The Director has always enjoyed the column that Nigel Hawkes, a free-lance journalist, writes in the BMJ. Last weekend’s article was a ray of insight. Increasing attendances at A&E are generally seen as a failure; a problem for the health service to be tackled with enhanced local services, such as extended GP opening hours, telephone advice services and improved community nursing. But Nigel says that high demand shows that A&E is a popular choice with patients. It is rational too, since gate-keeping is not perfectly sensitive and inevitably results in some misclassification of serious, but treatable, diseases such as cancer. So why not expand A&E provision and market it as an alternative to primary care? For this to work, money would have to follow patients, but it is an interesting idea worth further attention. Again, the CLAHRC WM would like to hear your views, since integrated care across the Hospital Community divide is one of our topics.
- Hawkes N. The role of NHS gatekeeping in delayed diagnosis. BMJ. 2014; 348: g2633.
- Vedsted P, Oleson F. Are the serious problems in cancer survival partly rooted in gatekeeper principles? Br J Gen Pract. 2011; 61: e508-12.