A&EJeremy Hunt has sunk to the lowest common denominator playing party politics by blaming General Practitioners and the last Labour government for the current NHS crisis in emergency care.  This clearly confirms that the Conservative party are prepared to blame anyone rather than take responsibility for their failings on their watch occurring during a massive top down reorganisation of the NHS.

Using the 2004 GP contract to explain the current crisis is not only unhelpful in addressing the problem, it is factually wrong.  Jeremy Hunt knows this, notice his solution is not to renegotiate the contract.

Working on the frontline in the NHS it is clear to see that Accident and Emergency departments are at breaking point.  This isn’t a new problem and has not arisen due to unexpected demands, it was wholly predictable.  Emergency attendances have risen over the last decade at a steady rate and there are many reasons behind this, none of which are directly related to the GP contract.

Firstly the population is aging, baby boomers have reached retirement and are requiring more from the health service.  The NHS has also become a victim of its own success, people are living longer and surviving illnesses better than they ever have before.  Older patients have more complex medical and social needs and the system is not designed for this.  Accident and Emergency departments are very good at dealing with acute conditions such as fixing broken ankles and treating chest infections.  Where the system falls down is when patients with multiple coexisting medical conditions are admitted because their care needs can no longer be met in the community.  These patients require care, compassion and a helping hand but are instead stuck in a system set designed to deal with problems that can be easily treated with medicines or plaster casts.

Whist resources are being inefficiently used to manage complex older patients there is increasing demand from the rest of the population.  Patients have high expectations and they want to be see a doctor quickly.  A&E is open twenty four hours a day, nearly everyone is seen within four hours and it is free.  This understandably makes it a service in high demand.  Expectations are rising, patients don’t want to wait and see if their earache gets better and instead turn up for a quick once over placing increasing demand on an overstretched service.  The solution to was the creation of minor injuries units and urgent care centres which rather than take the pressure off busy A&E departments have instead further created demand.  Out of hours GPs and the new 111 service have rightly received bad publicity all of which has made the problem in A&E worse not better.

Not surprisingly many doctors don’t want to work in A&E.  Busy shifts working antisocial hours until the age of 68 is not an attractive proposition.  This needs to be addressed more than blaming GPs.

All this has been brewing whilst NHS management has taken its eye off the ball by being reorganised due to the Health and Social Care Act.  Moving the chess pieces around has shifted focus away from the challenges the NHS faces.  GPs are now in charge as commissioners, the same GPs which Jeremy Hunt is trying to make liable for the A&E crisis.  This is the signal that the new system was set up with the intention of failure from the start.  The Conservatives can then hold the GPs responsible creating an argument for privatisation by the back door.

Our vision of the future of the NHS is to get back to basics.  Put patients first and design systems around them.  Rather than try and put patients off using A&E departments, we should be catering better to the needs of those turning up.  GPs, hospital and care providers need to work closer together to deliver integrated solutions.  One practical example is to have GPs working in A&E.  It isn’t rocket science, but it is about challenging the current way of thinking.

The Health Secretary should be leading this agenda from the top, empowering doctors, promoting innovation and defending the principles of the NHS.  Instead he is stirring up division within the medical profession and playing party politics with our NHS.

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11 Comments

  1. thehoarsewhisperer7440 says:

    The biggest problem with A&E attendance levels is not baby-boomers with multiple conditions but people attending inappropriately instead of going to their GP or local Walk-In Center. Examine the drop in attendances at A&E during Christmas Day and New Years Day when people are off work and on their ‘own time’ rather than their employers.

    1. mprior1984 says:

      You’re right it is a combination of changing demographic and inappropriate admissions of the drunks and drop in attendeest. But an ageing population presents new challenges and A&E is not a place where I would want my elderly relatives with multiple problems to be treated as it is not set up to treat them in they way they need.

      1. thehoarsewhisperer7440 says:

        People can be prosecuted for ‘wasting police time’. I would like to see a similar offense for wasting NHS resources. The NHS is a highly valued service that should be used appropriately, not by people regularly getting ‘tanked up’ on a ‘night out’ spree and then expecting ambulance and A&E services to patch-’em-up till the next wild night out.

