A recent policy paper from the College of Emergency Medicine (CEM), working with the Royal College of Paediatrics and Child Health, Royal College of Physicians and Royal College of Surgeons, proposes 13 recommendations to reduce the rising pressure on urgent and emergency care services, curb A&E waiting times and improve patient safety.
Acute and emergency care: prescribing the remedy. London: College of Emergency Medicine / Royal College of Paediatrics and Child Health / Royal College of Physicians / Royal College of Surgeons, July 2014.
Here is an “at a glance” verbatim quotation of the 13 CEM recommendations:
- Every emergency department should have a co-located primary care out-of-hours facility.
- Best practice that directs patients to the right care, first time, should be promoted across the NHS so as to minimise repetition of assessment, delays to care and unnecessary duplication of effort.
- All trainee doctors on acute specialty programmes should rotate though the emergency department.
- Senior decision-makers at the front door of the hospital, and in surgical, medical or paediatric assessment units, should be normal practice, not the exception.
- Emergency departments should have the appropriate skill mix and workforce to deliver safe, effective and efficient care.
- At times of peak activity, the system must have the capacity to deploy or make use of extra senior staff.
- Community and social care must be coordinated effectively and delivered 7 days a week to support urgent and emergency care services.
- Community teams should be physically co-located with the emergency department to bridge the gap between the hospital and primary and social care, and to support vulnerable patients.
- The delivery of a seven-day service in the NHS must ensure that emergency medicine services are delivered 24/7, with senior decision makers and full diagnostic support available 24 hours a day, including appropriate access to specialist services. This will require additional resources.
- The funding and targets systems for emergency department attendances and acute admissions are unfit for purpose and require urgent change.
- Delivering 24/7 services requires new contractual arrangements that enable an equitable work–life balance.
- It is essential that each emergency department and acute admissions unit has an IT infrastructure that effectively integrates clinical and safeguarding information across all parts of the urgent and emergency care system.
- If configured properly with significant clinical involvement and advice, NHS 111, NHS 24, NHS Direct and equivalent telephone advice services can help to reduce the pressures on the urgent and emergency care system.
There are separate CEM recommendations statements tailored for England, Northern Ireland, Scotland and Wales.
Workforce Issues (NHS Confederation)
The following briefing summarises conclusions drawn at meetings in February and March 2014 at the NHS Confederation’s Hospitals and Urgent and Emergency Care Forums (hosted by PwC). The main focus is on developing a flexible, integrated workforce to deliver urgent and emergency care 24 hours a day, seven days a week.
A workforce fit for the future: working together to improve the delivery of urgent and emergency care. London: NHS Confederation’s Hospitals Forum and Urgent and Emergency Care Forum, August 2014.
Disagreements between doctors and NHS officials about seven-day working has led to the British Medical Association (BMA) abandoning longstanding negotiations with NHS Employers.
Doctors walk out of seven-day service talks. London: BBC Health News, October 17th 2014.