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Shake up of emergency surgery needed

BMJ 1997; 315 doi: http://dx.doi.org/10.1136/bmj.315.7101.143d (Published 19 July 1997) Cite this as: BMJ 1997;315:143
  1. Jacqui Wise
  1. BMJ

    The Royal College of Surgeons of England has called for a major reorganisation of emergency surgical services which would lead to the merging of many smaller units.

    It says that the ideal emergency service would serve a population of around 500 000, with consultants in the main surgical specialties freed from other commitments while on emergency duty; services would also have 24 hour dedicated operating and imaging facilities.

    The president of the college, Sir Rodney Sweetnam, said: “Competing emergency services can no longer be provided by every district general hospital.” He added: “Trusts with only 200 000 patients which are competing against one another should pass into history, as frankly there aren't the resources.”

    Figure1

    Emergency surgical services are under strain

    JOHN GREIM/SPL

    Sir Rodney said that such reorganisation would not mean that hospitals would have to close, but hospitals would need to cooperate with each other. One hospital, for example, could provide the emergency services while its neighbour could concentrate on day case surgery, outpatient appointments, and specialist clinics.

    The college's report, The Provision of Emergency Surgical Services: an Organisational Framework, says that a major expansion in the number of consultants is needed for the changes to occur. But perhaps more importantly the public and politicians would need to recognise that it is not possible for each small hospital to provide a satisfactory service for surgical emergencies and that patients may need to travel to get such a service. Sir Rodney said that the service has become increasingly strained due to patients' rising expectations, the new specialist training arrangements for doctors, and the reduction in junior doctors' hours.

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