In the past few months, ambulance delays have frequently made the headlines. Alongside a growing elective care backlog – with a record seven million people now waiting for treatment – emergency services are facing huge surges in demand and struggling to reach patients fast enough.
While Prime Minister, Liz Truss, has pledged to solve what she terms ‘unacceptable’ wait times, government policy fails to recognise that the root of this problem doesn’t just lie with the number of available ambulances and staff. Rather, it is the result of a more complex chain of issues which begins elsewhere: in primary care.
GPs are also facing an influx of patient demand post-pandemic. Without sufficient support to boost primary care capacity in response to this, the result is that many patients unnecessarily turn to emergency services to access care. This, in turn, piles additional pressure on the ambulance system, with a shortage of paramedics facing an ever-growing number of patients calling on A&E.
We must not underestimate the impact of the challenges in primary care on emergency services. Tackling these is in fact a key step to reducing the pressure on our ambulances and A&E departments.
One of the factors exacerbating ambulance wait times is the inefficient tools at the disposal of clinicians in primary care. GPs have to rely on disjointed, slow communications systems and referral pathways when trying to direct patients to the most appropriate line of treatment.
Clunky, outdated and non-interoperable tech leaves GPs working in silos, unable to easily communicate with their secondary care colleagues or gain advice and guidance regarding referrals. This slows down patient triage, exacerbates waiting lists and results in a higher number of patients being sent unnecessarily to A&E.
Some patients are calling ambulances because their condition has gotten worse whilst waiting for outpatient treatment. Others are unable to obtain a GP appointment in the first place, due to a lack of clinical capacity.
To increase this capacity, and effectively tackle the waiting lists pushing patients into emergency care, we must hand GPs the digital tools which help streamline the referral process, reduce their admin burden and give them more time to spend with patients. This will ultimately make more appointments available, helping a higher number of patients access primary care as their first port of call. In turn, this will lead to fewer patients calling 999, reducing the pressure on overstretched ambulance services and allowing those who really need emergency care to be seen sooner.
Digital advice and guidance platforms can provide primary care clinicians with direct access to specialist advice from their secondary care colleagues. Connecting via an app, they can message or call to request advice on individual patient cases and receive guidance remotely from specialist consultants. This enables a more informed, shared referral decision to be made.
Rather than initially referring a patient to be seen in secondary care, GPs can access real-time advice about the most appropriate course of action, and triage the patient accordingly. This saves time, reassures the patient and reduces the number of people being sent to A&E or joining waiting lists unnecessarily. For those who are deemed to be in need of a referral, they can be seen much more quickly.
The impact of introducing digital advice and guidance tools for primary care clinicians can be seen in Norfolk, where use of the Cinapsis platform by GPs to access specialist advice on dermatology referrals has reduced wait times from 50 weeks to just 48 hours. By driving similar innovations throughout primary care, these results can be replicated and scaled across a diverse range of specialties. The result: a dramatic reduction in wait times for secondary care and fewer patients turning to A&E for support.
To effectively tackle ambulance delays, we cannot view them in isolation. Instead, we must look holistically at how NHS services work together and impact one another. By providing more support for GPs through access to intuitive, digital tools which enable them to collaborate with secondary care, and triage patients more efficiently, we will be able to significantly reduce the burden our emergency services face this winter.
Dr Owain Rhys Hughes is an NHS surgeon and founder of an initiative working with NHS organisations across England to boost collaboration between primary and secondary clinicians.
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