Budget reaction: GP triage in A&E 'could deepen NHS crisis'

Plans for a £100m GP triage service in A&E departments across England will add to pressure on an already overstretched workforce and could drive more patients into hospital, doctors' leaders say.

GP leaders called on ministers to explain where they plan to find GPs to staff an A&E triage scheme set out in Wednesday's budget announcement, and warned that the announcement by chancellor Philip Hammond failed to address a £30m 'gaping hole' in NHS finances.

Statements from the RCGP and BMA said that with practices already struggling to cope with soaring workload, general practice could ill afford the loss of GPs to staff the £100m triage scheme set out in the 2017 budget.

The BMA argued that placing GPs in A&E 'won't reduce admissions' and could end up attracting a growing number of patients into hospitals.

GP workforce

The RCGP said the best place for GPs was 'in their communities providing high quality general practice', arguing that the £100m fund would be better spent on 'shoring up' existing GP services.

GP leaders welcomed plans for £2bn additional funding for social care set out in the budget announcement, but criticised plans to target additional invesment at only a 'small number' of sustainability and transformation plans (STPs).

GPC deputy chair Dr Richard Vautrey said the budget did nothing to ease 'the enormous pressures overwhelming general practice in England'.

'GPs and their staff are struggling on a daily basis to cope with rising patient demand, stagnating budgets and endemic workforce shortages that have left many GP practices unable to deliver enough appointments to patients. Putting GPs in A&E will do nothing to address this crisis.'

BMA chair Dr Mark Porter - who called ahead of the budget for a £3bn investment in general practice - said: 'This budget does nothing to address the gaping hole in NHS finances. There is a £30bn gap to fill and we should be increasing the UK’s health spending by at least £10.3bn to match that of other leading European economies.

'The NHS and social care are at breaking point and have been failed by party politics for too long. We need politicians from all sides to come together to agree a long-term solution to the challenges facing health and social care.

'We have a crisis in social care happening right now, so any funding to help provide the care patients so clearly need is a help. Failures within the social care system hugely affect an already stretched, overworked and underfunded NHS - most NHS trust finance directors have said that cuts in local authority social care budgets are adversely affecting NHS services. For doctors to look after patients well, social care needs to be well-funded and adequately staffed.

NHS crisis

'The crisis in the NHS doesn’t stop at the hospital door – our A&E’s are struggling because of an overstretched system. Having GPs in A&E won’t reduce admissions – if anything this could have the effect of attracting more patients to hospitals. The government also needs to explain how it will fund and recruit GPs to work on site at hospitals when there already aren’t enough to meet the needs of the public. Many are already working in practices with permanent vacancies which they are unable to fill, despite government promises at the last election to recruit 5,000 more doctors into general practice.

"The chancellor’s announcement of £325m of funding for some STPs is unlikely to go far enough, and we know that the plans need at least £9.5bn of total capital funding to be delivered successfully.

'Our health service is one of the best in the world, but is, increasingly, failing too many people for too much of the time. Put simply, today’s budget does not go far enough to address this.'

RCGP chair Professor Helen Stokes-Lampard said: 'We feel that the best place for GPs is working with patients in their communities to provide high quality general practice and the money just announced for new triage systems in A&E departments would achieve more if most was spent shoring up general practice so we can deliver more care and services, and in doing so alleviate pressures right across the NHS.

'GPs working in A&E units have been successful in some areas, but the decision to implement this must be based on local need. The government must realise that the most severe pressures in A&E are not simply down to inappropriate attendance but the inability to admit seriously unwell patients, and lack of capacity to discharge them into the community.

'The entire health and social care system is in crisis so the extra funding for social care is a good start, but it is only a short-term sticking plaster and we must make sure that the extra investment and additional GPs promised by NHS England in the GP Forward View do not fall by the wayside.

'The promise of extra funding for only a small number of local STPs reflects the mixed quality of these plans, and we remain concerned that promised improvements in GP services are not reflected in many of the current proposals. This money must be ploughed into GP and other community services and frontline patient care and not used to plug gaping financial holes in hospital trusts. We will be monitoring the situation closely and expect more detail in the Autumn statement.

'We repeat our calls on the government to review funding for the whole of health and social care – and to implement the pledges made in NHS England’s GP Forward View.'

Dr Vautrey also warned that the GPC was concerned about the impact of national insurance changes on practices. 'We are concerned about the possible implications of the national insurance changes on both GP partners and locums, and will be seeking further clarification from the government on how this will operate in practice.'

Photo: iStock

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