Approach to surgery in United Kingdom should be shaken up

doi:10.1136/bmj.323.7304.106/a

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Philip A Isaac, staff anaesthesiologist

Diplomate American Board of Anesthesiologists, St Anthony North Ambulatory Surgery Center, 6205 North Santa Fe, Suite 100, Oklahoma City 73118, USA

EDITOR—With respect to the article by Wilmore and Kehlet on the management of patients in fast track surgery, the NHS needs to overhaul its surgical model completely.1 Although there will always be a need for hospital based surgery for major procedures and for less major procedures in higher risk patients, many procedures could be performed more efficiently in outpatient surgical facilities.

When my father reached the top of the waiting list and had elective wrist surgery in an NHS hospital, he spent a night in …