Put GP surgeries in A&E departments, say 61% of doctors polled
GP surgeries should be placed in accident and emergency departments to see patients who turn up to hospital inappropriately, according to a poll of doctors.
As key targets for waiting times are missed at A&E departments across England, the survey found that 61% of GPs and secondary care doctors believed this step was necessary to relieve pressure on emergency departments.
There are widespread concerns that patients turn to A&E rather than attempting to see a GP first. The poll of more than 500 doctors for the Press Association, carried out by healthcare intelligence firm Wilmington Healthcare, found that 27% of doctors believed up to a third of people go to A&E when they should be seen by a GP or nurse.
Some 13% said more than half of patients should be redirected to GP services on arrival at A&E.
Official NHS figures show about 13% of people who attend A&E are discharged without requiring treatment. A further 35% are discharged after being given advice or guidance only.
In the poll, 75% of doctors said they thought people went to A&E without needing to because thought they would be seen faster. Some 74% said patients misunderstood the purpose of A&E and 62% said patients thought they would get to see a specialist.
In November, MPs on the Commons health committee warned that poor performance in A&E has "become the norm" for some NHS trusts.
A&E departments are now routinely missing the national target to deal with 95% of patients within four hours.
Major type 1 A&E departments - those that are located in hospitals - perform the worst, with 87.9% of patients admitted, discharged or transferred within that timeframe in 2015/16.
The poll found that just 28% of doctors did not think GP services should be co-located in hospitals.
Educating patients on when they should go to A&E was seen by 72% of doctors as a key step to relieving pressure on emergency departments.
Improving access to GPs was seen as necessary by 60% of doctors, while 40% said increasing the availability of doctors out of hours would have an effect.
One doctor said: "Inappropriate A&E attendances should be redirected to primary care services for review and patients should be given education at the same time."
Another said: "Increase A&E waiting times in a 'minor illness' area and stop trying to achieve targets for the sake of it. If patients have to wait, they won't use it. Also increase the number of GPs and increase patient responsibility for self-care."
Another said: "We should not be discouraging patients from attending A&E, but should be providing the services that they need and want at one convenient destination - this could include pharmacy, primary care, minor injuries, emergency department and rapid access."
Gareth Thomas, managing director of Wilmington Healthcare, said: "Urgent action must be taken to tackle the escalating crisis in A&E departments across the country, where patient numbers have been increasing for more than a decade and estimates suggest that many patients should be directed to primary care services.
"Our survey shows that a significant proportion of doctors believe that co-located GP services could help to alleviate the problem, while improving patient education and access to primary care and out-of-hours services are also key."
Taj Hassan, president of the Royal College of Emergency Medicine, said: "The results here bear out what this college has been advocating for many years. It is important to match the level of services available to reflect both rising demand and our ageing population. Co-location of primary care services can offer some solutions to the challenges faced by the rising tide of patients arriving at emergency departments."