27 Jan Poor access to GPs cannot be causing the urgent care crisis
The recent comments attributed to the Prime Minister have upset GPs who feel they are being scapegoated for the problems in the wider urgent care system and particularly in hospitals.
For someone who has, in a previous life, run hospitals that have busy A&E departments, this debate brings back many memories. This is a complex issue, multifactorial in nature, and it is depressing that despite the time that has passed the real causes are still not acknowledged. And this recent suggestion, that the pressures result from poor access to GP services, simply doesn’t make sense.
The so-called ‘minors’ who may well attend A&E if they cannot access a GP, are quickly and easily dealt with in most A&E units. They are not the cause of the congestion.
The critical issue here is not A&E attendance, but admissions. It is the complex patients, who require admission, that are difficult to move through A&E because of a lack of available ward beds. This is caused, in turn, by delays in discharging patients from the wards, particularly when they require ongoing community or social care support.
If poor GP access is a prime cause of the current crisis, then patients must be both bypassing their GP, and being admitted to hospital unnecessarily. If they did meet the criteria for admission, then it is unlikely a GP could have managed the patient at home anyway?
There will be an occasional unnecessary admission through A&E, but it seems unlikely to be happening at sufficient scale to cause the widespread congestion we are currently seeing.
Another possibility, which I think may well be material, is that there are patients being admitted who could have been managed at home under the care of their GP, if adequate and timely nursing and/or care support was available.
If this analysis is correct, then simply creating more GP appointments will not have an impact. Indeed, Nigel Edwards recently tweeted that 26 GP appointments are needed before a single A&E attendance is saved.
My strong suspicion is that the provision of more care and nursing support in the home, available quickly and at all times of the week, would go a long way to resolving the congestion that is happening. It would also allow GPs to oversee the care of patients in their own home.
Surely this is a soluble problem, and surely it is something the new integrated community providers should be addressing as a priority.