Exclusive Commissioners are considering local enhanced services for GPs to do more urgent home visits next year under new NHS England plans to reduce A&E pressures.
NHS England has asked CCGs to work with NHS 111 providers and councils to set up A&E Delivery Boards to consider this model alongside measures such as more GPs in A&E departments.
The boards will be responsible for drawing up plans to avert winter pressures, but NHS England has also sent out ‘best practice’ guidance for year-round measures to reduce pressure on A&E, due to be implemented by June next year.
As part of the plan, NHS England has advised the boards to ‘have processes in place to respond to and prioritise requests for urgent home visits, usually through early telephone assessment and a duty doctor rota’.
The guidance said: ‘Early and effective assessment of frail and vulnerable adults can enable general practice to plan alternatives to hospital admissions or arrange for early specialist hospital review.
‘Where specialist assessment is needed, early conveyance ensures that patients attend hospital early enough to avoid a default admission, which is typical where patients arrive after 2pm.’
Asked how this may be delivered on the ground, an NHS England spokesperson said LESs was one way but that it was ‘for local systems to determine the best solution for implementation’.
GPC deputy chair Dr Richard Vautrey said these initiatives are being pushed because of increased demand on the NHS all year round.
He said: ‘Many CCGs, and PCTs before them, have developed schemes focused on winter pressures. The reality now is that the health and social care system is under severe pressure 12 months of the year, and needs additional support throughout the year.
‘It’s important that all such schemes are properly resourced and don’t just have a narrow focus on A&E activity and hospital admission but also recognise the significant pressure that general practices are under as well.’
He added that incentivising GP home visits should ‘be negotiated with LMCs who would know what was workable for their particular area’.
But Dr Peter Swinyard, chair of the Family Doctor Association, said incentivising GPs to carry out urgent home visits is ‘trying to put a sticking plaster’ on increasing ambulance delays, and GPs no longer have ‘the resources to go rushing off in the middle of surgery’.
He said: ‘If you’re working in the surgery during the day, you are absolutely chock-a-block and you don’t have time to rush out and do an emergency home visit. If you do that you have four patients sitting in the waiting room who are not going to be seen.
‘I think the Government is trying to put a sticking plaster on the fact that the ambulance services are not responding in a timely fashion and they are trying to dump the problem on to general practice.’
Pressures on urgent care services
The news of the new scheme for GPs to pick up more urgent care work in hours comes as Pulse revealed earlier this week that worsening delays to ambulance response times had left some GPs to drive patients to hospital themselves.
Very young and elderly patients are dying because of these worsening delays, said campaign group GP Survival, calling on the Government to step in to ensure emergency services are properly funded, and GPs not left to pick up the pieces.
But in Yorkshire, the ambulance service is instead trialling longer response times for when a GP or other healthcare professional dials 999.
Response times are being extended to as much as 40 minutes for certain serious health conditions when the patient is already with a GP or other healthcare professional, including heart attacks, strokes, sepsis, meningitis, and acute exacerbation of COPD or asthma.