NHS leaders call for extended GP access over Christmas to avoid winter meltdown

NHS leaders have demanded an urgent review of how the health service copes with winter pressure after a near 'meltdown' in recent weeks, which would consider how GP access 'can be extended over the holiday period'.

NHS Providers chief executive Chris Hopson warned on Friday that the health service had 'so far, just about managed this year’s winter pressures in the face of unprecedented demand without a crisis or meltdown'.

But he warned: 'It has been a close run thing and some trusts have failed to cope for short periods of time.'

Analysis of official NHS England data by GPonline reveals that more than 50 hospital trusts reported a high level alert about pressures facing them in each of the first three weeks of 2017. Many have frozen routine work, leaving practices facing repeat visits from patients waiting for treatment.

A total of 51 trusts reported alerts under the NHS operational procedures escalation framework in the week to 20 January, data published today show. Among these, 11 reported level four alerts - the highest possible warning.

NHS crisis

Declaring a level four alert indicates that a hospital is facing severe, rising pressure and that it is 'unable to deliver comprehensive care'. NHS England guidance warns of 'increased potential for patient care and safety to be compromised' where hospitals are at this level.

In the first week of 2017, 66 out of 152 hospital trusts in England declared an alert, with six at level four. In the second week, 68 trusts declared an alert, with a staggering 27 at level four.

The call for a review from NHS Providers says that the work should be led by NHS Improvement and NHS England. It says that the review should 'investigate how effectively the NHS prepared for this winter looking at how funding for winter pressures is distributed and how services are supported by social care and GPs'.

Among key areas for review set out by NHS Providers are: 

  • How effectively the NHS prepared for this winter.
  • Whether the NHS should revert to specific, dedicated, winter funding (many trusts believe that mainstreaming dedicated winter funding into the overall NHS budget has led to the loss of much needed extra winter capacity).
  • How effectively the cancellation of elective operations worked, the knock-on impacts, and where this approach should be extended or reduced next year.
  • How primary care access, particularly to general practice, can be extended over the holiday period.
  • What can be done to consistently ensure social care fully supports the NHS.

NHS winter pressure

GPC chair Dr Richard Vautrey said: 'There is no evidence that increasing the number of GP appointments at the weekend will reduce emergency admissions and it's a red herring to focus on this when the real need is for investment across social care and healthcare to increase capacity.

'By doing this we could then respond better to both the growing and the increasingly elderly population. It's self evident that with more people with more care needs we need more healthcare professionals to care for them and the NHS hasn't been given the resources to enable this to happen, particularly in general practice and community care.

'There is a GP service available every day and night of the year, including Christmas Day, but it's been starved of resources.  Investing properly in GP urgent care services rather than creating duplicate and fragmented systems is long overdue.'

House of Commons health select committee chair and former GP Dr Sarah Wollaston backed the call for a review.

'Given the pressure that all parts of the NHS have to face, I agree with NHS Providers that a review of how the urgent and emergency care system has dealt with winter pressure is necessary,' she said.

Dr Wollaston warned that the 'ongoing crisis in social care is undermining the ability of hospitals to respond to winter pressures'.

She also called for an assessment of how cancellation of routine work had affected patients and the health services. 'When we examined the measures being put in place to cope with winter pressures the health committee warned that cancelling elective operations meant delaying and denying patient care. Any review of measures designed to cope with winter pressures should analyse the impact of this measure and examine whether patients who had operations cancelled actually ended up seeking care in A&E departments.'

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