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NHS England pilot area found front-door A&E GPs ‘did not work’



An area piloting NHS England’s new care models has said placing GPs at the front door of A&E departments ‘did not work’, and that they were better placed overseeing patient discharge.

The comments, which related to a trial at the Frimley Park Hospital in Hampshire, come after NHS England has told all hospitals they must use GP front-door streaming this winter.

But Dr Andy Whitfield, chair and clinical lead of NHS North East Hampshire and Farnham CCG, which runs a Primary and Acute Care System (PACS) vanguard, told a conference of health professionals: ‘One thing that didn’t work is the national programme to get GPs at the front door in A&E.’

He added: ‘Actually we found putting GPs at the back door more effective, managing discharge of patients. We found this was far better than having them at the front door.’

Dr Whitfield stressed that this was the experience in their local area and the model may have worked elsewhere. Meanwhile, in his CCG area they are recruiting GPs to help with patient discharge from hospital by working with long-term conditions patients in the frailty unit.

A CCG review of last year’s winter pressures at Frimley Park found that ‘performance challenges’ were driven not just by high numbers of patients attending, but also more complex needs of patients who were admitted and delays in discharging patients fit to leave hospital.

According to Dr Whitfield these GPs are ‘supporting early intervention and discharge out of hospital in less than 72 hours’.

He told Pulse: ‘We have worked with our local acute provider to create and establish a shared model using the experience gained over years of successful collaborative clinical working, to implement an adapted role to suit local circumstances. 

‘We have been able to expand the GP role and we are currently recruiting as a result.’

NHS England has ploughed £100m into its mandate for ‘every hospital’ to implement a ‘comprehensive front-door streaming model ahead of this winter.

But the plan has been met with criticism by GP leaders due to workforce concerns and a lack of evidence to back up its efficacy.

Are there enough GPs to stretch to A&E?

GP leaders have warned that a ‘chronic lack of GPs’ meant it was ‘doubtful’ that the Government’s plan is feasible, adding that ‘most importantly we actually need more GPs in local surgeries’.

Health secretary Jeremy Hunt praised the model, saying it worked ‘spectacularly at hospitals like Luton and Dunstable’, which was able to admit or discharge 95% of its patients within four hours last winter despite pressures.

However, a Pulse analysis found that in order to roll out Luton and Dunstable University Hospital’s model across all trusts in England, between 278 and 417 GPs would need to be working in A&Es on any one day.

A Pulse analysis of hospital plans for GP streaming found some trusts planned to have three GPs in A&E at any one time this winter, with CCGs taking a variety of approaches to recruitment.