A&E diverts cause death

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A SCHEME to divert patients away from A&E resulted in a patient’s death, prompting NHS officials to launch a national review of the ‘front-door streaming’ programme.

The scheme involves a GP posted at the front door of every A&E. When a patient enters the A&E, a GP assesses them and decides whether they should be seen in A&E or diverted back out of the door and told to see their local GP.

Every NHS trust in the country has been instructed to introduce ‘front-door streaming’ by this autumn. However GPs and A&E doctors alike have warned that this is a recipe for disaster. The pilot scheme, itself has resulted in the death of a patient, so doctors say that to roll this scheme out across the country is dangerous.

GPs and doctors are opposed to the scheme for many reasons: Firstly, there is the potential for patients with life threatening conditions to be overlooked and and as a result not receive the urgent attention they need. Secondly, the scheme takes GPs out of the local community where there is already an extreme shortage.

During the pilot in Bristol, David Birtwistle, 44, a father-of-one, died from a pulmonary embolism after being turned away, 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.

NHS England has commissioned the £1m review of the safety of the scheme. The documents, by Cardiff University, state: ‘The evidence base to support service models of General Practitioners working within EDs (emergency departments) is weak.’

Deputy chair of London region BMA Anna Athow, in a personal capacity, commented: ‘Employing GPs at the front door of hospitals’ A&E departments is dangerous. ‘NHS England has provided millions of pounds for this compulsory scheme, as a means of “managing demand”.

‘In plain language its purpose is to reduce the number of emergency patients being seen inside the A&E department proper, so as to save money by making it less likely that a patient will be admitted onto a ward.

‘GPs are not emergency specialists. Patients presenting themselves urgently are often much more difficult to diagnose, and they often come unaccompanied and are less able to give their history. ‘Its no good NHS England doing a year-long study to check on safety. Patients have already died and it is unsafe.

‘It should be stopped immediately, together with all the other “streaming” tricks used recently to keep patients out of hospital, such as triage by clerks and nurses and diversion into urgent care centres at the front door.’