----- Original Message -----
Sent: Saturday, March 04, 2006 12:18
PM
Subject: Primary care front door
Dear
Colleagues,
I
would value your assistance with an issue that has arisen locally, but which
may have implications across the UK.
In
common with everywhere else, our local health community is under
substantial financial pressure, and this will only worsen with the additional
savings and imperative to achieve financial balance that are being imposed
during 06/07.
In
an effort to reduce costs, our local PCTs have decided that patients are
increasingly bypassing primary care and attending the ED because this is an
easy option. From the ED they are being unnecessarily admitted
to hospital because this is also an easy option, and
makes more money for the acute trust under the payment by
results system. I am informed that 50% of the patients in my emergency
department could be dealt with in primary care (does anybody have any evidence
to support this?).
In
response, the four PCTs in our region have decided that they will institute a
"primary care front door" to all local emergency departments. Nobody will be
allowed to attend an ED unless they have first been seen and "triaged"
by a primary care practitioner. I have pointed out the costs, problems
and potentially negative publicity that may result from this,
and have even undertaken research to show that only 25% of acutely ill
patients admitted to hospital come to the ED directly, with the vast
majority contacting primary care first, from where they are often
directed to the ED (some of you have kindly helped me with this, and I will be
presenting the results at the BAEM conference later this month).
Nevertheless, the PCT tell me that this revolutionary idea is
currently sweeping the country and is being successfully instituted all
over the place.
My
main question is, does anybody have a primary care front door to their ED? If
so, does it work? Has it been suggested and dropped: if so, why? I recall
corresponding with Ruth on this subject a few months ago, and thought the
whole thing had been laid to rest, but round here it just refuses to lie
down.
Best
regards,
Jonathan.
PS:
It will come as no surprise to many that the PCT's thinking around this issue
is very woolly: Obviously the cost of placing a GP in the ED 24/7
is phenomenal, and when I pointed this out it was suggested that
perhaps a nurse could do it with GP back-up, or maybe a GP could spend a few
hours in the ED during weekday afternoons. Interestingly, the PCT actually
paid to put a GP in our ED about four years ago to screen and reduce
acute medical admissions (the GAMA project: GPs avoiding
medical admissions). This showed that GPs had a marginal effect (<5%
reduction) at best, and really only worked well when they encountered
their own patients in the ED. Sadly, the local PCTs have a very short
memory, and are desperate for some sort of "magic bullet" that
will save immense amounts of cash in a very short space of
time.
