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Patients 'snub GP slot for A&E'

Published 03/06/2015

The report described the A and E brand as
The report described the A and E brand as "particularly strong"

Many people are attending accident and emergency departments despite being offered a same-day appointment with their GP, a report has found.

Research showed that many patients are reluctant to accept a wait of as little as three hours to see their family doctor if they think their needs are urgent - even when their symptoms have been present for several days.

The joint report by the Royal College of Emergency Medicine (RCEM) and the Patients Association highlighted that, although most are aware there are alternatives to going to A&E, "the A&E brand is particularly strong".

Substantial numbers also go because they are advised to do so by other healthcare providers, which it said suggested was because, like patients, many healthcare providers behave and give advice based on a lack of confidence in viable alternatives to A&E.

It said the NHS not only needs to ensure that patients are fully informed of services such as out-of-hours GPs, walk-in centres and the NHS 111 phone service, but must also make sure that these services have sufficient capacity and are available when required.

It also warned that in a third of cases, patients had already received care from other healthcare providers for the same episode of illness, demonstrating a lack of unplanned follow-up provision.

The report suggested the decision to attend A&E by many patients despite being able to get a same-day appointment with their GP is a "function of both patient confidence and convenience".

It recommends locating other out-of-hours services at A&E departments to make it easier for patients to attend them.

The report, which includes a survey of more than 900 people who had recently been to A&E, found the biggest majority attended due to an injury (47%), followed by acute illness (37%) and a long-term health condition (11%).

Less than a quarter (23%) said they had tried to get a GP appointment beforehand.

The report, Time to Act - Urgent Care and A&E: the Patient Perspective, suggested there is an "inescapable message arising from this survey, with many patients reluctant to accept a wait of as little as three hours to see a GP when they perceive their care needs as urgent - even when their symptoms have been present for several days."

It said the A&E brand is "immensely powerful" and "redirection has been repeatedly shown to be ineffective".

"It is futile to discourage attendances, as those most likely to heed the advice may well be those whose need is greatest or most appropriate," it added.

"NHS England must ensure that the public is not only fully informed about appropriate service use - such as out-of-hours GPs, walk-in centres and the NHS 111 service - but must also ensure that these services have sufficient capacity and are available when required.

"Unless this issue is addressed, we will continue to see more pressure on an already overstretched A&E system."

RCEM president, Dr Cliff Mann, said: "Co-location of primary care services has previously been supported by many national organisations and the Keogh Review of Urgent and Emergency Care, but RCEM's work has shown that in 60% of systems no such co-location exists. Co-location now needs to be implemented."

Katherine Murphy, chief executive of the Patients Association, said: "The arguments for co-location are compelling. Now is the time to act to decongest A&E departments and, in so doing, benefit all patients."

Professor Maureen Baker, chairwoman of the Royal College of GPs, said i nstead of moving towards having alternative services located within A&E departments, more needs to be done to raise awareness of them, so that patients know where to turn when they fall ill in the evenings or at weekends.

"The college strongly supports integrated services and the need for new models of patient care, but decisions about which models are implemented and how need to be made in the best interests of the local population," she said.

"In some cases, this might involve GPs working within A&E departments, but we believe that it is best for most health economies - and patients - that new models of care are GP-led and promote collaborative working across larger geographic areas.

"Our patients want to be treated in the community, closer to home, so we must ensure that our GP surgeries are properly staffed before we divert any of our resources to hospitals."

Dr Alistair Douglas, president of the Society for Acute Medicine, said: "Getting patients with urgent care needs to the right place, first time, is a fundamental principle and we need to see action taken to ensure services are set up accordingly to achieve this.

"With current out-of-hours primary care not adequately meeting patients' needs, co-location with A&E departments - but also near to acute medical units (AMU) and critical care wherever possible - would be a significant and positive development.

"Highly-functioning systems perform at a level where 70% of urgent medical admissions bypass A&E by seeing a GP and going direct to AMU, where they receive appropriate care from specialists in acute internal medicine.

"Combined with co-location of out-of-hours primary care services, efforts to bring A&E departments, AMUs and critical care closer together would ensure more patients are treated in the right place sooner and help to further relieve pressure on emergency care."

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