Re: An inconvenient truth: urgent care is not primary care
David Loxterkamp (BMJ 2015;350:h1657) argues that family medicine / general practice is a better setting for treating urgent problems than dedicated urgent care centres. This has relevance here in the UK. The Conservative Party, in their 2010 manifesto committed to trusting doctors more. As a result, the government subsequently took advice from their GP advisors (who shared Loxterkamp’s view) and closed down or downgraded many developing GP-led (Darzi) health centres. As it turns out, this made neither economic nor ethical sense.
Arain et al. (Emerg Med J 2015;32:295-300) showed that the Darzi health centre in Sheffield was responsible for a significant reduction in emergency department attendances in Sheffield in 2010. I was the clinical director of that service at the time and campaigned to increase the scope of our service because it was clear to me that we would have had a greater impact still if we acquired the technology and skills to deal with common low risk emergency department presentations. Unfortunately neither the NHS commissioners, nor our own provider organisation, was prepared to take this next step.
As a group of experienced GPs, coming from conventional practices to work in the new service, we believed that access to general practice was usually good. Anyone with an urgent problem would be slotted in – or so we thought. Our experience in Sheffield taught us that we had been deluded. Even with the best appointment systems, many patients found it difficult to get past the receptionist. It was generally “their fault” – for being unskillful in telephone negotiation mainly. This disadvantaged those who were homeless, those whose first language was not English and particularly those who were sick and could not face the whole telephone rigmarole.
Urgent Care Centres satisfy ethical principles well. Quickly available structured assessment reduces clinical risk. Comprehensive treatments that allow care to be completed at the first attendance provide direct benefit. Having a care option available to patients that is popular respects their autonomy rather than just the prejudices of doctors. And making care available to people who walk in at any time of day distributes resources more justly than putting barriers in the way that favour the better educated and more pushy.
In the UK, we have an Emergency Medicine and Acute Medicine crisis with more and more patients requiring assessment and treatment that is beyond the scope of conventional general practice. Much of this is not beyond the scope of well-planned and adequately resourced urgent care centres, who could do the work at lower cost and without denuding the already-stretched emergency medicine workforce. The convenient truth is that primary care is not urgent care, and we need more of the latter – of the highest quality.
Competing interests: No competing interests