'Never full' practices key to A&E crisis, says top GP

Practices should be prepared never to turn patients away during core hours, to help solve the urgent care crisis, a GP commissioning leader has said.

Dr James Kingsland: practices must never turn patients away
Dr James Kingsland: practices must never turn patients away

National clinical lead for the NHS Clinical Commissioning Community, Dr James Kingsland, said the solution to increasing pressure on emergency and urgent care services could only come through demand management in general practice.

‘Meeting demand by just improving capacity - building walk-in centres, NHS 111, NHS Direct, minor injuries units - is not the solution,' Dr Kingsland told the Health+Care 2013 conference in London on Thursday.

‘Part of the solution is investment in primary care, particularly general practice - the primary care home, to allow the expansion and finishing of more episodes; making more and buying less for patients.’

Dr Kingsland said evidence from patient access programmes showed triage systems that used GPs as the first ‘port of call’ cut face-to-face time, freeing up resources and increasing capacity to deal with urgent care by around a third.

He said rapid response to home calls would reduce the likelihood of a ‘blue-light’ call.

Around 80% of urgent care demand is during GP core hours, explained Dr Kingsland, so ‘never full’ practices, which never turn a patient away reduce pressure on urgent care services.

‘My practice is one of a number that says we are never full. So that between our opening hours, no patient is ever turned away.’

‘We found that by having a never full practice, the number of calls made between 7am and 8am, to GP OOH, and between 6.30pm and 9pm, for a practice population of 5,000, is just one call every four weeks.’

He said resources were released with fewer staff required in out-of-hours time.

The Royal College of Physicians’ Future Hospitals Commission lead fellow, Professor Timothy Evans, said integration between general practice and acute care was the solution.

’I don’t know where general practice stops and secondary care - escalation of care - starts,’ he said. ‘We need an integration of the two. We need to bring together general practice and hospital care.

'We need far more hospital specialists working to support general practitioners in specialist clinics. And we need far more access points to the service that are coordinated and facilitated by excellent IT.’

‘It’s not hospitals, it’s not general practice, it’s both,’ he said.

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