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Exclusive: National review of schemes to divert patients from A&E amid safety fears

From left, Trina, Tia and Dave Birtwistle
From left, Trina, Tia and Dave Birtwistle

A national review of schemes to divert patients away from Accident & Emergency departments is underway, amid fears that desperately-ill cases have been put at risk.

Every NHS trust is under instructions to introduce “front-door streaming” by this autumn, with GPs stationed at casualty units to weed out the least sick patients.

The initiative is part of attempts to relieve hospital overcrowding, and stave off pressures on units across the country.

An investigation by The Telegraph reveals that a national review of such schemes is underway following the death of a man turned away by a pilot scheme.

And researchers leading the investigation have said the evidence to back the initiatives - currently being introduced in every part of the country - is “weak,” while it is “unclear” whether the models being brought in are safe.

Dave Birtwistle at Liverpool Football Club
Dave Birtwistle at Liverpool Football Club

David Birtwistle, 44, a father-of-one, died from a pulmonary embolism after being turned away by a pilot scheme in Bristol, just six days after its launch.

Instead of being seen by A&E doctors, he was seen by the GP service - which failed to order basic tests which could have saved his life.

A coroner has now written to health officials, calling for a national review of “serious incidents” and “near misses” as a matter of urgency, in order to prevent tragic blunders being made across the country.

4 Hour waits in A&E
4 Hour waits in A&E

Mr Birtwistle went to Bristol Royal Infimary’s A&E suffering from breathlessness last November, after being referred there by the NHS 111 helpline.

He was discharged, only to return by ambulance six days later, when symptoms worsened. However, he was diverted to a new “streaming” system which had just been set up to relieve pressures on A&E, where staff failed to carry out basic tests such as blood pressure.

The local scheme, run by BrisDoc Healthcare Services, was immediately halted.

But every part of the country is under orders from NHS England to set up such measures by this autumn, in a bid to reduce pressures on hospitals and record waiting times.

From left, Trina, Tia and Dave Birtwistle
From left, Trina, Tia and Dave Birtwistle

The coroner’s report on Mr Birtwistle, issued to NHS England in order to prevent future deaths, urges health officials to check the safety of other schemes - and to set minimum safety standards, in order to reduce the risks.

All such initiatives should at least include taking a “basic set of physiological measurements” to detect immediate threats to health, the report warns.

The National Institute for Health Research has embarked on a £1m review of the safety of the measures - although it will not report until next summer, at least six months after every scheme gets underway.  

The research proposals, seen by this newspaper, warn that the current evidence base to support the schemes is “weak” and says it is “unclear” whether such measures are safe.

The documents, by Cardiff University, state: “The emergency care system is in crisis and evidence is needed urgently to understand how to manage workload and demand to safely achieve the highest standards of clinical and operational care, and whether the recommended addition of co-located GPs adds value.”

“The evidence base to support service models of General Practitioners working within EDs (emergency departments) is weak,” it continues, saying it is “unclear” what impact different models may have on service quality and safety.

The research will compare three models - having GPs working in A&E, next door to A&E, or operating a triage and screening scheme - with traditional methods of assessing patients in casualty units.

The study will examine all patient safety incident reports for the most frequent and harmful incidents related to GPs and A&E clinicians, the proposals state, with further research tracking 12 study sites, to report by next June.

An NHS England spokesman said:  "Guidance to hospitals on making sure patients get the level of clinical care they need has been specifically updated in the light of this, so as to make sure that people who need GP care can get it, and people needing specialist assessment can quickly do so.

"GPs successfully look after 300 million patient consultations every year, compared with 23 million A&E visits."