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Two-tier system of A&E centres proposed

Changes to primary care essential in A&E overhaul

Adrian O'Dowd

Wednesday, 13 November 2013

A new system of two tier A&E departments should be introduced to help improve urgent and emergency care across England, claims NHS England in a major review published today.

The ambitious plans acknowledges that changes and improvements in primary care must also happen to allow that kind of transformation to take place and GP leaders have insisted that greater funding and resources including more GPs will be vital.

National medical director of NHS England Sir Bruce Keogh published a report on the first stage of his review of urgent and emergency care in England today.

The plan is to have a fundamental shift in provision of urgent care, with more extensive services outside hospital and patients with more serious or life threatening conditions receiving treatment in centres with the best clinical teams, expertise and equipment.

Sir Bruce wants to introduce two types of hospital emergency department – emergency centres and major emergency centres.

The former will be capable of assessing and initiating treatment for all patients and safely transferring them when necessary, whereas major emergency centres will be much larger units, capable of not just assessing and initiating treatment for all patients but providing a range of highly specialist services.

Sir Bruce said he envisaged around 40-70 major emergency centres across the country.

There should be a system-wide transformation over the next three to five years, and Sir Bruce said he expected significant progress over the next six months on several areas including:

  • identifying and getting transformational demonstrator sites to trial new models of delivery for urgent and emergency care and seven-day services
  • completing new NHS 111 service specification so that the new service - which will go live during 2015-16 - can meet the aspirations of the review.

The report acknowledges the pressures on GPs, saying: “We know that many parts of the system are already coping with sustained pressure and multiple demands, particularly GP practices which have themselves experienced significant increases in patient consultations in recent years.”

NHS England also wants to provide highly responsive urgent care services outside of hospital and says this will mean putting in place faster and consistent same-day, every-day access to GP, primary care and community services.

Dr Clare Gerada, chair of the RCGP, said she was pleased the report recognised the vital role of general practice and other community primary care services in providing care to patients with urgent needs.

“It is encouraging to see a report that sets out landmark changes in the way NHS emergency and urgent care will look in the future but that doesn't blame GPs,” she said.

“It explicitly recognises the sustained pressure and multiple demands on general practice in recent years, and the need to 'create headroom' to transform the way we work so that we can continue to provide safe care for our patients. For the recommendations in this report to become a reality, that 'headroom' has to include greater government funding and resources, including more GPs.”

Dr Mark Porter, chair of BMA Council, said: “There is no doubt that, where appropriate, we should seek to treat patients as close to home as possible, but to deliver this we need to carefully assess what is needed in terms of targeted funding, resources and staff.”

Nigel Edwards, senior fellow at The King’s Fund, said: “If the strategy outlined in the report is to succeed, it will depend on wider changes to improve care outside hospital. This includes reforms to primary care to ensure it better meets the needs of people with long term conditions by providing a wider range of services, closer to people’s homes.”

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