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| A&E care requires overhaul amid rising pressure of patient numbers – report | A&E care requires overhaul amid rising pressure of patient numbers – report |
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| GP surgeries should be set up at hospitals to ease the growing pressure on accident and emergency units, which are struggling to cope with an "unsustainable" increase in patients, a report from the UK's emergency doctors warns. | GP surgeries should be set up at hospitals to ease the growing pressure on accident and emergency units, which are struggling to cope with an "unsustainable" increase in patients, a report from the UK's emergency doctors warns. |
| Family doctors, as well as nurses and specialists in looking after frail elderly people, need to assess and treat as many as 30% of the patients arriving at hospital and keep them away from the casualty departments, according to the College of Emergency Medicine (CEM), which represents the NHS's 4,000 A&E doctors. | Family doctors, as well as nurses and specialists in looking after frail elderly people, need to assess and treat as many as 30% of the patients arriving at hospital and keep them away from the casualty departments, according to the College of Emergency Medicine (CEM), which represents the NHS's 4,000 A&E doctors. |
| The call for extra services to help tackle the crisis in A&E departments coincided with a warning from hospital managers that the whole emergency treatment system might collapse next winter unless urgent changes were made to funding. The Foundation Trust Network says the present funding system penalises A&E departments seeing more patients. | |
| A report by the CEM, based on a survey of conditions at 131 of the UK's 248 A&E units, calls for a major overhaul of how emergency care is delivered. It urges a big expansion of what it calls "co-located primary care services" – especially GP services and urgent care centres – to look after between 15% and 30% of those arriving as emergency cases. | |
| These services could attend to patients with more minor illnesses, such as sore throats, sore stomachs and colds, coughs and flu-like symptoms, leaving A&Es to deal with more serious cases, said Dr Taj Hassan, the college's vice-president, who is a consultant in emergency medicine in Leeds. | These services could attend to patients with more minor illnesses, such as sore throats, sore stomachs and colds, coughs and flu-like symptoms, leaving A&Es to deal with more serious cases, said Dr Taj Hassan, the college's vice-president, who is a consultant in emergency medicine in Leeds. |
| In addition, frail elderly patients could be assessed by suitably-qualified nurse practitioners, said Hassan. The ageing population forms an increasing proportion of all emergency arrivals. | In addition, frail elderly patients could be assessed by suitably-qualified nurse practitioners, said Hassan. The ageing population forms an increasing proportion of all emergency arrivals. |
| Growing concern about the ability of A&E units to cope with rising demand, expressed by the Care Quality Commission watchdog and others, last week forced ministers to announce a hastily assembled plan. New "urgent care boards" will devise "local recovery and improvement plans" for hospitals where emergency services are under the greatest pressure. The CEM recently said the sometimes chaotic situation in many A&Es meant they were becoming like "warzones". | Growing concern about the ability of A&E units to cope with rising demand, expressed by the Care Quality Commission watchdog and others, last week forced ministers to announce a hastily assembled plan. New "urgent care boards" will devise "local recovery and improvement plans" for hospitals where emergency services are under the greatest pressure. The CEM recently said the sometimes chaotic situation in many A&Es meant they were becoming like "warzones". |
| The college urges ministers and the NHS to double the number of A&E consultants to 3,200, and increase by 50% the number of middle-grade doctors or registrars in the speciality, to reduce the workload of those in post now and stop emergency medicine becoming a speciality that future doctors choose to avoid. All A&Es should have at least 10 consultants so that a senior doctor is in charge for 16 hours a day every day, and larger units should have 16, but many currently have 7.5 consultants, said Hassan. | The college urges ministers and the NHS to double the number of A&E consultants to 3,200, and increase by 50% the number of middle-grade doctors or registrars in the speciality, to reduce the workload of those in post now and stop emergency medicine becoming a speciality that future doctors choose to avoid. All A&Es should have at least 10 consultants so that a senior doctor is in charge for 16 hours a day every day, and larger units should have 16, but many currently have 7.5 consultants, said Hassan. |
| It highlights that "never events", which pose a serious threat to patient safety, such as wrong-site surgery or a piece of surgical equipment being left inside a patient after an operation, occurred in 2011-12 in 6% of the 131 emergency departments it surveyed. | It highlights that "never events", which pose a serious threat to patient safety, such as wrong-site surgery or a piece of surgical equipment being left inside a patient after an operation, occurred in 2011-12 in 6% of the 131 emergency departments it surveyed. |
| The CEM also backs the reshaping, merger or closure of A&E units on a significant scale to help improve quality of care – about 25% to 30% of units are already involved in discussions about such changes, said Hassan – and changes to the "tariff" system under which A&Es are paid for the care they provide. | The CEM also backs the reshaping, merger or closure of A&E units on a significant scale to help improve quality of care – about 25% to 30% of units are already involved in discussions about such changes, said Hassan – and changes to the "tariff" system under which A&Es are paid for the care they provide. |
| Present funding arrangements designed to encourage a reduction in A&E admissions mean hospitals are only paid 30% of the normal fee when numbers rise above levels seen five years ago. That means a rise in patients is costing some hospitals millions of pounds a year. | |
| Chris Hopson, chief executive of the Foundation Trust Network said: "A&E services have been under huge pressure and although performance is now stabilising, there is a danger the system will fall over in six months' time unless we plan effectively for next winter." | |
| Hospitals were already running close to capacity in winter so small changes in the number of patients needing to be admitted created major problems. "The wider NHS system isn't working effectively. Patients can't get the GP appointments they need, many doctors out of hours' services aren't working in the way they should and patients simply don't know where they should be going to get the right emergency care. So up to 30% of people in A&E shouldn't even be there in the first place," said Hopson. | |
| "Two thirds of hospitals are admitting more patients than they did five years ago, some as many as 40% more. This means re-opening wards and employing more staff to cope with this extra demand. Yet hospitals only get paid 30% of these costs. Some are losing more than £5m a year as a result, on top of the 5% savings they're already being required to make. This can't be right." | |
| Norman Williams, president of the Royal College of Surgeons, said A&Es were under "relentless pressures. We hear from our members that the current crisis in emergency departments in parts of the country is hampering access to emergency theatres and intensive care facilities and preventing consistent access to consultant-led care," he said. Elective surgery was also being disrupted as a result, he added. | Norman Williams, president of the Royal College of Surgeons, said A&Es were under "relentless pressures. We hear from our members that the current crisis in emergency departments in parts of the country is hampering access to emergency theatres and intensive care facilities and preventing consistent access to consultant-led care," he said. Elective surgery was also being disrupted as a result, he added. |
| Shadow health spokesman Jamie Reed said: "It has come to something when A&E doctors issue statements like this. Sadly, they are right to warn that A&Es have become unsustainable on David Cameron's watch. These are well-considered warnings from senior A&E staff on the very frontline of the NHS." | Shadow health spokesman Jamie Reed said: "It has come to something when A&E doctors issue statements like this. Sadly, they are right to warn that A&Es have become unsustainable on David Cameron's watch. These are well-considered warnings from senior A&E staff on the very frontline of the NHS." |