Partha Kar

Time to get your house in order over A&E

First it was all a bit of ‘fun’, then it was black humour and now it’s just silly. We seem to be falling over each other to blame someone for the A&E crisis.

GPs, risk averse junior doctors, social services…what have I forgot…ah yes, work shy specialists, lazy nurses and of course those naughty patients. Now it’s everyone’s fault.

I have read reams of paper on what needs to happen; interestingly everyone has the answer, on a power point or a flip chart. And I have been seeing the same ‘blocks’, same ‘solutions’, since 2008.

I am pretty sure they have been around since before that, but I continue to be bemused – bemused that no one has been able to implement all the sage advice.

So, you know what, I’ve got some tips for acute trusts and their commissioners:

1. Policy-makers: Stop being risk averse. You will never get the perfect mix. Sometimes you have to take a leap of faith to make things happen. Cut down on the endless meetings and debates and start somewhere. You think you have heard about the perfect model from the Kings Fund/Nuffield Trust/Faculty of Leadership – put it in place. See what happens. Allegedly it can’t get any worse.

2. Leaders: Stop lecturing others. If you are a specialist, don’t lecture a GP how to run primary care. You don’t do their job and possibly think the world revolves around your speciality so give it a break. Vice versa by the way.

3. Leaders: Stop trying to please everyone. It doesn’t work. This isn’t the X-Factor, so there is no prize at stake by winning the popular vote. If you feel that every patient needs review everyday by a senior, either physically or at the very least a discussion with juniors and nurses, then implement it. If job plans say they should be doing it and are not, then haul them to account. If not job planned then make it happen. Doing structured regular morning ward rounds isn’t rocket science…

4. Physicians: If you work in a DGH and are a physician, stop behaving like a super specialist. You are a general physician with skills in another particular speciality. By all means fulfil your specialist responsibility but AFTER you have done your generalist role for the hospital, working with your acute medical colleagues. Don’t ask the diabetologist or respiratory physician to pick up your patient with cellulitis. You went to medical school, it’s not that complex. They are as busy as you with their outpatient work, so give it a rest.

5. Commissioners: If you think something needs to happen, commission it boldly. A provider should deliver what is commissioned, so if you feel regular early reviews are essential, put it in the commissioning document. Heck, even CQUIN it for a laugh.If it’s not done, hold the provider to account.

6. Commissioners: If you want to create a more integrated approach to unscheduled care, go to one provider rather than Tom, Dick and Harry, all trying to create a business margin off the poor patient. If people prefer to go to A&E, fair enough, equip it to deal with the higher pressure. Stop using phones, mobiles, telehealth or whatever else to try and create “another” avenue. Hey, how about even considering using the acute trust as the one provider organisation?

I have one simple mantra in life – you can point fingers at others when your own house is in order. During my training, I saw immense variability as to how acute trusts work. So, if you want to blame social care and GPs, go a head but AFTER your own house in tip top condition.

‘Yes’, we all know that social care is struggling, but when there are so many issues to tackle, it would make any analysis easier if the acute part of the system was delivering everything it ought to.

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One Response to “Time to get your house in order over A&E”

  1. Blue Teeth says:

    Hmmm, not sure exhorting policy wonks to be ‘risk averse’ is the greatest way forward. How about a round of proper clinical engagement first, before just listening to the latte-sitting nerds that populate our less-than-objective think tanks (and who have rarely stepped inside a hospital, let alone dealt with a real patient).
    Take you point on generalism though – amazing how some acute trusts are set up, with many med specialties able to avoid acute and gen med just through pre-eminence and ‘strong’ characters internally. Let’s get back to basics…

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