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GP A&E referral letter warns practices ‘can’t get through’ to specialists


GPs referring to A&E to use letter explaining they 'can't get through' to specialist


An LMC has created a template letter for GPs to send patients to A&E when they are ‘unable to get through’ to a specialist.

Lincolnshire LMC guidance said that it is ‘best practice’ to discuss referrals for hospital admission with an ‘appropriate specialist’, but that this has recently ‘become more difficult’ as there are now ‘multiple pathways’ to admit patients.

GPs trying to contact a specialist can spend ‘hours’ waiting for the switchboard to answer and then ‘further hours’ for a specialist to answer their pager, to then be told to ‘send the patient to A&E’, it added.

It said: ‘What is even more frustrating is that GPs then get criticised for misusing A&E.’

The guidance added that the LMC has developed a form to ‘counteract’ this that ‘highlights why the patient is in A&E rather than an admissions unit’.

The template letter should be used to ‘indicate why you are sending the patient to A&E rather than admitting through another pathway’ so that ‘the patient gets seen by the appropriate specialist as quickly as possible’, it said.

It lists three options for why GPs are sending patients to A&E:

  • The patient has ‘had an accident or is an emergency’, making this the ‘appropriate pathway’;
  • The GP has ‘tried to speak to specialist/admissions unit to refer but was unable to get through’;
  • The GP has spoken to the specialist or admissions unit but was told to send the patient to A&E.

It also includes space for information on patients’ history of the current issue including symptom duration, medical history, medications and allergies.

The form can also be used to send patients to an urgent treatment centre (UTC), it said.

The LMC added: ‘Please continue to try to make the appropriate specialist referral but if you are unable to get hold of a specialist or they advise you to send the patient to A&E, then please use this form so that the patient gets seen by the appropriate specialist as quickly as possible.’

Last year, the RCGP disputed the health secretary’s suggestion that people are turning up at A&E because they cannot reach their GP.

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READERS' COMMENTS [6]

Patrufini Duffy 5 April, 2022 1:03 pm

The reason you are sending the patient to the hospital – is because you are not the hospital. And your tendon hammer and otoscope hasn’t converted yet into a surgical unit or on-call team of everybodys.

David Church 6 April, 2022 7:58 am

Most of us still remember the days when the front door of the hospital was locked after visiting finished at 9pm, so the only door by which to get into hospital was A&E; and most specialties would ‘clerk in’ the patients in A&E, which is why most ‘admissions units’ are in or next door to A&E.
It makes best sense really, to have patient initially in A&E, where you can ask deaf patients their history without disturbing patients sleeping on the ward; have an ECG (most surgical wars do not have one), send bloods more easily, XRay is closer, Porters are on hand; and relatives can sit in the W/R without being let loose inside the hospital unsupervised until you were ready to let them go home.
Plus, often, it was the only door on ground level!
Back to A&E !

Kevlar Cardie 6 April, 2022 11:25 am

Brilliant.
Another proforma and flow chart.
Problem is solved.

Isabelle Zuchelkowski 6 April, 2022 1:20 pm

Why would a GP need to refer to another GP in an urgent treatment centre?

Patrufini Duffy 6 April, 2022 4:28 pm

I always thought it was good to send to the hospital. They earn a tariff. They get to code lots of hypothetical stuff. And they get more money for their CEO. And they get to survive. Isn’t that right NHSE?

Dylan Summers 16 April, 2022 10:45 am

@Izabelle Zuchelkowski

Love your question.

As a GP who occasionally does these UTC shifts and occasionally ends up seeing patients referred to A&E by a fellow GP, but without the benefit of notes or access to investigations, I agree something strange seems to have happened to referral pathways.