    2. ToruOkada69 says:

      People would love to go to the Walk-In Center. Unfortunately, the government decided to close it. But they can still email their GP, as suggested by Jeremy Hunt.

      1. Martin Rathfelder says:

        Its very rare for GPs to permit patients to email them

  2. Dripdedo98 says:

    Do you have any idea what your talking about?

    You say “Accident and Emergency departments are very good at dealing with acute conditions such as fixing broken ankles and treating chest infections”. Have you ever actually worked in an A&E? I have. Most ankle fractures require surgery for ORIF or external fixator. The vast majority of chest infections should be treated by GPs & never even come near a hospital. Its only the tiny minority [high CURB-65] that need hospitalisation. People with chest infections usually end up in A&E because they are unregistered with a GP [refugees, itinerants, homeless, or undocumented residents] or, more commonly, because they cannot get an prompt appointment to see their GP.

    You say “the system falls down is when patients with multiple coexisting medical conditions are admitted because their care needs can no longer be met in the community” That’s actually the whole point of hospitals. The vast majority of ill health can be self-managed, a tiny fraction requires medical input, most of this is provided outside hospital. It’s the tiny fraction of people whose needs can’t be met in the community who need admission. Are you seriously advocating they aren’t admitted?

    The 2004 GP contract is the main reason for increased attendances. What gets measured gets done. Previously, GPs were paid to provide 24/7 care. The 2004 contract meant most GPs dropped OOH care. PCTs contracted with dodgy outfits-that people didn’t trust. So, OOH, people would rather go to A&E than call the outsourced OH service. During daytimes, GPs continued to get capitation fees, but they were incentivised to QOF tickboxes for extra payments. The 2004 GP contract is a typical example of contracting failing ordinary people. GPs could boost their income by hitting ridiculous targets. The DH spun that these targets were evidence-based but that’s ridiculous. This was great for sales of statins, but it meant that GPs fixed on hitting QOF targets instead of providing medical care. There was no money in providing the medical care that people actually needed. So GPs cut back on doing it-that’s why folks wait upto 10 days for a routine appointment. Its just like hospitals chasing targets & ignoring patients. This is the problem with commissioniing-what gets measured gets dome, whats not measured is neglected.

    Whenever people visit their GP, the GP gets pop up boxes (on their PC), prompting them to tick QOF boxes. Most normal people don’t specifically book a GP appointment just so they can fill in missing blanks in the practices QOF database. So there you have somebody, who has waited >5 days for a GP appointment & they end up speaking to a GP, staring at a PC, ignoring their presenting problem & asking them irrelevant questions relating to QoF. Not surprisingly, people get frustrated. They know the GP will try to fob them off without a prescription or referral. Those with sharp elbows get what they want. The underassertive get fobbed off. Even if they manage to get a referral, they’ll get diverted to a referral management service, paid to try their hardest to stop the patient ever seeing a surgeon. That’s why people got fed up with New Labour.

    EDs are under pressure because primary care ceased to provide proper medical care & because there have been huge reductions in hospital beds. If people are discharged, prematurely, from hospital, it shouldn’t be a surprise they return. During the New Labour years, Mckinsey decieded that there were too many hospital beds, based on costs. We got years of top-down “There needs to be more care in the community”. New labour & the coalition both closed thousands of beds & the result is chaos. Both advocate closing A&E departments when the existing set up cannot cope with the demand. Instead of learning from whats happening, they both continue to press for A&E, bed & hospital closures. Funnily enough, ex-new Labour & tory health ministrs have links to the companies that benefit from PFI, hospital closures & outsourcing.

    People are fed up with career politicians, trying to score cheap political points. Andy Burnham & Hunt are equally to blame for the crisis in acute care.

    1. Matthew Prior says:

      I currently work in A&E and have done for the last six years. You’re right many fractured ankles require definitive surgery, however as I’m sure you’re aware A&E stabilise fractures and deal with any other trauma. That isn’t to mention all of the sprains and not fractures A&E treat every day.

