Table 4 Reported challenges in implementing and delivering primary care services and emergency medicine services
Type of service | Challenges | Quotes |
|---|---|---|
Separate primary care service | Low and inconsistent primary care demand | “Do we have enough patients to keep the GPs busy, probably we don’t, so we’re seeing just over 2 patients per hour, on average, and it also depends on if it’s a busy shift where there’s lots of appropriate patients”. (hospital 4) |
Difficulty in recruiting GPs and covering the rota | “So we started to employ, or rather the CCG employed, GPs to do an early and a late shift Monday to Friday in the department. They were never successful at fully recruiting to cover all those slots”. (Hospital 8) | |
Inability to provide a consistent service | “Some days it doesn’t open at all because someone’s off sick and they can’t cover it last minute”. (Hospital 18) | |
Integrated emergency medicine service | Low primary care demand | “The CCG has terminated that because they felt that they wanted them to be seeing 3 to 4 an hour, and we just couldn’t give them the patients, we just didn’t have the right kind of patients for them to see”. (Hospital 19) |
Not labelling the primary care area in an integrated model | “We’ve not changed the label outside the hospital, it doesn’t say Urgent Care Centre, it doesn’t say anything else because we didn’t want to have a honey-pot effect of attracting more people in” (Hospital3) | |
Avoiding publicity to manage provider induced demand | “We kind of opened it surreptitiously, we’ve never opened with a big bang, so I think any increase in demand has been via 111 rather than walk-un patients” (Hospital 7) | |
No primary care provision | Lack of space in the ED for GPs | “I think if we had, from a pragmatic point of view, a GP in the department, it would increase pressures because by definition of taking up a room, to deliver that service, that would be one less room to flow patients through from an ED perspective”. (Hospital 16) |
Insufficient funding and inability to recruit | “That’s always been our difficulty I think, in recruitment, is we can’t pay anything like GPs would have been paid to work through OOH”. (Hospital 1) | |
Concern that GPs ‘go native’ i.e. start behaving like ED clinicians and ordering lots of tests. | “My worry is that once in the ED footprint, and working that closely with the ED teams, is how soon before they sort of fall back into a non-primary care role”. (Hospital 16) |