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DH report shoots down evidence for shift of work from A&E to GPs

By Ian Quinn

NHS plans drawn up by Lord Darzi to shift huge numbers of patients from hospital A&E departments to polyclinics and urgent care centres are fundamentally flawed, according to a report commissioned by the Department of Health.

The Primary Care Foundation, which studied the work of GPs already working in emergency departments, found that the proportion of patients going to emergency departments that could have been cared for in primary care is much lower than has been previously claimed.

The premise has formed the basis of much of Lord Darzi's case for polyclinics and the the report comes with trusts across the country planning to shift huge volumes of work from A&E to primary care in a bid to bail the NHS out of its major financial crisis.

The Primary Care Foundation found that despite increasing numbers of GPs and primary care nurses were working in Emergency Departments-and with trusts planning a big expansion of polyclinics and urgent care centres- there was little evidence it had driven down costs or avoided inappropriate hospital admissions.

The report said: ‘When a consistent definition of all attendances was applied, the proportion that could be classified as primary care (types that are regularly seen in general practice) was between 10% and 30%. This contrasts with widespread assumptions that up to 60% of patients could be diverted to GPs or primary care nurses.

‘There is a paucity of evidence on which to base policy and local system design. There may be benefits of systems of joint working between primary and emergency care but at present this cannot be said to evidence based.'

Dr David Carson, joint director of the Primary Care Foundation, said: ‘We were surprised to find there was no evidence that providing primary care in Emergency Departments could tackle rising costs or help to avoid unnecessary admissions.'

Dr Paddy Glackin, secretary of Camden and Islington LMC, an area where NHS mangers claim ‘local modelling' has identified more than 200,000 of the current 500,000 A%E attendances per year could be handled in ‘alternative, lower costs settings' said: ‘This report proves that one of the cornerstones of the Darzi plan has been based on completely false assumptions. They have basically been pulling the figures out of a hat all along.

‘The big question is, now that this report is out, is will anyone stop and question? I have some doubts. It's absolutely the opposite of evidence based medicine.'

Dr David Colin-Thomé, National Director for Primary Care, admitted the report provided a ‘realistic assessment of current primary care services within or alongside Emergency Departments.'

Report questions evidence for shifting A&E care to GPs Read the full report

To read the Primary Care Foundation's full report, 'Primary Care and Emergency Departments', please click here.