Allow GPs to refer directly to hospital not A&E, say Northern Ireland GPs

GPs in Northern Ireland have argued that hospital policy forcing GPs to refer acutely ill patients to hospital via accident and emergency (A&E) has unnecessarily increased admissions and risked de-skilling the next generation.

Dr Dunn: ‘GPs should be allowed to admit acutely ill patients directly to hospitals negating the need for retrograde triage at A&E.'
Dr Dunn: ‘GPs should be allowed to admit acutely ill patients directly to hospitals negating the need for retrograde triage at A&E.'

Delegates at the Northern Ireland LMCs conference in Newcastle, County Down, on Sunday voted in favour of a motion which insisted that ‘GPs are totally capable of deciding when a patient needs admission to hospital without the retrograde triage at emergency departments’.

Presenting the motion, on behalf of Northern LMC, Larne GP Dr Brian Dunn said: ‘In days gone by we used to phone up the house officer and admit the patient directly. Then we had to call the bed manager. Then it was decided GPs were admitting too many patients so it was decided they should be sent to A&E.’

Dr Dunn said that GPs were experts at assessing acutely ill patients and they should be allowed to make referrals directly to hospital when they deemed it necessary.

Dr Dunn said: ‘GPs are often best placed to decide when a patient needs admission and we should be allowed to admit acutely ill patients directly to hospitals negating the need for retrograde triage at A&E.'

Speaking in favour of the motion, Newry GP Dr Arnie McDowell said that GPs in the Southern LMC area had been able to directly refer patients to hospitals for the last three years, which had reduced the number of admissions to A&E.

‘However in the recent years we have seen some retrograde steps with the bed manager recommending A&E attendance,’ Dr McDowell said.

Dr McDowell also warned that forcing GPs to refer acutely ill patients to A&E instead of directly to hospital would stop new GPs developing referral skills.

‘What we’re also doing is running the risk of de-skilling the next generation – who won't learn how to make that call, on where to send an acutely ill patient,’ he said.

Earlier in the day Northern Ireland GPC chairman Dr Tom Black said that despite the high number of A&E attendances in Northern Ireland, the situation still did not compare to the sheer volume of patients seen by GPs.

‘Do you know what the ratio between GP consultation rates and A&E consultation rates is? Would you believe it’s more than 20 to one,’ he said.

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