Sick Scots face being sent away from the country’s crisis-hit accident and emergency (A&E) departments if their conditions are more than three days old or could be treated by their GPs, under “reckless” guidance issued to health boards.
Humza Yousaf, the SNP’s under-fire Health Secretary, unveiled rules that would mean more people attending A&E departments would be referred instead to doctors’ surgeries and pharmacies or told to look after themselves.
Suggested criteria for “signposting” people to other services included them having an “illness or health problem normally seen and dealt with” by GP surgeries or having a “condition that has been present for more than three days”.
They may also be sent away if they are seeking treatment for a condition for which they have already consulted their GP “or have an ongoing treatment plan in place”.
Mr Yousaf, pictured below, said the guidance would help ensure a “consistent approach” was taken in A&E departments across Scotland and “ultimately release doctors to deliver emergency care to those who really need it”.
But many Scots have complained they have found it extremely difficult to get timely appointments with their family doctors owing to Covid-19 restrictions.
Opposition parties said the advice was “condescending and reckless” and warned it would “only pile on the pressure elsewhere in our overstretched health service”.
The British Medical Association said redirection had previously proved to be “very effective” but warned against too many people being sent to their GP surgeries, saying this would leave family doctors “unable to cope with surging demand”.
The guidance emerged the day after official figures disclosed A&E waiting performance has deteriorated to another record low, with fewer than seven in 10 patients seen within four hours.
NHS Lothian, which covers Edinburgh, last week became the latest health board to advise its residents not to attend its A&E departments unless they have “life-threatening” conditions.
Move could cut delays in assessment
Mr Yousaf this week unveiled an extra ￡10 million for A&E departments, with physiotherapists and occupational therapists diverted to help out.
Unveiling the A&E rules, he said: “It is widely recognised that more people could be better seen away from hospital and closer to home by a more appropriate care provider such as a pharmacy or GP practice or indeed, managed with self-care guidance.”
The Health Secretary said the guidance would “help our healthcare staff safely signpost people to care more appropriate to their need in the right place and at the right time for their condition”, cut delays in assessment and treatment and “prevent overcrowding”.
But Jackie Baillie, Scottish Labour’s health spokeswoman, said: “A&E services are at breaking point and the SNP’s solution is to turn more people away.
“The Health Secretary is detached from reality if he thinks the biggest problem here is crowds of people desperate to spend 12 hours sitting in A&E for no good reason.”
Dr Andrew Buist, chair of the BMA’s Scottish GP committee, said the new system made sense but “this should not result in everyone being redirected from A&E to their GP practice”.
He said patients should be made aware of other options “including community pharmacists, physiotherapists and minor injuries units”.
The Scottish Government said the guidance draws on “established good practice” in NHS Tayside and NHS Grampian, and Greater Glasgow and Clyde health board had already adopted it.
Patients to be given guidance
It stated that people with a condition “not requiring emergency care” will be clinically assessed “for potential signposting/redirection”.
While waiting for help, it said patients should be given a copy of the guidance with a “positive message about the advantages of seeking care from alternative care providers.”
However, it said they should receive treatment if there is a “clear and pressing need for immediate intervention”.
This was defined as “the sudden onset of a medical condition” with “acute symptoms” that if not treated “could reasonably be expected to result in placing the patient’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part”.
The guidance also provided a suggested script to use for patients attending A&E with conditions more than three days old, with medics arguing anyone being sent elsewhere “would prevent an unnecessary wait in the Emergency department without any benefit to you”.
Dr John Thomson, vice president of the Royal College of Emergency Medicine in Scotland, noted that “emergency department resources are not infinite” and the guidance would “help our NHS staff safely redirect those to the best place for their healthcare need”.