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A&E should ‘repatriate’ non-emergency patients back to GPs

A&E departments should not be paid for treating non-emergency patients and be told instead to ‘repatriate’ them back to GP practices, says a leading GP.

Dr James Kingsland, president of the National Association of Primary Care and and a GP in Merseyside, said that the only way to reduce the pressure on urgent care was to have a more ‘accessible primary care system’.

He added that he had implemented the idea of a ‘never full’ practice that provides same-day access to all patients, but that this had been undermined by the lack of change in the rest of the system.

Dr Kingsland also argued GPs could save money if they were given the funding currently provided to walk in centres, saying that as ‘50% of all activity in walk in centres are seen with the same condition by their general practice within the same week’.

Speaking at the the Nuffield Health Summit 2014, Dr Kingsland said: ‘We created the “never full” practice. So we are confident for our registered population, same day care, urgent care, immediate care, pre-booked care, is all available.

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‘But having got that, the patient flows haven’t changed, even though patients can access our service any time of the day. They don’t have to ring at eight in the morning, they don’t have to wait on the phone.

‘So to change the patient flows, we’ve got to change where they go to. We’ve got to have the appetite to change the duty of care in A&E. So a patient who goes to A&E, who is not an accident or an emergency, could be repatriated immediately to their “never full” practice’, via an IT system. But then tariffs [have to be] changed, I’d be delighted if A&E see a baby with a temperature for three days, but they don’t get paid for it.

‘Unless we’ve got these mechanisms, the patient flows won’t change, even if we’ve got a good accessible primary care system.’

NHS England’s director for urgent and emergency care Professor Keith Willett agreed: ‘That’s just about the offer, isn’t it? At the moment patients don’t see that as the standard offer. They don’t recognise that, and they don’t work, they don’t respond to that. That’s something we have to get right. 

‘The Healthwatch report, despite four out of five people know 111 exists. Only one out of five choose to use it. Fifty percent choose, to go to straight to hospital. We have to build that they can see that they can get something different. You’re right it can all be done [in primary care].’