GPs: Charge patients for A&E visits

Salisbury Journal: A third of GPs believe there should be a fee for some casualty department visits, according to a new survey A third of GPs believe there should be a fee for some casualty department visits, according to a new survey

A third of GPs believe patients should be charged for some A&E visits, while most think Government changes will do nothing to alleviate current pressures, according to a poll for the Press Association.

One in three (32%) family doctors said introducing patient fees for some visits would be the most cost-effective way of cutting unnecessary A&E attendances.

Charging patients £5 or £10 every time would stop many people visiting A&E at the "drop of a hat". Refunds could then be given if the trip was found to be necessary.

More than 800 GPs from across England answered the survey for Doctors.net.uk, carried out for the Press Association.

Four in 10 (39%) said placing a GP surgery - with extended opening hours - right next to every A&E department would help drive down the numbers seeking help and cut spiralling hospital admissions.

Meanwhile, 11% think more NHS walk-in centres would help ease the strain on A&E, while 8% think an improved 111 phone service - set up to replace NHS Direct - could provide the answer.

The overwhelming majority said changes announced by Health Secretary Jeremy Hunt in November regarding GP contracts would do little to help ease pressure on A&E, which is facing unprecedented demand from patients.

Mr Hunt said a 2004 contract for GPs, introduced under Labour, had enabled doctors to drop responsibility for out-of-hours care and put "huge pressure" on A&E departments.

He pledged to rectify this by offering all elderly patients and those with complex conditions access to a named GP, responsible for overseeing their care. GPs will also be given more responsibility for monitoring out-of-hours care and hospitals will have more access to GPs when considering whether to admit patients.

Today's poll found three-quarters of GPs (74%) disagreed that giving older people a named GP would cut the numbers ending up in A&E (43% strongly disagreed and a further 31% somewhat disagreed).

Just one in 10 doctors agreed this would help alleviate pressures on the system.

Almost two-thirds (63%) also disagreed that giving hospitals greater access to GPs when thinking about admissions would aid struggling departments. Some 18% neither agreed or disagreed, while 16% agreed.

More than half (53%) disagreed that giving GPs greater responsibility for monitoring out-of-hours care would improve out-of-hours care for patients.

A fifth neither agreed nor disagreed, while 21% agreed.

Doctors reacted to Mr Hunt's suggestion that allowing doctors to opt out of providing out-of-hours care was one of the reasons A&E departments are now seeing increasing numbers of patients.

Some 67% strongly disagreed and a further 14% somewhat disagreed (81% in total) that this was the case. Just over a fifth (22%) agreed.

Dr Tim Ringrose, chief executive of Doctors.net.uk, an online network of doctors, said: "The emergency care crisis has been one of the most hotly debated healthcare topics this year (2013).

"However, our research suggests that many GPs remain unconvinced that key changes to their contracts in 2014 will reduce the burden on emergency departments. So what is the answer and how can the NHS work in a more joined-up and cohesive way?

"Improving the relationship and interface between primary care doctors and their secondary care colleagues is critical.

"The 2014 contract seeks to address this, but does it go far enough? The response from GPs suggests that a more integrated approach is needed - one that enables them to physically work alongside emergency departments in providing out-of-hours care, rather than rely on telephone consultations.

"The research highlights another interesting point in that inappropriate use of emergency care has to be addressed from the patient's perspective too.

"With emergency departments increasingly being used for trivial complaints, it is not surprising that many GPs believe people who abuse the system should be hit in the pocket.

"It may be a clear departure from the traditional NHS vision, but many doctors are now saying that radical action has to be taken to reverse the 'free at the point of abuse' culture that is a key contributor to the current emergency care crisis in some areas."

A Department of Health spokesman said: "Charging patients who use A&E goes against the founding principles of the NHS and there are no plans to introduce fees.

"We know radical action is needed to tackle pressures on A&E. That's why we recently agreed a new GP contract, backed by doctors across the country, which will mean better care for older people out of hospital. These changes are part of a longer-term plan to bring back the personal link with patients so GPs can focus on giving people the care they need and preventing unnecessary trips to hospital.

"Longer term we're investing £3.8 billion in joining up health and social care services to make services available closer to patient's homes and working with NHS England to find a long term solution to out of hours care."

Shadow public health minister Luciana Berger said: " Forcing patients to pay at the door of A&E is not the way to end David Cameron's crisis.

"Under this Government, it's become harder to get a GP appointment after ministers took away the support for evening and weekend opening in 2010. They must help patients see their family doctor and stop the closure of NHS walk-in centres to reduce the pressure on A&E.

"A staggering number of GPs can see that Jeremy Hunt's plan to keep older patients away from A&E will have little effect. He and David Cameron must bring forward realistic plans to tackle the crisis they've caused."

Royal College of General Practitioners spokeswoman Dr Helen Stokes-Lampard, added: "The overwhelming majority of GPs still respect the founding principle of the NHS: that healthcare should be provided free at the point of need.

"Charging patients for the use of emergency departments would put us on the slippery slope towards the Americanisation of healthcare - where only those who can afford it get the care and attention they need.

"Doctors have a duty to provide healthcare to patients regardless of their ability to pay. Patients seek healthcare when they are at their most vulnerable and if they attend A&E, it is usually because they don't know where else to turn."

An NHS England spokesperson said: "Sir Bruce Keogh's urgent and emergency care review has highlighted that we need system-wide change so that those people with urgent but non-life threatening needs can receive highly responsive, effective and personalised services outside of hospital.

"As part of the review, we will ensure that that innovative models of delivering care (such as co-location of primary care centres with A&E Departments) are championed where this makes sense for the needs of local communities."

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