Support the new gatekeepers

In his editorial, Gillam explains the reasons for the erosion of the gatekeeping function of general practitioners (GPs).1 Consequently, a large proportion of these patients are seen in the emergency department by junior doctors (such as foundation year 2 doctors) who may have had as few as 8-10 days of acute medical experience before taking their current job. If the junior doctor in the accident and emergency department seeks a specialist opinion, this is often provided by an equally junior doctor in that specialty.

Appropriate support must be provided for these juniors (often in the emergency department) to fulfil the gatekeeping role performed by more clinically experienced and confident GPs. Such support could include trusts ensuring all referrals for inpatient admission are directly discussed by the referrer with a senior clinician (such as the medical or surgical registrar or consultant), and that junior doctors have ready access to senior clinicians to determine which patients require admission and how the remainder can be appropriately managed in the community.

The increasing role of junior doctors as hospital gatekeepers must be recognised and supported by trusts and directorates to help stem the current increasing tide of inpatient admissions.