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Replace GP out of hours with GP-fronted A&E departments, Monitor urges

NHS should consider adopting a Dutch system of out-of-hours GPs working within the England’s A&E departments, Monitor has urged.

This would improve care quality, cut rates of unnecessary A&E attendance and enhance GPs’ job satisfaction as a result of not having to be on call, the health services regulator said.

But the GPC said the proposals, from a new report titled Exploring international acute care models, would require a solution to the GP workforce crisis first.

The Dutch system championed by Monitor sees patients who need urgent treatment at night or weekends first contact an out-of-hours GPs based in a specialist clinic that is often co-located with an A&E department. And, according to the report, Holland sees only 120 A&E attendances per thousand of the population per year compared with 278 in England.

The report said: ‘[W]here GP posts are co-located in hospital premises there might be cost efficiencies resulting from shared use of resources and infrastructure, particularly X-ray availability, simple suturing and so on.

‘The Dutch system reports good GP job satisfaction and work-life balance improvement. Average time on call out-of-hours for a GP was reduced from around 19 hours per week to four hours per week when GP posts were introduced.’

But GPC chair Dr Chaand Nagpaul said: ‘Most importantly there is an acute shortage of GPs that has been exposed this year by the 450 vacancies across England for GP trainee positions. Comparisons with other countries, while useful, cannot be taken as like for like, especially when – as Monitor indicates – the UK spends less on its healthcare than other developed economies, a fact that applies particularly to out of hours services.’

He added: ‘This report highlights the compelling case for more GPs and the need for a coherent plan to establish a clear urgent pathway for patients that integrates a range of services, including NHS 111.’

The BMA previously opposed very similar calls made in a report from the College of Emergency Medicine earlier this year, which suggested all A&Es should have a GP working there.