GPs answer the call to help under pressure local hospitals

12 January 2021

Doctors Jagan John and Anil Mehta

Last weekend saw two senior GPs from East London join acute colleagues at Queen’s Hospital in Romford to work on two general medical wards at the hospital caring for patients. Doctors Jagan John (Chair of Barking and Dagenham CCG) and Anil Mehta (Chair of Redbridge CCG) were on hand to support hospital doctors as the NHS comes under ever greater pressure as a result of the Covid/winter double whammy. It also gave our hugely experienced local GPs the opportunity to help discharge some patients – those well enough – back home or into the community, with support from out of hospital services.

“We had to help and we felt we have a lot to contribute,” says Dr John. “We saw first-hand the resilience and hard work of our hospital colleagues, including the amazing junior doctors. We supported discharges where it was appropriate and challenged the need for some patients to be reviewed by specialists, which would have delayed things and contributed even further to pressure on beds at this time of year.”

The GPs offered their services to one of the capital’s busiest hospitals in line with an integrated care agenda that continues to go from strength to strength across this area in particular. Their experience of local community services – which can even differ across boroughs – was invaluable on the wards in accessing support for discharges, something that can cause delays, particularly at weekends when some community teams aren’t able to accept referrals.

As generalists, they were also able to support less experienced colleagues with appropriate responses to a wide range of conditions, without the need to seek advice over the phone from senior consultants. They were also able to refer a large number of diabetes patients directly back to GP colleagues with clear instructions on the care required.

“Diabetes is a real issue for us locally and we saw a number of patients who were core general practice in terms of the required medication and titration,” says Dr John. “Dr Mehta and I noticed that there was no support over the weekend for diabetes. It’s just one of the things we’ll discuss with colleagues and look to improve on, working jointly between primary and secondary care settings.

“Admissions is something that hospital and GP leaders have looked at together for years in our patch,” adds Dr John “We saw a number of younger patients who had come into A&E and been admitted, but really neither A&E nor the wards were the right place for them as they had wider issues – things that Dr Mehta and I see every day in our surgeries. We need to work smarter as a system to work out how we better manage these patients – something else we’ll take away and discuss urgently with colleagues.”

Donna Walker, consultant geriatrician at the Hospitals Trust, who oversaw our GPs as they supported on wards at the hospital, was not only grateful for the on-the-ground support they provided, she also saw how the benefits of this closer working will improve patient care in the future. 

She said: “Their support made a huge difference. It’s really tough on weekends, often I come home so exhausted I could cry and this was the first time I didn’t quite get to that point. 

“What was really useful was their help as generalists, which allowed me to provide more high quality, specialist care to patients. They were also able to see where there are bottlenecks in the local healthcare system, so they can go away and look at community pathways and see where improvements can be made. This will improve care for our patients in the future. It was really good for them to see the pressures we are facing, and for us to have a fresh pair of eyes on the ward.”

Dr John and Dr Mehta have committed to working more shifts at the hospital in the coming weeks and are now busy helping to recruit more GP colleagues to follow their lead, working both on the wards and in A&E reviewing admissions, patients and supporting discharges.

This ‘back to the wards’ approach is yet another example of the local appetite for further developing relationships between primary and secondary care across north east London, providing opportunities for shared learning and supporting improved hospital flow when beds are at a premium.