All emergency departments must have GP led triage by October

Every hospital in England must have a “comprehensive” GP led triage system in emergency departments by October 2017 in a bid to avoid a repeat of the winter crisis that gripped the service this year, NHS leaders have said.

The requirement is one of several “concrete changes” demanded by NHS England’s chief executive, Simon Stevens, and the chief executive of NHS Improvement, Jim Mackey, in a letter sent after the chancellor Philip Hammond’s budget pledge to give the NHS an extra £100m (€115m; $120m) in 2017‑18 to spend on easing pressures in accident and emergency departments.1

Announcing the budget in a speech to the House of Commons on 8 March, the chancellor said, “Experience has shown that onsite GP triage in A&E departments can have a significant and positive impact on A&E waiting times.”

In a joint letter sent to all NHS and local government leaders on 9 March, Stevens and Mackey instructed trusts to ensure that “every hospital implements a comprehensive front door streaming model by October 2017, so that A&E departments are free to care for the most urgent patients.”

The letter said that the £100m of capital would be deployed in the next six months and that trusts would be made aware of proposed allocations within the next six weeks after agreement had been reached with the Department of Health.

In a session to MPs on the House of Commons Public Accounts Committee on 9 March Stevens said that the money was intended “as a way of kickstarting a turnaround in A&E performance so that the NHS goes into next winter in a better position than we faced this past winter.”

He added, “We want all hospitals [with A&E departments] to have comprehensive, front door streaming with GPs by next Christmas,” explaining that between 50 and 100 hospitals would need some of that £100m capital to put this in place.

Stevens and Mackey also urged local leaders to implement a series of additional measures to help stem the rising demand in emergency departments and reduce delays in discharging inpatients from hospital.

These include:

• Ensuring that care homes have direct access to clinical advice to reduce the risk of their residents being admitted to hospital

• Making evening and weekend GP appointments available to 50% of the public by March 2018 and 100% by March 2019

• Increasing the proportion of calls to the 111 telephone advice line that receive clinical assessment by a third by March 2018, so that only patients who genuinely need an ambulance or emergency care are advised to seek such care

• Implementing the recommendations of the ambulance response programme by October 2017, so that ambulance crews are “conveying patients to hospital only when this is clinically necessary,” and

• Replacing the “confusing array” of urgent care options such as walk-in centres, minor injury units, and urgent care centres with single centres offering a “consistent, high quality service.”

Stevens and Mackey also urged that a portion of the extra £1bn that the chancellor pledged for social care should be used, in partnership with local government, to help free up 2000-3000 acute care hospital beds this coming year.

As the letter was issued, England’s health secretary, Jeremy Hunt, demanded that hospitals return to seeing 95% of patients in emergency departments within four hours by the end of December, after sharply declining performance against the target this winter.2

Speaking at the think tank Reform’s health conference in London, Hunt admitted that progress would not happen “overnight” but said, “It is absolutely essential that we do get back to the 95% target. That is critical for patient safety.”

But Mark Porter, the BMA’s chair of council, said that the money committed in this week’s budget “didn’t come close to addressing the black hole in NHS finances.” He said, “It would be naive to think that the crisis in the NHS stops solely at the hospital door, when, in fact, our A&E departments are struggling because of an overstretched system. The NHS isn’t at breaking point because of frontline financial mismanagement, or individual chief executives’ poor decision making, but because of the conscious and constant underinvestment in our health service.”