Threats and opportunities in accident and emergency

Accident and emergency departments may be the place where the public's and the professionals' views of health care most diverge. People persist in using departments for what many professionals consider “inappropriate” uses. They seem to be doing so increasingly and despite the fact that they may wait for hours on uncomfortable seats before seeing a rather junior doctor. The public undoubtedly feels cheated when a full blown department is replaced by a minor injuries unit. Yet the idea that every district general hospital needs an accident and emergency department is now being seriously challenged.

The immediate cause of the challenge is a staffing crisis. Already this year accident and emergency departments have had severe difficulties in recruiting senior house officers—the departments' traditional foot-soldiers. And in October …