Exclusive: Hospitals could need more than 200 GPs to staff NHS A&E plans

Hospitals could hire more than 200 GPs to work in A&E departments in the next 12 months under plans to put primary care doctors 'on the front door' at every emergency department in the country.

Analysis of figures obtained by GPonline has revealed that 18 hospital trusts plan to take on an extra 26.3 whole-time equivalent (WTE) GPs to work in their emergency departments in the next year. This could equate to more than 200 extra GPs being recruited to work in hospital emergency departments across England.

NHS England has ordered every hospital trust with an emergency department to set up a triage and streaming system by Christmas this year that will filter non-emergency cases to primary care clinicians, to help reduce waiting times and avert another winter capacity crisis.

The government announced £100m of infrastructure capital to help trusts set up the systems, the first half of which was awarded to 70 trusts in April.

GP recruitment

Freedom of information requests to all 70 trusts awarded a share of the funding revealed how they plan to spend the money and how many GPs they plan to recruit to run the services.

Of the 70 trusts, 39 have so far responded. Of those, 18 were able to provide details of their GP staffing plans for the next 12 months. Recruitment plans ranged from Lister Hospital emergency department, which plans to take on 4.07 WTE additional GPs, to a number of hospitals which do not plan to take on any, including those which already employ GPs, such as Kingston Hospital, and those such as Cumberland Infirmary, which plan a nurse-led  service.

The remaining 21 trusts, which responded but did not provide GP recruitment numbers, include many that are yet to finalise plans, and those where the service will be staffed by a third party such as a GP out-of-hours provider or federation.

The 18 hospitals that revealed their recruitment ambitions plan to take on a total of 26.3 WTE GPs in the next year, an average of 1.46 per trust. If those plans are replicated across all 139 emergency departments in England that have been ordered to implement primary care streaming, they would need a total of 203 WTE GPs to staff the new systems.

When chancellor Philip Hammond first announced the plans in the budget in March the government said that ongoing operating costs, including for staffing, would have to be found locally. Local NHS organisations could be required to reconfigure existing GP services, such as out-of-hours, to support the new triage systems.

GP workforce

NHS England chief executive Simon Stevens said the central capital funding would go to 'hospitals that need remedial work or a bit of extra capacity creation'. Mr Stevens cited the Luton and Dunstable hospital as a successful example. The GP-led service there is staffed by between 2 and 3 GPs every day of the year.

Plans by trusts for spending the capital reveal most intend to use it to pay for premises alterations or development. They include building new facilities including consultation rooms and reception areas. Some hospitals also plan to invest in new IT systems to support the services.

GP leaders said the £100m would be better spent in existing GP services. GPC deputy chair Dr Richard Vautrey told GPonline: ‘Rather than spending £100m on taking GPs out of the community and setting up a service that will simply attract even more patients to unnecessarily attend A&E the government should be investing in general practice where that much needed additional funding could be far better spent.’

Chair of the House of Commons health select committee and former GP Dr Sarah Wollaston has previously warned ministers the GP workforce would not stretch to cover plans for general practice services co-located with every A&E department.

Dr Wollaston told ministers: ‘Having a general practice workforce that can fund these co-located departments alongside out-of-hours departments, and alongside proving routine surgeries on Sundays - I'm afraid we simply don't have the workforce to be able to sustain that.’

Earlier this week GPonline reported that commissioners in Kent had raised concerns over unfilled GP shifts at one co-located GP A&E service.

Photo: iStock

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