----- Original Message -----
From: "Dunn Matthew"
Subject: Re: Primary care in A&E
> We probably need to change the way we work. Basically we can accept that a
lot of primary care will come to us and deal with it...
It's already happening, and showing no signs of improving!
> Trouble is that (for a partner on parity) by working entirely between
08:00
and 18:30, weekends and bank holidays off average pay is estimated at 80-
85k from NHS work with the new contract; and I know a lot of GPs who reckon
they should be able to make between 100 and 120k.
And how much were our "leaders" negotiating for us?
> If there isn't a GP to back them up, who takes the cases they can't deal
with? Also, how about referrals for admission. Has it been cleared with the
inpatient teams that they'll be taking referrals from nurses now, or are
they going to (particularly for the 'iffier' cases) want an A and E opinion
first? Might be great, might mean a lot of extra work for A and E. What
happens if it does turn out to mean extra work for A and E?
Surprise, surprise...
> If there are 3 A and E departments close enough that consultants can cover
all 3 adequately you might want to look at merging a couple of them.
Certainly locally I can't think of any way to do it without having some
consultants taking a hour or more to come in- also I can cope with a couple
of critically ill patients in my own department, but obviously couldn't if
they were in different departments. Works for some specialities (GU med,
public health, dermatology are obvious ones); but for A and E it would mean
going back to the idea of a consultant not being involved in the sickest
patients.
I agree.
> PCTs won't want to upset GPs. If anything, this makes it more likely that
they'll try to provide the service on the cheap. Cheapest way I can think of
is to have a nurse or paramedic practitioner who passes everything dodgy on
to A and E. Particularly if any cases that may need admission or may prove
difficult get sent straight to A and E from telephone triage. After a couple
of years, patients appreciate that they'll be told to go to A and E anyway,
so might as well turn up.
See above!
> This is obviously a worst case scenario. Important to stop it from
happening
though- work closely with your PCTs (which is also the best deal for
patients). There is a lot of money for providing GP out of hours (maybe £1-
1.5 million for the population covered by a typical A and E department). As
long as you make sure the money follows the workload it's more of an
opportunity than a threat. Decide what you want to happen and get proactive
in making it happen.
Certainly seems like an opportunity in my patch, Matt, to move towards a
24-hour middle grade presence. We've already established that a significant
proportion of our "breaches" occur after midnight, and it looks like much of
our recent increase in attendances occur out of hours too.
Adrian Fogarty
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