Not the old GP vs ED thread /again/! Come on guys, we can move on from that.
There is lots of acute stuff seen in Primary Care, but the definition of
acute is a little different from ours. For example, I would not call a chest
infection in a young otherwise fit person acute if the person isn't terribly
unwell. COPD and a PCO2 of 8 is a different matter. Ditto backache that came
on after lifting on Saturday. But these all would count as acute in primary
care as opposed to a pill represcription. In fact, one of the most
interesting aspects of having GPs reviewing our workload as they pick their
patients from it is their reluctance to get involved with what I would call
acutely unwell. Their view is either that if they saw the patient in the
community they would admit the patient in any case, so why get involved, or
the treatment is outside their comfort zone.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
Sent: 26 May 2007 01:36
To: [log in to unmask]
Subject: Re: EM- juniors future
To be fair Jel, Matt actually said "most general practice is not acute".
Your own figures (well, from "Julian") admits that of 1,000,000 GP
attendances, 1-200,000 are acute. So, simple mathematics should tell you
that over 80% of general practice is not acute. Hence, that would seem to
concur with Matt's viewpoint.
And as for "Fay's" view, well clearly she must work in a parallel GP
universe to the one I'm used to seeing in central London. She suggests that
her GP practice is full of acute work on a Monday morning, but that doesn't
seem to fit with the patients pouring into my department on a Monday who
tell me they can't access their GP for days. She also mentions an OOH co-op
on a Saturday evening as an example of "the acute side [being] well covered
elsewhere in the NHS". Fine, but how does 90% of GPs giving up OOH work
following the new contract constitute "the acute side being well covered"?
And as Helen rightly points out, how do eight consultations with a GP OOH
service which fail to identify serious sepsis constitute "the acute side
being well covered"? We're currently working with a co-located GP OOH pilot
at the moment, and I'm shocked, truly shocked, by what the GPs sometimes
send back to us, claiming they can't deal with.
Who knows, maybe Gordon Brown will see sense in all of this madness.
AF
----- Original Message -----
From: "Jel Coward" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, May 25, 2007 10:44 PM
Subject: Re: EM- juniors future
> Dunn Matthew (South Warwickshire General Hospitals NHS Trust) wrote:
>> Most general practice is not acute. General Practice is changing as a
>> speciality, but it seems that what GPs do best and what has the most
>> impact on the health of the population are primary prevention, secondary
>> prevention and chronic disease management (in that order). The acute side
>> of a GPs work is usually a fairly minor part of the workload and is well
>> covered elsewhere in the NHS.
>>
>
> So I had to ask about this on another jiscmail list - 2 replies below
> ;-)
>
>
> Reply 1:
> What is printed below is bollocks.
>
> We do about 50 - 80% of the acute care AFAIK, the vast majority of CDM
> (which includes secondary prevention), and are fit in a little primary
> prevention though that is basically the job of HVs, councils and national
> government (health not sickness management).
>
> The hospital point of view is simply so much narrower that it does
> not,
> and cannot, describe the reality. The concern is that they do have
> significant influence.
>
> Locally the stats are roughly:
>
> A&E 70,000 attendances - about 50% minors, some of which could be
> dealt
> with elsewhere.
> GP 1,000,000 attendances with GPs, some additional with practice nurses
> and others.
> Of the 1m GP attendances 1-200,000 are for acute conditions - hence,
> roughly, GPs do 50-80% of acute care.
> On top of that our OOH service has 35-50,000 contacts per annum, many at
> the far more serious end compared to WiCs, and especially to NHSD.
>
> Strangely GPs know quite a lot about what goes on in hospitals.
>
> Very asymmetric.
>
> Julian
> NB Pls feel free to copy to acad-ae-med, attributed.
>
>
> Reply 2:
>
>
> "The acute side of a GPs work is usually a fairly minor part of the
> workload and is well covered elsewhere in the NHS. "
>
> Two incorrect statements there. He clearly has not seen what goes on
> in a
> GP practice on a Monday morning or an OOH co-op on a Saturday.
> At least when I pontificate about A&E I can do so from the standpoint of
> having worked there both 2 decades ago and recently.
>
> Fay
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