Investing in primary care services has the potential to reduce annual emergency department (ED) attendances by up to 250,000, according to the National Association of General Practitioners.
The NAGP highlighted international evidence which shows that the main reason for attending emergency departments is to access services which are not available through primary care. Only half of all ED attendees require specialist consultation. Resourcing general practice to provide such services would have a substantial effect on continuing ED overcrowding.
Dr Keith Swanick, Secretary of the NAGP said: “As those of us on the front line have repeatedly stated, the solution to the emergency department overcrowding issue lies outside the hospital system. Funnelling scarce finances into a bottle-necked hospital system has not and will not resolve the problem. The focus needs to shift away from the familiar fire-fighting approach we have seen over the last decade and must urgently allow patients to access the services they need through their GP in order to avoid attending the emergency department in the first place.”
A survey of 9,206 patients attending two Canadian emergency departments over a 6-month period in 2005 found that only 56% had attended the ED to see a specialist within a reasonable time. In comparison, 81% had attended to access services which were not provided through their regular primary care provider and 65% had attended in order to have diagnostic tests carried out in a reasonable time frame. Extrapolating on those figures would suggest that only half of the 1 million ED attendees documented by the HSE in 2013 were, in fact, seeking specialist care.
“Having people waiting on trollies and chairs in ED corridors is unacceptable. Patients deserve better than this from their health service. The public and the medical profession must unite and demand that the Government addresses the issue once and for all.
“There are low-cost, primary care-based solutions to this continuing catastrophe, solutions which are supported by international evidence. The Government must engage with GPs and other primary care providers so that initiatives can be identified which would prevent patients having to access emergency departments for services that could be provided far more cost-effectively elsewhere in the health care system.
The NAGP also responded to the advice being given to the public to attend their GP instead of their local emergency department.
“While we acknowledge that our emergency departments are overwhelmed at present, there are significant patient safety considerations in advising people to avoid EDs,” Dr Swanick said. “There has been much talk of inappropriate attendees in recent days. The fact is, no attendance is inappropriate. Patients and GPs are well aware of the state of our emergency departments and no-one would voluntarily put themselves or anyone else into a situation where they could be lying for days on a trolley in a corridor, if it were at all avoidable. Patients are attending A&Es because it is their only way of accessing the services they require for their situation.
“Furthermore, to divert patients from a besieged ED network to a crippled GP system shows a complete lack of awareness of the current state of general practice. There are simply not enough GPs out there to treat the numbers of patients already attending general practice. To suggest that an under-resourced and overwhelmed general practice system can pick up the overflow from the acute hospital sector is ridiculous.
“The entire healthcare system is crumbling around us,” Dr Swanick said. “What is needed is a complete re-think of how we structure and resource patient care. The NAGP supports the INMO’s call for an emergency meeting between all key stakeholders so that the issue can be addressed once and for all and GPs must be included in such discussions so that informed, results-driven solutions can be identified.”