No wonder A&E can't cope when GP surgeries have lost the faith of their users

We may be about to reap the consequences of neglecting care in the community

Share

The squeals of pain from doctors and managers about the state of England’s accident and emergency service are the first clear sign that things are going wrong with the NHS. After the record injection of funds over the last decade and record low waiting lists – which persist despite the doomsayers -  the dramatic improvements we have seen in health care and the state of the hospital and GP service since the beginning of the millennium are in danger of going into reverse.

Anyone who followed the extraordinary BBC series Keeping Britain Alive: The NHS In A Day – which ended this week having shown with extraordinary vividness the miracle of modern medical care – will know that there has never been a better time to be ill. The sophistication and sensitivity of the care delivered to millions is without parallel in history.

But the country’s A&E service is the canary in the mine. When it looks sickly it sends an alarm signal that the whole NHS is under threat. With an extra four million patients pouring through the doors annually in the last decade the pressure is now at danger level. 

A key factor is the public loss of faith in the out-of-hours service since GPs relinquished responsibility for it under contract changes in 2004. People complain bitterly about lack of access and do not trust the commercial agencies that now provide much out of hours care – something GP leaders are reluctant to face. Result: dissatisfied patients increasingly turn to A&E.

Second, an ageing population with multiple health problems and increasingly complex needs suffer more crises because the regular care they need in the community is not there. Result: a problem that might have been dealt with simply becomes a crisis leading to admission to A&E.

Third, under new complex funding arrangements, when A&E admissions rise above a threshold set in 2008, hospitals are paid only 30 per cent of the cost with the remaining 70 per cent retained to pay for extra community services.  The idea was to incentivise hospitals and health authorities to provide more care in the community to reduce pressure on A&E. But it has had the reverse effect – GPs quickly grasped that once the threshold was breached it cost only 30 per cent of the full rate to pack another patient off to hospital. Result: yet more pressure on A&E.

We have known for decades that medical care was skewed towards hospitals and neglected in the community. Now we may be about to reap the consequences. Jeremy Hunt, the health secretary, must turn back the tide in A&E before it overwhelms the NHS. Addressing GPs’ responsibilities and the perverse funding arrangement would be a start.

React Now

  • Get to the point
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

Recruitment Genius: Senior Digital Marketing Consultant

£28000 - £45000 per annum: Recruitment Genius: A Senior Digital Marketing Cons...

Recruitment Genius: Assistant Stores Keeper

£16640 - £18500 per annum: Recruitment Genius: An Assistant Stores Keeper is r...

Recruitment Genius: Claims Administrator

£16000 - £18500 per annum: Recruitment Genius: This is an excellent opportunit...

Recruitment Genius: Software Developer - C# / ASP.NET / SQL

£17000 - £30000 per annum: Recruitment Genius: Developer required to join a bu...

Day In a Page

Read Next
Mosul falls: Talk of Iraq retaking the town, held by IS since June, is unconvincing  

Isis on the run? The US portrayal is very far from the truth

Patrick Cockburn
John Rentoul met Ed Miliband aged 23, remarking he was “bright, and put up a good fight for the utilities tax, but I was unconvinced.”  

General Election 2015: Win or lose, Ed Miliband is not ready to govern

John Rentoul
'It was first time I had ever tasted chocolate. I kept a piece, and when Amsterdam was liberated, I gave it to the first Allied soldier I saw'

Bread from heaven

Dutch survivors thank RAF for World War II drop that saved millions
Britain will be 'run for the wealthy and powerful' if Tories retain power - Labour

How 'the Axe' helped Labour

UK will be 'run for the wealthy and powerful' if Tories retain power
Rare and exclusive video shows the horrific price paid by activists for challenging the rule of jihadist extremists in Syria

The price to be paid for challenging the rule of extremists

A revolution now 'consuming its own children'
Welcome to the world of Megagames

Welcome to the world of Megagames

300 players take part in Watch the Skies! board game in London
'Nymphomaniac' actress reveals what it was really like to star in one of the most explicit films ever

Charlotte Gainsbourg on 'Nymphomaniac'

Starring in one of the most explicit films ever
Robert Fisk in Abu Dhabi: The Emirates' out-of-sight migrant workers helping to build the dream projects of its rulers

Robert Fisk in Abu Dhabi

The Emirates' out-of-sight migrant workers helping to build the dream projects of its rulers
Vince Cable interview: Charging fees for employment tribunals was 'a very bad move'

Vince Cable exclusive interview

Charging fees for employment tribunals was 'a very bad move'
Iwan Rheon interview: Game of Thrones star returns to his Welsh roots to record debut album

Iwan Rheon is returning to his Welsh roots

Rheon is best known for his role as the Bastard of Bolton. It's gruelling playing a sadistic torturer, he tells Craig McLean, but it hasn't stopped him recording an album of Welsh psychedelia
Russell Brand's interview with Ed Miliband has got everyone talking about The Trews

Everyone is talking about The Trews

Russell Brand's 'true news' videos attract millions of viewers. But today's 'Milibrand' interview introduced his resolutely amateurish style to a whole new crowd
Morne Hardenberg interview: Cameraman for BBC's upcoming show Shark on filming the ocean's most dangerous predator

It's time for my close-up

Meet the man who films great whites for a living
Increasing numbers of homeless people in America keep their mobile phones on the streets

Homeless people keep mobile phones

A homeless person with a smartphone is a common sight in the US. And that's creating a network where the 'hobo' community can share information - and fight stigma - like never before
'Queer saint' Peter Watson left his mark on British culture by bankrolling artworld giants

'Queer saint' who bankrolled artworld giants

British culture owes a huge debt to Peter Watson, says Michael Prodger
Pushkin Prizes: Unusual exchange programme aims to bring countries together through culture

Pushkin Prizes brings countries together

Ten Scottish schoolchildren and their Russian peers attended a creative writing workshop in the Highlands this week
14 best kids' hoodies

14 best kids' hoodies

Don't get caught out by that wind on the beach. Zip them up in a lightweight top to see them through summer to autumn
Robert Fisk in Abu Dhabi: The acceptable face of the Emirates

The acceptable face of the Emirates

Has Abu Dhabi found a way to blend petrodollars with principles, asks Robert Fisk