A day in the life of...
a GP working in A&E

Scarborough Health Community piloted a GP integration into A&E scheme for three months which involved combining A&E and the GP out of hours service to see whether a GP working in A&E (particularly in a large hospital) would be effective.

The scheme called for new and extended roles of GPs who would be called to work in the A&E department during twilight hours and weekend periods.

This new role enabled the GPs to review patients, particularly those with slightly more complex problems, and instigate appropriate investigation, facilitate rapid patient management plans, admit / discharge patients and support junior doctors.

Calling Time interviewed Dr Phil Jones to ask about the experience and its impact on moving towards the directive.

What is your average day to day role as a ‘normal’ GP?

I currently work at two practices as a long term locum averaging four sessions a week. At one of the surgeries I see patients every ten minutes for three hours twenty minutes with a twenty minute coffee break before completing my session with review of the results and letters for the patients which I have seen recently in the practice.

At the other surgery I have a more flexible working pattern, again seeing patients for ten minutes. I average about fifteen a session but also do home visits or see extras according to the workload within the surgery.

What is your average day to day role now as a GP working in A&E?

I work with two consultants within the department on a 1:3 on-call rota as well as doing an average of five sessions per week on the shopfloor in A&E. While I do similar work to my consultant colleagues in supervising the junior and middle grade doctors on the shopfloor, I am often called to see patients who colleagues are unsure whether would be best admitted or returned to primary care / their GP for further investigation and treatment.

Did you welcome the changes to your role?

I actually, having spent ten years in London working as a GP, moved to Scarborough with the intention of continuing GP work, however at the time of my arrival there was not much work. I decided to work as a locum within the hospital initially starting as an SHO in care of the elderly, which was quite a shock to the system after such a long time as my own boss within general practice. However, I found the experience extremely beneficial and went on to do a number of jobs within the hospital before deciding to take on the role of associate specialist within the A&E department.

There is little understanding amongst many junior hospital doctors and some of their senior colleagues about the role of primary care and particularly the recent changes which the Government has made to encourage the workload being transferred from secondary to primary care. The advantage of having someone with primary care experience in A&E is that the interface between services is brought closer.

Did you ever envisage that as a GP you might work in A&E?

Certainly while working in London I would never have thought I would end up as an A&E doctor. However my time spent working around Scarborough hospital has certainly taught me there is a place for general practitioners within the secondary care system to improve the understanding and communication between primary and secondary care. It was in fact the consultants within the A&E department who recognised I would be a useful asset to the department and strongly encouraged me to take up a permanent role within the department. It was the way in which I have been utilised within the department that led us in A&E to come up with the idea oftrying to combine the GP out of hours services with the A&E department as many of the roles are similar and there is much crossover.

Have you seen a direct impact due to the Working Time Directive pilot scheme?

While the pilot was running it certainly became evident that the nurses were able to recognise patients who would be better directed towards primary care for management rather than seen within secondary care, which is why having reviewed the pilot result those of us involved now feel quite strongly that the GP out of hours and A&E should be co-located so as to allow the most appropriate person to see the patient to provide the best service for patients.

In recent years increasing numbers of patients have chosen to no longer contact the primary care service out of hours but to come direct to A&E and while many of these can be dealt with by the hospital doctors on duty clearly an experienced GP is able to devise a better management plan and expedite the patient’s progress through the system and this has been shown by the pilot which reduced both admissions and waiting times within the department. However, observing the junior doctors at work with the GPs, it was clear that their understanding of primary care and what it was able to offer was greatly improved by working alongside GPs and I do feel more patients are being sent back to primary care that previously would have been admitted if it wasn’t for this pilot scheme.

The pilot scheme ended in March and a review process is taking place to determine whether or not the scheme will be implemented full time.