Acute and emergency care: prescribing the remedy

Urgent and emergency care services face profound pressures that are most obviously experienced by patients and clinicians working in emergency departments and acute admission wards.

The Royal College of Physicians, the College of Emergency Medicine and the Royal Colleges of Surgeons and of Paediatrics and Child Health have produced a joint report, Acute and emergency care: prescribing the remedy, which provides 13 comprehensive local and national recommendations to address these challenges and to build safer, more effective and efficient urgent and emergency care services for all patients.

The recommendations are:

  • Every emergency department should have a co-located primary care out-of-hours facility- It is unreasonable to expect patients to determine whether their symptoms reflect serious illness or more minor conditions. Co-location enables patients to be streamed following a triage assessment.
  • Best practice that directs patients to the right care, first time, should be promoted across the NHS so as to minimise repetition of assessment, delays to care and unnecessary duplication of effort. Examples of best practice include:  stroke patients being transferred directly to stroke Units,  medical patients who have been assessed by a GP being taken directly to the medical admissions unit, patients with post-operative complications being returned to surgical care, GP-to-consultant advice lines, easy access to urgent clinics etc
  • All trainee doctors on acute specialty programmes should rotate though the emergency department.
  • Senior decision-makers at the front door of the hospital, and in surgical, medical or paediatric assessment units, should be normal practice, not the exception. It should include acute physicians, acute paediatricians, GPs, emergency care physicians, geriatricians and psychiatrists.
  • Emergency departments should have the appropriate skill mix and workforce to deliver safe, effective and efficient care. Where an emergency department does not have onsite back-up from particular specialties, there should be robust networks of care and emergency referral pathways.
  • At times of peak activity, the system must have the capacity to deploy or make use of extra senior staff.
  • Community and social care must be coordinated effectively and delivered 7 days a week to support urgent and emergency care services. The aim should be to facilitate the safe discharge and timely transfer of care of patients from the hospital to their own home or usual place of residence.
  • Community teams should be physically co-located with the emergency department to bridge the gap between the hospital and primary and social care, and to support vulnerable patients. Co-located teams should include primary care practitioners, social workers and mental health professionals.
  • The delivery of a seven-day service in the NHS must ensure that emergency medicine services are delivered 24/7, with senior decision makers and full diagnostic support available 24 hours a day, including appropriate access to specialist services. This will require additional resources.
  • The funding and targets systems for emergency department attendances and acute admissions are unfit for purpose and require urgent change.
  • Delivering 24/7 services requires new contractual arrangements that enable an equitable work–life balance.
  • It is essential that each emergency department and acute admissions unit has an IT infrastructure that effectively integrates clinical and safeguarding information across all parts of the urgent and emergency care system.
  • If configured properly with significant clinical involvement and advice, NHS 111, NHS 24, NHS Direct and equivalent telephone advice services can help to reduce the pressures on the urgent and emergency care system.


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