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Separate primary care service
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Low and inconsistent primary care demand
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“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)
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Difficulty in recruiting GPs and covering the rota
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“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)
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Inability to provide a consistent service
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“Some days it doesn’t open at all because someone’s off sick and they can’t cover it last minute”. (Hospital 18)
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Integrated emergency medicine service
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Low primary care demand
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“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)
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Not labelling the primary care area in an integrated model
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“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)
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Avoiding publicity to manage provider induced demand
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“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)
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No primary care provision
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Lack of space in the ED for GPs
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“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)
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Insufficient funding and inability to recruit
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“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)
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Concern that GPs ‘go native’ i.e. start behaving like ED clinicians and ordering lots of tests.
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“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)
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