      Of course the point of hospitals is to deal with patients who can no longer be manage in the community. However the boundary between when needs hospital admission and what can be managed at home is blurred. Where this point is pertinent is with regards to social care. A condition in which a normally fit and well person could manage by self caring is in an elderly person enough to tip the balance between a care home and the hospital. A small input of targeted care resources in the community could prevent the cascade of a full blown hospital admission involving an ambulance, A&E visit and occupation of a medical bed before finally having a new care package sorted. This is a horrendous experience for an elderly person to have to experience when it could be managed so much better in the community.

      Your arguments surrounding the GP contract are false. Providing good medical care is not always about coming away with a prescription of referral as you suggest. Fobbing patients off with antibiotics for a viral illness or an inappropriate referral to a specialist is counterproductive.

      Care should be focussed on the needs of patients and not based on avoiding a politically toxic decision in relation to where it is provided. If better clinical outcomes are achieved by having your heart attack or stroke treated in a specialised centre then that is how services should be organised.

  3. Very interesting/useful information.The problems are easily seen.The absence of effective remedies is as plain to see.It seems to be a failure of policy and then a denial of the failure of policy,and then flogging a dead horse,or lots of dead horses.Mps,ministers,policy makers and advisers in the DoH who are too close to the seat of power and can further their careers by advancing the ideas of politicians who are rank amateurs and who can switch from running one huge department to another-Hunt,Burns,Lansley,these guys are never,ever going to admit their policies are failures.Ever,ever.It is absolutely insane for mps to become ministers moving from department to department with absolutely no experience.Department managers should be fire-walled from mps who should not be involved at all.It is obvious that any system run like this is going to result in mayhem.
    When the economy is good,such problems can be buried in money[even now the tories have found/borrowed £130 billion to finance the next housing bubble],but when the economy is poor,incompetency and incompetent policies can not be obscured,bought off or buried by money-‘cos there is none,deliberately or actually.So when times are hard,the incompetency of a government is plain to see,and we have seen so many failed policies of the present government crash and burn,and queues of them waiting to do so.Of course if Mckinsey and Company modelled to destruction and wrote policy,like they did with the H&SC Bill,government policy would probably acheive what the policy intends-no matter how unpopular,because there is no constitutional means for stopping government enacting what the hell it likes.The H&SC Bill is clear proof of how effective professionally developed policy can be-i.e. designed by professionals and factoring from experience and knowledge,with well-modelled and very informed in-built projections which have guaranteed delivery of the NHS into the private sector,a lot of who sponsor the conservative party[why such obvious corruption goes unoutraged in the media-oh,right the media is the poodle,or is that the mps are the poodles?].It can only be hoped that in some distant future when politicians are actually working for the interests of their constituents,when corruption by sponsorship and lobbying is regarded as morally offensive,rather than as a perk of being an mp,that policy will be designed for the benefit of the electorate by expert,informed,knowledgeable people working together to arrive at the best resolutions and effective policies.Politicians making policy is like giving infants razor blades to play with.Their ignorance,vanity and ambition make them a danger to public health

  4. Stacey Donnelly says:

    It’s not all about medics – ‘caregivers??!’ Nurses play an important role too as do AHPs – but the government chooses to freeze pay and down grade nurses. Give nurses the right tools, education and development and we can improve access to the community; stream patients more effectively in the ED and work collaboratively with other professions to develop patient centric care. I have been an ED nurse for 16 years and I have never known it this bad! The Trauma networks were set up with no forethought or financial support – I work in an MTC and there was no discussion around training or education for ED staff or how it would impact overstretched departments; there was a noteable absence of nurses at any trauma related meeting I attended and our nursing numbers haven’t increased! “More Consultants needed”! cried the BMA, and rightly so, but not a mere mention of the effect on the nursing workforce. I am a Clinical Educator and I have had to fight ‘tooth and nail’ for funding to develop our nurses; nurses are your constant, invest in them wisely and invite them to sit on your commissioning boards before their good will runs out!

    1. Matthew Prior says:

      Here here

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