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GPs: 'Gatekeepers' of care

GPs: 'Gatekeepers' of care


The NHS should take inspiration from other healthcare models and allow GPs to act as the gatekeepers for emergency care claims a leading health regulator.

The ‘Exploring International Acute Healthcare Models’ report, issued by Monitor highlights how in countries where patients were encouraged to see GPs before seeking out-of-hours urgent care, then the numbers of patients in A&E would drop dramatically.

In the Netherlands, where GPs are often the gatekeepers for emergency care, A&E attendances are about 120 a year per 1,000 people, compared with 278 in England.

In the Netherlands  GP posts provide out-of-hours primary care. Many are located at or near many hospital A&E sites and 39% of patients attending A&E are referred by GPs. In England this figure is 5%.

The British Medical Association commented on the report. Its Committee Chair, Dr Chaand Nagpaul, said:

“It is vital that patients are directed to the right services to meet their health needs and that we look at new ways of helping to manage the demand being placed on all parts of the NHS. It is encouraging that Monitor has acknowledged the pivotal role of GPs in providing out of hours care.

“However, if we are to direct more patients to GP services we do need to address the fundamental issues that have left general practice under incredible pressure with its current rising workload, such as falling funding, increasing patient demand, and more care being transferred into the community.

“Most importantly, there is an acute shortage of GPs that has been exposed this year by the 450 vacancies across England for GP trainee positions.  Comparisons with other countries, while useful, cannot be taken as like for like, especially when as Monitor indicates the UK spends less on its health care than other developed economies, a fact that applies particularly to out of hours services.


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