Report calls for co-location of primary care with A&E

BMJ 2015; 350 doi: (Published 04 June 2015) Cite this as: BMJ 2015;350:h3011
  1. Jacqui Wise
  1. 1London

Primary care services should be located alongside hospital emergency departments, a new report from the Royal College of Emergency Medicine and the Patients Association concludes.1

The report said that patients continued to go to emergency departments even when they were aware of the alternatives, such as out-of-hours GP services, walk-in centres, and the NHS 111 telephone service. In many cases this was because the alternative services may not have had enough capacity or were not available when needed. However, the report added that a substantial and increasing number of patients attended emergency departments because other healthcare providers advised them to.

The joint report recommended co-location of urgent care services on one site so that patients could be triaged appropriately to the necessary emergency or urgent care service. It said that this configuration of services would optimise interventions, minimise duplication, and simplify what was currently a very fragmented system of out-of-hours care.

Co-location of services was recommended by the review of urgent and emergency care by Bruce Keogh, medical director of England’s NHS, in 2013.2 But a recent survey by the Royal College of Emergency Medicine found that only 43% of hospital emergency departments in the United Kingdom had a co-located primary care facility.

In 2014 14.6 million patients attended hospital emergency departments in England, placing the service under enormous pressure. Previous research by the college showed that 15% of such patients could be seen safely in the community if they could get an appointment within 24 hours. And this figure rose to 22% if primary care services were co-located.

The new report was based on the results of an open access survey run on the Patients Association website. A total of 924 responses were received, all from people who had previously attended an emergency department for an urgent healthcare need. Nearly 40% of respondents said they had been advised to attend the emergency department by other healthcare providers.

The survey also showed that patients were unwilling to wait even a short time for a GP appointment if they thought their problem was urgent. Almost a quarter of patients (23%) had contacted their GP surgery to make an appointment before presenting to the emergency department. Of these, 45% had been told that they could be seen the same day, with an average appointment time within three hours of their telephone call.

The report said that co-located services should include emergency medicine doctors, GPs, primary and secondary care nurses, frailty teams, palliative care teams, and mental health teams. Pharmacists and dentists would add to the efficiency and effectiveness of the service, it said.

Katherine Murphy, chief executive of the Patients Association, said, “The arguments for co-location are compelling. Now is the time to act to decongest A&E departments and, in so doing, benefit all patients.”


Cite this as: BMJ 2015;350:h3011


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