Top doctor calls for two-tier A&E to relieve NHS casualty wards 'creaking at the seams'

Sir Bruce Keogh proposes that GPs, local pharmacists, paramedics and the NHS 111 telephone service should all do more to keep people out of hospital

Health Reporter

The NHS should have a two-tier A&E system and the role of telephone consultations with GPs and nurses should be greatly expanded to take the pressure off casualty wards that are “creaking at the seams,” England’s top doctor has said, in the biggest proposed shake-up of NHS emergency care since the 1970s.

Sir Bruce Keogh, NHS England’s medical director, said in a report that the majority of patients with minor conditions should be treated “as close to home as possible”, while treatment for the most serious medical emergencies should be concentrated at a small handful of high-performing “major emergency centres”.

GPs, local pharmacists, paramedics and the NHS 111 telephone triage service should all do more to keep people out of hospital, while A&E wards should be redefined, the report said. Under the plans, between 40 and 70 A&E units with the most specialist equipment and expertise will become the first port of call for around 5 per cent of patients with the most serious conditions – such as heart attacks and strokes – while another 70 to 100 will be known as “emergency centres” to treat serious conditions that may not require specialist intervention.

The report, which comes as the NHS braces itself for what doctors warn could be the “worst winter yet” for A&E overcrowding, sets out a  three-to-five-year timeframe for reform. However, the Royal College of Emergency Medicine said the crisis was “here with us now” and warned that the NHS was failing to address drastic shortages in the number of doctors training for senior positions on casualty wards. One in five emergency admissions to hospital could have been avoided last year and 40 per cent of patients who attend A&E are discharged without treatment, the report said.

Its recommendations include GPs and social carers doing more to treat people in the community; 111 telephone services being enhanced to make it easier for patients to speak to clinicians; and paramedics receiving broader training and having better access to specialist advice in order to treat patients at the scene rather than bring them into hospital.

He said the reforms were “the only way to create a sustainable solution” to the crisis while maintaining “a rapid, high-quality and responsive service, free at the point of need”. He said: “The last time we had a systematic review of emergency care services was in the 1970s. Since then medical science has advanced dramatically, technology has advanced, society has changed. People are living longer, which brings multiple health problems, and expectations from the public have changed.”

He said that, in a rush to meet growing demand, the NHS had introduced more than 20 different “bolt-ons” to A&Es – such as walk-in centres, minor injury units and urgent care centres – which had created “a whole heap of confusion” about where patients should go to be treated. All such services should be grouped together under “a standardised name”, he said.

Plans for a two-tier A&E system – under the working title “emergency centres” and “major emergency centres” – are based on successful reforms to the way the NHS handles heart attack patients in a small number of specialist centres and the concentration of London’s stroke services from 32 to 8 hospitals – both of which have dramatically improved survival rates. The report was broadly welcomed by the medical profession, but the Royal College of Emergency Medicine said that problems on casualty wards were a result of a staffing crisis which the report did nothing to address.

“The current crisis is a lack of recruitment and subsequent retention of senior trainees and consultants in emergency medicine in the UK,” Dr Clifford Mann, the college’s president, said. “Any plan to provide emergency care must be based upon an adequate number of appropriately skilled clinicians and on this matter the review is disappointingly silent.”

Jeremy Hunt, the Health Secretary, said the NHS needed to change but that this would not happen “overnight”. “We’ve already taken action to help the NHS cope, investing £500m to help with winter pressures and agreeing a £3.8bn integration fund to look at joining up health and care services,” he said.

Suggested Topics
Life and Style
ebookNow available in paperback
ebooks
ebookA delicious collection of 50 meaty main courses
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
SPONSORED FEATURES

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Recruitment Genius: Sales Executive or Senior Sales Executive - B2B Exhibitions

    £18000 - £30000 per annum: Recruitment Genius: A Sales Executive or Senior Sal...

    Recruitment Genius: Head of Support Services

    £40000 - £55000 per annum: Recruitment Genius: This is an exciting opportunity...

