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NHS England Urgent Care Review – beginning to talk sense

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NHS England has just published its principles for urgent and emergency care.

It identifies the emerging principles of how to manage urgent and emergency care highlighting ’12 system design objectives’ ranging from social care, general practice, out-of-hours services and A&E.  It is clear that this is about seeking views, stimulating discussion and conveys very important messages on the value of senior (and experienced) clinical input to triage of patients, the use of GP telephone consultation and out of hours services.
But I wonder how often the issue is not so much that people are not sure of where to go if they need advice from a doctor but more a case of dealing with the problem when it arises?  Managing a patient with a condition, as it occurs BEFORE it becomes the urgent or emergency episode turning up at A&E or contacting the GP out-of-hours service?

Could this be done faster, for less effort in primary care?  I’ve just been working with a Wokingham practice who had suffered years of rising demands, patient complaints about access, stress and anxiety.  Within two weeks of change they were responding to all their patients, all day, every day in a median of 30 minutes.  Stress removed, 80% of patients saying the new system is better.

Over a longer period, we’ve seen that rapid GP response by telephone has had a direct affect on reducing attendances at A&E whilst at the same time increasing patient satisfaction. The Elms surgery in a deprived area of Liverpool has seen the average number of days wait to see a GP fall to less than a day, GPs responding to patients within 20 minutes of contacting the surgery and A&E attendances 40% below average for the city.  Thurmaston Health Centre near Leicester began a similar service two years ago, now finding their A&E visits are down 49%, ACS admissions down by 64% and elective admissions down by 14% (CCG figures).  All on our case studies page.

So maybe there should be more emphasis on meeting peoples’ needs straight away in general practice BEFORE it becomes urgent and requires expensive secondary care. By doing this much we will address demand at source in the simplest most effective way.

Dr Thoreya Swage, GP Access partner and independent health management consultant

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