A debt-ridden primary care trust has met fierce opposition from its local hospital over proposals to have accident and emergency arrivals triaged by primary care staff.

North Yorkshire and York PCT, thought to be the country's most indebted with a£45m in-year overspend, drew up plans to send emergency care practitioners into the A&E department at York Hospital to divert appropriate cases back to primary care. But hospital consultants have bitterly opposed the proposals.

Hospital sources said the scheme was due to start on Monday this week. The PCT said discussions were 'ongoing' but denied that a start date had been postponed.

A&E consultant Steve Crane told HSJ: 'The policy they [the PCT] sent us was that anybody who walked into A&E would be seen first by an emergency care practitioner employed by the PCT. Only those deemed to be requiring the skills of A&E would be sent round to see us.

'The way they described it was as something very separate, with emergency care practitioners triaging patients - something they are not fully trained to do.'

He said there had been no consultation on the proposal and the PCT had not responded to e-mails asking for more information. 'It has been railroaded through,' he said.

Dr Crane added: 'Everyone is clear that there are people in A&E who should not be there. I have spent 18 months talking about developing an integrated service where primary care doctors and nurses come over to work with us; we see patients together and work out the finances afterwards.'

York Hospitals trust chief operating officer Mike Proctor said: 'The current proposal is not acceptable. The model is not good for patients and has some operational issues.' He said he was keen to talk to the PCT about alternative ways forward.

A PCT spokesman confirmed there were ongoing talks with both York Hospitals trust and Harrogate and District foundation trust about PCT staff taking over responsibility for dealing with patients when they first arrive in A&E at evenings and weekends.

He said: 'This could involve closer partnership working between A&E staff and their PCT colleagues, with the PCT involved in triage and signposting patients to the most appropriate care. If agreed, doctors and nurses employed by the PCT would work in the department, freeing A&E staff to use their skills more appropriately or where needed most.'

The foundation trust said it continued to work with the PCT with regard to its financial challenges. A spokesperson said the trust had suggested an alternative model to that proposed by the PCT, which included better promotion of urgent care and out of hours services, and the use of a primary care 'stream' which could follow triage in A&E.

Protests flare over cost-cutting measures

The rows over triage schemes come hot on the heels of an increasingly bitter protest over North Yorkshire and York primary care trust's plans to save£10m by the end of March.

A demand management programme has provoked a fierce battle with GPs and the local press. The imposition of minimum waiting times on acute trusts has also been unpopular, although less publicly so.

The PCT has drawn up a list of treatments and diagnostic services that it will not fund except in exceptional circumstances.

Some are subject to an indefinite ban while others have been suspended for three months. Indefinite exclusions include anal skin tags and treatment of all non malignant skin lesions. Services suspended for three months include varicose veins, IVF and direct access MRI and CT scans.Exceptions are reviewed by a PCT panel of two doctors and two managers.

North Yorkshire local medical committee has advised members not to co-operate, saying that the system could be harmful to patients.

Dr Doug Moederle-Lumb, LMC deputy medical secretary said: 'We know our referrals will be sent back to us, but our advice is that any GP who goes along with this scheme could fall foul of the GMC.'

He was extremely critical of the PCT, saying there had been no consultation on setting up its priority approval and 'negligible' opportunity for clinical leadership. The LMC was not against changing referral patterns, but this must be done in conjunction with pathway redesign and setting up alternative services, he said.

He added: 'Serious damage has been done to relationships between this fledgling organisation, GPs, consultants and the general public.'

One hospital manager said the imposition of minimum waiting times was proving extremely challenging. 'We have a very narrow window in which to operate,' she said. 'Too soon and we don't get paid. Too late and we breach targets.'