The acute physician service works as you might expect.
A senior doctor sees the patient, has the clout to get the 
investigations in a timely manner and makes decisions.
The major problem is currently space, and training for the 
registrars in medicine who are often off doing admission 
work on the AAU when they could have been with the Acute 
physician.
Not all consultants are comfortable with the pressure of 
the rapid decision making and the good ones do get very 
tired with the stress of it.
How to maintain the service is going to be a problem and 
it really needs to expand as a service to include an acute 
clinic for follow-ups.
As usual the PCT and all want this without paying for 
anything

The GP in the department was indeed an additional hand and 
the trial was with keen senior GP's who offered a good 
service but with a 3-5% over discharge resulting in return 
of the patient within 6 hours as might be expected with 
their ability to carry a higher level of risk. This seemed 
higher than our department's underlying rate.
They stopped 1-2 admissions per shift, mostly vague belly 
ache that a senior ED would also send home.
The returns were mostly cardiac, mainly LVF missdiagnosed 
as late onset asthma. A common failing round her it seems 
to me.

The care they offered was good and they were supportive of 
our juniors.

Since we have tried to re-institute this by integration 
with the primecare service it has mostly gone to rats.
The streaming of primary cases to them results in them 
seeing 5 cases an evening and us seeing 10 primary cases 
and 40 majors in the same shift period. They are not 
seeing the grey area majors were they were useful. They do 
an average of 1 visit a night. The weekend service is 
separate at present.
The failure is primarily political since primecare have a 
1.5M contract which is being shown to be expensive and 
they not un-naturally don't wish to lose the income. There 
is unrest among the primary care service as the frontline 
staff are getting limited infomation from their employers 
and what they get can often be conflicting so we in the ED 
are seen as the cause of their distress.

Quite how our previous CEO could have balanced the books 
with the PCT refusing to sign up an SLA until 9 months 
into the financial year is beyond me.
This has been, and continues to be a very dirty political 
mess.
SGH is too small to take any significant reductions in 
size without imploding. We supply the core services 
advised by the CEM document responding to "Urgent care" 
and little more. Quite what will be left when the dust 
settles, I am concerned to see.

Andy V
On Sat, 21 Jul 2007 19:28:22 +0100
  Andrew Webster <[log in to unmask]> wrote:
> We had some people from Andy's trust telling us how they 
>had transformed
> acute care in the hospital me thinks this may not 
>necessarily be the whole
> truth.
> 
> 1) Getting the physicians to run an acute physicians 
>unit-i.e. a small room
> which was previously a day room converted to assess 
>patients.
> 
> 2) How an experienced GP managed to cut waiting times in 
>the evening and
> added an experienced pair of hands. Not surprisingly the 
>GP was an
> additional resource, and not surprisingly waiting times 
>fell when more
> people were seeing patients. I heard after the pilot 
>things were not going
> quite as smoothly.
> 
> 
> Andy Webster
> 07886 407783
> 
> -----Original Message-----
>From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Andrew 
>Volans
> Sent: 21 July 2007 19:13
> To: [log in to unmask]
> Subject: Re: Job Cuts
> 
> We have got three new senior directors bounced onto us,
> a CEO who used to run a PCT, a turnaround director who 
> didn't realise she was pregnant with twins and comes 
>from 
> Simon's neck of the woods in her past life and a 
>financial 
> director who appeared on the TV who is a major bruiser.
> 
> I think the small but perfectly formed CEO is using his 
> two female henchmen as the bad cops and will so appear 
>as 
> a nice guy.
> I hope this is the first hand in a dangerous game of 
>poker 
> with HMG, however our previous CEO was forced to fall on 
> her sword when she tried it, as were all her team.
> 
> The fundamental problem is that the Scarborough area 
>gets 
> £411 per patient for health care whereas York and 
> Harrogate get £561 per patient. If we were funded  at 
>the 
> rate of the rest of North Yorks then we would not have a 
> problem and indeed would be in profit by a long way.
> 
> Of our 1973 WTE, there are 175 medics, 650 nurses and 
>150 
> PAMS so there should be some cuts without losing front 
> line staff.
> We had all our ambulances stacked on my driveway whilst 
> the cameras were here due to lack of space to unload, 
>due 
> to the failure of the PCT to return patients to their 
> homes or a nursing home. The PCT has closed several of 
>out 
> intermediate care beds set up by the acute trust as they 
> won't be needed.
> We cant access the community hospital beds because the 
> GP's won't accept the patients into their care.
> We have a ward now full of cases waiting to die because 
> their nursing homes wont accept them back for end of 
>life 
> care.
> 
> It will be interesting!
> The first we as consultants new of this was when radio 2 
> reported it at 11am when the first meeting with the 
>staff 
> was at 12.30!
> the consultants are due to be told next week!
> 
> I had a meeting with the financial director on the 
>tuesday 
> but no mention was made. This was the first she had 
>heard 
> of the "urgent care document" and the fact that the CEM 
> had responded to it.
> She is now telling everyone I am going to save the 
> hospital because my department will take on all acute 
>care 
> and save the world, Oh and do it on 250 000K a year 
>less!
> 
> More when I know it
> 
> Andrew
> On Wed, 18 Jul 2007 19:12:40 +0100
>  "McCormick Simon Dr, Consultant, A&E" 
>             <[log in to unmask]> wrote:
>> So, is Andy Volans going to give us an insider's view on 
>>the latest
>> consequence of `restructuring` the NHS for the future.
>> 
>> 
>> 
>> Simon McCormick
>> 
>> 
>> 
>> Rotherham
>> 
>> 
>> 
>> (Short staffed but not about to lose 30% more staff!)
>> 
>> 
>> 
>> 
> 
> 
> 
> This message has been scanned for viruses by BlackSpider 
>MailControl -
> www.blackspider.com
> 
> 
> 
> 
> 
>