Winter pressures are a well-established part of NHS life. We see these creating headlines every year in the press, and we feel it on the ground, without a doubt.
For me, as a GP, the effect of winter pressures is dual. Firstly, the work of the practice changes: we see a different mix of patients, with more viral infections, especially in children, for example; and, simultaneously, we are busy vaccinating for flu and/or Covid, which puts extra pressure on the practice team.
This year it feels like we’ve been in winter pressures mode all summer, and the pressures now are as high as they have ever been in my career. 4-hour waits were at their highest ever level in October, and ambulances are backed up outside departments, unable to offload their patients. Hospital medics are working flat out in very difficult conditions.
Under these circumstances, primary care is, understandably, asked to reduce hospital referrals wherever possible. The trouble with this – for me at least – is that I am already trying to avoid sending patients to hospital unless absolutely necessary. I know how busy my hospital colleagues are at the best of times and what a challenging experience it can be for patients, so I have to be pretty worried to make a same-day referral.
Keeping patients out of hospital
There are, arguably, two main reasons why patients end up in hospital:
- The first is that their medical condition can only be treated in a secondary care setting, e.g. where there is a surgical emergency.
- The other is where the medical situation leads to a loss of function and the patient cannot safely remain at home, which is more common when they are elderly or live alone.
Fortunately, in many areas, local healthcare commissioners and providers have realised the importance of the latter group and put in place a variety of solutions: hospital at home, virtual wards, urgent care packages etc.
However, a significant challenge remains for us GPs: how do we decide whether a patient is safe to stay at home? Is their medical condition treatable in a domiciliary setting? GPs tend to have a pretty short window for decision-making. Appointments are back-to-back, with breaks rare, and any ‘spare’ minutes are filled with admin and visits. Ringing the hospital and holding for an unspecified amount of time to see if there is someone available to advise me about my patient makes life very difficult, and in many situations, like my colleagues in primary care, I simply don’t have the time to wait, so sometimes it’s quicker, easier, and safer to refer.
How rapid and secure communication between clinicians helps them and their patients
One can potentially assume that Advice & Guidance (A&G) is a medium-term process; turnaround times are usually in days. What Consultant Connect has shown over the years is that rapid A&G can have huge benefits. A direct, secure and rapid connection (30 seconds average UK call connection time) via the app or a centralised number to a specialist who can help think through how a patient can be safely managed in their own home is hugely beneficial.
Over the last eight years, Consultant Connect has formed a critical part of winter resilience plans for NHS areas, with the service now covering 40 million patients across the UK.
Outcome data shows how patients benefit profoundly when clinicians use rapid A&G:
- 68% of telephone advice calls to elective specialties result in the patient avoiding a trip to hospital
- 36% of calls from ambulance staff avoid unnecessary patient conveyances, with 43% of calls to Acute Medicine lines avoiding a conveyance
- Over 52% of calls to urgent care specialties avoid unnecessary admissions
As the husband of a geriatrician who specialises in admission avoidance, I know there is a huge amount to this. As a GP, I have a strong gut instinct regarding the need for admission, but the ability to rapidly connect to a specialist to talk through this can often lead to a new angle to be considered. I’m so grateful to my secondary care colleagues for their help in managing my patients in their time of need.
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