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    Scotland sets out policy on improving workforce planning for primary care

    Wednesday, 09 May 2018 16:12
  • DHSC to address concerns of prescription direction to distance selling pharmacies

    DHSC to address concerns of prescription direction to distance selling pharmacies

    Thursday, 19 April 2018 16:51
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a-and-e-signJune 10 2015

Patients are aware of alternatives to A&E, but many still attend A&E because they are unable to access help elsewhere, a study has reported. In addition, substantial numbers of patients attend A&E because they are advised to do so by other healthcare providers.

Announcing the study published jointly by the Royal College of Emergency Care and the Patients’ Association, the organisations have renewed calls for other out-of-hours services to be co-located alongside A&E departments.

The study presents the outcome a survey of 924 patients between September 2014 and February 2015 who accessed A&E services for urgent healthcare needs and who were asked about the choices, decisions and experiences of patients.

Of the patients surveyed, all had previously attended an A&E department for an urgent healthcare need. The survey found that 69% of patients when surveyed had attended A&E without seeing any other healthcare provider on this occasion. “However, 31% had previously sought assistance for the same episode of illness or injury. In four out of five cases, this was at a location other than A&E.”

Excluding respondents who arrived at A&E by ambulance (17%), patients were asked if they had ‘self-presented’ to A&E or were referred. The study found that 51.8% of patients decided to go to A&E themselves, 39.2% attended on the advice of another part of the healthcare system, 7.2% attended on the advice of a friend, relative or colleague, and 1.8% did not remember.

When asked to select their preferred treatment location for urgent health needs, A&E departments were the first choice for almost half of the respondents (47%). GP surgeries were the second most selected choice (33%).

“Our findings demonstrate that the NHS not only needs to ensure that patients are fully informed of services such as out-of-hours GPs, walk-in centres and the NHS 111 service, but must also ensure that these services have sufficient capacity and are available when required,” say the RCEM and Patients’ Association in a joint statement.

They add that the findings also demonstrate the power of the A&E brand. “As patients continue to attend even whilst being aware of the alternatives, the Patients Association and the RCEM recommend co-location of other out-of-hours services with A&E departments to simplify patient decision making whilst ensuring that all patients are streamed to the most appropriate care provider in a safe and timely manner.”

Dr Cliff Mann, RCME President, said: “Co-location of primary care services has previously been supported by many national organisations and the Keogh Review of Urgent and Emergency Care, but RCEM’s work has shown that in 60% of systems no such co-location exists. Co-location now needs to be implemented.”

Responding to the study, Professor Maureen Baker, Chair of the RCGP, referred to the RCGP’s report into GP out of hours providers, launched earlier this year. This found that 59% of out of hours services are either led or run by GPs with the remainder also staffed largely by family doctors.

“What is concerning, is that 45% of people do not know how to access GP services out of hours, according to the latest GP Patient Survey. Instead of moving towards having these services located within A&E departments, more needs to be done to raise awareness of them, so that patients know where to turn when they fall ill in the evenings or at weekends.

“The College strongly supports integrated services and the need for new models of patient care, but decisions about which models are implemented and how need to be made in the best interests of the local population.

“In some cases, this might involve GPs working within A&E departments, but we believe that it is best for most health economies – and patients – that new models of care are GP-led and promote collaborative working across larger geographic areas.

“Our patients want to be treated in the community, closer to home, so we must ensure that our GP surgeries are properly staffed before we divert any of our resources to hospitals.”

Links:

Patients’ Association statement     

RCEM and link to report (download from News column)     

RCGP response     

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