Asking the impossible of GPs

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One of the ways McKinsey has decided it's possible to save £20 billion in the NHS is to reduce the number of acute admissions made to hospitals.

Acute admissions are, of course, the emergency ones, that go through accident and emergency or straight into a medical assessment unit.

I am now aware that some Primary Care Trusts are asking GPs to reduce the number of these admissions by 20%.  This is a curious target. Only 25% of acute admissions are referred into hospital by GPs. The rest of these admissions, all of whom are by definition GP patients and are therefore logged against their names, turn up in hospitals inthe back of ambulances, or are driven there by their friends or relatives when seriously ill.

To deliver the reduction in acute admissions demanded of GPs they either have to stop their referral of people who front up with heart attacks in their surgeries by 80%, or they have to ignore meningitis in children, or send people home with deep vein thromboses. Alternatively, they have to set up roadblocks that prevent ambulances carrying their patients arriving at accident and emergency units.

None of these are very likely, are they?

I wonder how much McKinsey's were paid for this fabulous insight? And I wonder what part of the savings will result from this cut in admissions? I suspect it will be close to 0%.

This is because GPs refer people to hospitals because they are sick,  not because it is fun. And they do so because they know that if they get things wrong they are likely to suffer serious consequences, including being sued, and being referred to the General Medical Council. All of those complaints procedures will, of course, remain intact despite the cuts. But supposedly  McKinsey think that GPs will now take a massive increase in risk to help balance the books of the NHS.

I have a message for McKinsey and Andrew Lansley: they may be stupid, but GPs aren't, and the rest of us should be grateful that GPs will still refer when necessary.

Disclosure: I am married to a GP