GP workload increases as hospitals discharge patients in middle of night

Patients need to leave hospital with a care package that does not rely on a GP home visit the next day, warns RCGP chairwoman Dr Clare Gerada, after a study revealed thousands are being discharged in the middle of the night.

Dr Gerada: ‘If a patient is discharged there needs to be a wrap-around care package that does not rely on GP doing a home visit the next day.'
Dr Gerada: ‘If a patient is discharged there needs to be a wrap-around care package that does not rely on GP doing a home visit the next day.'

Out of the 170 English hospital trusts asked by The Times how many patients were discharged between 11pm and 6am in 2011/12, 100 responded revealing a total of 239,233 discharges in these hours.

The figures published today account for 3.5% of all hospital discharges and include A&E admissions only if they have been admitted to a ward.

Dr Gerada said: ‘If a patient is discharged there needs to be a wrap-around care package that does not rely on a GP doing a home visit the next day.

‘GPs are heaving under the workload. The number of patients GPs are seeing has increased, activity has more or less doubled and we are seeing increasingly complex cases and the points of access has increased.’

GPC deputy chairman Dr Richard Vautrey said: ‘The government needs to realise that operating hospitals at 100% capacity is not in the interests of patients. There needs to be a small amount of slack in the system. We do see patients who are discharged without proper care packages and without support. And a GP will be asked to visit patients who are discharged to sort things out and it is not how it should be.

‘It is not just about late night discharging. The other issues are 24-hour care. GPs will often struggle to get patients admitted to hospital and they can be left at home because of the pressure on hospital beds.’

Dr Vautrey said the Health and Social Care Act will not solve the issue as it allows hospitals to go bust, so they will be under increasing financial pressure.

He said: ‘More care in the community is an aspirational aim but it is misaligned as hospitals are being encouraged to drive up their activity while clinical commissioning groups (CCGs) are encouraged to drive it down.

‘Monitor will now be responsible for integration and encouraging competition which are diametrically opposed so we will have to see how that dilemma works out.’

Medical director of the NHS Sir Bruce Keogh said: ‘I am concerned to hear that some patients may be being discharged unnecessarily late. Patients should only be discharged when it's clinically appropriate, safe and convenient for them and their families. It is simply not fair to be sending people home late at night. We will look at this.’

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