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    There are new plans to establish a two-tier A&E service beginning today.

    NHS England’s medical director, Sir Bruce Keogh, has said that it is an illusion to think that all hospitals are as good as each other.  He says that it was absolutely necessary to rethink under-pressure A&E services because too many people turn up there who do not need emergency care.

    Almost 40% of people leave A&E without any treatment, frail and elderly people end up waiting hours and sometimes could have been better cared for at home, reports the Guardian.

    In the remodelling of A&E none of the current 140 A&E departments in England would close. However the proposals are set to be controversial as it will see some A&Es become downgraded. Around 40-70 will become “major emergency centres” with the 70-1000 remaining A&Es becoming ordinary emergency centres. Major emergency centres will be where the seriously sick and damaged will be taken for hi-tech treatment and other centres will deal with problems requires less specialised care.

    “We now find ourselves in a place where, unwittingly, patients have gained false assurance that all A&Es are equally effective. This is simply not the case,” said Keogh. He wants the public to cut their attachment to their local A&E.

    The plan not only looks at changes to A&E units but also envisages a much greater use of the NHS 111 phone service which sees doctors and dentists available at the end of the phone.

    Dr Tim Ballard, a Wiltshire GP said that “GPs are working to capacity,” at the report launch, but added that: “I do think GPs have a responsibility to look after their patients.” Given “headroom”, he said, which would involve contractual negotiation, “we think we can bring a large part of the solution to this.”

    Dr Mark Porter, chair of the Council of the British Medical Association which negotiates doctors’ contracts, said: “There is no doubt that, where appropriate, we should seek to treat patients as close to home as possible, but to deliver this we need to carefully assess what is needed in terms of targeted funding, resources and staff.” 

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    November 13, 2013 by Laura Matthews Categories: Care Quality

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