When is a GP not a GP? When he/she works in an Emergency Department Dr Marion McNaught,Associate Specialist Emergency Medicine

EADT Shift balance of unscheduled care Emergency care at most appropriate level:quickly and conveniently SPECIFICALLY –Reduce A&E attendances

RCGP manifesto More local community services Better access to diagnostic service Specialists in the community e.g. geriatricians/paediatricians More say in commissioning OOH services-(despite mostly opting out of responsibility for 24 hour care)

CEM At most,25% of urgent attendances may be cared for in primary care setting Believe that improved access to GPs and out of hours Primary care services is best way of dealing with problem Support co-location of primary care OOH Do NOT support urgent care centres (triage of ambulatory patients by non-ED staff deciding whether ED attendance required)

GPs in ED Spectrum of patients? Work to ED protocols/guidelines? Different clinical setting:on-site diagnostics Different patient population? Who has clinical responsibility? GP?Consultant? ED middle grade? In litigation-who are you peers?

GPs in Emergency depts Reduce admissions? Increase attendances? Sustainable?-already difficult to staff OOH service Improve ED/GP interface? Improve education?-different experience Effect on ED staff retention-relative pay rates How many GPs really want to do it?

GPs in ED Some areas employing “salaried GPs” to work in EDs-By definition if they are working full time in ED they are not a GP. Some GPs work in ED in middle grade role.See more than Primary Care patients.Tend to be those with an interest in emergency medicine-small numbers

Where do we go from here?