> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Rowley Cottingham
> Sent: 18 November 2006 12:13
> To: [log in to unmask]
> Subject: Re: 48 y/o male 1st fit
>
>
> > *From:* "McCormick Simon Dr, Consultant, A&E"
> > <[log in to unmask]>
> > *To:* [log in to unmask]
> > *Date:* Fri, 17 Nov 2006 14:08:45 -0000
> >
> > I find this discussion interesting because we are moving towards a
> > system which desires less face to face attendances for emergency
> > calls, more assessment at the scene if attended and
> ultimately fewer
> > patients transported to hospital.
> >
> > Clearly there are concerns about the system's ability to do this.
> >
> > Simon
> >
> I don't think this is news. There has been a concerted move
> towards an
> HMO style of access to emergency care for over 10 years. I'm not sure
> that the Government is in tears that GPs aren't providing OOH
> services
> any more as they were expensive and less amenable to controls such as
> these.
>
> NHS Direct was the first try, and that has resulted in large
> numbers of
> people who phoned for a bit of advice being directed to EDs.
Personally I think NHS direct is a complete waste of resources for
that fact it';s also demand creating
person rings NHS(re)Direct and gets sent 999 ambulance or told 'go to
A+E straight away' - then is assessed and depending on model of
provison in use at the time either assessedand put in cat 4 or 5 and
back to the waiting room to a 2 to 3 hour wait or 'trick or treated' and
sent on their way with a flea in the ear ...
> There is
> now a concerted move to train nurses in the community to provide
> services previously provided (by doctors) in hospital.
> Although I don't
> know the paper, I caught a discussion on the R4 news the
> other morning
> where this had been reviewed and found to be ineffectual at
> preventing
> admission. This is not good news for the bean counters, and
> there will
> be some quiet satisfaction in some clinical quarters.
> Certainly I see no
> evidence locally that demand management is having any impact at all.
The question is can we demand manage ?
The greatest problem with demand management is clinicla technology
once a group of prioviders say that the use of " widget c" is required
to exclude 'Condition D' in a particular presentation suddenly
evetyone with that presentation needs to have a 'widget C' brought to
them or them be transported to a 'widget C'...
While some will paint ECPs or none physician led OOH primary care as a
panacea it’s not but one can only hope that it at least provideds a
better service than that occaisionally seen by current services where
OOH GP services do not have basic clinical assessment tools and /or
rely on the Ambulance service and Eds to do their patient assessment ...
--
No virus found in this outgoing message.
Checked by AVG Free Edition.
Version: 7.1.409 / Virus Database: 268.14.7/537 - Release Date:
17/11/2006
|