GPs should respond to an urgent call for help from elderly patients ‘within 30 minutes’, according to new standards developed with the RCGP published today.
The advice says the new ‘clinical audit standard’ is needed to reduce the ‘greater variability’ in response times from GP practices in-hours, compared with out-of-hours.
The ‘silver book’ – endorsed by the Department of Health – also suggests that a national audit of primary care response times to urgent requests from elderly people should be carried out annually.
It also says CCGs should set up multidisciplinary teams to respond to all requests within two hours.
The standards – due to be published next week – are designed to ensure fail elderly people are kept out of hospital, but have been criticised as ‘nonsense’ by GP leaders.
They were written by representatives from several major medical organisations – including the Royal College of Physicians, the RCGP and the Royal College of Nursing – and endorsed by three DH national clinical directors, including those for urgent and emergency care and dementia.
It says: ‘Acutely ill older people are very sensitive to delays in care. The longer they wait for a definitive consultation, opinion, investigation and treatment, the more likely they are to end up attending the hospital.
‘Response times for an urgent health need are measured in minutes for the ambulance service, but in hours for other health services, including GP services, with often greater variability in the urgent care response by GP practices during office hours compared to out of hours.
‘There must be an initial primary care response to an urgent request for help from an older person within 30 minutes.’
Co-lead author Dr Simon Conroy, head of the geriatric medicine service at University Hospitals of Leicester, told Pulse: ‘The response will vary depending on the locality and the patient’s circumstances, but the point is to do it sooner rather than at the end of surgery.
‘At present there is variability throughout the health system and we are hoping to reduce that.’
Co-lead author Dr Agnelo Fernandes, a GP in Croydon, said: ‘Elderly patients tend to wait for the GP surgery to open, even if they have been ill overnight, and then request a home visit.
‘Given that they have a high probability of ending up in hospital, then if a call comes in, a GP should carry out a telephone investigation to determine the urgency and get an idea of what’s needed.’
However Dr Robert Morley, executive secretary of Birmingham LMC, described the 30-minute standard as ‘nonsense’.
He said: ‘Bringing in arbitrary targets and deadlines isn’t going to help. Some requests need to be dealt with within seconds and others within several days.
‘Any request for help from a patient needs to be dealt with appropriately, and arbitrary timescales are a complete nonsense and lead to clinical priorities becoming distorted.’
A Department of Health spokesperson said the ‘silver book’ was a ‘welcome publication’
He said: ‘It is about what good practice looks like; not conducting additional assessments and collecting more information.’
What the ‘silver book’ says
- Initial primary care response to an urgent request for help from an older person within 30 minutes.
- Older patients with one or more `frailty syndromes’ – falls, immobility, delirium/dementia, polypharmacy, incontinence, end of life care – should be assessed by a multidisciplinary geriatric team within two hours (14 hours overnight).
- A 24/7 single point of access should be commissioned to provide the two-hour multidisciplinary response.
- Clinicians should be able to recognise and interpret non-specific presentations such as falls and immobility. They should consider medication review to identify inappropriate prescribing, and should not over-use urine dipstick testing as this can lead to `erroneous diagnosis of infection [and] inappropriate use of antibiotics’.