ࡱ> ?A>y qbjbjEE *''qKKKKK____ k_ $tZZZ#######$~% (#KZZZZZ#KK#...ZRKK#.Z#.."Q#@W_)#u##0 $=#(.((Q#(KQ#$ZZ.ZZZZZ##.ZZZ $ZZZZ(ZZZZZZZZZ :  LMC Discussion Paper on Primary Care Response to Acute Hospital Bed Crises Summary The LMC asks PCTs to plan now for how GPs and practices should respond to the increasing risk of admission restrictions at local acute hospitals. This plan should include agreed arrangements for managing clinical risk if normal admission procedures are limited or suspended. Background Under normal circumstances NHS Acute hospitals serving Somerset have just about enough capacity to meet demand for emergency admissions. However, the steadily increasing number of admissions over recent years means that an increase in bed demand for example, an outbreak of respiratory illness, or a decrease in bed supply for example, closures due to hospital acquired infection, mean that demand cannot be met. This most often applies to general medical beds. The LMC anticipates that this problem is likely to arise increasingly often and we would like to agree an escalation policy with PCTs and NHS Trusts. GP Urgent Admissions GPs request admission based on their clinical assessment of the patient and their personal risk management policy. Admission rates vary between GPs but it is extremely difficult to reduce individual doctors acute referrals; whether or not this would in fact be appropriate or desirable. GPs are required under the terms of their contract to refer patients when this is appropriate. Furthermore, the GMC has specifically stated that inadequate resources do not relieve a doctor of his or obligation to provide care. GPs therefore cannot stop making urgent referrals for specialist assessment. Medical Assessment In the LMC view responsibility for managing admissions primarily rests with the receiving Trust. If the Trust does not have capacity to admit all referred patients, then transfer on to other units should be arranged by them after an initial assessment. We have long pressed for active Medical Assessment Units in which patients with symptoms or signs worrying to the GP can be investigated and observed. However, in practice very few patients are not admitted after a GP referral. If pressure on beds is great then the Trust may be able to discharge more patients if the MAU has extra resources. Special arrangements must be made to communicate with the GP if patients are not admitted. Impact on Primary Care Services of a Bed Crisis If fewer patients are admitted, or are discharged earlier, then more work is undertaken in primary care. Where patients do not go home, care may be provided through intermediate care beds, in the private sector, or using social services contracted accommodation. In all cases medical input will be required from local practices. This is not GMS work and should be resourced through a Local Development Scheme or as a Local Enhanced Service. Help for practices from the PCT When a bed crisis is declared by an Acute Trust, we would ask PCTs to undertake the following: Negotiate with the Trust the best arrangements for medical admissions this might include streaming them through A+E, giving the MAU extra resources, or encouraging practices at the edge of the catchment to refer to adjacent DGHs. Rapidly pass on to practices, the ambulance service, and the out of hours service what the plan is, how long it will apply for, and what the escalation arrangements are. If early discharge, deferred admission, or assessment without admission are part of the plan, to activate the LDS/LES previously agreed. If the crisis reaches the point where GPs are expected not to refer patients for assessment, then the PCT should have agreed with local GPs in advance who should be managed at home and to accept medicolegal responsibility for this element of the plan. To report back to practices after the event on how the crisis was handled and what changes should be made to the plans for dealing with similar problems in the future. Harry Yoxall LMC Secretary April 2003 NVj k v NaF"S|EjklqhC5>*CJ hC5>* hC5hC56>* hC>*hCjhCUMNVj k v   MNaF"$a$  %&#$/iBCDER`klmnopq$a$$ & Fa$(/ =!" #$% DdP  <  C AbA&(0[ "\$MD n&(0[ "\$MPNG  IHDRP *gAMAPLTE# pHYsbcbm,<8 IDATx[ Ds $$HBJTlߦ                oz>) tP(XGN@u7Qm`ՁV Y8z1@kYK3yLϦ,ΑUл;7N8 L&ed(6;!ُMR1DE 4U^Tä֯}lWN9_ ='L48cPfic-MiCn` KHI4B\O!7гAJޕ0D$nHFz942%W%l4C6:Y81@~p `8dHي18yEꎣ`Gڕ\z/r^!-YXE%~1a]k^C4˛/9EރCHzz7B.@4χЂ'_Թ/>}z-\$r&xR#$SR81c3)I,9dlZ8Egh9=".8-]T>p:l3N-ՠPe<l.H?VQvyQ/EhTo8h}x20[)#[gyFGQ{p=3, gC RtxW̜|{@K&:({KN#b5bv5܇+΃N{w0{Pԁ!%\ YzO C@VgW?V&kzmQo3ae sʀƸv) > hµuZw01ȫX.)tM J@9Px[Pk{X} )p U]sWs#'7݁jEh&(kRJ6Pml_H PqY P]` j.@|C1^(S c8c<j-b8ߛ4t tw: sYCJjwfg~8Mu>ў7w=IWkx/@6-Df@-_(({([xuϷ"jik즽8^lNh0f#XVC4a짾8/! L-m$.\OINFxxzzZN86.ٳ^81R}AxGiuZ ԝǣmr!gZB7BJk_tG]}~2u3גz]sZ@ў [N@sYVؤxN3Ѯ҈eY> aNW]Y{J/&4s,?|DT9WhZ@_m\I[dֳxvW -.z&62a[\=ٻH3L@10ԡՁV{HMwzZ/yeI@JADk=J`7;k],V6aj m\ ;{fQ@ O_& .AvxpF!6Enf_@OU/ -ܡ̔,Z}oȿʤaqGG/H8ͨлӗSO"ĨӀ8}` nM}y։"yzս}:_߹P pd6:8IsTO]y@&Ge[U{a(s5@ >( CGe]tYOI󥩏eI<ȤlSy66Yl;ُrPRTFm^h4Cr5;b<ՙ6ќC,^)+ԟ<^us<il2PWY+;3"L w y Po׹S 4W4}ΎusQVB*-?K&m@3WD7@D%!nI 9S9/>9hi .X68KŘ$#)@˼lKެp&rs-Y.j2 *$=9tV]h>:sxV\ hnxYRy<ϠO6‡)@FXf/TsF(Ѫ)z(ܞ3#q5;6@ۛhy!;п$P+bҟ lRkE<1'7h>iPKv9{X_FHx"*![peG4}*[5=Q^\ gۉ^%vյMP #@D qY$ gMݷ Krg"@-.ߪ{f_G*K?Erg>.O ?3uRԬw~SIE/͛AfAX(X(X(X(X(X(X(X(X(X(X(X(X(X(X(X(X(X(X(X&l IENDB`^ 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH 8`8 Normal_HmH sH tH JJ  Heading 1$$@&]a$5CJFF  Heading 2$@&] 5CJ\DA D Default Paragraph FontViV 0 Table Normal :V 44 la (k ( 0No List :B:  Body Text ]CJHPH  Body Text 2 ] 5>*CJ\6U6  Hyperlink >*B*ph@Q@"@  Body Text 3 5>*CJ\PK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] qq q 8@0(  B S  ?cg` d D M c g als+3L\ajT b s3333333333A+h?EN (~vQU