Millions 'Should Not Be In A&E' - Exclusive

By Thomas Moore, Health Correspondent

Up to 6.5 million patients every year should avoid going to A&E and be treated by GPs, paramedics and even chemists instead, the doctor leading the review of NHS emergency services claims today.

Around one third of all people who visit A&E each year could be diverted away from hospital under plans to be unveiled shortly by NHS chiefs.

In an exclusive interview with Sky News, the doctor in charge of re-shaping emergency services in England said family doctors, ambulance staff and pharmacists could treat them instead to relieve the pressure on A&E.

Indicating for the first time how he hopes to radically reform A&E, Professor Keith Willett, the national director for Acute Episodes of Care, said: "We know that 15% to 30% of people who turn up to be treated at A&E could have been treated in general practice.

"They did not know that because the system did not obviously make itself available to them."

He said patients with routine medical problems are going to A&E because they cannot get a quick enough appointment with their GP. Others are frustrated by out-of-hours services.

Prof Willett says a long-term solution is needed

"We can look at the way primary care is available to people," he said.

"By changing the way we deliver services we can start to address the demand. We can do the same thing in terms of the ambulance services and how much, how many patients they treat, at the scene, rather than transfer and that's about them having the right information.

"We would look to the public to understand the issues and when the situation does get difficult, to take the advice that I've suggested about phoning first, to get the right advice, to go to the right place, to think of using your general practitioner or indeed your pharmacist, (who) give a lot of advice for minor ailments."

Professor Willett and the medical director for NHS England, Professor Sir Bruce Keogh, will publish their plan for reforming emergency services later this autumn. It is expected to be implemented two years from now.

The plan will acknowledge that demand for care will continue to rise with an ageing population. But it will set out a series of measures for reducing pressure on A&E departments.

They are expected to include:

:: A&E units will have to ensure a consultant is available seven days a week

:: Other senior doctors, such as elderly care specialists, will be expected to help assess and treat patients arriving at A&E

:: Paramedics will treat more patients at home or by the roadside so they don't need hospital care

:: Patients will be encouraged to 'ring first', using the NHS111 helpline to be directed towards appropriate care.

Health Secretary Jeremy Hunt wants GPs to be more proactive

Health Secretary Jeremy Hunt has also said GPs must take on a bigger role. Next week he will call on GPs to do more to prevent patients with chronic conditions, such as diabetes, from suffering emergency complications.

In an interview for State Of Emergency, Sky News' 24 hours of live coverage from Nottingham's Queen Medical Centre which begins today at 5pm, Mr Hunt said: "The role of GPs in caring for older people needs to be proactive - checking up on people, finding out how they are, heading off problems before they happen - rather than reactive.

"GPs are busy, so to make that happen we have to find ways of getting more capacity in the system and that is a big challenge.

"But we have to address that. In the end, if the NHS is to be sustainable, it has to be about prevention as much as cure."

But GPs say they are already doing what they can.

Professor Mike Pringle, president of the Royal College of General Practitioners, said: "They are overwhelmed by the workload they are expected to deliver.

"We have got to start to build general practice, not blame it, not victimise it.

"We have to invest in it if we are going to solve these problems. And I am sure the Secretary of State recognises that."

England's A&E departments were under severe pressure last winter.

Waiting times reached their worst in nine years between January and March 2013, with more than 300,000 patients waiting more than four hours for treatment.

The Government has given the NHS an extra £500m over two years to find short-term solutions to the likely rise in demand for emergency care in the winter months.

Hospitals could bring GPs into A&E departments to see patients with more minor problems and more locum A&E doctors are likely to be employed to fill vacancies.

Only half the training posts for emergency medicine have been filled in the last two years, and more than a third of hospital trusts have vacancies for A&E consultants.

Professor Willett said a long-term solution is required.

"We do have to address the emergency medicine workforce," he said.

"But that will not produce new consultants for several years. So we have to manage the situation and take away from emergency medicine teams those patients who could be managed by other parts of the system.

"Defaulting to seeing an emergency medicine consultant is not necessary for many of those patients and it is frustrating to wait."

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