response (EPRR) lead Adam Bland also suggested that CCGs put out information to the public stating that their GP practice ‘might be open longer tonight or on Saturday’ because the Yorkshire Ambulance Service was experiencing ‘unprecedented demand’ and struggling to meet response rate targets for emergency calls.

But local GP leaders were angered by the email, and said the suggestion GPs should phone their patients over the weekend to ensure they wouldn’t bother the ambulance service ‘would be laughable were it not illustrating a total misunderstanding of the role… of general practice’.

It comes after Pulse reported last week that emergency admissions reached record levels last week, with nearly 5,000 more patients admitted than in the same period last December, despite new schemes like the unplanned admissions DES being brought in to tackle this.

The email said that Yorkshire Ambulance Service was ‘experiencing unprecedented demand’, which meant ‘they are struggling to reach all emergency calls in an expected time frame’.

It urged GPs to ‘make every effort: to ensure an ambulance transfer to the ED is the absolute last resort for all patients; to attempt to contact patients who might be at risk of requiring urgent and emergency care tonight and over the weekend to assess their health and help them access alternative services if necessary; to ensure any patient requests for appointments this afternoon and tomorrow are accommodated as much as possible.’

NHS England also said that the ‘public and patient message via twitter, websites etc’ should be: ‘The ambulance service are really busy today, a lot busier than usual. Your GP practice might be open longer tonight or on Saturday. Try them before ringing 111 or going to A&E. In a real emergency always call 999 but keep the ambulances for those who really need it.’

Dr Andrew Green, chair of the GPC prescribing subcommittee and a GP in Hedon, East Yorkshire, said he was ‘staggered’ by the email.

He said: ‘I was staggered that NHS England (West Yorkshire) would send this email to GPs at all, let alone at 4pm on a Friday afternoon, a time when most GPs will be fully booked with patients until the end of their contracted hours.
 
‘It is surely predictable that there will be times when ambulance services have increased demand, yet the head of emergency preparedness, resilience and response seems to think that the appropriate action for this is to try, with no notice, to ask a different part of the NHS to take on yet more unresourced work.
 
‘The suggestion that we might personally phone our sickest patients then or over the weekend to check they are alright and won’t bother the ambulance service would be laughable were it not illustrating a total misinderstanding within NHSE of the role, responsibillities, and workload of general practice.’

He added that the public message would give patients the idea that their practice should be open out of hours, ‘stoking patient expectations without there being any realistic possibility of them being met’.
Dr David Macklin, executive director of operations at the Yorkshire Ambulance Trust, said: ‘We are currently receiving hundreds of 999 calls every day to patients with breathing difficulties and other serious conditions.  We really need people to use our emergency service wisely so that we keep ambulances available for those patients who need life-saving help.

‘While many people do use our emergency service appropriately, some callers could be helped by other more appropriate healthcare services.

‘Anyone needing advice and treatment for non-emergencies should consider options such as contacting a local pharmacist or GP surgery, a call to NHS 111 or visit an urgent care centre.’

Pulse reported last month that GPs would be receiving just 3.5% (£25m) of a £700m tranche of additional funding to support the health service in coping with winter pressures.

NHS England (West Yorkshire) area team were approached for further comment but had not replied at time of publication.

Email to CCG leads from NHS England

 

From: Bland Adam (NHS ENGLAND)
Sent: 12 December 2014 15:55
To:
Cc:
Subject:
Message to GPs

 

CBU leads to cascade the following message to all CCGs to ensure that all GP practices have the following message by email and phone call:

Yorkshire Ambulance Service are experiencing unprecedented demand. This means that they are struggling to reach all emergency calls in an expected time frame.

Please can you make every effort:

·         To ensure an ambulance transfer to the ED is the absolute last resort for all patients

·         To attempt to contact patients who might be at risk of requiring urgent and emergency care tonight and over the weekend to assess their health and help them access alternative services if necessary

·         To ensure any patient requests for appointments this afternoon and tomorrow are accommodated as much as possible

Public and patient message via twitter, websites etc. The ambulance service are really busy today, a lot busier than usual. Your GP practice might be open longer tonight or on Saturday. Try them before ringing 111 or going to A&E. In a real emergency always call 999 but keep the ambulances for those who really need it.

 

Adam Bland

Head of Emergency Preparedness, Resilience and Response (EPRR)

NHS England (West Yorkshire)

Readers' comments (30)

  • Never fear, send Ivan Bennett in!

