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Offer more same-day phone consultations for urgent patients to reduce burden on ‘creaking’ A&E, GPs told

GPs should offer more telephone consultations for urgent patients to ensure ‘faster and more consistent same day, every day access to primary care’ and help alleviate the intense pressure on A&E departments, a major NHS England review has concluded.

A report published today by NHS England medical director Professor Sir Bruce Keogh, which sets out plans for two-tier A&E services and a wide-ranging overhaul of urgent care, says GP surgeries provide ‘variable’ responses to patients with urgent care needs. It urges GPs, out-of-hours services, community health teams and NHS 111 to work ‘together and differently’ to ensure patients receive prompt advice and care ’24 hours a day, seven days a week’.

As part of this, the report suggests GP practices should provide ‘prompt telephone consultations’ for more patients, in order to free up additional time to spend with patients who would benefit from face-to-face advice.

Today’s report marks the first phase of Sir Bruce’s review, with the next stage due to ‘develop the tools’ for implementation of his proposals, which is expected to take three to five years. The review was launched in June in response to the perceived crisis in emergency care in England, which health secretary Jeremy Hunt said had been caused by four million extra patients attending A&E as a result of the ‘disastrous’ 2004 GP contract negotiations.

Today’s report proposed a range of new measures to alleviate the burden on A&E services, which Sir Bruce said were ‘creaking at the seams’. They include:

- a revamp of A&E departments to create two levels of emergency department: ‘emergency centres’ and ‘major emergency centres’

- increasing the use of self-care by providing greater information

- improving access for GPs to specialist advice.

Under the proposals, GPs will be expected to provide telephone advice for a ‘significant proportion’ of urgent care work in an attempt to free up face-to-face appointment slots.

The report warned: ‘At the moment, patients contacting their GP’s surgery with an urgent problem receive a very variable response, and may be directed elsewhere.’

The report said NHS England’s aim was to ‘provide faster and consistent same day, every day access to primary care and community services for people with urgent care needs.’

‘This is likely to mean general practice, out-of-hours services, community health teams and NHS 111 services working together, and differently, to ensure that patients with urgent care needs can receive prompt advice and care 24 hours a day, seven days a week.’

‘There are many innovative options to explore. The evidence for prompt telephone consultations is compelling, and can free up appointments to spend with those patients who would benefit from face to face care.’

Other innovations to free up time included GPs leading ‘integrated multidisciplinary teams to manage whole pathways of care including the exacerbations of those patients with long term conditions’, and improving GPs’ access to hospital specialists. The report also identified wider problems around GP access, warning that ‘even the simple task of ringing a GP practice to request an appointment can result in a frustrating assault course on a telephone keypad’.

Professor Keogh said that there is a feeling that this winter will be difficult.

He said: ‘We’re here, really, because A&E is creaking at the seams. It’s not broken, but it is struggling.’

‘When A&Es become busy, it means other parts of the system are creaking, that they’re under stress. It’s against that background that there’s a feeling that this winter will be difficult.’

Professor Keogh added it will take three to five years to enact the change necessary, though NHS England expect several key changes to be in place within six months.

Professor Keith Willett, national director for acute episodes of care and co-author of the report, said: ‘The public tell us there’s a lot more we can be doing out there, to improve access to primary care, that means we need to work with GPs to create the headroom for them to be able to respond differently, to give better access to primary care and to community teams.’

However Dr Agnelo Fernandes, the RCGP’s urgent care lead and a GP in Croydon, south London, said more resources were needed in order to increase capacity.

He said: ‘The workload of GPs has gone up and up. There are over 300 million consultations a year. It is by far the most used part of the NHS. However, we also know the resource of general practice has not kept pace with that. There has to be additional resource to increase the capacity.’

‘One way of increasing the capacity is by increasing consultations on the phone, but that requires adequate numbers of GPs to do that as well. You can’t do everything on the phone, you do need GPs to see people too, so you need resources to do that. There is good evidence that you can increase capacity by increasing telephone consultations but there are only so many hours in the day.’