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Many people attending emergency departments (EDs) could be managed by GPs and employing GPs to work in or alongside emergency departments (GPED) is a way to address increased pressure on EDs. This study highlights the benefits of GPs choosing to work in GPED roles such as professional development, sharing skills and knowledge across both contexts, and retaining GPs in some capacity within the clinical workforce. However, GPs working in GPED services expressed concerns that the GPED model may not be sustainable and may also contribute to destabilisation of core general practice. By exploring the views, motivations, and experiences of GPs choosing to work in GPED roles, this study may inform planning and implementation of both GPED services and core general practice. Site GPED model GP role Birch Inside ED: parallel GP in ED (including investigations) Chestnut Inside ED: parallel GP in ED (usual primary care) Outside ED: off-site Hawthorn Inside ED: parallel (OOHs only) GP in ED (usual primary care) Juniper Outside ED: on-site (OOHs only) GPs either work in usual primary care role or adapt a dual role where they become involved in managing patients with ED health issues Inside ED: integrated Linden Outside ED: hospital site + off-site GP in ED (UCC) (usual primary care) Nutmeg Inside ED: parallel GP in ED (UCC) (usual primary care) Poplar Outside ED: on-site GP in ED (including investigations) Redwood Inside ED: parallel GP in ED (including investigations) Rowan Inside ED: parallel GP in ED (usual primary care) Teak Inside ED: parallel GP in ED (including investigations, Outside ED: off-site increased acuity) ↵a Inside models — GPs co-located within ED. Can be: integrated — GPs work within the ED team managing a range of patients, or parallel — patients assessed as suitable for GP care ‘streamed’ to GP within the department. Outside models — patients assessed in ED then sent to GP outside ED, either within hospital grounds (on-site) or off hospital grounds (off-site). ED = emergency department. GPED = GPs working in or alongside EDs. OOH = GP out-of-hours service. UCC = urgent care centre.
Sustainability of GPED Sustainability of core general practice Sustainability of both GPED and core general practice Offer flexibility in work patterns, for example, shift patterns, locum, and part-time work balanced with need for effective service planning and provision Systemic change required to make general practice sustainable, for example, flexible working, collaborative working environment Support for portfolio careers such as working in GPED roles may allow some GPs to extend their working life, reduce early retirement and attrition, and prevent burnout Support GPs to broaden clinical opportunities when working in GPED services to enhance the core GP role Support flexibility of workload organisation, for example, consultation duration Portfolio working and novel GPED roles require structured education and support from training systems and medical royal colleges Support for GPs to adapt to different ways of working in GPED roles according to their career plan and aspirations Use GPED to promote general practice to junior doctors and other healthcare professionals working in ED Consideration of strategies to prevent/limit competition for finite GP resource Development of strategies to reduce competition for GP resource Potential for core general practice to ‘borrow’ learning from the positive benefits GPs experience in GPED roles Develop strategies that value shared learning and support for collaborative working Provide ‘incentives’ to work in GPED services such as support and supervision, career planning Supporting GPs to work part-time in GPED services or other portfolio working, as well as working part-time in core general practice, may assist retention of GPs Develop the GPED role to include input into system changes, for example, streamlining primary/secondary care referral processes Utilise GPs as a resource to share learning and primary care philosophies with ED colleagues GPED roles can be used as a ‘stepping stone’ for those GPs yet to make longer-term career decisions Professional reciprocity and broadening clinical opportunities enhances both primary and secondary care ED = emergency department. GPED = GPs working in or alongside EDs.
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Perspectives of GPs working in or alongside emergency departments in England: qualitative findings from the GPs and Emergency Departments Study
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