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GP out-of-hours service may relocate to hospital to ‘take pressure off A&E’

A GP out-of-hours service may be relocated to a nearby hospital trust to ‘alleviate pressure’ on the A&E department under CCG plans.

NHS Cambridgeshire and Peterborough CCG has proposed to move the service currently based at the Chesterton Medical Centre in Cambridge into Addenbrooke’s Hospital.

It says this will require more GPs and could mean increased parking costs – leading to more GP home visits.

But, responding to a CCG consultation, Cambridgeshire LMC said moving to the hospital risked ‘overwhelming’ the service which already struggles to cope.

According to the CCG plans, Addenbrooke’s already has a GP clinic between 11am and 11pm and combining this with the out-of-hours service would extend GP access from 11pm to 8am the next day.

The CCG says that 50 to 70 patients who attend A&E each day, 15-20% of total attendances, could be handled by the combined GP and out-of-hours service.

It says: ‘The CCG and the trust believe that combining this service with the current GP streaming service at Addenbrooke’s can start to alleviate the pressure at the A&E department.’

It also lists a number of other benefits, including ‘immediate access’ to specialist input for out-of-hours GPs when a patient is deteriorating, and says ‘this is the most appropriate service to meet the needs of the patient’.

But the CCG plan indicates that more GPs will be required and that the out-of-hours service would have to provide more home visits.

It says there will be ‘additional costs associated with public transport fares and parking costs which could dissuade some patients from attending the Addenbrooke’s.

‘This could be offset by the patient being offered a GP home visit or indeed receiving verbal advice and guidance triaged by clinicians.’

Cambridgeshire LMC raised several problems with the scheme that it wants the CCG to address before it goes ahead.

It also questions why the idea is predicated on alleviating A&E pressures which ‘is not the job of out of hours’.

A newsletter to local GP practices said: ‘This out-of-hours service already struggles to fill shifts yet the implication from the consultation is that more GPs will be needed as a result of the move.

‘The impact assessment states that more home visits would occur as a result of the proposed move of the out-of-hours base and that home visits could “offset” the reluctance of patients to travel to and park at Addenbrooke’s.

‘[But] there is a limit to the number of home visits that the service can offer and with the capacity issues that already exist, the service risks becoming overwhelmed.’

NHS Cambridgeshire and Peterborough CCG chief officer Tracy Dowling, said: ‘The demands on the GP workforce are high and covering an increasing number of sites with GPs out of hours is a challenge.

‘Focusing the out of hours GP services in one location in Cambridge should improve availability of GPs, and therefore improve the care for patients with urgent primary care needs.This view is supported by NHS England and NHS Improvement advice.’

The consultation was launched prior the announcement of the Spring Budget last week, in which the Government pledged £100m towards capital costs of locating a GP in every A&E department ‘by next winter’.

The drive to co-locate GPs in A&Es

The Government has decided that having GPs in hospitals is the answer to reduce pressure on A&E departments, so that inappropriate attendances can be dealt with onsite.

The Spring Budget pledged £100 million to the NHS in England in 2017/18 for capital investment in A&E departments to ‘enable trusts to invest in measures to help manage demand on A&E services and ensure that patients are able to access the most appropriate care as quickly as possible’.

It said that ‘for example, the funding will allow for better assessment of patients when they arrive at A&E and increase the provision of on-site GP facilities’.

But critics have suggested the plans could lead to more inappropriate attendances, as patients struggle to book GP appointments at busy GP practices but know that they can turn up to see a GP at A&E.