Urgent update, immediate priorities and recommendations from the Royal College of Emergency Medicine (RCEM), Royal College of General Practitioners (RCGP), Royal College of Physicians (RCP), Royal College of Psychiatrists (RCPsych) and the Society for Acute Medicine (SAM).
In 2020 as we learned from the pandemic, we said that urgent and emergency care in the NHS needed transforming immediately and made 10 recommendations for UK governments, the NHS, and local systems. These recommendations remain pertinent and appropriate, but the situation for patients and services has become even more critical.
Rebuilding the NHS: better medical pathways for acute care 2022 lays out the priorities for patients with acute medical presentations and 10 updated recommendations to hospitals and integrated care systems (ICS). Currently in the NHS patients with acute medical presentations are often:
- delayed at home before being brought to hospital, with the risk of deterioration
- spending prolonged periods of time in overcrowded emergency departments, with delayed assessment and treatment, poor experience, and without the care they require if they need to be admitted
- delayed in moving from acute medical units to appropriate inpatient wards
- cared for on multiple wards, creating poor continuity and patient experience, and increasing time in hospital
- delayed in leaving hospital because of difficulties with social care provision
- at risk of readmission, because of pressures to be discharged earlier in their recovery.
We must be honest with the public and patients that, with current workforce constraints, NHS professionals cannot always provide the care that they would want to, and that we are prioritising those with greatest need.
We have published our recommendations for the medium to longer term in more detail with respect to care in the community in emergency departments, and for urgent medical care. But at this time of crisis, with patients and clinicians fearing worsening pressures over the coming months, we must prioritise interventions that might be deliverable despite current constraints.
For patients with acute medical presentations, primary care, emergency medicine, acute medicine and specialty medicine must be enabled to work most effectively together. RCEM, RCGP, RCP, RCPsych and SAM believe that we have a professional and ethical duty to collaborate to improve patient care.
Local clinical leaders and managers will continue to work together to improve care for patients, and we strongly recommend self-assessment and the development of urgent plans against our priority recommendations.
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