Scottish health boards have been told to follow government guidance on ‘redirecting’ patients who could be treated elsewhere away from A&E.

Recommendations published by the Scottish government flag ‘variation’ in current approaches and provide a framework for boards to follow, with four ‘high impact’ key changes.

But Dr Andrew Buist, Chair of BMA Scotland’s GP committee, told healthandcare.scot there was little capacity elsewhere in the system to pick up extra patients.

Pre-pandemic research found that roughly one in ten patients attending Glasgow emergency departments did so because they could not get a GP appointment.

However less than a third of those surveyed believed they had a medical emergency, with convenience and the belief that A&E would be the quickest place to be seen cited as factors in attendance.

The most recent A&E figures saw performance against the four hour standard fall to a new low.

Just over 30% of patients waited longer than this, and then admitted, transferred or discharged.

In Glasgow, half of patients at the Queen Elizabeth University Hospital Emergency Department waited more than four hours.

A total of 231 patients are estimated to have died due to long waits in crowded A&Es, the Royal College of Emergency Medicine said today.

Andrew Buist said: “…This must be about proper resourcing across the whole system…this should not result in patients simply being redirected from A&E to their GP practice who may equally not have the capacity to see them.

“Patients must be made aware of the options available to them, including community pharmacists, physiotherapists and minor injuries units.

“If the public messaging is clear, this guidance could help make improvements – but it runs the risk of pushing people around an overstretched system if we don’t also address staffing and resources. If not, we run the risk of hospitals and GPs simply being left unable to cope with surging demand.”

The Scottish government says numbers self-referring to emergency departments are returning to pre-pandemic levels.

A separate programme that asks patients to call 111 rather than take themselves to A&E was launched in late 2020 with the aim of reducing pressure on hospitals.

But a senior clinician has said the reforms are having “no impact” in reducing self-presenters.

Today’s guidance was drawn up by a group co-chaired by East Ayrshire HSCP director Eddie Fraser, Craig Cunningham of South Lanarkshire HSCP and Gerry Mooney, a government unscheduled care improvement advisor.

It suggests that a defined group of patients should be considered for redirection, or signposting, if they meet certain criteria.

They include those presenting with concerns normally dealt with in primary care, conditions for which patients have already been seen, and a condition that has been present for three days or more.

A clinical decision is to be made by a professional with a ‘working knowledge of available social care and community support services’.

The new advice is based on a policy introduced by NHS Tayside, one of the best-performing mainland boards for A&E waiting times, that has been in place since 1998.

Royal College of Emergency Medicine Vice President (Scotland) Dr John Thomson said: “Emergency department resources are not infinite. As the demand from patients continues to increase, it is essential we have the capacity to care for those who require the skill and expertise of the emergency department team. This guidance will help our NHS staff safely redirect those who do not to the best place for their healthcare need.”

 

Read more: Hospital sets record low for four-hour A&E target; A&E call-ahead reforms having “no impact”; 111 delays risk A&E call-ahead plan

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