Ignoring the prescription

This information was obtained through The Kings Fund

This paper reports the findings of a survey of 142 clinical leaders in emergency medicine across the UK. The survey was carried out in response to the unprecedented pressures over the 2014/15 winter period and reveals just how much needs to be done to address the profound challenges facing A&E services.

The Press Release

In 2014 four Medical Royal Colleges produced 13 recommendations to improve urgent and emergency care entitled:

‘Acute and emergency care – prescribing the remedy’

This survey by the Royal College of Emergency Medicine looks at what happened next…

The Report

An Extract

‘…….Executive summary

1. Less than half of EDs in the UK have fully implemented co-located primary care out-of-hours facilities. A third have no co-located primary care facility at all.

2. More than half of EDs across the UK are able to undertake some best practice models enabling specific patient groups (e.g. stroke, post-op complications, readmissions) patients to bypass the ED. However a third have no such processes and in many cases the implementation is not fully realised.

3. Two thirds of UK EDs do not currently have trainee doctors on acute specialty programmes rotating through the department as standard practice.

4. A third of hospitals do not have senior clinical decision-makers deployed routinely for prompt assessment of all new patients in all their acute admission units.

5. Less than a third of departments have an appropriate skill mix and workforce in place to deal with their patient volumes and casemix.

6. More than half of departments are not assisted by senior decision makers from in-patient teams at times of peak activity. In only 10% of EDs is this routine practice.

7. In two thirds of departments there is no effective direct access to community teams 7 days per week.

8. In 40% of EDs there are no on-site community teams.

9. More than 80% of EDs are not supported by fully functioning 7 day services. This deficit is due to lack of senior clinicians or lack of full diagnostic support or lack of access to specialists.

10. Only 3% of acute trusts and CCGs have reformed the current funding mechanisms for ED attendances and acute admissions. More than 80% are still obliged to operate an ED and acute admission tariff that is widely accepted as unfit for purpose.

11. Only 4% of acute trusts have introduced innovative terms and conditions that support equitable work/life balance for EM clinicians.

12. Almost 90% of EDs do not have adequate IT infrastructures in place to provide reliable data of their urgent and emergency care system.

13. Two thirds of EDs report inadequate integration with telephone triage services properly supported by trained clinicians.

14. £700 million was allocated by the government for emergency care in England this winter and a derisory 1% (£6, 685, 000) was spent directly on emergency department services.  ……………….’


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