Primary care must take on greater urgent care role, MPs warn

Primary care has 'an important role to play' in delivering urgent care but cannot do so without structural reform backed by funding transferred from hospitals, MPs have warned.

Health select committee chairman Stephen Dorrell: primary care has key role to play
Health select committee chairman Stephen Dorrell: primary care has key role to play

A report by the House of Commons health select committee found that ‘a significant proportion of emergency care could be classified as primary care and more appropriately undertaken by a GP’.

Health select committee chairman Stephen Dorrell (Con, Charnwood) said: ‘Enabling primary care to assume a more active role in dealing with urgent cases is an important part of this.

‘We recommend that NHS England, as the commissioner of GP services, should actively seek innovative proposals for community based urgent care services, including improved access to step-up/step-down residential facilities.’

However, MPs found ‘no evidence that primary care has the capacity to absorb additional work’ and warned that ‘a transfer of funding from the acute sector into primary care is required’.

The report warned current NHS services are ‘fragmented with poor signposting’ and that the complexity of commissioning arrangements is a ‘fundamental weakness’.

MPs concluded that the 2004 GP contract was one of several factors behind rising pressure on emergency care services, along with the botched roll-out of NHS 111 and ambulance services ‘conveying too many patients to A&E’.

NHS 111, the report said, was rolled out ‘prematurely and without a sufficiently sound evidence base’.

The select committee expressed concern that NHS 111 ‘did not apply the principle of seeking early engagement by a senior clinician, with the result that many calls took longer than necessary and some patients were advised to attend A&E but did not, in the event, need to be there’.

The report cited evidence from RCGP chairwoman Professor Clare Gerada that GPs are trained to ‘deliver care to patients with complex needs and deal with uncertainty in acute conditions’, concluding that in its current form primary care is ‘not designed to provide urgent care’.

The report says primary care will need to change to take on a greater urgent care role, but MPs said they did not want ‘a single blueprint from the DH or NHS England’.

MPs warned that a lack of clear data to explain the causes of pressure on emergency care and hospital services meant the NHS was ‘flying blind’.

‘More accurate information about the causes of rising service pressures is not simply a management convenience; it is fundamental to the delivery of high quality care,’ the report warned.

MPs called for CCGs and health and wellbeing boards to ‘explore the benefits of establishing single commissioning teams for out-of-hours care, ambulance services, 999 and NHS 111’ to cut fragmentation of services.

Responding to the report, Professor Gerada said: 'The committee has got its analysis of the root causes of the problems facing our urgent and emergency care services spot on. No one part of the system - hospital departments, GPs or ambulance services - is to blame but the overall fragmentation of the system is not serving the best interests of patients.

'We welcome the committee's acknowledgement that a significant proportion of urgent care is delivered by GPs, and that the profession is currently under huge pressure. The committee is right to call for more resources to be allocated to primary care in the long term.'

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