    Recruitment Genius: Warehouse Team Leader

    £22000 per annum: Recruitment Genius: This industry leading company produces h...

    Recruitment Genius: Business Development Manager / Sales - OTE £40,000

    £20000 - £40000 per annum: Recruitment Genius: This IT provider for the educat...

    Day In a Page

    The Silk Roads that trace civilisation: Long before the West rose to power, Asian pathways were connecting peoples and places

    The Silk Roads that trace civilisation

    Long before the West rose to power, Asian pathways were connecting peoples and places
    House of Lords: Outcry as donors, fixers and MPs caught up in expenses scandal are ennobled

    The honours that shame Britain

    Outcry as donors, fixers and MPs caught up in expenses scandal are ennobled
    When it comes to street harassment, we need to talk about race

    'When it comes to street harassment, we need to talk about race'

    Why are black men living the stereotypes and why are we letting them get away with it?
    International Tap Festival: Forget Fred Astaire and Ginger Rogers - this dancing is improvised, spontaneous and rhythmic

    International Tap Festival comes to the UK

    Forget Fred Astaire and Ginger Rogers - this dancing is improvised, spontaneous and rhythmic
    War with Isis: Is Turkey's buffer zone in Syria a matter of self-defence – or just anti-Kurd?

    Turkey's buffer zone in Syria: self-defence – or just anti-Kurd?

    Ankara accused of exacerbating racial division by allowing Turkmen minority to cross the border
    Doris Lessing: Acclaimed novelist was kept under MI5 observation for 18 years, newly released papers show

    'A subversive brothel keeper and Communist'

    Acclaimed novelist Doris Lessing was kept under MI5 observation for 18 years, newly released papers show
    Big Blue Live: BBC's Springwatch offshoot swaps back gardens for California's Monterey Bay

    BBC heads to the Californian coast

    The Big Blue Live crew is preparing for the first of three episodes on Sunday night, filming from boats, planes and an aquarium studio
    Austin Bidwell: The Victorian fraudster who shook the Bank of England with the most daring forgery the world had known

    Victorian fraudster who shook the Bank of England

    Conman Austin Bidwell. was a heartless cad who carried out the most daring forgery the world had known
    Car hacking scandal: Security designed to stop thieves hot-wiring almost every modern motor has been cracked

    Car hacking scandal

    Security designed to stop thieves hot-wiring almost every modern motor has been cracked
    10 best placemats

    Take your seat: 10 best placemats

    Protect your table and dine in style with a bold new accessory
    Ashes 2015: Alastair Cook not the only one to be caught in The Oval mindwarp

    Cook not the only one to be caught in The Oval mindwarp

    Aussie skipper Michael Clarke was lured into believing that what we witnessed at Edgbaston and Trent Bridge would continue in London, says Kevin Garside
    Can Rafael Benitez get the best out of Gareth Bale at Real Madrid?

    Can Benitez get the best out of Bale?

    Back at the club he watched as a boy, the pressure is on Benitez to find a winning blend from Real's multiple talents. As La Liga begins, Pete Jenson asks if it will be enough to stop Barcelona
    Athletics World Championships 2015: Beijing witnesses new stage in the Jessica Ennis-Hill and Katarina Johnson-Thompson heptathlon rivalry

    Beijing witnesses new stage in the Jess and Kat rivalry

    The last time the two British heptathletes competed, Ennis-Hill was on the way to Olympic gold and Johnson-Thompson was just a promising teenager. But a lot has happened in the following three years
    Jeremy Corbyn: Joining a shrewd operator desperate for power as he visits the North East

    Jeremy Corbyn interview: A shrewd operator desperate for power

    His radical anti-austerity agenda has caught the imagination of the left and politically disaffected and set a staid Labour leadership election alight
    Isis executes Palmyra antiquities chief: Defender of ancient city's past was killed for protecting its future

    Isis executes Palmyra antiquities chief

    Robert Fisk on the defender of the ancient city's past who was killed for protecting its future