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Trend to dissuade patients from attending A&E is flawed

Emergency doctors ‘concerned’ by appeals

Jo Carlowe

Wednesday, 24 February 2016

Emergency doctors have slammed hospital appeals that call on patients to not attend A&E “unless emergency care is needed”. 

The Royal College of Emergency Medicine has described this trend as “concerning” and notes that similar calls have been made across the UK. Instead, it says measures to tackle A&E pressures, drawn up by the College last year, should be introduced, rather than the blame placed on patients. 

The College states that higher admissions rates, reflect changes in the population. 

“In simple terms many of those coming to us are increasingly elderly; many have several illnesses both acute and chronic, are very ill and therefore require more time and attention.

“The challenges facing social care and GP colleagues are well documented and where those services are under severe pressure then it is no surprise that people attend the place that is always open. A&E is a trusted brand but whilst the service is resourced to provide emergency care it is increasingly asked to provide care that historically was provided by other services.”

The College’s STEP campaign, launched last year, aims to tackle these challenges. STEP calls for: 

  • Staffing expansion: to grow the workforce numbers to meet demand. 
  • Tariff reform: to allow hospitals to invest in A&E services rather than lose money on them, which is currently the case. 
  • Terms and conditions improvements: to try and retain doctors in Emergency Medicine by providing a sustainable rota pattern. 
  • Exit Block: for the NHS to invest time and resources into speeding the flow of patients through hospitals so that patients no longer requiring hospital care are repatriated promptly enabling patients requiring admission access to acute beds whenever needed. 
  • Primary Care Co-location: to group services around the A&E so that GP out-of-hours care, pharmacy services and mental health teams are co-located alongside each A&E. 

Commenting, the College’s president Dr Clifford Mann, said: “We don’t blame patients for coming. We’re here to treat those who are sick and injured. However, this is a supply and demand problem: we’ve been calling for more investment to expand the number of A&E doctors and nurses for some time. Currently there is one A&E consultant for every 11,000 patients attending an A&E. Despite more doctors in training, the growth of our workforce isn’t keeping pace with the rise in patient numbers. We don’t see shutting or merging A&Es as the answer – indeed there is good evidence that this has exacerbated the problem. Any reconfiguration must start with what best serves patient needs. 

“There are times when we experience peak demands and in those moments we know patients will understand that we have to prioritise the care for those most in need. At those times, with staff working flat out to ensure those most sick are attended to, as a last resort we appeal for those who can wait to do so or even come back another day to ease the pressures. If that happens we ask for co-operation and understanding.” 

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