Urgent and emergency care
This is Greta. Greta has fallen over and hurt her arm. She is in pain and worried she has broken it.
Greta knows that all the A&Es in south east London offer the same quality of care so she goes to her closest centre.
She is greeted in the departed by an experienced nurse who asses her using a checklist and makes a quick decision to stream her into the Emergency Department (ED).
The ED is busy but not overwhelmed because up to 40% of patients attending the A&E are streamed by the nurse to the on-site GP-led urgent care centre.
In the department, Greta is seen by a doctor to asses what tests and treatment she needs. This includes a set of questions to ensure she doesn't have any additional mental health needs.
Greta has an x-ray that shows that her arm is not broken. She is given some painkillers, advised to rest for a few days, and seek help from her local pharmacy if she needs any more advice. She is discharged from the department within four hours.
Greta is happy that her injury is not more serious and confident in the treatment and advice she has received.
Case for change
There is a growing demand for urgent and emergency care services.
Nationally, number of attendances in A&E has increased by over 39% since 2003.
We know some of the people who access urgent and emergency care could be seen in other settings, such as by a GP.
Many emergency admissions into hospital could be avoided with better care planning and on-going support.
People tell us that it can be hard to access alternative services, and it can be hard to know which services to use.
We also have other specific issues such as:
- In south east London no hospital fully meets the London Quality Standards, the minimum standards for safety and quality in emergency care set by clinicians and patient representatives. These include the requirement that senior doctors (consultants) are present on emergency wards a minimum of 16 hours a day, 7 days a week.
- Not all our hospitals have their most senior doctors working at night and weekends.
- Patients with mental ill health often have long waits to see a psychiatric liaison nurse, which can lead to them leaving
We want to develop accessible alternatives to A&E, providing better and faster care closer to home - such as extended GP services with bookable appointments available 8-8, 7 days a week - to help stem the rising demand.
When people do need to access urgent or emergency care, we are developing:
- A single number to call outside of GP opening hours, with advice about where to go for urgent care.
- Consistent services at all our centres so residents know where to go.
- Better access to specialist care at the earliest point, including mental health emergency services and experts in fraility (in old age) and paediatrics (children).
- Faster admission to hospital from A&E for those that need it, and earlier discharge planning so patients can leave hospital as soon as they are well enough.
- Short stay paediatrics units in every A&E and rapid response teams to help children stay out of of hospital.