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GPs have limited role in relieving winter A&E pressure

MPs want more evidence on benefits to A&E of extending GP hours and co-location

Louise Prime

Thursday, 03 November 2016

Primary care will play only a limited role in addressing acute winter pressure on A&E departments, as the real challenge for the system is managing complex patients who require hospital admission, the Health Committee said this morning in its latest report on winter planning in A&E. MPs warned against making assumptions that simply diverting patients away from A&E and into primary care would be helpful, as there has been little evidence that this has been successful in the past; and they called for further evidence that the Government’s proposals for extended GP hours could limit demands on A&E. They added that unless the shortfall in social care provision is addressed, people will continue to face avoidable admission and delayed discharge from hospital.

In the Government’s own evidence to the Committee, it highlighted its expectation that primary care will make an important contribution to reducing A&E pressure over the winter; and it claimed that poor advertising of extra general practice services last winter meant that people still went to A&E. The Royal College of Emergency Medicine argued that pressure on A&E cannot easily be relieved by enhancing primary and urgent care services, partly because the proportion of patients whose care cannot be delivered outside the acute hospital setting has risen; it pointed out that admissions have increased at a faster rate than attendances.

MPs cautioned that although improving access to primary care is an important objective, extending opening hours could have potential unintended consequences if it undermines the ability to staff existing urgent out-of-hours provision. They concluded: “There is little evidence that previous attempts to divert patients away from emergency departments and into primary care have been successful. As we approach winter, primary care will only play a limited role in addressing acute winter pressure, as the challenge for the system is managing complex patients that require admission to hospital. We would like to see further evidence that the Government’s proposals for extended GP hours will limit the demands placed on emergency departments.”

But the Health Committee argued that, in the long term, “Enhanced and properly resourced primary care … will be crucial in helping to prevent the escalation of illness to an extent where emergency admission to hospital is required.”

The RCEM told the Health Committee it believes that a model in which A&E sits at the centre of a hub and co-located urgent care could deflect cases away from the emergency department. The Committee responded that although co-location of primary care with emergency departments is theoretically attractive, this approach might have the unintended consequence of attracting more people to attend A&E in the future rather than contact their primary care service directly. It called for much greater investigation into the risk of creating supply-induced demand.

Besides, MPs added: “Given the shortfall in GP numbers, it is unlikely to be sustainable to operate several parallel systems for out-of-hours GP access and it is important that commissioners to consider the wider impact on primary care provision for patients as well as for A&E.”

The BMA told the Committee in August that to ensure effective planning for winter pressures within the health system it is also necessary to tackle wider public health issues, such as keeping vulnerable people warm in winter and ensuring that older people, and those with co-morbidities, are adequately cared for in the community.

BMA council chair Dr Mark Porter said this morning: “It is vital that there is sufficient capacity across the entire health and social care system, including in accident and emergency departments, general practice and social care provision. Doctors are particularly concerned that a lack of investment and resource in social care is increasingly impacting on the provision of healthcare, especially in winter.

“Short-term fixes, however well meaning, will only get us so far. We have to look at the long-term funding and recruitment issues facing the NHS as a whole if we are to get to grips with the pressures hospitals face year in, year out, but which are compounded during the winter months.”

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