Exclusive GPs working at an urgent treatment centre (UTC) have raised concerns about clinically ‘risky’ situations arising from the use of SAS doctors.
Foundry Healthcare Lewes, a PCN highlighted by the 2022 Fuller Stocktake for its success in managing urgent demand, has ended an arrangement with its local trust to see patients who require on-the-day care at the UTC rather than at their GP practice.
The PCN held a contract with Sussex Community NHS Foundation Trust (SCFT) to fund GP medical cover at the UTC.
However, PCN clinical director Dr Phil Wallek told Pulse that the trust has now ‘withdrawn’ the contract, meaning that from the start of this month, the same-day service moved to a hub within one of the GP practices.
Dr Wallek said the contract withdrawal was ‘partly about the cost of a GP against the cost of an A&E staff grade doctor doing the shifts’, but he also expressed concerns about the UTC being supervised by these staff grade doctors, now called specialty and associate specialty (SAS) doctors.
He claimed that his GP teams noticed clinically risky situations under this staffing model.
‘The concern is because they’re not GPs, we’ve had a number of slightly iffy clinical scenarios where things that have been prescribed or done for patients by staff grade doctors is not what we would have approved of as GPs,’ Dr Wallek told Pulse.
A spokesperson for SCFT told Pulse that the trust ‘regularly’ monitors the service for ‘performance and quality’ and that all incidents reported by staff are reviewed locally by managers.
Dr Wallek told Pulse that such scenarios arose during the winter when the UTC was given ‘additional funding’ which provided A&E SAS doctors to ‘bolster the staffing’ – and this is the workforce model the trust will continue with from this month now that the contract for GP staffing has ended.
Dr Wallek said: ‘It’s in that situation that’s been happening during the winter, which is the model which then the SCFT has chosen to go with, which is to stick with having those doctors seeing patients as opposed to GPs supervising the urgent care practitioners.
‘And it’s during the experience of that over the winter that we’ve seen the outcomes of a number of those cases where the care hasn’t been quite optimal from our perspective.’
He said some incidents were ‘clinically risky’ but some were also about ‘not managing risk appropriately’, for example patients being sent to A&E inappropriately.
‘We feel like we end up picking up more work as a result of things that have been done – either not done or not done to what we think would have been the right care pathway, the right treatment, and then we’re picking up the pieces and end up doing more work afterwards,’ Dr Wallek added.
The PCN clinical director also said staff working at the UTC, such as urgent care practitioners, were concerned about GP teams leaving from this month.
‘The staff who’ve been working at the UTC are all now saying: “How come you guys are going? We think it’s going to be a disaster now, because we will have other A&E doctors who are now working with us as opposed to GPs who know the area”.’
A spokesperson for SCFT told Pulse that ‘99.9% of patients’ at the Lewes UTC are seen by members of the multi-disciplinary team within four hours.
They said: ‘We are focused on ensuring a positive and high-quality service for any patients who need the UTC and regularly monitor the service for performance and quality through our governance processes.’
The Foundry PCN’s model of separating same-day patients from those with ongoing conditions or complex needs was spotlighted as a pioneer in the influential Fuller Stocktake, which recommended same-day appointments are dealt with by ‘single, urgent care teams’.
Other areas are now pursuing this model, with North West London ICB attempting to effectively mandate the use of same-day access hubs via its enhanced services single offer.
Despite significant pushback from GPs and patients in this area of London, Foundry Healthcare’s Dr Wallek told Pulse that hubs like this should be rolled out across primary care ‘in a mandatory way’.
And NHS England’s national director for primary care said last week that she wants to ‘step back’ and let ICBs test out models of same-day care at scale.
“Fuller Stocktake, which recommended same-day appointments are dealt with by ‘single, urgent care teams’”
This nonsensical mandate is a policy searching for a report. Same-day access hubs are a regressive, siloed, dis-integrated model; where once we had a successful, economical, truly joined up model of general practice. It replaces us as GPs.
Let’s deal with the language first: same-day access hubs are rubbish compared to what we’ve got and what we need. Only a dangerous fool would pretend that it’s fine and perfectly normal to be trained for one medical discipline only to practise another (or indeed no medical discipline at all), ignoring the real and obvious holes in care. How is this ‘one-size fits all’ actually ‘stepping back’ and ‘letting the ICBs test out the model’? Fuller is the antithesis of what general practice purports to be.
One has to question what is meant by governance at NHSE – if it weren’t for GPs having done the right thing here, patients would continue to be exposed to such unacceptable and unnecessary risks.
It’s influential only because NHSE says it is and it’s DHSC’s intended direction of travel. It isn’t good Medicine, or progress, or integration.
When the additional funding dries up, all the pioneers will disappear, with only dysfunctional 111 care, and the in-fighting, remaining.
Fully agree with you NM. Fuller’s output is typical of a bureaucrat with no “Skin in the Game”, separated from the consequences of her actions. As Nasim Taleb writes in his book of the same name that, if no risk attaches to you for what you say or produce, then it’s just cheap talk or rotten.
*Things designed by people without skin in the game tend to grow in complication (before their final collapse)
*Non-skin-in-the-game people don’t get simplicity.
Clearly this calculating Govt, in its “last days of Rome” phase, is intent on destroying primary care (which worked beautifully when it was kept simple).
I would like to raise concern about the state of NHS, mostly secondary care and all the horrible appendages of “trust” culture in primary care: 111, “community teams”, “UCC s” , “ooh GP”- remember them as almost functioning services some time ago, not past 12 months or longer.
Let me save you some money RCGP; here’s the conclusion of a consultation ‘there is no place for PAs in General practice. They are of little use anywhere and of no use in General practice. What is the benefit of someone who has a massively restricted watered down version of medical training to produce a ‘professional’ of uncertain and lesser knwoledge nad experience’ who will always have to be supervised and isn’t particularly cheap. A careeer cul de sac’
Love it ‘they should call them the RC of non-GPs’
The dilution of expert care in General Practice is an entirely ideological and politically driven approach by the Tories. Just the same as when Thatcher initiated a purge on hospital beds in the 1980s. They are little more than short selling city wannabes who know the price of everything and the value of nothing