GPs face urgent care overhaul

Urgent care: DoH review will say that GPs should treat urgent cases more quickly.

Practices could be forced to increase capacity to tackle urgent cases immediately under plans drawn up by a DoH adviser.

The plans could see practices obliged to treat patients who believe their case is urgent without appointments and to employ a GP responsible solely for responding to urgent cases.

More than a third of practices currently do not have the staff or resources to respond adequately to priority patients, according to former GP Dr David Carson, who has been commissioned by the DoH to review urgent care.

Recent conference presentations by Dr Carson - who is expected to complete his report imminently - accuse practices of operating a system that creates 'an inverse care law, with those with the greatest needs being left until last'.

A case study reported in the presentation found that small practices were unable to prioritise home visits without disrupting normal surgeries.

But the GPC has rejected the claims and said that more responsive urgent care could be achieved if funding for walk-in centres and Darzi centres had been directed to existing practices instead.

GPC negotiator Dr Chaand Nagpaul said there was not enough funding to provide immediate care to all patients presenting with urgent needs.

'If the government insists on moving in this direction, it has to invest heavily in existing practices, many of whom want to provide this,' Dr Nagpaul said.

'It seems unfair to be focusing on general practice when I see patients being failed by emergency wards, walk-in centres and NHS Direct.'

Dr Carson's presentation said urgent cases should be 'defined by the patient, until an assessment is made.'

Receptionists should be trained to identify potentially urgent cases, which then must be dealt with immediately.

Delegates at his seminars have reported that Dr Carson wants home visits to be made within an hour to prevent unnecessary hospital admissions.

LMC leaders warned that, before any targets were set, the definition of urgent care needed to be clarified. Dr Brian Balmer, chief executive of Essex LMC, said: 'I notice the use of the word urgent, and not emergency.

'If someone comes in looking pale and sweaty and not very well at all I think most practices would do what they can to see them straight away. If someone says I've fallen over and hurt my leg, well that might be urgent, it might not.'

Dr Carson's Report

Dr Carson's criticisms of urgent care in general practice:

'Our experience so far suggests that most general practice has a limited focus on dealing with people with urgent needs.

'In general, there is an inverse care law, with those with the greatest needs being left until last.'

Practices must:

  • Deal with patients wherever they present.
  • Have capacity and plans to react if a patient needs to be seen.
  • Have a 'duty clinician' or arrangements for early assessment.
  • Have receptionists with adequate training to identify potentially urgent cases.
  • Have adequate receptionists for calls and face-to-face contacts.

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