When is a GP not a When is a GP not a GP?GP?

When is a GP not a When is a GP not a GP?GP?

When he/she works in an When he/she works in an Emergency DepartmentEmergency Department

Dr Marion McNaught,Associate Specialist Emergency Medicine

EADT• Shift balance of unscheduled care• Emergency care at most

appropriate level:quickly and conveniently

• SPECIFICALLY –Reduce A&E attendances

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RCGP manifesto• More local community services• Better access to diagnostic service• Specialists in the community e.g.

geriatricians/paediatricians• More say in commissioning OOH

services-(despite mostly opting out of responsibility for 24 hour care)

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CEM • At most,25% of urgent attendances may be

cared for in primary care setting• Believe that improved access to GPs and out

of hours Primary care services is best way of dealing with problem

• Support co-location of primary care OOH• Do NOT support urgent care centres (triage of

ambulatory patients by non-ED staff deciding whether ED attendance required)

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GPs in ED• Spectrum of patients?• Work to ED protocols/guidelines?• Different clinical setting:on-site

diagnostics• Different patient population?• Who has clinical responsibility? GP?

Consultant? ED middle grade?• In litigation-who are you peers?

GPs in Emergency depts

• Reduce admissions?• Increase attendances?• Sustainable?-already difficult to

staff OOH service• Improve ED/GP interface?• Improve education?-different

experience• Effect on ED staff retention-relative

pay rates• How many GPs really want to do it?

GPs in ED• Some areas employing “salaried GPs” to

work in EDs-By definition if they are working full time in ED they are not a GP.

• Some GPs work in ED in middle grade role.See more than Primary Care patients.Tend to be those with an interest in emergency medicine-small numbers

Where do we go from here?