Dr Andrew Hargraves fears for the future of A&E in Hereford County Hospital

2:59pm Thursday 20th November 2008

I WRITE in support of the members of Herefordshire’s Local Medical Committee for raising their concerns regarding the proposed “GP-led Health Centre”.

My own concerns regarding this centre were raised in the Hereford Times several months ago. At the time I was reassured Hereford PCT had, in response to a national policy decision, developed an innovative scheme that would integrate well into local primary care, and not prove a threat to traditional general practice. Sadly this decision has been reversed and, once again, the threat looms.

The LMC mention one ‘worst-case scenario’ of practices being forced to close. This would be a sad occasion, but I feel there is an even bleaker possibility.

All bar one of the parties bidding to run the new centre are, I believe, private sector companies. Their overriding priority would be, as is understandable for private enterprise, to maximise profits.

To do this they would have to see as many patients as possible. A significant proportion would, of course, come from existing practices. The main group targeted would be the 13,000 people annually who attend A&E with minor ailments. But what if the new centre decides to offer a minor injuries unit? If they do, there is a very real possibility the numbers attending A&E would drop below the threshold for maintaining a viable department. A&E itself could be scaled down, having a knock-on effect on the local GP vocational training scheme, which would cause difficulties in filling junior medical staff posts at the hospital and lead to a reduction in specialties offered at the County Hospital.

The casualty department at Kidderminster was scaled down due to insufficient patient numbers several years ago – and Kidderminster is now without a district general hospital.

I was also mystified at the implied criticism of city practices by the PCT representative, pointing out “only” half of the practices offer extended opening hours. I was mystified as it was made clear from the beginning of negotiations that the PCT were only expecting 50% of practices to offer extended hours – indeed, they only had sufficient funding for 50%. Even so, I believe more practices would have been prepared to move forward with plans for extended hours were it not for the 11th hour decision by the PCT to reduce, by half, funding promised to support this move.

I would strongly urge the PCT board to consider the options carefully, and, in making their decision on the provider of the new service, to choose the bid that will have least potential negative impact on both primary and secondary care in the county, rather than simply awarding the contract to the lowest bidder.

DR ANDREW HARGRAVES, Castle Mead, Weobley.