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BMA calls for meeting after health secretary blames GPs for pressure on emergency services

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2729 (Published 26 April 2013) Cite this as: BMJ 2013;346:f2729
  1. Zosia Kmietowicz
  1. 1BMJ

The BMA has written to secretary of state Jeremy Hunt asking for an urgent meeting to discuss the best way to manage increasing demands on emergency departments and rising emergency care admissions.

In a speech to Age UK on 25 April, Hunt blamed “disastrous” changes to general practitioners’ contracts made in 2004 under the Labour government for the “decline in the quality of out of hours care” and four million extra people a year using emergency services.

He said that it was time “to rethink the role of primary care” to prevent emergency admissions and to “make sure people with long term conditions are better looked after outside the hospital system.” Hunt said that there would be an announcement on “plans for local pioneer sites to lead the way on this” shortly.

“Too often people with long term conditions are left to their own devices, without the help, care, and guidance that local services should provide,” Hunt said. “Then something goes wrong and they end up straight back in hospital needing emergency care at great cost to themselves as well as to the system.”

However, earlier in the day, Hunt denied that there was a crisis in emergency departments during an interview on Radio 4’s Today programme, although he admitted that services were “very much under pressure.” He said: “We’re still seeing 90% of people within the four hour target, and the average wait is 53 minutes.”

The shadow health secretary, Andy Burnham, told Today: “Jeremy Hunt needs to ask himself why two million more people are coming to [emergency departments]. Might it be because they’ve closed NHS walk-in centres, might it be that they’ve broken up a successful NHS Direct service, or might it be that they’ve cut social care funding to the bone?”

Mark Porter, chair of BMA Council, accused Hunt of taking a “completely simplistic” view of what has caused increased pressure on emergency care.

“Singling out individual parts of the health service and engaging in a blame game is unhelpful and misses the point. Spending on healthcare is squeezed, patient demand is rising, and staffing levels are often inadequate,” he said.

“Ministers should be engaging positively with healthcare professionals to improve and maintain services for patients, rather than demoralising NHS staff who are working harder than ever with fewer resources, wherever they are in the service.”

Porter said that general practitioners were conducting more consultations, and hospitals were facing similar levels of high demand that were likely to rise as the population grows and people live longer. He said that the BMA had written to the secretary of state, asking for an urgent meeting to discuss the best way of meeting this challenge.

Laurence Buckman, chair of the BMA’s general practitioners committee, said out of hours care was historically underfunded. He added, “The bungled introduction of NHS 111, which was intended to alleviate pressure on the system, has just made matters worse.”

Clare Gerada, chair of the Royal College of General Practitioners, said: “Once again, general practitioners are being used as a scapegoat and it is not acceptable.”

She said that there was no evidence that the increase in demand on emergency services was a result of the changes to the general practitioners’ contract in 2004. A shortage of emergency care consultants and a lack of coordination between health, community, and social care was leading to unnecessary admissions and needed to be dealt with.

Gerada added: “We are one NHS with patients accessing different services at different times—be it their GP surgery, walk-in clinics, pharmacy, NHS 111, or minor injury units, as well as hospitals. Focusing on [emergency] departments misses the bigger picture and does great disservice to the people working across the NHS who are trying to do their best for all their patients.

“These are tough times for us all, and one of the issues Mr Hunt should be addressing is the shortage of 10 000+ GPs across all services, not just out of hours.”

Notes

Cite this as: BMJ 2013;346:f2729