Intended for healthcare professionals


Crisis in A&E: start making sense

BMJ 2019; 365 doi: (Published 13 May 2019) Cite this as: BMJ 2019;365:l2193
  1. Gareth Iacobucci
  1. The BMJ

One of the biggest current challenges in the NHS is how to tackle the rising tide of emergency department attendances. Gareth Iacobucci reports on the latest ideas

The NHS in England has been trying to get to grips with rising numbers of accident and emergency (A&E) attendances and admissions for several years, with the 2013 Keogh review, the 2014 Five Year Forward View, and the recent long term plan all proposing various solutions.1234

But still the trend continues. The latest figures show a 7% rise from April last year in the number of daily attendances at major hospital emergency departments and the worst performance on record against the target for 95% of A&E patients to be admitted, transferred, or discharged within four hours, despite a milder winter this year.5 The NHS has not met this target since July 2015 and now (perhaps not coincidentally) wants to replace it.

The NHS long term plan, published in January, pledged investment in primary and community care to divert more non-emergency cases to “new service channels” such as urgent treatment centres and a beefed-up version of the NHS 111 telephone and online service. Also being trialled is “same day emergency care,” with the aim to reduce overnight …

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