The long-awaited Urgent and Emergency Care Review by NHS England medical director Sir Bruce Keogh, warns that urgent care services across England are fragmented, leaving patients confused and turning up at A&E departments unnecessarily.
The urgent care system in England needs to be simpler and more co-ordinated, with less duplication, it said.
NHS England launched a survey about the future of urgent care services today, which includes a ‘possible implementation option’ of having ‘decision support from a patient’s own GP practice and hospital specialist nurse/team, seven days a week’. Other possible options include ‘seven day continuity of care from a patient’s GP practice’ and ‘GP telephone consultations both in and out-of-hours’. The survey closes on 8 August.
The review found that some patients lack confidence in telephone advice and often seek a second opinion at A&E departments, leading to a duplication of ‘service provision’.
It said that most out-of-hours services work ‘effectively to deliver a high standard of care to patients who need urgent care when their GP practices are closed’. ‘However there are variations in the standard of care provided and commissioners are not always able to hold providers to account,’ it said.
Increased pressure on primary care means that ‘some’ patients go to urgent care and emergency care services when they cannot get access to their GP quickly, it found.
The report reads: ‘National workforce analysis highlights a growth in the GP workforce in England however, local variation exists in unequal access to GPs between areas of high and low deprivation.
‘Analysis of the available evidence on the demand for GP services points to a workforce under considerable strain. The existing GP workforce has insufficient capacity to meet current and expected patient needs.’
The report's findings echo results of an RCGP poll that found rising pressure had left 85% of GPs unable to guarantee safe care for their patients.
The review found that there was increasing pressure across all urgent care services, including walk-in centres, telephone advice lines, minor injury units and GP out-of-hours services. Monitor began a review into the closure of walk-in centres last month.
Constant change in the NHS is undermining integration of urgent care services, RCGP chairwoman Professor Clare Gerada warned the House of Commons health select committee's emergency care inquiry last week.