Emergency cases cause NHS alarm in three cities: GPs asked to pay up to keep services going, while some patients are being sent out to surrounding towns. Nicholas Timmins reports

FAMILY doctors in Newcastle, Birmingham and Liverpool are warning of major problems in getting medical emergencies into hospitals, while the Mersey Regional Health Authority has asked its 100 GP fundholders to hand back pounds 5,000 per practice to keep services going in the face of rising emergency admissions.

GPs in Newcastle upon Tyne have written to Virginia Bottomley, Secretary of State for Health, warning that patients with 'life- threatening' illnesses are having to be sent to surrounding towns because hospitals in the city cannot provide beds.

In Birmingham, Dr Charles Zuckerman, secretary of the city's local medical committee, said 'the system seems to be breaking down'. Patients were having to wait 'inordinate' lengths of time on casualty trolleys for beds, or were being be moved from 'hospital to hospital' to gain admission.

In Liverpool, the regional health authority is constructing an emergency fund culled from its own resources and those of health authorities to try to prevent waiting-list operations being cancelled as emergency admissions have risen sharply. GP fundholding practices are each being asked to contribute pounds 5,000 to provide an extra pounds 500,000 for the fund.

Doctors in all three cities report increases in emergency admissions since the summer that have now been compounded by the mild flu epidemic.

In Birmingham, the region has overridden the National Health Service internal market and persuaded its NHS trusts to agree to a more powerful bed bureau which can order hospitals to take patients. How the patients will be paid for has yet to be decided. Brian Edwards, regional general manager, said: 'Acute medical emergencies take priority. We sort the patients out first and we sort the cash out afterwards.'

Dr Zuckerman said the combination of higher medical admissions and bed closures to balance books meant 'we were warning the hospitals thoughout the summer that they were on the edge and any outbreak of 'flu would push them over. It looks as if we are going over the edge . . .'

Dr Frankie Walters, chairman of the Newcastle upon Tyne local medical committee, has written to Mrs Bottomley on behalf of 150 GPs expressing 'extreme concern' about health care in the city. Some patients were having to endure journeys to Gateshead, Sunderland, Ashington and Hexham for treatment.