New emergency centres will be needed to cope with number of non-urgent patients, warn health chiefs
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Casualty doctors have urged Matt Hancock and NHS leaders to introduce specialist emergency care services to prevent A&E departments from being overwhelmed as the lockdown is lifted.
The Royal College of Emergency Medicine (RCEM) said it is vital that emergency departments are able to treat genuine emergency cases, which are rising steeply as more people go back to work and school. If numbers return to pre-pandemic levels, people may have to queue outside A&Es to prevent overcrowding and maintain social distancing.
Yet other parts of the NHS are referring less serious cases to A&E because they still do not have the capability to deal with potential Covid-19 patients.
Dr Katherine Henderson, president of the RCEM, said some walk-in patients could be treated in new same-day emergency care units, and patients with ongoing conditions who experience complications should be treated by specialist out-of-hours services.
She and other senior RCEM leaders have spoken to Hancock and Stephen Powis, NHS England’s national medical director, to urge them to redesign the emergency care system, and she is due to talk to the Commons health select committee this week.
Henderson told the Observer her emergency department had recently seen a patient with a sore throat. The patient’s GP had not been able to diagnose his condition via videocall, so he was referred to NHS 111. They told him to go to an urgent treatment centre, which in turn sent him to A&E for fear that he was contagious with Covid-19. Yet when he was seen by an emergency doctor wearing full PPE, he turned out to have tonsillitis – a condition usually treated with antibiotics by a GP.
“That is a ridiculous runaround for a normal condition that involved this poor man making a ridiculous number of phone calls,” Henderson said. “I think he’s had five encounters before he actually got the treatment he needed. If we don’t sort this out very rapidly, we will waste a huge amount of time.”
In another case, a cancer patient was ferried by ambulance from an oncology centre to an emergency department to be assessed for Covid. When they were given the all-clear, they were taken by ambulance back to the oncology centre and readmitted.
“That makes no sense,” Henderson said. “If they were Covid-positive, you’ve then exposed an ambulance crew and an emergency department. Let alone to say that’s a really poor experience for a patient.”
Often, emergency doctors need specialist help but have no easy way to access it, Henderson added.
“I can often be in a situation where a patient is on a drug that I can’t even spell and they need advice about it,” she said. “So I spend the next hour trying to hunt down the right person. That’s probably not the best use of my time when there are lots of urgent cases to deal with.”
Some specialist services exist already, such as the older people’s emergency department at Norwich hospital where patients can be seen by a geriatrician within two hours.
Addenbrooke’s Hospital in Cambridge runs an acute oncology service for cancer patients who suffer side effects of their treatment. They can call a 24-hour helpline staffed by nurse practitioners, a service which has grown in importance during the pandemic as patients’ immune systems are weakened by cancer therapies, making them much more vulnerable to Covid-19.
Yet services like these are rare, according to Dr Adrian Boyle, a vice president of the RCEM who also works as an emergency consultant at Addenbrooke’s.
“My oncology colleagues have organised services very well to try and look after patients when they run into problems out of hours,” he said. “Except we think we’re an outlier. And we think there is a big problem that there is huge variation in the way that individual hospitals or consultants will look after their specialty patients when they become ill.”
A&Es currently have some breathing space. Attendances at emergency departments in May were about 41% lower than in 2019, but numbers are rising rapidly again, from 689,720 visits in April to 924,215 in May.
The RCEM published guidance for emergency doctors last week, recommending they should establish the maximum number of patients who can occupy clinical areas.
“We’re very anxious about maximum occupancy levels within our departments,” Boyle said. “Pre-Covid we had crowded emergency departments with people next to each other cheek by jowl. We just cannot go back to that.”