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09.03.17

£100m A&E triage schemes boost ‘better spent shoring up general practice’

The government will provide £100m of capital investment, available immediately, to support up to 100 triage projects at English A&Es in time for next winter, Philip Hammond has revealed in the Spring Budget.

Speaking at the House of Commons yesterday, the chancellor listed delayed discharges and “inappropriate A&E attendances by people of all ages” as two of the biggest pressures on English hospitals.

“Experience has shown that onsite GP triage in A&E departments can have a significant and positive impact on A&E waiting times,” he added. “I am therefore making a further £100m of capital available immediately for up to 100 new triage projects at English hospitals in time for next winter.”

The money, available in 2017-18, will enable trusts to “invest in measures to help manage demand on A&E services and ensure that patients are able to access the most appropriate care as quickly as possible”, the Budget document explained.

“For example, the funding will allow for better assessment of patients when they arrive at A&E and increase the provision of on-site GP facilities,” it added.

The move, broadly welcomed by health organisations, came just a day after a poll conducted by the Royal College of Emergency Medicine (RCEM) found that only a third of MPs believe emergency departments are sufficiently resourced to ensure patient safety. The survey, which received 92 responses from cross-party politicians in the UK, also found that 60% supported a transformation fund to help with the retention and recruitment of A&E staff.

Nigel Edwards, chief executive of the Nuffield Trust, said that putting family doctors into A&E departments to help treat less sick patients “is a good idea”, and the new capital funding will “help hospitals which don’t currently have enough space to do it”.

“But the big question is whether we actually have enough GPs to make this policy a reality,” he added.

In its detailed briefing document compiled after the Budget, the NHS Confederation also pointed out that although the £100m fund was designed to target increased GP provision, there was no mention of future revenue to maintain the funding of these services.

And as Dr Graham Jackson, co-chair of NHS Clinical Commissioners, argued, the money is welcome – but does not mean the challenges are over.

“Year on year the money available to the NHS has simply not kept pace with the increasing demand for services,” he added.

‘Best place for GPs is working in communities’

Prof Helen Stokes-Lampard, chair of the Royal College of GPs, also argued that her organisation feels the best place for GPs is working with patients in communities, and that the new money announced for new triage systems in emergency departments “would achieve more if most was spent shoring up general practice so we can deliver more care and services”.

“GPs working in A&E units have been successful in some areas, but the decision to implement this must be based on local need. The government must realise that the most severe pressures in A&E are not simply down to inappropriate attendance but the inability to admit seriously unwell patients, and lack of capacity to discharge them into the community,” she said.

In his Budget, the chancellor also announced an extra £325m fund for a handful of STPs that are ready to be implemented ahead of the Autumn Statement. But Prof Stokes-Lampard said the extra funding for only a small number of plans reflected their mixed quality, and reiterated concerns that “promised improvements in GP services are not reflected in many of the current proposals”.

The new money should be ploughed into GPs and other community services and frontline patient care, and not used to “plug gaping financial holes in hospital trusts”, she argued.

A cautious welcome

Similarly, the RCEM “cautiously welcomed” the extra A&E money for new schemes, “provided it is used appropriately”.

Its vice president, Dr Chris Moulton, explained: “For some time, RCEM has called for co-location of urgent care services around major A&E departments and having primary care on site will undoubtedly benefit patients.

“The college would like to see this as the first step to co-locating more services, including frailty teams and out-of-hours mental health teams, around the A&E department. By creating a hub of services, patients can be swiftly directed to the treatment or service most appropriate for their needs, without the need to travel elsewhere or book another appointment.”

The new money will hopefully help ease winter pressures, Dr Moulton added, but argued the devil will be in the details.

“With enormous system pressures all year round, more will be needed to halt the long-term decline in performance that our departments are experiencing and keep our patients safe,” he concluded.

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