Report sets out plan for tackling urgent and emergency care pressures

BMJ 2013; 347 doi: (Published 18 July 2013) Cite this as: BMJ 2013;347:f4629
  1. Jacqui Wise
  1. 1London

A 10 point action plan to deal with the challenges faced by urgent and emergency care services has been laid out by the Royal College of Physicians, the NHS Confederation, the Society for Acute Medicine, and the College of Emergency Medicine.1

The plan, Urgent and emergency care: a prescription for the future, calls for greater collaboration in hospitals and for hospital services to work alongside general practice, social care, and mental health services to manage emergency patients. It says effective liaison between emergency departments and mental health services should be in place seven days a week.

The consensus document wants patients to have access to consultant led care, regardless of the day of the week. A consultant physician should always be available on call and should be present in the acute medical unit for at least 12 hours a day, seven days a week, with no other duties except the delivery of care to acute admissions.

The report also calls for an adjustment to the financial incentives across the system. It says that the marginal rate, which sees hospitals paid 30% of the tariff price for patients who are admitted above a baseline for emergency admissions in 2008-09, has not resulted in a reduction in such admissions. And it is not clear how the remaining 70% of the tariff has been reinvested and whether it has been spent on developing community care. The reduced tariff was introduced to encourage hospitals to act to cut emergency admissions.

The plan wants a simplified system so that patients have access to alternatives to hospital admission across seven days, effective discharge planning to support patients to leave hospital seven days a week, and greater investment in early intervention and preventative strategies.

The Royal College of Physicians says it will use the report in discussions with NHS England and the review currently taking place of emergency care services.2 The college’s Future Hospital Commission will make recommendations relating to many of these areas and report on 12 September 2013.

Chris Roseveare, president of the Society for Acute Medicine, said, “The recent pressures on acute services within the NHS have been unprecedented. Urgent action is required if we are going to prevent a further deterioration in the quality of care for patients admitted to hospital in an emergency. Collaboration by clinicians across traditional boundaries will be a vital part of the solution.”

Doctors who want to join the debate can go to


Cite this as: BMJ 2013;347:f4629


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