Quality | 2010.03.05
Patients should feel welcome at A&E
Report warns that those discouraged from attending hospital may not seek appropriate medical care
Attempts by NHS chiefs to persuade patients with minor ailments not to turn up at hospital A&E departments risk leaving vulnerable people without access to any form of healthcare, a government-commissioned report warned today.
Policymakers believe that too many patients attend A&E "inapropriately," putting pressure on already stretched staff and budgets, and have encouraged hospitals to "educate" those people to see their GP or attend minor injuries units instead. But the report questions assumptions within the NHS that up to 60% of patients who attend casualty departments could be diverted to GPs or primary care nurses .
It says there is a risk "some of the most vulnerable patients (who) for cultural, personal and socio-economic reasons, will almost always turn to the emergency department for their care will effectively be denied access to the health service...These are the very people that it is vital the NHS delivers care to. Trying to redirect them elsewhere may well mean they do not receive it at all."
The report adds: "There is good evidence that the majority of patients choose the correct level of care. A few do not and it is always a risk to plan for the few rather than the many.
"For instance, patients presenting with a headache to general practice have a very small risk that there is a significant underlying problem producing the symptom. But up to 60% of patients presenting to emergency departments with the same symptom are found to have a significant underlying problem. Using a service model to lower the acuity of the response or discourage patients from seeking care... will not improve quality."
The study said that locating GPs in emergency departments could improve patient care but it found little evidence that the approach cut costs or unnecessary hospital admissions.
About half the 200 A&E departments in England now offer some primary care services, according to the report from the Primary Care Foundation , a private advisory and consultancy body.
Its study comes as the Department of Health tries to concentrate emergency services, including specialist A&E care for major trauma, heart attacks and strokes in fewer hospitals and encourage more use by patients of walk-in centres and minor injuries units.
The report, Primary Care and Emergency Departments, suggested only between 10% and 30% of A&E patients had conditions regularly seen in general practice and that partnership schemes often use GPs paid by the shift, with little or no long-term commitment to the work. The main driver for introducing them had been reducing cost, it said, but often no assessments had been made about real savings.
The report\'s authors were also unconvinced of any link between enabling specialists to concentrate on "classic emergency department cases" and reducing hospital admissions or meeting four-hour waiting time targets in A&E .
Rick Stern, one of the foundation\'s three partners, later told the Guardian it was concerned that some in the NHS were trying to divert patients elsewhere too quickly, although he added that one-to-one advice after the patient had received treatment might be worthwhile.
The report had reservations about assumptions savings might be made simply through primary care consultations being cheaper then admission to hospitals. However services that properly integrated urgent care, developed local tariffs, and incentivised all partners to work in the patients\' best interests might drive down costs.
David Carson, joint director of the foundation, said: "Alongside general practice, (A&E) is the front door of the NHS, Patients know who their GP is and where the nearest emergency department is. So it is vital to get the service right."
David Colin-Thomé, national director for primary care at the health department, said the report provided "a realistic assessment of current primary care services within or alongside emergency departments. The report emphasises the importance of aligning financial incentives, allowing clinicians to focus on what is right for the patient."
For more information, please visit
http://www.guardian.co.uk/society/2010/mar/05/emergency-services-nhs
