One in five requests made by London doctors for hospital beds for acutely ill patients is being turned down, according to a study completed by the departments of general practice at Guy's and St Thomas's hospitals. The study said that of 537 phone requests made by 111 GPs surveyed in south-east London, 115 were rejected.

According to the study, it took one doctor four-and-a-half hours to find a bed. The average waiting time was 18 minutes.

It is not unusual for doctors to spend an hour trying to find a hospital that will take a patient, according to Dr Tony Stanton, secretary of the Local Medical Committee, which represents about 2,000 inner-London GPs.

More than a third of admissions were problematic in some way, according to the GPs. Usually the problem was that no beds were available, but often the doctor was unable even to get an answer from the hospital switchboard. It was hardest to find beds for patients more than 75 years old.

According to Clare Jenkins, one of the study's researchers, many doctors had problems dealing with the hospital's duty doctor, who was often unwilling to take the patient - especially if that patient was elderly.

''Elderly people are seen as causing bed-blocking,' said Ms Jenkins. 'Once in hospital, they are difficult to displace.'

If a doctor decides that a patient needs to be admitted immediately, he or she must phone a hospital, speak to the doctor dealing with admissions and then try to negotiate a bed. If they cannot obtain one, the GP will transfer the case to the Emergency Bed Service, a London-wide unit funded by the NHS, which will try to find a place. The Bed Service can force a hospital to take a patient if all else fails. Emergency admissions on a 999 call bypass this process.

Graham Hayter, service manager of the service, said he was not surprised by the the study's findings. 'There is a reduced bed supply in London compared with a few years ago. The problem is not just the number of beds, but the way they are used. Hospitals are under great pressure to use them as intensively as they can.'

The number of hospital beds available has dropped by 9,186 in the past five years, down from 43,997 in 1988-89 to 34,811 in 1992-93.

Hospitals will not keep beds empty for emergency admissions. If, for example, a hospital has an emergency case to fit in, the options are to try to dismiss other patients early; place the emergency case on an inappropriate ward while waiting for the right bed to come up; or cancel non-emergency operations from the waiting lists.

According to Mr Hayter, the proportion of cases in which the Emergency Bed Service has had to force a hospital to take a patient has risen from 29 per cent in 1992 to 32 per cent in 1993.

'If it just took one phone call to get someone in to hospital, that would transform doctor's lives,' said Dr Tony Stanton. 'Often, the Emergency Bed Service goes back to the first hospital anyway. It's an extremely frustrating experience.

He believes that, although the survey was originally carried out in September to November 1991, the situation is still as bad, if not worse, today. 'I don't think anything that has happened has improved matters.

The Department of Health argues its initiatives to improve primary health care will eventually reduce the problem.

The Government has spent pounds 85m on primary care this year. It argues that this expenditure will reduce the need for people to be in hospital and, for those that are, will allow speedier discharge after treatment.

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