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GPs asked to help identify patients to discharge from hospital


Hospital discharge


Exclusive GPs in Essex have been asked to go into hospitals and help discharge patients to free up capacity, Pulse has learned.

It comes as NHS England has said that Covid patients across the country are to be discharged ‘earlier’ for remote GP management with pulse oximetry.

NHS Basildon and Brentwood CCG this weekend asked local GPs to volunteer to identify ‘level one’ patients who can be discharged amid a ‘state of emergency’ in acute hospitals.

An email sent to GPs and seen by Pulse said: ‘Following urgent conversations regarding the current state of emergency facing the acutes, there is a need to identify Level 1 patients who can be discharged in order to create space and staff for Level 2 and Level 3 provision next week.

‘To reduce risk of readmission from inappropriate allocation of patients, we need GPs to match discharged patients with the most ideal setting where ongoing care needs could be met.’

It outlined three discharge ‘scenarios’, including patients being sent to care homes or their own homes with ‘routine support’ from their GP and other primary care staff.

Another option is for ‘patients requiring ongoing regular support (from GP teams?) to [be discharged to] Intermediate Care settings’, it added.

Essex LMC chief executive Dr Brian Balmer told Pulse that some local GPs have volunteered to help hospitals with discharging patients ‘out of their dedication to the service’. 

But he warned that a ‘clear plan’ must be in place for these patients and communicated ‘directly’ with their GP before they are discharged, so the GP can tell the hospital if discharge is ‘impossible’.

And it is ‘very likely’ that some patients will be discharged ‘too early’, he said.

A spokesperson for the Mid and South Essex, West Essex and North East Essex CCGs – including Basildon and Brentwood – said: ‘The support of local GPs has been and continues to be vital as the NHS responds to the ongoing pressures in the local health and care system, while dealing with rising Covid-19 admissions to hospitals.’

They added that GPs working alongside social care providers to assist a patient’s step down from hospitals is a typical response to managing the on-going pressures in the NHS during the pandemic.

At the same time, the LMC is developing a protocol with its STP on how primary and secondary care can collaborate on the management of ‘patients who should be in hospital but can’t get in’, Dr Balmer added.

He said: ‘Moving patients elsewhere has ceased to be a solution in some areas. We’ve already done that, so level one patients are inevitably going to come out to the community and patients with other problems who would normally be admitted we already know are not being admitted. 

‘We’re making it explicit because if we don’t and things go wrong, inevitably somebody – probably a politician – will blame GPs.’

He added: ‘What we don’t want is the system to say ‘we must protect our hospital’ full stop. And we are hoping, between me and hospital colleagues, that we come out of this closer together rather than pushed apart.’

Nationally, NHS England has said that ‘lower risk’ Covid patients may be discharged from hospitals ‘earlier’ for remote GP management, while Covid ‘virtual wards’ will be immediately rolled out to support the ‘earlier’ discharge of ‘moderate’ risk patients.

An NHS England GP bulletin sent on Tuesday evening said: ‘Given current pressures, all local areas should pursue immediate national rollout of a Covid “virtual ward” model for earlier safe and supported discharge if this model is not in place already.’

‘Lower risk patients may be appropriate for earlier discharge onto Covid Oximetry@home.’

Under the Covid ‘Oximetry @home’ scheme, those with symptoms measure their oxygen saturation levels with a pulse oximeter for practice monitoring.

Virtual wards should be implemented by the ‘most appropriate’ local providers, which will be either community or ‘most likely’ acute providers, NHS England said.

It added that a ‘limited supply’ of pulse oximeters are available to CCGs and trusts free of charge, following a previous pledge it would make 200,000 available to primary care practitioners.

Meanwhile, the BBC reported earlier this week that GPs in Essex have said the threshold for sending a patient to hospital for supplemental oxygen is now an oxygen saturation of 92%.

However, the spokesperson for the Essex CCGs told Pulse there has been no change to referral criteria based on a patient’s oxygen levels.

In November, GP leaders warned that patients whose oxygen saturation drops should be seen in hospital, after new guidance said patients being remote monitored via pulse oximetry should call their GP if their sats dropped to 93% or 94%.

It comes as the health secretary this week said that the UK is now ‘at the worst point’ of the pandemic, with the number of people in hospital rising ‘sharply’.

More than 35,000 people are currently in hospital with coronavirus, according to the latest Government data and Wednesday’s death toll marked the worst of the pandemic to date.

READERS' COMMENTS [5]

John Glasspool 14 January, 2021 1:13 pm

Brill idea! Get all those committee GPs to do it. “Normal” GPs are busy enough. Oh, and demand a LES.

Decorum Est 14 January, 2021 1:28 pm

What a fantastic plan! (DOI – I’m unfortunately unavailable for the foreseeable future).

Patrufini Duffy 14 January, 2021 2:18 pm

Because a paediatrician, cardiologist, dermatologist or general surgeon can’t do it? No, of course not – because that’s the hospital staff.

John Clements 14 January, 2021 4:16 pm

How about all those surgeons who’s list have been cancelled? I’m sure they will be delighted to help on the medical wards

James Weems 14 January, 2021 11:23 pm

I thought discharge planning was a hospital job? Maybe the consultants can come and see my list while I vaccinate?