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
Voices
On the last day of campaigning before the polling booths open, the SNP leader has written to voters in a final attempt to convince them to vote for independence
scotland decidesIs a huge gamble on oil keeping First Minister up at night?
Arts and Entertainment
Rosalind Buckland, the inspiration for Cider with Rosie died this week
booksBut what is it like to be the person who inspires a classic work of art?
Life and Style
techApple has just launched its latest mobile operating software – so what should you do first?
News
A male driver reverses his Vauxhall Astra from a tow truck
newsThe 'extremely dangerous' attempt to avoid being impounded has been heavily criticised
PROMOTED VIDEO
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
Life and Style
ebooksFrom the lifespan of a slug to the distance to the Sun: answers to 500 questions from readers
Arts and Entertainment
Lionel Messi in action for Barcelona
filmSo what makes the little man tick?
Arts and Entertainment
tvReview: An undercooked end (spoiler alert)
News
i100
Arts and Entertainment
Pharrell dismissed the controversy surrounding
musicThe singer said 'the last thing I want to do is degrade'
Sport
Cesc Fabregas celebrates his first Chelsea goal
footballChelsea vs Schalke match report
Arts and Entertainment
Toby Jones (left) and Mackenzie Crook in BBC4’s new comedy The Detectorists
tvMackenzie Crook's 'Detectorists' makes the hobby look 'dysfunctional', they say
Life and Style
fashion

Olympic diver has made his modelling debut for Adidas

News
i100
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

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

    iJobs Job Widget
    iJobs General

    Maths Teacher

    £110 - £200 per day: Randstad Education Leeds: Secondary Maths Teacher for spe...

    Maths Teacher

    £90 - £160 per day: Randstad Education Leeds: Secondary Science Teacher (mater...

    Maths Teacher

    £110 - £200 per day: Randstad Education Leeds: Secondary Maths Teacher for an ...

    Maths Teacher

    £22000 - £37000 per annum: Randstad Education Leeds: A West Yorkshire School i...

    Day In a Page

    Mystery of the Ground Zero wedding photo

    A shot in the dark

    Mystery of the wedding photo from Ground Zero
    His life, the universe and everything

    His life, the universe and everything

    New biography sheds light on comic genius of Douglas Adams
    Save us from small screen superheroes

    Save us from small screen superheroes

    Shows like Agents of S.H.I.E.L.D are little more than marketing tools
    Reach for the skies

    Reach for the skies

    From pools to football pitches, rooftop living is looking up
    These are the 12 best hotel spas in the UK

    12 best hotel spas in the UK

    Some hotels go all out on facilities; others stand out for the sheer quality of treatments
    These Iranian-controlled Shia militias used to specialise in killing American soldiers. Now they are fighting Isis, backed up by US airstrikes

    Widespread fear of Isis is producing strange bedfellows

    Iranian-controlled Shia militias that used to kill American soldiers are now fighting Isis, helped by US airstrikes
    Topshop goes part Athena poster, part last spring Prada

    Topshop goes part Athena poster, part last spring Prada

    Shoppers don't come to Topshop for the unique
    How to make a Lego masterpiece

    How to make a Lego masterpiece

    Toy breaks out of the nursery and heads for the gallery
    Meet the ‘Endies’ – city dwellers who are too poor to have fun

    Meet the ‘Endies’ – city dwellers who are too poor to have fun

    Urbanites are cursed with an acronym pointing to Employed but No Disposable Income or Savings
    Paisley’s decision to make peace with IRA enemies might remind the Arabs of Sadat

    Ian Paisley’s decision to make peace with his IRA enemies

    His Save Ulster from Sodomy campaign would surely have been supported by many a Sunni imam
    'She was a singer, a superstar, an addict, but to me, her mother, she is simply Amy'

    'She was a singer, a superstar, an addict, but to me, her mother, she is simply Amy'

    Exclusive extract from Janis Winehouse's poignant new memoir
    Is this the role to win Cumberbatch an Oscar?

    Is this the role to win Cumberbatch an Oscar?

    The Imitation Game, film review
    England and Roy Hodgson take a joint step towards redemption in Basel

    England and Hodgson take a joint step towards redemption

    Welbeck double puts England on the road to Euro 2016
    Relatives fight over Vivian Maier’s rare photos

    Relatives fight over Vivian Maier’s rare photos

    Pictures removed from public view as courts decide ownership
    ‘Fashion has to be fun. It’s a big business, not a cure for cancer’

    ‘Fashion has to be fun. It’s a big business, not a cure for cancer’

    Donatella Versace at New York Fashion Week