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Precisely. Same goes for neurosurgery where it's very time critical. Yet everyone throws a "hissy fit" when you try to take away general surgeons or orthopods. Give me a resident neurosurgeon any day over a resident general surgeon or orthopod. AF Andrew Webster <[log in to unmask]> wrote: There is some arguement to say we have the skills to stabilise and resuscitate them. The only extra skill surgeons have is cutting. The patient can be transferred for that as occurs in other countries where demographics don't warrant 24 hour surgical cover. Many places already do not have 24 hour vascular cover where potentially there is a moretime critical element to the illness. Andy Webster >Sure we've already rationalised to almost that extent in many units. How >often do you see surgeons operate at night these days anyway? And even when >you do have something urgent they take ages to get their act together. Most >of ours are non-resident now so you can see the attraction in rationalising >services into larger centres. And such centralisation already occurs for >many subspecialties, particularly surgical subspecialties. > >AF > >----- Original Message ----- >From: "Andrew Webster" >To: <> >Sent: Thursday, March 23, 2006 9:39 PM >Subject: Coming to a department near you soon? > >More rationalisation of services threatened with PBR? > >Acute plans call for A&E split >Emergency surgery and trauma services would not need to be provided on the >same site as accident and emergency departments under controversial >proposals submitted to the Department of Health. > >The National Leadership Network, which was asked by the government to draw >up plans for the shape of acute hospitals under choice and payment by >results, has specified what it sees as the 'core' services to be protected >at all hospitals with A&E departments. > >The proposal to protect some services responds to concerns that the new >market could lead to the closure of services which were financially unviable >but needed to support A&E. > >The document identifies the services - such as 24-hour access to acute >medicine and diagnostic radiology - which the authors say should be >protected. > >But they say some other services, such as emergency surgery, which are >required by A&E teams need not be provided at the same hospital, but >elsewhere locally. > >These services should be protected by the beefing-up of multi-hospital >networks, perhaps through the establishment of joint ventures between >trusts, the report says. > >Primary care trusts and practice-based commissioners will also be expected >to ensure all patients have access to the necessary A&E services. > >Project director Martin Hensher said: 'Present multi-hospital networks are >soft partnerships between trusts and in some places there are reports of a >bit of trouble where foundation trusts are part of networks. > >'We have suggested ways of making networks more robust organisational >structures, with firm contracts between trusts.' > >The document says A&E departments should be supported on site by 24-hour >access to acute medicine, level-two critical care, a non-interventional >coronary care unit, an essential services laboratory and diagnostic >radiology. > >However, the following services need not be provided on site and should be >supported by 24-hour local multi-hospital network access: > >emergency surgery; trauma and orthopaedics; paediatrics; obstetrics and >gynaecology; mental health; specialised surgery and interventional >radiology. > >Dr Dermot O'Riordan, chair of the Royal College of Surgeons reconfiguration >working party, said if there was not emergency surgery on site, an A&E >department would not be able to admit someone with, for example, intestinal >bleeding. > >________________________________________________________________________ >National Patient Safety Agency - supporting Doctors.net.uk members in safe practice. >http://www.doctors.net.uk/NPSA >_______________________________________________________________________ > > > Andy Webster Consultant in Emergency Medicine Royal Lancaster Infirmary 07886 407783 ________________________________________________________________________ National Patient Safety Agency - supporting Doctors.net.uk members in safe practice. http://www.doctors.net.uk/NPSA _______________________________________________________________________