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Who’s to blame for overcrowding in accident and emergency departments?

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2871 (Published 07 May 2013) Cite this as: BMJ 2013;346:f2871

Rapid Response:

Re: Who’s to blame for overcrowding in accident and emergency departments?

Dear editor,

Spence states that the government wished to take the 24 hour responsibility from GPs to improve efficiency. (1)

As I recall it, this decision had more to do with the Carson report and the European working time directive. (2)

The government was committed to reduce 'unacceptable variation' and improve the quality of out of hours services. This was laudable, but may not be achievable. (3)

The four hour targets in A&E and the 24 / 48 hour targets for access to primary care have undoubtedly served to raise expectation and lower thresholds to care.

Lower thresholds to obtain a more attractive free product have led to an increased footfall.

I am confused, was this not the aim of the exercise? Was any other outcome plausible?

(1) Spence, D. BMJ 2013;346:f2871, http://www.bmj.com/content/346/bmj.f2871

(2) Harrison, J, HSJ, 25/06/2007. Lessons learned in out-of-hours care. http://www.hsj.co.uk/resource-centre/lessons-learned-in-out-of-hours-car...

(3) Iacobucci, G, pulse 05/02/2010. Government to bring in national model contract for out-of-hours care. http://www.pulsetoday.co.uk/government-to-bring-in-national-model-contra...

Competing interests: No competing interests

20 May 2013
Hendrik J Beerstecher
GP principal
Canterbury Road Surgery
111 canterbury road sittingbourne kent ME10 4JA