We still run one. Not sure how important it is, but it doesn't use a lot of resources and it helps the patients. No reason why it couldn't be done by other specialties including primary care, but we tend to deal with it pretty efficiently, and as a lot of it is injuries to the skin or musculoskeletal problems it means we're just following up conditions we see a lot of anyway (so should have some idea of the natural history and subsequent treatment of them), or in my case sports injuries because of my interest in Sports Medicine. A fair amount of what we see is referred up to us from primary care in any case (probably because an individual GP doesn't see all that much of it so hasn't been able to develop expertise).
One advantage to the ED is that it increases the amount of daytime work. When we eventually move to a consultant delivered service this means that we will each be doing fewer nights. No reason why you can't drop clinics, but I can't see a huge advantage to doing so. You could ask the patient to come back for general review in the A and E department, but if you do that either you're not bringing them back at specific times and staffing for these times (in which case they could be waiting for no good reason) or you are (in which case you're effectively running a clinic in any case)

> --> In my experience, when I did work in a place with such a 
> clinic, ENPs and SHOs sent patients to the clinic instead of 
> asking for advice from the senior, who was in the ED at the 
> time. They "read" the clinic as something to do instead of 
> knowing what's going on, even though the advice was right 
> there (consultants, SpRs and experienced Staff Grades).
> 

Happens from time to time. On the other hand in my own review clinics a lot of our patients were initially seen by consultants and middle grades. If you're worried about this, you can get round it by a rule that patients can only be booked into clinic by a consultant or middle grade.

> Good is that we are no longer seeing 
> vast numbers of people with grade 1 ankle sprains etc that 
> people couldn't believe would get better. 

I see some of these. On the other hand I also see some tendon injuries around the ankle that would have been difficult to differentiate from sprains at initial presentation.

Overall, I wouldn't fancy doing clinics all the time but one or two a week breaks up the week a bit. From the patients' point of view they address a need and do so in a fairly efficient manner. I also wouldn't describe them as particularly a pressure on us. If you run clinics it's easy enough to get the extra resources to do so. In the past some places may have got round dropping clinics without dropping staffing levels, but that's going to get trickier in future (drop clinics and the hospital loses PbR payments, so money has to be saved somewhere- and if I was in charge of finance the first place I'd look to make savings would be the place that had dropped the clinics).

Matt Dunn


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