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Call for increasing A&E pressures to be tackled with on-site primary care

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All emergency departments must in the future have primary care services located alongside them with links to district nursing teams, if the NHS is to cope with the increasing pressures on accident and emergency, the president of the Royal College of Emergency Medicine has said.

Dr Clifford Mann said despite alternative community services being on offer, patients continued to attend emergency departments in increasing numbers due to their trust in the “A&E brand”.

“We are calling for [co-located GP services with] community mental health teams, community pharmacy, links to district nurses and links to social services”

Clifford Mann

Therefore, more effort was required to provide primary care services at the same site as emergency departments, he said yesterday at an event run by the King’s Fund think tank.

Dr Mann said last year’s 2.6% rise in emergency attendances in England was linked to population growth.

Future increases in the number of attendances could be expected as the population continued to increase in size, he said.

At present, around 40% of emergency departments have co-located services, but even these have varying degrees of capacity, he said.

“They might just have the out-of-hours GP service,” Dr Mann told Nursing Times. “What we are calling for is for this to include community mental health teams, community pharmacy, links to district nurses and links to social services.”

He said nurses would be “integral” to the model the college was calling for, because they had a role in almost all of these teams.


Clifford Mann

“Having nurses who better understand the interplay between medicine and social services will also be very important,” he said.

“Often junior doctors say ‘this patient can go home’, but it will be the nurse that thinks ‘well they can’t go home like that, I’d better ring social services to make arrangements’,” said Dr Mann.

He warned co-located services were not just required to deal with an increase in patient demand, but also to ease the pressure on staff working in emergency departments.

Anecdotal evidence suggested emergency nurses were increasingly looking to leave their jobs in favour of community nursing roles in order to achieve a better work-life balance, he said.

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Readers' comments (1)

  • We need a paradigm shift is how unscheduled care is provided. The current system is too complex for patients, too variable across and areas and trusts and is open to abuse. Having Primary Care alongside A&E makes sense and would be a step in the right direction.

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