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A new plan authored by six leading expert groups and shared exclusively with HSJ has concluded the NHS “got the winter it prepared for” and warned poor standards of urgent and emergency care has been “normalised and accepted”.
The plan, which calls for major reform of urgent and emergency care, has been jointly produced by leaders from the Royal College of Emergency Medicine, the Royal College of GPs and the Association of Ambulance Chief Executives, among others.
The proposals are being published ahead of the government’s anticipated UEC “improvement plan” for the sector which is due imminently and also comes with the NHS in the midst of yet another winter capacity crisis.
The groups conclude in the review, titled Our Urgent and Emergency Care Improvement Proposals, that poor care is being “normalised and accepted as inevitable as part of the expected annual ‘winter crisis,’” which has left staff “exhausted and demoralised” by their working conditions.
The expert groups, which also include The Patients Association, College of Paramedics and the National Association of Primary Care, say the urgent and emergency care system “remains fragmented and disjointed” and hard for patients to navigate. A joint statement on the proposed reforms adds that primary care “does not have the capacity to meet its patient demand,” the NHS is not “pro-actively” looking after the most frequent users of urgent and emergency care, and emergency departments have become “hugely congested” due to a lack of patient flow.
The centrepiece of the proposed reforms is the establishment of a “single ED service” but they also call on the government to put extra resource into primary care, by ensuring the uplift in funding it promised in 2025-26 “does translate into the ability of practices to employ more GPs”.
Other proposals include making flu vaccinations available “to a much broader group than currently defined”, subject to approval by the Joint Committee on Vaccination and Immunisation. They also include providing every older person in a high-risk group with a “full health MOT” every year, conducted by integrated neighbourhood health teams. This proposal would mark a more pro-active, community-based approach to risk assessing elderly patients – which are at greater risk of harm from long A&E waits.
The groups also say care and nursing home residents “should have the NHS delivered to them,” an approach led by GP and community teams as their first point of contacts for “most urgent care episodes,” rather than 999. They have also called for an OPEL-style national alert system for GP services to flag unsafe levels of workload.
The government’s UEC improvement plan is expected to be released by early March.
Kamila Hawthorne, chair of RCGP, said: “When general practice is properly resourced, our service can alleviate pressure across the whole of the NHS and provide cost-effective care closer to home, where patients want it. “With the right time and support we can work with patients to prevent health conditions reaching the point where emergency care is needed. This is why the college has supported the government’s aspirations to shift more care into the community – but this must be resourced appropriately.”
NHS England said: “We agree with many of these proposals to help improve care, which is precisely why, in preparing for this winter, we have focused on providing more care in the community and integrating urgent and emergency care services, alongside primary care, as well as making the most of tools like same day emergency care and care transfer hubs to boost patient flow.”
NHSE added it will “soon publish” its UEC improvement plan, which along with the awaited 10-Year Health Plan, would “deliver much-needed shifts from hospital to community and from treatment to prevention.”