‘Two tier’ accident and emergency departments proposed by NHS England to ease growing crisis

Posted: 13/11/2013


Radical plans to overhaul the way in which accident and emergency (A & E) departments are organised are to be unveiled today (Wednesday, 13 November 2013). The review by NHS England will suggest setting up ‘major emergency centres’, large units specialising in treating heart attacks, strokes and trauma, with other ‘emergency centres’ intended to treat less seriously ill patients. Under the plans, the existing 140 A&E units would be divided into around 40 to 70 A&E units to be designated as major centres with the remaining 70 to 100 emergency centres dealing with less seriously ill patients. A similar approach is already being adopted in London for the treatment of stroke.

The measures have been put forward to tackle growing pressures on A & E departments and growing concerns about how A & E departments can cope with rising patient numbers amid many instances of missed targets and patient safety incidents. The review also recommends changes to the way that the ambulance service and new 111 service operate with the objectives of easing the pressure on A&E units and encouraging greater co-ordination between primary care services in the community, such as GPs and hospital services.

It is estimated that about 40% of people who attend A&E do not need treating there. In addition, the review considers that half of ambulance call outs could be treated at the scene. For example, it is reported that one ambulance service, South East Coast Ambulance, has been working towards this by giving paramedics extra training so they can treat a range of physical injuries and wounds without taking patients to A&E. The review also wants to see greater integration of primary care services such as GPs, walk-in centres, minor injury units and pharmacies working together to provide access to care 24 hours a day, seven days a week, to ease the pressure on A&E departments.

NHS England medical director Prof Sir Bruce Keogh, who led the review, said: "A&E is creaking at the seams. It is not broken, but it is struggling. We need to change the way we work. But what we are suggesting here already exists in places, we are just trying to formalise it so it is available for everyone."

Guy Forster, clinical negligence partner in the Cambridge office of Penningtons Manches, said: “We totally agree that there is a need to rethink how accident and emergency services are organised in the long term. Time and time again we see the effects of a service that is under pressure, often with too few senior doctors and nurses on hand to treat the volume of patients they see.

“The real challenge is to ensure that patients are seen by the appropriate person in the appropriate place, whether that be someone with a life-threatening illness getting to a major specialist centre or a minor injury being treated in the community. All too often we are contacted by people who have suffered as a result of misdiagnosis or incorrect treatment, frequently by junior or non-specialist health professionals. A successful reorganisation of services must be one that is properly resourced at every level and will not result in the downgrading of some units in the hope that primary care services can pick up the pieces.”


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