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GPs asked to come into hospital to discharge patients and take on care

Exclusive NHS managers in the Midlands have put out an urgent call for GPs to go in to their local hospital to help discharge patients early and take over their medical care, in a desperate measure to free up beds, Pulse has learned.

The call was put out by NHS North Lincolnshire CCG managers frantically trying to deal with pressure on Scunthorpe General Hospital, which they said is ‘facing unprecedented demand’ on services, with patients ‘experiencing extremely long A&E waits’.

GP leaders said the move was ‘incredible’ and warned that GP practices were themselves overwhelmed and did not have the capacity to step in.

The CCG emailed practices this week asking them to confirm ‘whether a member of the senior clinical team could be mobilised to attend the hospital to review and potentially support the discharge of a small number of patients’.

It continued: ‘These patients will require medical oversight and support in the community which will need to be provided by their own practice.’

The CCG said it was ‘also looking at whether we can discharge patients to additionally commissioned community beds and we will be looking to secure enhanced GP and nursing cover for those beds’ and that ‘we will approach practices separately regarding this when available beds have been identified’.

One GP, speaking anonymously, told Pulse they had ‘never seen a request like it in over 20 years of practice’.

They added that it was ‘inappropriate to request these clinical decisions of GPs instead of hospital clinicians currently responsible for these patients’ and that ‘these patients should really still be in hospital if they still require “medical oversight”’.

The GP said that their own practice had turned down the request because they were already ‘firefighting’ and did not have the capacity to cancel a surgery to free up any GPs.

Lincolnshire LMC medical director Dr Kieran Sharrock said: ‘GPs in Lincolnshire are working at full speed already dealing with patients with both acute and chronic illnesses. Many practices are reporting having to work fifteen hour days to cope with the demand and associated administration. 

‘For the secondary care sector to have the temerity to ask GPs to then also assist in the work that the hospital should already be doing is outrageous.’

Dr Andrew Green, chair of the GPC clinical and prescribing subcommittee, said the request was ‘incredible’.

‘Patients rarely have discharges delayed due to a lack of a medical opinion, it is usually due to factors such as social care, or the provision of discharge medication.

‘These vital services must not be overlooked in what appears to be a panic reaction to a bed shortage, which once again illustrates the point that nobody believes that general practice is also in a workforce and workload crisis.’

An NHS North Lincolnshire CCG spokesperson said that ‘as is the case with hospitals in many parts of the UK this week, our local acute hospital is currently experiencing significant bed pressures’.

‘The CCG recognises that primary care is also experiencing extreme pressures but a system wide response has been necessary this week to ensure patient safety,’ they added.

Deputy GPC chair Dr Richard Vautrey highlighted the recruitment struggles GP practices are facing in areas like Lincolnshire and said it was ‘a concern that whilst NHS management is focused on trying to relieve the real pressures in hospitals, they do not seem to be offering the same level of additional support to general practice and community nursing teams but expect them to do more’.

It comes as another Midlands CCG has moved to discharge patients early, amid widespread reports of NHS trusts under huge strain and patients facing ‘trolley waits’ of over 24 hours in some cases before being admitted.

NHS West Leicestershire CCG sent out a press release explaining that patients may be discharged to ‘unexpected’ settings – including being sent home to be cared for by ‘their loved ones’.

Dr Nick Wilmott, the CCG’s clinical lead and a GP in west Leicestershire, said: ‘We’re asking people to be prepared to support their loved ones to recover at home wherever possible…

‘The idea of supporting recovery may seem daunting at first, but learning these basic techniques, such as administering injections or supporting someone to move from their chair to their bed in the correct way means that your loved one can be discharged earlier, and ultimately recover more quickly at home.’

The DH has told Pulse that there are no immediate plans on how to free up GPs’ time, despite health secretary Jeremy Hunt saying they are looking into temporary measures. Pulse understands that discussions are ongoing about the possibility of extending QOF reporting.

The winter A&E crisis

Hospitals are widely reporting unprecedented strain on services, and two deaths reported among patients while waiting for admission at Worcester NHS Trust. Data leaked to the BBC revealed that nearly 500 patients waited on trollies for over 12 hours before being admitted last week.

The Red Cross last week reported it was having to support a number of Trusts facing a ‘humanitarian crisis’ caused by the shortage of services to help discharge people from hospital. Prime Minister Theresa May said today that claim was ‘irresponsible’ and Health Secretary Jeremy Hunt has put much of the pressure down to inappropriate use of A&E.

Mr Hunt has proposed putting GPs into A&E to help manage demand and has said there may be temporary measures to release GPs to do this.