It’s tough in all sectors of urgent care right now.
Reports from the Department of Health and around the country show an eight-fold increase in the number of calls to GP out-of-hours (OOHs) services in some areas since GPs opted GPs out of OOHs care in 2004 when the new GMS contract was introduced.
Walk-in-centres and NHS Direct have not had the impact that was expected in reducing inappropriate or unnecessary contacts with A&E or GP OOHs services.
A King’s Fund review identified that as much as 50% of all contacts in walk-in-centres nationally were subsequently seen again within one week by the registered general practice and concluded duplication of care was the norm.
A&E departments are ever increasingly being used by patients for non-emergency care, with more and more routine ambulatory and sometimes simple, self-limiting illness presenting at these overstretched departments.
A central focus of the current reforms is to describe and demonstrate a remedy for the increasing demand on urgent and emergency care systems.
I believe improving the capacity and capability of the primary care system is the key to solving the urgent care crisis.
Urgent care began to break, when in 2004, general practice started to move out of urgent care provision for their registered populations.
Has there really been an eight-fold increase in urgent care in the past eight years? Of course not. What’s happened is since GPs stopped being accountable for their list from 6.30pm and PCTs took over this responsibility, the management of demand in OOHs care has gone.
The goal now has to be that by the time general practice closes most patients have been dealt with and had finished episodes of care so that in the evenings after surgery is closed, no-one is phoning out-of- hours because they have been denied access during the day.
Patients also need access to co-located services within the community, including pharmacy and dentistry as well as other community services, in order to provide truly integrated care out of hospital. This is what will ultimately prevent people going to A&E because they had poor access or disjointed care and couldn’t get to see their GP or dentist the day they needed them.
The mandate details that patients will have direct access to GP appointments by 2015, so they can book appointments online. The development from this will be for A&E to have direct access as well.
We need to be careful about deciding how and what to fix. Like all good diagnosis it begins with a clear history, understanding the nature of the disease and cause of the symptoms.
The management of urgent care need won’t be improved by focusing on hospital activity alone.
Dr James Kingsland is a GP and national clinical commissioning network lead for the Department of Health