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GPs not to blame for pressure on A&E, says NHS England adviser

Exclusive GPs are not to blame for the rising pressure on A&E departments as figures show that attendance at emergency departments is ‘stable’, an NHS England adviser taking part in its emergency care review has said.

Dr Agnelo Fernandes, the RCGP’s urgent care lead who sits on NHS England’s Emergency Care Review, speaking in a personal capacity, said that A&E attendance figures have remained flat over the decade, and the reason for an apparent increase in attendance is due to a change in recording figures and ‘risk-averse’ junior doctors.

Health secretary Jeremy Hunt has claimed there is a crisis in emergency care, and has blamed this on ‘poor primary care provision’ created through the ‘disastrous’ 2003/04 contract, resulting in an additional four million attendances at A&E departments.

But the latest NHS England figures show that while A&E performance ‘deteriorated significantly’ in the last quarter of 2012/13, attendance figures were 1.7% lower year-on-year.

The NHS governing body found that there was ‘no single trend or factor’ to explain the deterioration in A&E departments, despite Government ministers’ claims.

An analysis published by the King’s Fund showed that the jump in A&E attendances in 2003/04 was largely due to a change in the ‘data series’ used, smaller walk-in and minor injuries unit attendance included together with specialist emergency departments from that time in official figures.

Dr Fernandes – who is sitting on the review into emergency and urgent care being led by NHS medical director Sir Bruce Keogh that will look at whether GPs should take back out-of-hours care – told Pulse that emergency attendances have remained flat and Mr Hunt’s claims that they are the cause of the problems in A&E departments are wrong.

He said: ‘The fact is that A&E attendance has not gone up. It is stable. If anything, if it has changed, it may have gone up 1% or 2% in England.’

‘It is almost a flat graph over the last ten years. From 2002-03, they started counted the figures differently. What is included in the figures now is walk-in centres, minor injuries units, etc.’

He said that the real problem with the pressure on emergency departments lay with a lack of expertise and rising emergency admissions, and that this was not GP’s fault.

He said: ‘The decision to admit is not a GPs’ decision but the hospital doctors. The crisis is that they don’t have enough A&E consultants.’

‘You have A&E departments run by juniors and locums. What happens then is that they are more risk-averse and they admit.’

Dr Fernandes’ comments come after the chief executive of the NHS Confederation, Mike Farrar, said the past few months had been the ‘toughest many of us in the NHS can remember’.

He also said that GPs were not solely to blame: ‘The key thing is to understand that A&E doesn’t stand alone – pressure in our A&E departments is a visible symptom of a whole system under great strain and tackling it requires a whole-system solution.’