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A lack of access to GPs, including face-to-face appointments, has put pressure on A&E departments, the Health Secretary has told MPs.
Sajid Javid said he believed part of the reason people turn up to A&E when they do not need to be there is “because they’re not able to get through to their primary care services in the usual way”.
Mr Javid was being questioned by MPs on the Commons Health and Social Care Committee about claims from the Royal College of Emergency Medicine (RCEM) that virtual GP appointments have led to increased demand on emergency departments.
Mr Javid said: “During the pandemic, it’s understandable why virtual access … became a necessity, for many people there was sadly no alternative because of all the necessary rules.
“Where we are with that now is that as we move back to normal, those rules that kept people away are no longer there, plus there will be people that stayed away from their GPs, understandably, when they were asked to protect the NHS … as (people) come forward, it is important that ultimately there’s a choice in terms of how they’re seen.
“I think as we get more and more access to primary care, that will certainly help with demand in accident and emergency care.”
He said there were figures showing a “significant portion of people are turning up for emergency care when they could have actually gone to their GP”.
He added: “That is not the fault of those people at all. They have stayed away from the NHS when they were asked to, they now want to be seen and that is right … but part of the reason I think people are turning up in A&E perhaps when they don’t need it is because they’re not able to get through to their primary care services in the usual way.”
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Asked again if a lack of availability of GP appointments had led to increased pressure on A&E, he said: “I think that that general point is correct.”
He said 111 “has a big role to play here” and there was a plan to increase the capacity of the 111 service to make people see it as a “front door” to emergency care.
Earlier, Mr Javid said GPs had risen to the “challenge” of offering remote consultations.
“As we are now moving more to normal – we’re not quite there, the pandemic is still there … and more people are coming back to see their GP because perhaps they’ve held back before – that demand is increasing and GPs are getting record numbers of appointments,” he said.
“It’s important that those patients can be seen as quickly as possible, and where those patients have a desire to be seen face to face … think that choice should be respected as well.”
Mr Javid said he did not believe in putting a figure on how many GP appointments should be carried out face-to-face.
It comes after figures showed that around 60% of appointments are currently face-to-face compared to about 80% before the pandemic.
GPs have been put under pressure to increase the number of face-to-face appointments, with NHS England saying last month that “GP appointment data will be published at practice level by spring next year” to “enhance transparency and accountability”.
Mr Javid said he did not think there was a “right or wrong percentage” for the proportion of face-to-face appointments, adding: “In my mind, there’s no target.”
He continued: “For me, it’s never been about it should be 80% or 70%, it’s not about a number, it’s about doing the right thing, and ultimately it’s about choice for the patient.
“Where you have a patient that wants to be seen face-to-face, perhaps the initial consultation might have been remote but they feel that they should be face-to-face, I think it’s really important to try and meet that.”
Mr Javid said he did not know where the “idea of league tables has come from”, although he admitted the Government does intend to publish data on the proportion of face-to-face appointments by individual GP practice.
The RCEM has not supplied specific data showing that virtual GP appointments have pushed up A&E attendances.
However, in a report published in August, it said the GP patient survey 2021 showed that, in the first half of 2021, eight per cent of patients that could not or did not take a GP appointment attended an emergency department instead.
Meanwhile, 26% of those who tried to book a GP appointment but their practice was closed, subsequently attended an emergency department if they chose to contact another NHS service.
The RCEM said in its study: “Small deteriorations in the number of people accessing appropriate GP consultations have the potential to put great pressure on the urgent and emergency care system.”
It added that NHS 111 was also sending larger numbers of patients to A&E than ever before, adding: “For both virtual GP consultations and 111 services, the availability of these services may have led to supply-induced demand.”
During his session with MPs, Mr Javid also admitted the Government would not hit its target of recruiting 6,000 more GPs by 2024.
Asked if the Government was on track, Mr Javid said: “No, I don’t think we are….We’re not on track, I am looking at what more we can do, I want to see that increase but I’m not going to pretend we’re on track when clearly we are not”.
Mr Javid also warned NHS leaders that they must embrace technology, adding that some hospitals are still using fax machines.
Asked what keeps him up at night, Mr Javid said the pandemic.
He added: “I don’t think anyone is talking about an end, at this stage, to the pandemic.”
He urged people to remain on their guard and to get their vaccines.
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Professor Martin Marshall, chair of the Royal College of GPs, said the ratio of patients to GPs has increased by more than 10% and doctors are “burning out and working in conditions that are unsafe for their patients”.
He added: “Reasons for mounting pressures on A&E are many, but we’re unaware of any hard evidence that significantly links them to GP access.
“Far from intensifying pressures on emergency departments, GPs and our teams make the vast majority of NHS patient contacts and in doing so our service alleviates pressures elsewhere in the health service, including A&E.
“General practice needs to be sufficiently resourced and supported, so that it can continue to do so.
“It isn’t surprising to hear that the Government are not on track to keep their pledge of 6,000 more GPs by 2024 – this has been clear for some time – but it is disappointing.
“The college has consistently been raising the alarm about the intense workload and workforce pressures facing general practice – and the impact it is having on patients – while the Government focuses on ‘sticking plaster’ solutions to address them that do not address the fundamental challenges.”