Viewpoint: Dr Kailash Chand: Don't blame GPs for increased pressure on A&E

It is too simplistic, and arguably wrong, to blame GPs for increased pressure on A&Es, writes BMA deputy chairman Dr Kailash Chand.

Pic: Michele Jones
Pic: Michele Jones

This crisis is a microcosm of bigger problems the NHS is facing due to political mismanagement of healthcare.

In the final three weeks of December, soaring pressure on the health service saw around one in 10 patients at A&E forced to wait more than four hours. And at certain hospitals the situation is a lot worse. Pressures have become so great that a number of hospitals have had to declare major incidents, calling in extra staff, cancelling operations and - in extreme cases - diverting ambulances away from A&E units. It's not chaos in emergency departments, but it is a crisis.

Same increase in general practice workload as in A&E

I know from talking to colleagues that they were seeing the same increase in workload in general practice as in A&E services. We are in a situation where the NHS is like a balloon, where every part is under pressure. If you poke one part of the system, it bulges out somewhere else. Given the savaging of local government budgets in the past four years and hence the cuts to adult social care it's not surprising A/E's are under pressure and beds are blocked.

To tackle this, the government must develop long-term and short-term strategies to address the staff shortages across the NHS, and invest in systems and measures that direct patients to the service or setting that is right for them. The NHS reforms have categorically failed to address this issue, and indeed might have indirectly contributed to the rising tide of emergency admissions by reducing resources within the NHS.

Need for a holistic solution that is backed by an unambiguous integrated plan

The failure to implement policies that promote the integration of health and social care is lamentable, and an opportunity lost. If we are to tackle the increasing demands of an ageing population, we need a considered, holistic solution that is backed by an unambiguous, integrated plan produced in consultation with patients, the NHS and local authorities.

The key is to ensure that there is properly resourced community care, both to provide better and more care to ailing patients in their own residences and also to facilitate early discharge from burdened hospitals. Attributing this major failure of policy to the NHS staff ignores the basic reasons that explain why the system is so strained.

The NAO and the DH must be aware that a 24/7 consultant service will greatly improve the quality of care and safety of patients, but it will do little to enhance the community structures required to reduce the burden of demand. The figures for four-hour waits are a significant clue to the real problem A&E staff face. Almost 25% of emergency patients are admitted in the 10 minutes before breaching the target, indicating a failure in accessing acute beds as well as community support for patients to enable their discharge from A&Es.

We are in the middle of the third year of huge cuts in acute hospitals' budgets. The BMA would like at least to halt the fall in NHS bed numbers and has urged the DH to rethink its £30bn 'efficiency drive' in the NHS . We have all the symptoms of a system under pressure; these new figures are clear evidence of this. While these persist, it would be foolish to pursue a policy of constraining resources in the acute sector.

With the emerging powers of the CCGs there is a distinct possibility that local resolutions will emerge. However, with the increasing fragmentation of the NHS it is clear that these solutions will come piecemeal depending on the priorities of the CCG to tackle the issue, and the co-operation of foundation trusts in realigning their own resources to beef up the community.

So while the NAO offers practical advice on how to reduce emergency admissions, the implementation of this relies on the combined wills of leaders of the health and social care professions to put firm policies and procedures in place. There is, at present, no sign of this being done.

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