This site is intended for health professionals only

At the heart of general practice since 1960

The Hudson approach

A new emergency-care model seems simple enough on paper but our diarist finds it implementation anything but

A new emergency-care model seems simple enough on paper but our diarist finds it implementation anything but

The story so far

Dr Peter Weaving is a GP in north Cumbria and locality lead for Cumbria PCT.

As a former chair of a large PBC consortium he can see many sides of a PBC argument and regularly finds himself sandwiched between clinicians and managers. This month he is navigating a tricky redesign...

‘I've got to land this bird with no fuel in the tank,' says our director of finance looking round the room at the assembled clinical leads of the PCT. ‘And unless you lot start delivering, it's going to be in the Hudson.'

We shift uncomfortably in our seats.

He's right – our financial rescue of the PCT depends on the successful implementation of a raft of measures to modernise and streamline Cumbria's health economy. Simply put, we have to reduce the number of emergency admissions and outpatient referrals by developing primary care alternatives and re-engineering the front end of our acute hospitals.

However, our schemes are faltering somewhat. Although our admission rates are static, bucking the national trend of a 10-20% annual increase, we need a fall in our rates to enable the director of finance to reach the landing strip.

A large piece of the redesign of emergency care is sitting in my in-tray. On paper it looks straightforward and a group of us had visited a working model in a similar-sized hospital in rural Finland. Take one standard A&E, one out-of-hours service, one medical and surgical emergency assessment unit – and emcompass them in one single emergency floor.

Also working in this new area would be a Primary Care Assessment Service made up of GPs and nurse practitioners with good links to community support mechanisms and immediate diagnostic facilities. Similarly, the whole ethos of the unit is around early assessment and decision-making by senior clinicians. This leads to true patient assessment and timely use of appropriate investigations as alternatives to admission.

Everyone is agreed this is a logical way forward. So, as the financial year ends and the director of finance raises his eyebrows at me, what is the hold-up?

Well, there are a number of problems with implementing a project of this size. These range from ‘simple' matters such as the compatibility of the three different

IT systems, to ‘moderate' matters such as the physical geography of the buildings and how it raises patient expectation, to ‘tricky' matters such as timetabling consultants to work in a shift pattern so a patient who arrives at 9am is seen promptly, not at 5pm.

Many of the difficult areas are around personal relationships, rivalry and suspicion between different organisations. If a patient is processed through PCAS, does A&E lose the funding and its financial viability? If a PCAS clinician needs help, is it reasonable for A&E staff to assist? Do the various staff groups each have to provide their own equipment and drugs? (‘That's an A&E stethoscope, not a PCAS one.')

These issues could all be resolved if the emergency floor came under one organisational umbrella. I wonder how the A&E consultant would feel being employed by what used to be a GP out-of-hours co-operative? I wonder how the acute trust would feel?

Control tower calling the director of finance…

Rate this article 

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Have your say