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  • Why not just publicise the GP out-of-hours service instead of (politicians and media bods) pretending that it doesn't exist?

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  • P**s off!

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  • If this "system failure-passing the buck-shirking contractual responsibilty" scenario was carried out by a GP surgery (or group), a ton of legal and other bricks would be falling on their collective heads. Mr Bland will of course get of scot free, thanks to his chums. Mind the ambulance!

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  • Oddly enough I suspect that NHS England may find that the goodwill has all dried up...

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  • Just rang MPS to defer/retire my membership and they were so busy they had to call me back......

    Could this be a mass exodus at the end of the year? Has anyone asked them how many GPs are deferring their membership and how this compares with previous years?

    I do have to say that in the 30 years that I have been a member of MPS they have been incredibly pleasant and supportive. I'm lucky that I have never had to use their help.

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  • Abdul QADRI

    Out of service has been working tirelessly for many years. Nhs England is trying to give impression that they are proposing this service. At the same time, it is not a bad idea to contact vulnerable patients over the weekend but one needs to keep in mind that gps have also got family life & they need resources to provide that service.

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  • Preumably the ambulance service are giving part of their budget to General Practice as well..........

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  • Dear Adam

    General Practices across the country are facing unprecedented demand for appointments. Often GPs are working 12-14 hour shifts trying to clear the backlog of paperwork, much of it imposed by secondary care.

    Please can you cascade to your secondary care colleagues so that they make every effort:

    - not to add "GP review" for every discharge out of the hospital
    - not to ask GPs to "review the patient and consider referral to the neurologist" - you're a bloody physician, you can do it yourself.
    -not to discharge patients ridiculously early that they;re back in ward AMU in 48 hours.
    -not to reject my gateway referrals because if Im referring, its because I actually want the patient to be seen

    Whilst you're at it, could you stop CQC breatehing down my neck because I've not got an enhanced disclosure in the last 6 months?

    Dr A Noyed
    GP
    Pretty fed up and Burnt out (PFUBO)

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  • Oh Doctor thank goodness you rang - I was going to wait till Monday but since you called could you see fit to admit me over the weekend .

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  • Took Early Retirement

    It is worrying that they think GPs are contracted to work at weekends. even more worrying that they think people can have their illnesses prevented by a phone call from the GP: I am surprised they didn't ask that GPs "just pop in" on patients over the weekend.

    And if you e-mail the person who sent this out, I bet you get an "I am out of the office till 4th January" response.

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  • not another link to the xmas BMJ, surely you can't have this many comedy article links

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  • How long before an MP claims we have a 'moral duty' to compensate for deficiencies elsewhere in the system?

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  • NHS is getting better in passing the parcel to everyone and any one in the system. Demand management is never spoken about by politicians or Administrators.

    GPs do not have any support from either management or professional bodies. Consultations are now complex due to numerous guidelines, patient awareness and
    a habit of Googling first then see the GP.
    That doctor patient relationship does not exist, practice is considered as a service where Daily Mail keeps on advertising how Lazy and overpaid profession is.
    Practice workload and paperwork is uncontrolled, how can any GP even dream about after reaching home every day around 8.30Pm to take on ringing patients over weekend?
    Family responsibility and break from pressure is a must
    for the sanity and continuation of the service.
    We have good Outof hours service capable of supporting patient if commissioned properly.
    Ask them to write to Mr Andy Burnham , he wants Gps to be salaried , clock controlled contract will kill the NHS.
    Independent gps offer more value for money than any alternative service provider.
    I am saddened to see the impending destruction of GP services.
    General practice is already on death bed, do not put it on Liverpool care path ways.
    Let it keep its Dignity, pride and disappear gracefully
    taken over by the private sector.

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  • In response to Dr Glasspool, I did email him at about 1835 on the Friday, it's not yet January but as of now (Monday 2015, and yes, I'm still in surgery) he has not replied

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  • We have been seeing patients until 8pm tonight due to unprecedented demand today and staff shortages - did we email the hospital or the ambulance trust - no we didn't as we were too busy mucking in and getting on with it. I now just delete these emails for the sake of my BP

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  • .. thank goodness they emailed,I will just stop peeling the parsnips for a moment and ring the lot of them.
    Or maybe this nhs england could just learn the difference between public health and general practice..and get the right people on the job.

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  • Another example of an administrator making things up in his little isolated room where he has virtually no contact with reality.
    These sort of comptemptible edicts need reviewing by someone more grounded, so the creator avoids appearing idiotic to everyone else.

