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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 (
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
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