Feature Debate

How to fix out of hours care

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2356 (Published 27 April 2016) Cite this as: BMJ 2016;353:i2356
  1. Rebecca Coombes, head of features and investigations, The BMJ
  1. rcoombes{at}bmj.com

The BMJ recently held a discussion between experts in general practice, emergency medicine, and paediatrics about the state of out-of-hours care in the UK, and crucially, their vision for a better service. Are children a special case, can urgent care “hubs” be a silver bullet, is NHS 111 up to the job of triaging patients, are there enough clinicians involved in out of hours care, and are other countries doing a better job? Rebecca Coombes reports

Neena Modi, president of the Royal College of Paediatrics and Child Health

The state of out-of-hours care can best be described as “patchy.” Although some, even most, people receive good and timely care, they have to access a confusing plethora of services—walk-in centres, urgent care centres, out-of-hours centres, telephone consultation, and, that most recognisable of all NHS brands, the emergency department (A&E). But the experts on The BMJ’sdiscussion panel also identified serious deficiencies, which they attributed to core problems. Around the table were Clifford Mann, president of the Royal College of Emergency Medicine and an emergency medicine consultant in Taunton, Somerset; Neena Modi, professor of neonatal medicine at Imperial College, London and president of Royal College of Paediatrics and Child Health; and Martin Roland, professor of health service research at the University of Cambridge and who has 35 years experience as a general practitioner.

“There are signs all over the country directing people to emergency departments,” says Clifford Mann. “Patients go where they know for certain they will see a clinician. What they actually aren’t demanding is to see an emergency physician. They just want to see the right sort of person for them—maybe a pharmacist, or it could be a primary care practitioner such as a doctor or a nurse.” About a fifth of patients in emergency departments, says Mann, could be seen by other services, chiefly urgent out-of-hours primary care, but also …

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