GPs ring changes to take pressure off A&E

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FAMILY doctor Phil Earnshaw took a break from duties at his Yorkshire practice early this year to work a shift alongside colleagues at his local A&E.

Among the patients he saw were a number with relatively minor problems who visited the hard-pressed casualty unit at Wakefield’s Pinderfields Hospital because they were either unable to get an appointment at their GP surgery that day or did not believe they could.

The result has been that 19 out of 40 practices in the district have so far signed up to an agreement which means patients turning up at A&E but wanting to see their GP can be given a booking at their surgery on the same day.

They no longer have to queue to wait, it takes pressures off A&E staff and it saves the NHS cash.

The outcome, based on the experience of patient care on the front line, is the kind of change Ministers hope will drive the success of new GP commissioning groups which will take over responsibility for around two thirds of NHS spending next April.

Some 23 are being created in Yorkshire as part of moves to take the control of key decisions over local NHS services out of the hands of managers in soon-to-be abolished primary care trusts and hand them largely to GPs under the controversial NHS reforms.

But a survey by the Yorkshire Post has revealed significant difference in the proposed running of the groups, underlining fears their effectiveness could vary.

GPs are in the majority on most commissioning group boards. But in Rotherham the board includes four GPs and four lay members, while in neighbouring Doncaster there are 10 GPs elected by doctors drawn from five constituencies.

Most boards expect to have a NHS manager as their accountable officer legally responsible for the group’s activities. But a handful of doctors – notably several in North Yorkshire which faces some of the toughest financial challenges in the region – have taken on the role themselves.

Most groups are being chaired by GPs but a few are being headed by lay people.

In the Vale of York, which has a £400m budget, four GPs have taken operational roles and will work at least two days a week on commissioning group business. In contrast, all but one GP in Sheffield are being asked to give two days a month to board work.

Wakefield is among six from the region – the others are Rotherham, Bassetlaw, Calderdale, North East Lincolnshire and East Riding – aiming to be in the first wave of all 212 to be authorised nationally in assessments being carried out in coming months.

Dr Earnshaw, a GP in Ferrybridge and chairman of the Wakefield commissioning group, said GPs met patients every day and were ideally placed to find out where changes were needed.

“It’s the stories that we get which are illuminating and if you live in the area as I do it’s even more illuminating in terms of what is good, what needs to be better and what needs to change. There is a big danger we could turn ourselves into bureaucrats. What we have got to do is use our privilege of being a doctor to go where it’s happening and find out.”

In the Wakefield area, commissioning group work is being focused on reducing pressure on local hospitals which are facing the latest in a series of financial crises which will see the Mid Yorkshire NHS trust run up a deficit of more than £20m in the 12 months to next March. Dr Earnshaw said a key focus lay on treating people closer to home and getting people out of hospital more quickly if it was safe to do so.

He said one of the biggest problems facing the NHS in the area was that it had been extremely difficult to access specialist beds for usually elderly people who needed a bed for 24 hours while staff kept an eye on them.

They were now working on a new scheme for teams to intensively support patients at home for two or three days which allowed them to stay in their own beds and out of hospital.

He added: “There have been suggestions that GPs are new to this game but some of us have been at it for a long time.

“Before, we were supporting the managers but the philosophy of this is that they are supporting us.”