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Responsibility for A&E workload

I write this blog after listening to an MP talk about their experience in A&E. I hope that what was said was hiding a deep understanding and a calculation of the problems and the solutions – but I fear not!

“A&E was very busy” – yes we know that.

“The A&E staff work very hard” – yes we know that as well – absolute heroes – I wouldn’t want to do it and it would seem that newly qualified doctors are less sure as well.

“We must provide more funding to A&E” – and hang it all on achieving 75% immunisation to flu – That does it for me! What a waste of time and effort if this is all they can say!

So let me introduce you to some of the real issues and let us look at who is responsible for solving them. It is no longer tenable to run a Health Service with such a focus on A&E without both understanding the problems and making headway to the solutions.

As a rule of thumb you can split the A&E attendances into three broad categories:

  • Common conditions
  • Medico/social collapse
  • Accidents

So let us look at these three groups as to what you might want to do:

Common conditions: A&E has becomes the single known and reliable treatment point for common conditions which present relatively acutely. This is a job for NHS England and the CCG working together to create other reliable access points. They only become reliable when members of the public know about them, trust them and are happy to use them – so a lot to do here.

The solution is a merging of NHS111, community pharmacy and GP out of hours services to create an integrated solution. This single service needs to be co-created with the public and fully integrated so they are able to advise and treat the majority of patients without referral to A&E. We will need to sort out NHS111 dispositions, engage community pharmacy, giving them better access to medicines and link with GP out of hours through teleconsultations. All three should be able to book patients into dedicated slots within the patient’s GP practice.

Medico/social collapse: Why is A&E the hospital front door for known patients who develop predictable medical or social problems? The government has pledged more money for health and social care to work together and some do. The management of the elderly and people with long term conditions must be the responsibility of a multidisciplinary team within primary care. They should predict problems and respond quickly with suitable support to manage patients within the community. If the patient requires admission to a hospital then this should be arranged directly with the hospital consultant or to a community run unit.

Last week I was asking why a GP co-operative looking after 80,000 people was not able to employ a consultant care of the elderly physician. The automatic response was we can’t. That is not good enough. Care of the elderly and those with long term conditions require the practices and the local authority grouping together to sort out their problems and manage their patients without the “bundling into an ambulance” scenario.

Accidents: well that is clearly the responsibility of the local authority and the emergency services. A large “shoutout” to the fire service who continue to work very hard to reduce the number of house and workplace fires. The police force also works tirelessly to reduce crime and antisocial behaviour. The local authority work hard to reduce the number of accidents in the home and I have seen falls services that really do some great work. There is great effort to reduce accidents on the roads.

And then let me turn this on its head. It is the responsibility of the community to make it safe for the people living there. People need to get together and work closer with all of the organisations that ‘deliver safety’ to ensure that they engage, work together and deliver what is needed. I say this because I have seen the work of community 2 community programs and I have stared in wonder and admiration when they present their results. If some of the most “troubled” communities can turn themselves around then we all can with the right support and willingness.

So the next time an MP or a civil servant goes into A&E ask the people why they are there and what could be provided or done to make it less likely that they would attend A&E.

A&E should only be for the accidents and emergencies that we could not have reasonably prevented or managed in a more appropriate service. Let’s cure the demand not feed the beast.

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About markmandc (249 Articles)
A pharmacist with experience working in secondary care, primary care, community pharmacy and general practice.

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