The government’s White Paper ‘Designed to Care’ has as one of its key aims a desire to redesign services so that they are significantly better organised in the interests of the patient and of effective and efficient health care. To be as effective as possible, re-designed healthcare needs:

There are four changes in service organisation which can help to achieve these aims:

developing Clinical Pathways which "re-engineer" the sequence of events experienced by patients and apply available evidence about the most effective clinical practice. Much of what can sometimes require several visits to hospital today can all be accomplished in one visit if it is properly organised and programmed. Continuous review of Clinical Pathways in the light of developments in clinical research and technology also helps to underpin a systematic approach to staff training and development.

Ambulatory Care Centres which provide flexible accommodation and a range of services in one place rather than scattered around the hospital.

bringing together of consultants and their junior staff who are currently dispersed too thinly.

better streaming and separation of the flow of patients arriving at
Accident and Emergency Departments.

For GP emergency referrals this requires faster assessment by dedicated consultant teams on duty each day for general medicine and general surgery, eliminating the inappropriate filter of these being seen first by A&E medical staff (which can contribute to delay).

Multiple injuries and serious accidents occur sporadically but the ability to respond rapidly requires senior A&E consultant cover from say 7.00 a.m. until around midnight most days, with dedicated emergency support from an orthopaedic consultant readily available. The surgical and intensive care unit teams also need to be able to respond quickly. Other arrivals at an A&E Department need front-door assessment (called ‘triage’) to decide whether they can be treated by a nurse practitioner or need to be seen by a doctor. At present triage in Glasgow is a device for deciding which patients must be seen quickly and which can wait. Triage ought to be about streaming patients for prompt attention by suitably trained and skilled staff.

Our leaflet "Creating More Responsive Accident and Emergency Departments" goes into these issues more fully.