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UK will 'walk into another crisis' without A&E reform

The UK will "walk blindfold into another winter crisis" in hospital care if recommendations put forward in a report by leading doctors are not implemented and the strain is left on A&E services, a medical chief said.

Royal College of Physicians president Sir Richard Thompson said:

Over the past few years, services for ill patients have been stretched by the sheer amount of acute and emergency admissions, and we have to plan better for the future to protect patient safety.

These 13 recommendations are practical, evidence-based, and produced by doctors who care for patients daily - if we do not implement them, we shall simply walk blindfold into another winter crisis.

– Sir Richard Thompson


Out-of-hours GPs needed to 'stem A&E patients'

A group of leading doctors has called for out-of-hours GP services to be offered alongside emergency departments at hospitals to stem the "overwhelming" number of A&E patients.

In a separate study, Imperial College London found one in four A&E appointments were made because patients were unable to see a GP. Credit: PA

Doctors from the College of Emergency Medicine, the Royal College of Paediatrics and Child Health, the Royal College of Physicians and the Royal College of Surgeons, want every emergency department should have a co-located primary care out-of-hours facility.

Patients should not be expected to determine whether or not their injury is serious enough to warrant a trip to A&E or minor enough to contact a GP and should have access to both levels of care, doctors said.

However, the recommended it was inappropriate to expect A&E to deal with "anything and everything".

One in four A&E visits are 'down to lack of GP access'

More than a quarter of visits made to accident and emergency departments in England are made by people who cannot get an appointment with their GP, research has found.

One in four A&E visits are 'down to lack of GP access,' according to an authoritative study. Credit: PA

A study by Imperial College London revealed that almost 5.8 million trips to A&E stemmed from patients who had unsuccessfully tried to meet with their family doctor.

Around 58% of patients questioned at an emergency department in a London hospital admitted they were there because it was "quicker than getting a GP appointment".

A large majority of those patients' ailments could have been managed by a GP or emergency nurse practitioner, the research said.

Money spent on GP services 'increased by a third'

Government funds allocated to GP services have increased by a third over the last 11 years, according to a top NHS official.

Ben Dyson, director of commissioning policy and primary care at NHS England, disputed claims GP services were underfunded and overstretched:

Since 2002/03, the money that the NHS spends on GP services has increased by a third and patient consultations have been increasing year-on-year, but patients should not be unable to get appointments.

A major programme of work to help transform GP services, including patient access, has begun, including the Prime Minister's £50 million Challenge Fund that will support GPs in improving access to services, in more modern ways with greater use of telephone, email and video consultations as well as more flexible appointment times.

– Ben Dyson


GPs 'heaving under strain of rocketing patient demand'

GPs are "heaving under the strain of rocketing patient demand" as the NHS tries to care for an ageing and growing population, despite funding cuts.

Dr Maureen Baker, chairwoman of the Royal College of GPs, said:

Every patient should be able to see their family doctor when they need to, and GPs want to provide the best possible access and high-quality care for all their patients.

But this research is further evidence of the crisis in general practice, with family doctors heaving under the strain of rocketing patient demand, due to a growing and ageing population, and plummeting investment.

More than 90% of patient contacts in the NHS are dealt with in general practice - for only 8.39% of the budget.

– Dr Maureen Baker

Fears as GP patients 'turn to A&E'

Accident and Emergency (A&E) wards are struggling to cope with additional patients who were unable to get an appointment with their GP, it has emerged.

Most patients managed to book a convenient appointment with their GP, the report said. Credit: PA

A report published in the British Journal of General Practice found nearly six million patients had chosen to go to an English A&E department because they could not get a convenient appointment with their GP.

For every 100 patients who try to get an appointment at their local GP surgery, 1.7 will resort to attending the emergency department, the report authors said.

Experts from Imperial College London analysed the results from the national GP Patient Survey from 2012/13, which is answered by around one million patients, and the annual numbers of GP consultations.

Research suggested 1.67% of patients wound up at A&E because they struggled to get a GP appointment.

Govt: 'No easy fix' to A&E recruitment shortage

The Government has hit out at claims it has no clear plan for aiding struggling A&E services and claimed there "was no easy fix" to the problem.

Health Minister Dr Dan Poulter said successive Governments had failed to come up with a recruitment plan to train and hire specialist emergency care doctors.

Working with the College of Emergency Medicine we have a clear strategy to tackle the shortage, and have 414 more A&E consultants than there were in 2009, as well as filling all training places for doctors choosing to specialise in A&E.

It takes six years to train an A&E consultant, and there is no easy fix - but our long-term plans are robust, increasing the number of training places by 75 next year, and planning for all trainee doctors to spend time in A&E.

– Dr Dan Poulter

'Chronic shortage' of staff hindering A&E improvements

The "chronic shortage" of trained A&E doctors is suffocating any attempts to improve emergency admissions services, the head of the Public Accounts Committee has warned.

Margaret Hodge criticised the NHS' reliance on temporary staff, which she dubbed "expensive" and not capable of offering "the same quality of service".

Any attempt to improve emergency admissions services in the NHS is being completely stymied by the chronic shortage of specialist A&E consultants.

Nearly one fifth of consultant posts in emergency departments were either vacant or filled by locums in 2012. There are also major problems in training enough doctors in emergency medicine.

What we found amazing is that neither the Department nor NHS England has a clear strategy to tackle the shortage of A&E consultants.

With many hospitals struggling to fill vacant posts for A&E consultants, there is too much reliance on temporary staff to fill gaps.

– Margaret Hodge
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