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For Primary Care| View from the ground

Tensions in General Practice and A&E Point to a System in Crisis

View From the Ground, by Dr Murray Ellender

The rise in accident and emergency (A&E) department waiting times has been a matter of contention for decades. In England, 95% of people who visit A&E are supposed to be admitted, transferred, or discharged within 4 hours,1 but these targets have not been met since 2015.2 Although there are many reasons for this, the COVID-19 pandemic has only increased the pressure on emergency departments; in December 2021, A&E waiting times reached the highest ever recorded, with longer than 13,000 people waiting more than 12 hours to be admitted.3

However, it is not just A&E departments that are feeling the strain. Since the start of the pandemic, nearly one-quarter of people who self-referred to emergency care did so because they did not want to overload their GP surgery during the COVID-19 crisis (source: internal data from a survey conducted by eConsult and Censuswide between 22 July and 2 August 2021 involving 1006 UK respondents aged 16 years or over who had attended A&E in the preceding 12 months). Furthermore, six in 10 people who visited A&E had been saving up more than one ailment for their visit (source: internal data from the eConsult and Censuswide survey). Why didn’t these patients visit their GP surgeries as the first point of contact? The answer is simple—general practice has been equally inundated with patients, while also being tasked with setting up vaccination clinics in response to Government guidance. Demand has vastly outstripped capacity in both primary care and A&E departments.

As a result, crucial diagnoses and early interventions have been missed, the care of patients with long-term conditions has been delayed, and doctors have been under overwhelming pressure. Our health system is in crisis and, as we enter 2022, these issues do not appear to be easing.

A Broken Patient Pathway

The only way out of this stalemate is to re-assess the patient journey—including the route from GP to A&E. A recent survey conducted by eConsult and Censuswide found that nearly half of adults in the UK who visited an emergency department in 2021 did not actually require urgent treatment (source: internal data from the eConsult and Censuswide survey). Upon seeing a medical professional, 24% of these individuals were told to contact another service; around half were advised to see their GP, and the remainder were directed to a pharmacist (source: internal data from the eConsult and Censuswide survey). These findings suggest a broken patient pathway, with insufficient and disconnected triage at the beginning of the treatment journey.

The current patient pathway begins when patients call their GP surgery for an appointment, to discover that they may have to wait up to 2 weeks—perhaps longer—to be seen. As a practising GP, I understand the pain, stress, and frustration this causes. Patients often have to call multiple times to get through to a receptionist, among a flood of other callers also trying to make an appointment. 

Benefits of a ‘Digital-first’ Approach

How can we ensure that patients are seen by the right person at the right time, and prevent them from visiting the emergency department when they may not need to be there? A ‘digital-first’ approach to healthcare may be the answer. Digital consultation platforms that allow patients to receive care in a matter of hours or days, depending on the urgency, are currently in use in the NHS. Out of necessity, these platforms gained increased traction during the pandemic; in future, they may become an integral part of effective pathways for safe, fast, and appropriate treatment, in turn helping services to withstand the ever-growing demand on the healthcare system.

Many GPs are opting for digital triage to manage patient numbers and offer safe treatment, and it is likely that an increasing number of emergency departments will look to also adopt it in the coming year. Digital triage at the point of entry to A&E will allow patients to be triaged automatically, accelerating the initial nurse triage. It will also help patients to understand where they need to go to receive the appropriate care, reduce waiting times, and ensure that patients who need urgent care are seen quickly.

Putting tried-and-tested digital triage processes—that integrate across systems and get patients to the right clinician at the right time—at the heart of every patient journey may help to create an NHS in which services are joined, information sharing becomes the norm, and the system works in harmony to the benefit of patients and healthcare professionals. These steps may future-proof the health service against further strain, and save a system that is in crisis.

Dr Murray Ellender

GP and Chief Executive Officer of eConsult