We're in the new house! I now know that night shifts and moving house are a pretty bad combination but having a week off afterwards makes it all worth it. Move in was on Saturday, last box unpacked by Tuesday and the inevitable IKEA trip on the Wednesday. Still had a pot of cash left over from wedding presents so put that to good use. Only thing still missing is the curtains so that's a work in progress.
What's been going on over the past week... As ever, lots of NHS stories in the media, mostly coming from England and talks about big shake-ups to the way in which A&E services will be set out in the coming years, with a focus on greating fewer 'major' A&E departments which will cater for "heart attacks, strokes and major trauma", with a sub-section of 'minor' A&E departments. An interesting prospect, since centralisation of services seems to be a growing trend at the moment, although there are a lot more urgent conditions which have to be considered beyond what has been described here and a lot of clarification is needed. One reporter talked about the success of the recent changes (locally) in Forth Valley where two A&E departments and acute medical receiving units were combined to create one larger unit which was better staffed and has resulted in better patient outcomes.
Much of the talk about A&E seems to revolve around how to reduce the 'pressures on A&E' and there is a lot of talk about how the government's '4 hour waiting targets' were missed in many cases last year. There are still a lot of inappropriate attendances to A&E but the question is how can this be avoided? In Scotland we have an excellent GP out-of-hours service, which enable patients to see a GP out-with practice working hours. Although Amy assures me that GP OOH is very busy, I still feel that this has to be an under-utilised service. I think that a lot of people don't know that GP OOH exists and this leads to more A&E presentations. The GP service runs well so we need to direct more patients to it. Most GP OOH units are attached to A&E (often in the next building). Maybe GPs working out-of-hours could work at the front door of A&E departments to direct patients to the correct places (A&E or GP). GPs are often called the 'gate-keepers' to secondary care so why can't this extend to A&E attendances out-of-hours? The GP contracts have also been 're-drawn this week to reduce the amount of work on meeting targets and increase the amount of time GPs can spend with their patients.
On another note, the Royal College of Physicians of Edinburgh this week held a conference to address improving acute hospital services under times of increasing pressures. The Scottish government this year created a £50 million emergency care "action-plan" to speed up admissions and create more opportunities for treatment in the community. The recommendations from the college were as follows:
- An extension of seven day working by clinicians and support services in hospitals and the community in order to meet demand.
- Working towards "eliminating boarding" (patients being moved to wards inappropriate for their care during busy periods.
- Patients being seen immediately by the right, competent, clinical decision makers.
- A named professional responsible for the patient's care.
- Every acute medical receiving unit to have a dedicated multi-disciplinary team.
Many of these measures are already in place already, such as the named consultant responsible for a patient's care and extension of the working week. I feel that the extension of the working week has to apply to the specialties allied to medicine, such as physio, OT, social work etc. because often I find patients whose medical treatment is completed but are awaiting on-going physio and OT input prior to discharge. If this is the case on a Friday, there is often no progress by the next Monday, and there have been two more days spent in a hospital acute bed. There is no quick fix to improving services in our hospitals but it's reassuring that lots of work is being done to try to tackle these important issues.
