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’s priorities
The plan said that seven areas should be prioritised as they ‘will have the biggest impact on UEC improvement’ this coming winter:
- patients who are categorised as Category 2 – such as those with a stroke, heart attack, sepsis or major trauma – receive an ambulance within 30 minutes
- eradicating last winter’s lengthy ambulance handover delays to a maximum handover time of 45 minutes
- a minimum of 78% of patients who attend an A&E to be admitted, transferred or discharged within 4 hours
- reducing the number of patients waiting over 12 hours for admission or discharge from an emergency department compared to 2024/25, so that this occurs less than 10% of the time
- reducing the number of patients who remain in an emergency department for longer than 24 hours while awaiting a mental health admission
- tackling the delays in patients waiting once they are ready to be discharged – starting with reducing the 30,000 patients staying 21 days over their discharge-ready-date
- seeing more children within four hours, resulting in thousands of children receiving more timely care than in 2024/25
Source: NHS England
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.’
More incoherent supply side thinking.
Applying Rawls’s “veil of ignorance”, how should successive Tory and Labour Govt’s design general practice knowing they might be in the group that uses it (rather than in the group that has access to private care)? The traditional model, knowing your experienced GP who gave continuity, worked well until it was intentionally starved, beaten down and broken into fragments of an ill-fitting jigsaw, done in the name of the US import of neoliberal economic policy serving corporate rather than the public’s interest. Funding the core contract and maintaining GP independence is, and has been, the only issue. All else is political dissembling and distraction.
The well-minded paper politicians in the BMA are perpetually custard-pied by DHSC. Perhaps after the last nail has been hammered into the coffin of general practice, the BMA will finally conjure GPs to arise zombie-like from the grave and stagger drooling down to Downing St in noisy protest, visible marches and possibly strike action..
Let me guess…..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’…staffed by noctors who aren’t qualified to do the job and who will be asking the GP to do the needful tests follow ups referrals etc etc. Primary care is rapidly becoming an endless list of jobs to do on behalf of unqualified individuals for patients I have never met. Retirement beckons
The reason is simple the government and NHS sees the marginal cost of seeing a patient in GP as zero. You ask a GP to help and they step up. A paramedic calls and you help… and the marginal cost is zero.
The solution is you stop and redirect the paramedic to clinical help within their own organisation which is funded. Same with a an urgent care practitioner trying to redirect to you. Say no and point out they are funded to deal with the problem not you and you are busy with the things you are funded to deal with.