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  • Secure environments GP

    Well he lobbed a grenade in. Mind you I sometimes think the Pulse Team likes to selectively abstract the good stuff to see us vent cathartically :-)

    Perhaps the source of the problem best be brought to NHS England's "the one and only Adam Bland's " attention. Look what is easy to find to add context:

    Cutting in Yorkshire
    Take Yorkshire Ambulance Services Trust (YAS) – it’s looking to slash its budget
    by £10.3 million this year alone. Its ‘cost improvement plan (CIP)’ sets out a new operational model which threatens mass downgrading for ambulance staff and the loss of professionally trained technicians on ambulances altogether replaced by driver roles. Posts are not being filled and crews are driving from one 999 call to the next without the time to check or clean the back of their ambulances or have ad- equate rest breaks.
    To top it all off, YAS wants to do away with its ‘urgent tier’, opening the way for profit making companies like Virgin Care and Serco to move in and profit from our emergency care.

    The cuts are driving down wages and shrinking the publically-funded ambulance service to its bare minimum – this is the softening up before private companies pick up the slack and the
    creep of privatisation spreads even deeper into
    our NHS.
    ---
    So I would say DEAL WITH THAT rather than asking General Practice currently "dying by a thousand cuts" to stop late and call 200+ elderly and say;

    "This is Dr B. Would you mind awfully not calling an ambulance this weekend...(silence...cold call confusion response)...No I'm not selling over 50 life insurance, funeral expenses cover/plans,,,,no not PPI either. The ambulance service is too busy so "the NHS managers" wanted me to remind you to..., say, think about calling Bob from over the road to take you to hospital if you have another fall. Actually best don't walk around too much...don't forget to take your tablets..."

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  • Hilarious!!

    Perhaps the various QOF 'QP' schemes, and now the 'Admission Avoidance' DES, aren't having the predicted beneficial effect on emergency admissions!

    As any practicing GP could have told them.

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  • I worked on a project with the ambulance service in Essex. Was very good, we avoided a few admissions, I learnt from the paramedics and they learnt from me. It was pretty good. We relieved pressure from the GP's as queries would be dealt with by us. I would connect in with out of hours when we had to.

    Extra capacity in primary care either via general practice or via putting a Gp into the ambulance service has to be funded, however when it is the system does improve and there are significant upstream savings.

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  • Can this be that secondary care is so overrun with managers that they cannot cope with 8% of the consultations on 92 % of the budget and keep asking us GPs who already do 92% of the consults on 8% for help. Keep spending £4000 a day on management consultations, but hey ask them to ring the poor old dears at weekends.
    What is the average IQ of managers?

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  • That's what our ccg wants to do
    360k on management consultants
    Because they will solve all our vast overspend

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  • Why not just get rid of CQC and NHSE? They are packed full of incompetent jobsworths. Would save a lot of money that could be more usefully employed elsewhere and at a stroke improve NHS productivity

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  • Every GP should prepare a list of his/her vulnerable patients, and e mail it to Mr Bland. He should then phone the patients and if there are any concerns he should ring 111 on their behalf. GPs should worry about patients who have arrived at their surgeries and carry out a complete examination and practice proper medicine, like a long case, and not offer an OSCE style treatment. The woes of the NHS will disappear.
    Best wishes,
    In admiration of my hard working GP colleagues....

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  • "asking us GPs who already do 92% of the consults on 8%"

    Let's not turn this into a Primary v Secondary care bunfight. All of the Consultants I know work their backsides off and face a whole different set of pressures. Let's not be divided - the enemy is NHS-E and DOH whereever you work.

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  • David Barrett's comment (15th Dec 9.45pm) would seem to provide the real underlying cause of the problem: savage cuts in the Yorkshire Ambulance service: it is somewhat surprising that, in the absence of a major disaster, Adam Bland (Head of Emergency Preparedness, Resilience and Response (EPRR) ) only became aware of the problem at 15.55 on a Friday - and the email cascaded to CCGs so they could cascade it to practices (what time did it arrive?) doesn't suggest that there was a well thought threw Emergency Plan.

    Time for a change in leadership?
    If this is an example of Emergency Planning, heaven help Yorkshire if there is a Major Disaster!

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  • Anonymous 15/12/14, 501pm
    Thanks-I genuinely did LOL!!!

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  • It could be a good idea.....I know, just like QoF, you could ask your Practice Nurse to do it!

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  • What do GP's take that allows them to be awake 24/7 fro this stupid idea to work?

    Can I have a prescription for some of the dame tablets?

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