Crisis? What crisis? The A&E Crisis

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.