GP-led out of hours service could ease A&E burden: Tom Black

Dr Tom Black said Edwin Poots' diagnosis of A&E problems is correct
Dr Tom Black said Edwin Poots' diagnosis of A&E problems is correct

The Health Minister’s drive to ensure A&E services are fit for purpose is laudable, but the overcrowding problem will persist unless a viable out of hours alternative is available, a GPs’ representative has said.

Edwin Poots caused controversy earlier this week when he suggested a possible financial charge for those who turn up at often over-stretched emergency departments (EDs) drunk or abusive.

However, the chair of the BMA General Practitioners Committee in Northern Ireland, Dr Tom Black, said there is a widespread “demand” for medical services across the board which is much greater than the “genuine need”.

“I think the minister’s diagnosis is correct. There is a problem with patients with genuine need being seen in A&E because the system is clogged up with people with inappropriate demands, and also people who are drunk and disorderly, and we need to discriminate between those patients with genuine need and those with inappropriate demands.

“When they are all in a queue, and you are the doctor, it’s harder to get to the people with genuine need when you are trying to sort out people with demands.

“It is a generational thing. The older people really respect the service and know that it’s a community resource that has to be saved, and the younger people treat it like a pizza delivery service. That’s not acceptable, and we shouldn’t accept it as a community because it’s blocking off older people with genuine need,” Dr Black said.

The GPs’ spokesman dismissed suggestions that A&E overcrowding was, in part, linked to a lack of GP appointment slots, but said there was also a problem with inappropriate demands on GPs.

“Over the last 20 years the number of [GP} appointments being provided has doubled, so we are providing 6.5 appointments per patient per year when it used to be 3.5.

“There are a lot more older people with more illnesses, but it’s not double the need – it’s double the want and demand. If we could reduce it back to 3.5 or four per year then the people who really need the doctor would have no problem getting to them.”

Addressing a conference for GPs last November, Dr Black said the way forward was a “GP-led out of hours service” making a significant contribution to the Transforming Your Care programme.

“We need a local, flexible, adaptable and responsive service for out of hours which will integrate with local EDs and ambulance services ... facilitating keeping patients out of EDs and hospital admissions,” he added.