Intended for healthcare professionals

Letters GPs warn against ambulance scoring system

Fine balance between pragmatism and rigidness in system approaches to acute care

BMJ 2019; 367 doi: (Published 31 October 2019) Cite this as: BMJ 2019;367:l6226
  1. Damian T Roland, honorary associate professor and consultant in paediatric emergency medicine1,
  2. Andrew Rowland, professor and consultant in children’s emergency medicine2,
  3. Sarah Cotterill, senior lecturer in health services research and statistics3,
  4. Calvin Heal, research associate3,
  5. Steve Woby, honorary professor and director of operations4,
  6. Natalie Garratt, research and innovation business development manager4,
  7. Stephen Brown, academic network manager4,
  8. Tony Long, professor of child and family health5
  1. 1Children’s Emergency Department, Leicester Royal Infirmary, Leicester LE1 5UE, UK
  2. 2Pennine Acute Hospitals NHS Trust, Emergency Department, Manchester M8 5RB, UK
  3. 3Centre for Biostatistics, Jean McFarlane, University of Manchester, Manchester M13 9PYL, UK
  4. 4Department for Research and Innovation, Northern Care Alliance NHS Group, Salford M5 5AP, UK
  5. 5Mary Seacole Building, University of Salford, Salford M6 6PU, UK
  1. dr98{at}

Reluctance of the Royal College of General Practitioners to endorse NEWS2 (the second iteration of the national early warning score) has surprised some and been supported by others.1 This dichotomy over what seems to be a proved safety measure shows the fine balance between pragmatism and rigidness in system approaches to acute care.

The predictive value of NEWS2 is well evidenced,2 and acting on a high score might prevent excess mortality, leading to …

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