Top of the news today is the ‘A&E crisis’. Before you get really worried, this ‘crisis’ is based on hospitals that are not meeting the 4 hour target. The system is NOT close to collapse. However, the solutions being put forward to solve this crisis are short term and not sustainable.
It’s essential we focus on the causes of rising attendance, not simply think that a sticking plaster of money and staff is the solution. The causes include poor patient and practice management by GPs, an increase in complex elderly patients, unresponsive social services and people who get drunk.
Pro-active GPs have shown that if they evaluate their patient calls in the morning, then the majority of patients can have their needs met without even going to see the GP. Some have employed community based doctors who can make home visits quickly to sort out patients problems before they become an emergency. Other GPs have examined their patient records and worked out which patients need extra management to help reduce the chances of a crisis in the future. In all cases A&E attendance has dropped dramatically.
The other issue is personal responsibility. During the week about 30% of attendance is due to people being drunk; at the weekend this can rise to 70%. We have to start fining people who abuse the system in this way.
We need to take a long term view of how we manage the complex elderly patient differently with a more multidisciplinary model across social and primary care, and not through A&E. Trauma patients should be dealt with by specialist centres not in your average local A&E department.
In the past hospitals have spent a lot of time and money trying to sort out their A&E problems, but because hospitals are just at the receiving end, nothing sustainable has been put in to place. Over all these are short term measures to get us over the next 12 months. The answer is to solve the problem of rising attendances. We cannot go on increasing staff and money.
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