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DH set to scale back plan to shift A&E to GPs

By Ian Quinn

The Department of Health is set to ask NHS managers to look again at plans to shift a huge volume of A&E work to GPs in polyclinics and urgent care centres, after admitting there was ‘very limited' evidence to support the policy.

Ministers were forced into damage limitation mode last week as a major new report commissioned by the DH found claims as much as 60% of A&E work could safely be transferred to GPs were grossly exaggerated.

The Primary Care Foundation report studied GPs already working in emergency departments, and found the proportion of cases that could have been dealt with in primary care was far lower than claimed – perhaps as little as 10%. It comes as trusts across the country prepare to implement Lord Darzi's plans for a radical shift of A&E work to GPs as part of their mandated efficiency savings.

The foundation found little evidence that the expansion in GPs and primary care nurses working in emergency departments had driven down costs or avoided inappropriate hospital admissions. It said: ‘The proportion of cases that could be classified as regularly seen in general practice was between 10% and 30%. This contrasts with assumptions that up to 60% of patients could be diverted to GPs. There may be benefits of joint working between primary and emergency care, but this cannot be said to be 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 avoid unnecessary admissions.'

A DH spokesperson told Pulse: ‘There has been limited evidence about the proportion of A&E cases that could be treated elsewhere. This report helps with that – but whatever the exact figure, a significant number of people attend A&E with needs that can be met in primary care. The study rightly identifies the need for local commissioners to properly assess the needs of their populations and design services that meet these.'

Dr Paddy Glackin, secretary of Camden and Islington LMC, where NHS managers have claimed more than 200,000 of 500,000 A&E attendances a year could be handled in ‘lower-cost settings', said: ‘This proves one of the cornerstones of the Darzi plan is based on totally false assumptions. They have been pulling figures out of a hat.'

'There was no evidence that providing primary care in A&E could tackle rising costs' Dr David Carson How times change

‘This borders on hysteria. We expect many of the new contracts to go to GP-led consortiums, not private companies. In fact, Virgin has made it clear that it is not interested and will not even be bidding for these new practices.'

Alan Johnson, House of Commons, 17 June 2008

‘My Lords, A&E attendance is one of the biggest growth areas we envisage in London. The system as it stands will be unable to cope. The health centres to which we are referring will cope with significant numbers of patients currently attending A&E - in my hospital, you could claim 60% could be dealt with in a primary and community setting.'

Lord Darzi, House of Lords, 18 June 2008