Long-awaited urgent care plan completely overlooks general practice, GPs warn

The Government’s plan to reform urgent and emergency care is a ‘huge missed opportunity’ as it fails to offer proposals or funding to increase capacity in general practice, GP leaders have warned.

Announcing the plan today, the Department of Health and Social Care said it wants to ‘shift more patient care’ into ‘more appropriate care settings’ as part of the move from hospital to community, while ‘tackling ambulance handover delays and corridor care’.

It said that, backed with ‘a total of nearly £450m’, the plan will deliver:

• Around 40 new ‘same day emergency care and urgent treatment centres’ – which treat and discharge patients in the same day, ‘avoiding unnecessary admissions to hospital’
• Up to 15 ‘mental health crisis assessment centres’
• Almost 500 new ambulances will also be rolled out across the country by March next year

It said: ‘The new package of investment and reforms will improve patients’ experiences this year, including by caring for more patients in the community, rather than in hospital which is often worse for patients and more expensive for taxpayers.’

But the BMA’s GP committee England chair Dr Katie Bramall pointed out that despite mentioning a shift of more care into the community, the plan offers no proposal or funding for general practice.

She said: ‘There is a huge missed opportunity where this announcement mentions patients’ challenges in accessing GP services, but offers no proposals and zero funding to increase GP capacity at all.

‘With practices in England providing 50 million patient contacts each and every month, we cannot work any harder – the Government must create greater capacity to better meet patients’ needs. This requires investment to drastically expand GP surgeries to house more GPs providing more appointments.’

She added that the Government’s spending review next week and upcoming 10-year plan must address this and ‘properly fund’ general practice.

She added: ‘Practices are hanging on by a thread and desperately need a new GP contract to drive this transformation to make a tangible difference to the 1.5 million patients that access NHS GP services each and every day.

‘Anyone calling 111 for GP care will appreciate how dangerously stretched GP out of hours services are, with poor computer algorithms and cut-cost alternative staff replacing GPs, where patients may be sent to the wrong setting – at best this can be a waste of time, at worst it carries tragic consequences.’

The plan also mentions enhancing ‘paramedic-led care in the community’ to ensure more patients receive treatment at the scene or in their own homes.

‘This will be delivered through ambulance crews operating a call before convey principle and enabling “see and treat”, supported by additional clinicians in emergency operating centres (EOCs) and single points of access (SPoAs),’ the plan added.

But Dr Bramall said that there is a risk that additional paramedics may resort to calling GPs and asking duty doctors on-call to take decisions ‘outside their remit’ in order to avoid hospital admissions, when joined up urgent care services are ‘what is needed’.

She added: ‘There is much focus on the need for integration within the NHS but very little detail on delivering it, including access to social care packages which often delays discharges or fails and leads to patients being readmitted.’

Doctors’ Association UK GP spokesperson Dr Steve Taylor told Pulse that the introduction of more urgent care provision is to be ‘hugely welcomed’ but that general practice seems to ‘remain an afterthought’.

He said: ‘An urgent treatment centre appointment costs £85 on average to provide. Community care in the form of general practice remains an afterthought, yet provide similar appointments, if funded, at a third to half the cost to the NHS.

‘Actual numbers attending A&E have increased 200,000 per month over the past five years whilst GP services have increased 5 million.

‘There is more need for a better joined up approach to patient care between hospitals and the community, and this will see a better use of resources.’

As part of the plan, NHS England said it will publish and implement the recommendations from a review into NHS 111, to make the service ‘quicker and simpler to navigate’.

It added: ‘This includes using natural language processing technology to improve call streaming from October 2025. We will also work with GPs and other healthcare providers to improve the patient referral process to primary care.’

The plan also said that ICB leaders will ‘need to commit’ to developing and testing ‘collective winter plans’, which will be signed off by every board and chief executive within each system ‘by summer 2025’. 

As ‘a minimum’, each plan should show how by this winter systems will:

• increase the number of patients receiving care in primary, community and mental health settings
• meet the maximum 45-minute ambulance handover time standard
• improve flow through hospitals with a particular focus on patients waiting over 12 hours and making progress on eliminating corridor care
• set local performance targets by pathway to improve patient discharge times and eliminate internal discharge delays of more than 48 hours in all settings

Health secretary Wes Streeting said: ‘Far too many patients are ending up in A&E who don’t need or want to be there, because there isn’t anywhere else available.

‘Because patients can’t get a GP appointment, which costs the NHS £40, they end up in A&E, which costs around £400- worse for patients and more expensive for the taxpayer.

‘The package of investment and reforms we are announcing today will help the NHS treat more patients in the community, so they don’t end up stuck on trolleys in A&E.’