Terminal case will carry serious ethical problems
GPs can expect more pressure after an NHS report found emergency admissions are still rising by Ian Cameron
A key Government target to cut emergency hospital bed days is under threat after
figures revealed a sharp rise in admissions.
The NHS chief executive's report showed emergency admissions rose by 200,000, or 4.7 per cent, in 2004/5, the seventh consecutive annual increase.
The Department of Health target, which is part of its public spending agreement with the Treasury, is for an overall cut in emergency bed days of
5 per cent by 2008, based on a start date of April 2004.
GPs are at the forefront of the department's drive to hit the target by leading improvements in management of patients with long-term conditions in primary care.
The latest figures will lead to an increase in pressure on practices to adopt the controversial commuity matrons initiative, which ministers believe will bring down emergency admissions.
Sir Nigel Crisp, NHS chief executive, said he thought the target was still achievable. Primary care teams would have a greater role to play in pro-
actively managing patients with long-term conditions, he added.
'We will have a big push over the next three years to put in place arrangements that will reduce bed days and emergency admissions.
'We don't want a reactive service but one where we manage risk. PCTs and people should be thinking like that.'
Sir Nigel also stressed that the target measured emergency bed days, whereas emergency admissions were often for shorter periods. He added that the effect of the planned 3,000 community matrons had not yet been felt.
A positive sign in the figures was provided by GP practices and other primary care providers, who carried out 600,000 more former hospital procedures last year.
But a 12.6 per cent rise in emergency readmissions and 5.6 per cent rise in A&E attendance were also signs of the difficulty the Government will face in cutting bed days.
Dr Laurence Buckman, GPC deputy chair, said the rise in admissions reflected the fact the population was getting older. He criticised setting a target to cut bed days.
Dr Dermot Ryan, a GP
in Loughborough, Leicestershire, said primary care needed more access to diagnostics such as echocardiograms and spirometry and more community cardiac and pulmonary rehabilitation schemes.
He added: 'Above all we need more GPs rather than nurses taken off the streets, given six weeks' training and called community matrons.'