I guess that the background is a very real problem - it is difficult to
see how supporting servies can be maintained for all the EDs that we
have at the moment (paediatrics and major trauma are good examples of
current problems). As much of surgery becomes day case / private the
range of supporting services available will inevitably decrease. So in
the future fewer EDs will have all the supporting services necessary to
provide for all types of illness / injury, some EDs will be in a
hospital were only a limited range of patients can be treated - I guess
these EDs will evolve close working with Primary Care.
I don't see any suggestion that our speciality is dismantled. If
anything a reduction in specialist support to an ED means that there is
an increased need for skilled Emergency Physicians. There may also be
the implication that there is a greater need for emergency doctors out
on the road working with the ambulance service (as in the continental
european model) to triage and treat the serious cases before the longer
journey to a specialist hospital.
I am not sure that the status quo is going to be sustainable as the
health service is going to be changing around us - we are in for a
continuation of 'intersting times'.
Tim.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Rowley Cottingham
Sent: 24 April 2006 09:18
To: [log in to unmask]
Subject: The destruction of Emergency Medicine?
This worries me. A report in this week's Hospital Doctor (a free UK
magazine sent to hospital doctors) starts, "A new report from the
National Leadership Network (no, I hadn't heard of them before either),
an influential group of managers and clinicians advising the DoH, says
it is up to service providers to prevent A&E services being destabilised
as elective care is hived off to the private sector."
They want far more delivered in the community, and say that an A&E
department must have acute medicine, critical care, non-interventional
coronary care, and supporting services. All other services, such as
emergency surgery, trauma, orthopaedics, paediatrics, O&G, etc, could be
provided by clinical networks of services provided across a number of
hospitals.
Apparently 100 A&E departments could be closed. Martin Shalley says that
BAEM has been sidelined and has not been involved in the debate. Another
A&E Consultant, Mark Sedgwick, suggests that we could have something
between the European system (presumably the polyclinic model) and the US
system; funded by insurance, do away with A&E departments as we know
them and have a triage system to send seriously ill patients to the
relevant speciality.
It's worth reading.
http://www.nationalleadershipnetwork.org/public/NLN-StrengtheningLocalSe
rv
icesMain-170306.pdf
This is a shorter link: http://tinyurl.com/ozw8x
Now I know a lot of our colleagues have seen change, but I don't think
anyone else has heard a suggestion that their job, training and career
structure is about to be dismantled! Do we have a view on this?
/Rowley./
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