Invest in primary care to tackle A&E pressure, BMA urges

The BMA has called for more investment in general practice and community services which it said could have an 'enormous impact on reducing pressure' on A&E, in its submission to Sir Bruce Keogh's major review into urgent care services.

BMA: NHS 111 not to be rolled out until ‘clear beyond doubt the service is safe and efficient’
BMA: NHS 111 not to be rolled out until ‘clear beyond doubt the service is safe and efficient’

Action is needed to address the recruitment and retention of doctors in emergency medicine as well as ‘targeted investment’ in primary and community care, the BMA’s submission to the survey on the Urgent and Emergency Care Review carried out by NHS England medical director Sir Bruce said.

The BMA also called for NHS 111 not to be rolled out in any more areas until it is ‘clear beyond doubt that the service is safe and efficient’.

Incentives should be given to specialists who create integrated primary and secondary care commissioning systems, the BMA said. It also called for a greater focus on self-care and prevention, including public health initiatives.

NHS England launched the survey about the future of urgent care services in June, which includes a ‘possible implementation option’ of having ‘decision support from a patient’s own GP practice and hospital specialist nurse/team, seven days a week’. Other possible options include ‘seven day continuity of care from a patient’s GP practice’ and ‘GP telephone consultations both in and out-of-hours’. The survey closed on 8 August.

Sir Bruce’s review, published in June, warned that GPs are under 'considerable strain' and that the workforce has insufficient capacity to meet 'current and expected needs'.

The BMA welcomed the overriding principles of Sir Bruce’s review but said it failed to address the problems associated with the NHS 111.

It called for minimum patient-to-clinician call ratios for NHS 111 and said the ‘flawed introduction’ of the service added to the pressure on out-of-hours services and emergency admissions.

‘Urgent action must be taken to increase the seniority, skills and expertise of those handling telephone triage services, with minimum patient-to-clinician call ratios introduced,’ it said. ‘The BMA believes that no further areas should go live with NHS 111 until it is clear beyond doubt that the service is safe and efficient.

‘Targeted investment, for in-hours GP services and community services, for example, could have an enormous impact in reducing pressure on other services,’ it said.

The BMA warned that cost-saving measures, such as the drive for the NHS to save £30bn by 2020, are only adding to the urgent care crisis.

‘Management of capacity and demand behind the emergency department can add to problems with patient through flow,’ it said. ‘This gridlock is contributed to by the ongoing "cost-improvement programmes", which impact directly on urgent care provision.’

The BMA said that patients are prevented from being treated in the most appropriate setting, because of the cap on payments to hospitals. Hospitals only receive 30% of the tariff rate for A&E admissions that go beyond the 2008/09 levels.

‘The BMA would recommend that early intervention and preventative strategies are prioritised, with payment mechanisms designed to support coordination of these services,’ it said.

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