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Not dyspeptic at all, Vic. In fact you have supported my argument most cogently. GPs have a vital role to play in admission avoidance and as you say seniority helps immensely. GPs can't contact specialties for all sorts of reasons. Sadly, while it may be better that a patient goes directly from bed to bed I'm afraid that is the exception rather than the rule. It is ridiculous to set up parallel access systems as well as expensive in terms of staff and resources. Published data shows that patients get investigated more quickly and treated earlier if they come to EDs. There is no evidence that in house teams are any better at determining whether a patient goes home or comes into hospital, and maybe that is because of seniority issues. The urgent care centres are proving, where they work well, to support this system very successfully. I'm pleased to say that our own joint venture was described as a potential future model in the long awaited Primary Care Foundation report (page 37) http://www.collemergencymed.ac.uk/CEM/About%20the%20College/Current%20Issues %20and%20Statements/Primary%20Care%20and%20Emergency%20Departments . Power to your elbow in this work, but don't bother referring to specialties. BW R _____ From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Victor Calland Sent: 11 March 2010 08:40 To: [log in to unmask] Subject: Re: GP referrals to specialities I think Specialists are archaic ;-) Come on Rowley, I hope you took some Rennies and got over your dyspepsia! Working at the Urgent Care Centre in Ambulance Control at the moment I am coming across situations where the GP is either not referring to a specialty because they can't get to talk to the admitting doctor because they are in a phone queue or the bleep is unanswered, or they ask the family or nursing home to call the ambulance - so it goes to A&E. It is clearly better if a frail patient is transferred from bed to bed and does not have four hours on a trolley. It takes the pressure of the Emergency team. Unfortunately the whole system is running at capacity and so everybody is looking at ways of dumping the burden of unscheduled care simply because it hasn't been scheduled. Part of what we do is to deflect 999 calls to the GP, part of it is to upgrade where necessary - often admissions direct from a GP's surgery which have been automatically downgraded because there is a defibrillator on site. Initially I was profoundly sceptical of the project, but even at this early stage I am becoming convinced of the need for someone with experience and authority to direct where people go. Its amazing how professional staff are more prepared to accept their responsibilities when they know the call is recorded! Vic Calland On 10 March 2010 22:16, Rowley Cottingham <[log in to unmask]> wrote: I think GP referrals to specialties are archaic and should be banned. BW R -----Original Message----- From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Redman Paul (Frimley Park Hospital NHS Foundation Trust) Sent: 10 March 2010 22:07 To: [log in to unmask] Subject: GP referrals to specialities I seem to be seeing a spate of referrals from GPs to the speciality teams that are being batted sideways with a request from the specialities that the GP send the patient to the ED and the speciality SHO can be called by the ED staff if we are concerned. I eventually lost my rag with the ortho sho today over this - it wouldn't have arisen if the letter from the GP hadn't incriminated the sho in question. Is it our hospital or is it becoming more common? How have others dealt with it? Are you ignoring it? It seems all specialities are involved but obviously some personalities are more apparant than others. Paul Redman **************************************************************************** **************************************** This message may contain confidential information. If you are not the intended recipient please inform the sender that you have received the message in error before deleting it. Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents: to do so is strictly prohibited and may be unlawful. Thank you for your co-operation. 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