GP access not ‘key factor’ behind pressure on A&E departments

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More seriously ill patients is the main reason why A&E departments have struggled to cope this winter, a leading think tank has said.

Severe illness and patients with more complex needs is the key reason for pressure on A&E departments, according to the King’s Fund analysis.

The findings come after a row erupted between doctors and the government in January when ministers suggested poor access to GPs was one of the key reasons for pressure on A&E, reports.

Downing Street warned GPs in England who refused to open surgeries from 8am to 8pm, seven days a week, that they would lose funding unless they offered more appointments to patients.

But the BMA accused the government of scapegoating doctors for the winter crisis, while organisations such as the Society for Acute Medicine insisted they were seeing sicker and more complex cases.

The King’s Fund analysis showed that 80% of 80 NHS finance directors surveyed identified higher numbers of patients with severe illnesses and complex health needs as the key reason for the pressures on A&E units.

Some 70% also cited delays in discharging medically fit patients from hospital.

Just 27% pointed to poor access to GPs while 20% said shortages of clinical staff were key factors. To prepare for winter, 70% of trusts increased their staff, while 80% of CCGs paid for extra resources in primary care, the King’s Fund said.

Other measures included postponing planned treatment, paying private companies to take on NHS work, and paying higher rates to recruit more agency staff.

The King’s Fund warned there was increasing risk that the Department of Health will be unable to stay within the budget voted by Parliament due to NHS deficits.

It said cancelling operations was also likely to lead to longer waiting lists.

Richard Murray, director of policy at the King’s Fund, said: “It is clear that the NHS pulled out all the stops and the pressures on hospitals would have been far worse without extensive planning, the heroic efforts of staff and relatively low levels of norovirus and flu. Despite this, performance has continued to deteriorate, with waiting times in A&E the worst they have been since the four-hour target was introduced.

“Our survey suggests the key factor behind this is that already overstretched hospitals are struggling to cope with rising numbers of patients who are difficult to treat, rather than an influx of people who are unable to get appointments with their GP. It is also further evidence of the additional pressure that the social care funding crisis is putting on hospitals.”

Almost two-thirds of trust finance directors and more than half of CCG finance leads surveyed said the quality of care in their area had got worse over the past year.

An NHS England spokesman said: “NHS frontline services have come under real pressure this winter but it is a tribute to the professionalism and dedication of GPs, nurses and other staff in A&E who continued to see, treat, admit or discharge the vast majority of patients within four hours.”

Professor Helen Stokes-Lampard, chairwoman of the RCGP said: “The fact is, as shown today, that our patients are living longer and as they do, more and more of them are inevitably presenting with multiple, long-term conditions, which is steadily increasing demand for health and social care services.

“We are pleased that this report shows, without any doubt, that the recent winter pressures that have been facing our colleagues in Emergency Departments have not been because GPs, or any other clinicians in the NHS, aren’t working hard enough, but that the resources and workforce to cope with escalating patient demand simply aren’t there.”

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