As if there is not enough demand on GPs already, there is now the suggestion that they should become “proper doctors” again and help staff after A&E departments. This has been tried and shown to be successful in that there are fewer admissions, and more people are sent away to see their GP or self care/recover naturally. The trouble is that government cannot clone GPs: there just are not enough for a short term fix.
Part time working for a larger number than foreseen means that most GPs no longer work 9 sessions, and most are looking for some other outlet as well as GP. In the National “fear” ranking, lack of emergency service cover trumps chronic disease management and minor illnesses in GP. (In Place of Fear A Free Health Service 1952 Chapter 5 ). The RCGP response is predictable and relates to staff training rationing – “told you so”… for the last 25 years. The post-code lottery is worse in rural areas. In 2015 there were suggestions that Consultants could run GP, and now: that GPs have the time to go and help in casualty!
Most doctors believe GP surgeries should be placed in accident and emergency departments to deal with patients who turn up at hospitals inappropriately.
A survey of doctors found that a significant majority thought the move was necessary to relieve pressure on A&E units.
Official NHS figures show that about 13 per cent of people who attend A&E are discharged without requiring treatment. A further 35 per cent are discharged after being given advice or guidance only.
In November MPs on the Commons health committee warned that poor performance in A&E has “become the norm” for some NHS trusts. Casualty units are now routinely missing the national target to deal with 95 per cent of patients within four hours.
The survey of more than 500 doctors conducted for the Press Association found that 61 per cent of GPs and secondary care doctors believed that surgeries should be introduced in the emergency departments. It also found that just under 30 per cent of doctors believed that up to a third of people went to A&E unnecessarily.
Three quarters of doctors thought that people going to A&E unnecessarily did so because they thought that they would be seen more quickly. Seventy-four per cent said that patients misunderstood the purpose of A&E and 62 per cent said patients thought that they would be able to see a specialist.
One doctor said: “Inappropriate A&E attendances should be redirected to primary care services for review and patients should be given education at the same time.”
Another said: “Increase A&E waiting times in a ‘minor illness’ area and stop trying to achieve targets for the sake of it. If patients have to wait, they won’t use it. Also increase the number of GPs and increase patient responsibility for self-care.”
Another said: “We should not be discouraging patients from attending A&E, but should be providing the services that they need and want at one convenient destination — this could include pharmacy, primary care, minor injuries, emergency departments and rapid access.”
Gareth Thomas, managing director of Wilmington Healthcare, which carried out the polling, said: “Urgent action must be taken to tackle the escalating crisis in A&E departments across the country, where patient numbers have been increasing for more than a decade and estimates suggest that many patients should be directed to primary care services.
“Our survey shows that a significant proportion of doctors believe that co-located GP services could help to alleviate the problem, while improving patient education and access to primary care and out-of-hours services are also key.”
Taj Hassan, president of the Royal College of Emergency Medicine, said: “The results bear out what this college has been advocating for many years. It is important to match the level of services available to reflect both rising demand and our ageing population. Co-location of primary care services can offer some solutions to the challenges faced by the rising tide of patients arriving at emergency departments.”
NHS middle managers too comfortable to take top jobs “Kafkaesque regulation and rising patient expectations mean that managers and doctors opt for an easier life in less demanding roles”… political courage is needed.