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ACAD-AE-MED  May 2007

ACAD-AE-MED May 2007

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Subject:

Re: Changes in EM[Scanned]

From:

"Gant Laurence (Homerton University Hospital NHS Foundation Trust)" <[log in to unmask]>

Reply-To:

Accident and Emergency Academic List <[log in to unmask]>

Date:

Thu, 24 May 2007 18:12:04 +0100

Content-Type:

text/plain

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Parts/Attachments

text/plain (1 lines)

We also went through this discussion a couple of years ago but ended in a  
slightly different situation. 
 
Our WiC now sits behind the ED assessment point.  In other words we see the  
patients and decide who would benefit from the expertise of a primary care  
specialist rather than the other way round.  The unit is staffed by both Nurse  
Practitioners and GPs and overnight holds the GP OOH service which takes up to  
4 patients an hour from us (although in truth they are more flexible than this).   
The centre also holds a PMS practice which takes all the unregistered patients  
attending the ED so that they can benefit from proper follow up. 
 
We do not receive any tariff for the patients that are sent to primary care but the  
PCT pay a contribution to our reception and assessment nurse costs based on  
the percentage of our total attendances that they see.  Currently some 25-30%. 
 
It's not a perfect relationship but it works well on the whole.  We get access to  
proper primary care and they get access to our advice and diagnostics. 
 
Interestingly they are trying to go for the GP at the front door again but our CEO  
is gently telling them to go away.  One of the advantages of being a Foundation  
Trust I suppose. 
 
Laurence Gant 
 
---- Original message ---- 
>Date: Thu, 24 May 2007 15:31:03 +0000 
>From: mark nicol <[log in to unmask]>   
>Subject: Re: Changes in EM[Scanned]   
>To: [log in to unmask] 
> 
>I spent a thrilling 3.5hours at urgent care strategy meeting yesterday going  
>over same debate as last year but with different stakeholders...new faces in  
>post as the two PCTs of mid and east cheshire merged. 
>we did agree on: 
>1.not too invest in walk in centres 
>2.wait for sir george albertis next document on urgent and emergency care  
>out soon (according to bma news last week ), 
>3. invest IT integration can Extramed CRISystem transfer registration info  
>from ED over to GP OOH service (Adastra)- yes, but who's going to pay for  
>that integration 
>4.would review split tarriff-I understand (2nd hand)that Bedford have split  
>tarriff when pt registered and triaged by ED to then go to GP OOH. 
>5.would review resource demand matching of all relevant disciplines and  
>specialties across the 7 days of the week-why do rapid response intermediate  
>care not work across 7 days, why dont' heart failure respiratory community  
>nurses work across PCT patch 7 days a week 
>6.develop care bundles for those 15 top admission diagnoses whch are  
>actually homogenous enough to be suitable for care bundles- probably only 6  
>(inclusive of exisiting acute MI, chest pain). 
>7.cautioned against long term strategies based on theoretical models of  
>reduced activity(projected at 15% reduction in our patch) has anyone yet  
>seen a reduction in demand on ED service from changes in the prehospital  
>setting..... 
> 
>where are you working [log in to unmask] 
>mark at macc 
> 
>>From: Doc Holiday <[log in to unmask]> 
>>Reply-To: Accident and Emergency Academic List <ACAD-AE- 
[log in to unmask]> 
>>To: [log in to unmask] 
>>Subject: Re: Changes in EM[Scanned] 
>>Date: Wed, 23 May 2007 10:10:28 +0000 
>> 
>>From: John Paskins <[log in to unmask]> 
>>>Our PCT has decided to "re-configure" the "A/E" services locally... 
>>>Emergency Department will care for only those patients suffering  
>>>"life-threatening illness or injury". > This has the backing of the  
>>>Department of Health and will be copied in many other areas. 
>>>Does anyone have a view? 
>> 
>>--> How about this view: 
>>Let's say a consultant in EM works in an ED which, by some miracle DOES  
>>manage to exclude all non-emergency presentations. (and I don't think it  
>>will ever happen, no matter who backs it and ESPECIALLY if it is the DoH). 
>> 
>>As Paul's pointed out - they never will manage it, but let's assume they  
>>did... This EM consultant will be seeing a very acute and emergent spectrum  
>>of pathology... Day in, day out, for months and then a year and more... 
>> 
>>With a year or more of this on his/her CV, I would not hire such a  
>>consultant to transfer to my ED, as he/she would be that many years out of  
>>practice with about 2/3 of a normal ED caseload... I'd advise any  
>>consultant who is about to have their experience NARROWED to this extent  
to  
>>consider carefully their future job prospects in the UK, or OZ or NZ or the  
>>USA or Planet Earth... 
>> 
>>Lucky for you - there are many "less progressive" (i.e. normal) EDs about  
>>for you to escape to before this happens, even in major trauma centres... 
>> 
>>_________________________________________________________________ 
>>Play your part in making history - Email Britain!  
>>http://www.emailbritain.co.uk/ 
> 
>_________________________________________________________________ 
>Advertisement: Looking for a home loan? Compare 2,000 mortgages at  
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