We have done some analysis as part of work towards the QP12 and QP13 QOF indicators, and also as a part of our CCG's QIPP analysis.
In our peer review, it was encouraging to see that small practices managed extremely well – both in admissions to A&E and outpatient admissions to hospital per 1,000 population.
My impression is that small practices are well organised and the staff are extremely helpful, know the patients and accommodate them at a reasonable time as urgent, emergency and often walk-in patients. Frontline staff have been extremely influential and helpful in managing patients' problems.
There was some suggestion from practices that NHS Direct, which advises our patients out of hours and on other occasions, tells patients they should attend A&E.
This practice should be discouraged, and there should be more educational tools and information explaining to patients about the appropriate use of the A&E department.
I have previously written to Pulse arguing that GPs do not have any control over A&E attendances, particularly out of hours.
While we can do our bit on education, we can't be expected to police inappropriate attendances – these messages should come, instead, from the Department of Health as a part of public education and the public health agenda.
I would be interested to know from your readers if they have any different views or suggestions.
From Dr Krishna Chaturvedi, Westcliff-on-Sea, Essex
