The government must provide effective alternatives to A&E for patients without acute severe illness or injury seven days per week and at least 16 hours per day.
This is key demand from the College of Emergency Medicine, which has released action points for addressing the growing crisis in emergency care.
A&E cannot mean ‘anything and everything’, no other healthcare system works in this way, it says.
Dr Clifford Mann, president of the College of Emergency Medicine, said: “For over a year now the college has been warning about the pressures in the healthcare system which combine at A&E departments to create real challenges for those working very hard to deliver an effective patient service.
“We need urgent action by all stakeholders to work with us to provide a stable long term future for A&E services whilst tackling the short term immediate pressures.”
The college has identified five priorities for the government and NHS leadership address this crisis. The other four are:
– amending the tariffs so acute trusts are not penalised by each and every non-elective admission. Perverse incentives produce dysfunctional systems, they say.
– ensuring ‘exit block’ does not occur.
– revising the current employment contracts to better recognise evening, night and weekend work as well as the intensity of A&E work.
– ensure money is spent wisely and strategically. Last year £120 million was spent on EM locums, and it’s a feature of a fragile system, it says.
Mann said: “Our proposals are the collective view of practicing emergency physicians; they represent cost-effective solutions to ensure we can deliver safe patient care.”
Trusts have struggled to hit A&E waiting time targets all year, which is raising concern with winter approaching. Twice as many trusts missed the target to see patients within four hours of them arriving at A&E in the second quarter of this year compared with the same period in 2012/13.
Dr Mark Porter, chair of BMA council, commented: “Rising demand and funding pressures together with a retention and recruitment crisis mean emergency departments are being stretched to breaking point. Doctors and other staff are working in some of the most challenging conditions in the NHS.
“The disastrous roll out of NHS 111, which should have alleviated pressure on hospital admissions, instead led to many patients being directed to emergency departments unnecessarily, making the problem worse.
“The priorities outlined by the CEM highlight the importance of a system-wide approach to dealing with this crisis. In addition to greater funding and attracting and retaining more staff we also need to ensure only those who should be, are being treated in emergency departments.”
In September, the government created an ‘A&E bailout fund’ which will see the 53 trusts most at risk of heavy demand getting to share £235m of extra funding.