Wider group of health professionals should be located in emergency departments, college says

The Royal College of Emergency Medicine has urged the government to co-locate general practitioners, psychiatrists, mental health teams, and community pharmacists in all hospital emergency departments in England to help ease current pressures.

Clifford Mann, chairman of the college, is to hold talks with the Department of Health this week to discuss plans to pilot the “hub” model across the country, after record attendances were reported at emergency departments in 2015.

Some emergency departments in England already have co-located GPs to triage patients and to ensure the large volumes of people presenting to emergency departments are treated in the right place.

Mann told The BMJ that the college now had support from across the NHS to scale this model up to include GP out-of-hours services, psychiatry, crisis teams, mental health teams, and community pharmacy in all departments, with links to dentistry, nursing, and palliative care.

“Our proposal is that the time has come to simplify the system. We think we are building a reasonably powerful consensus,” he said. “We have tried signposting patients to different services. We are not suggesting that people in other parts of the system are not trying hard. We are simply saying that despite our best endeavours, people are still turning up [to emergency departments]. Why don’t we put everything there?”

He added that the volume of people attending emergency departments this Christmas highlighted the need for integrated co-location. “Several [emergency] departments recorded record numbers or close to record numbers of daily attendances this Christmas,” he said. “The time has come to grasp this nettle.”

Mann said that the college was urging civil servants to support its plans and for NHS England to recommend the hub model in national guidance and plans. He said that the college would like to see the model piloted in 2016 and rolled out nationally from 2017.

“Over the next six months we want to get enthusiasts to sign up and others to follow. We want to create an unassailable argument for this,” he said.

Mann added that, although hospitals were much better prepared for handling the flow of patients this Christmas, with many opening up extra beds, emergency departments were still overwhelmed by the number of people attending.

“This year, it was quite clear that hospitals have been very proactive . . . opening up extra beds, for example. Unfortunately it means they’ve had to cancel quite a few operations but it means people have not had the same long waits [in emergency departments] as last year,” he said. “The patient experience was good. But we still had record attendances.”