Increased Attendances at A&E – Problem or Opportunity?

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.[1] 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.[2] 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.

— Richard Lilford, Director of CLAHRC WM


  1. Hawkes N. The role of NHS gatekeeping in delayed diagnosis. BMJ. 2014; 348: g2633.
  2. Vedsted P, Oleson F. Are the serious problems in cancer survival partly rooted in gatekeeper principles? Br J Gen Pract. 2011; 61: e508-12.

One thought on “Increased Attendances at A&E – Problem or Opportunity?”

  1. As an active member of the local PPG (Patient Participation Group) in Leighton Buzzard which I am told, but cannot (yet?) confirm is probably has one the largest town populations in England without a local hospital, much recent discussion concerns the fact that LB patient have a high rate of attendance at the A & E departments in Luton, Milton Keynes and Aylesbury (Stoke Mandeville)

    As a result there is pressure to try to get some kind of walk-in centre in Leighton Buzzard.

    But this pressure is partially based on the delusion (as stated by the local GP member of the CCG) that, when MK A&E charges the LB medical budget £80 per attendance that is increasing the cost to the tax-payer.

    In fact because of the economies of scale the cost to the tax-payer of attending any A & E department must be less, not more than using a relatively inefficient local walk-in centre + if MK hospital does not get £80 x N fees it will go bankrupt even faster than ever + a local walk in centre will tend to attract more users compared with the effort required by patients to arrange to travel to Luton or MK + when LB residents decide they need a house call from a doctor he has to be chauffeured from Luton anyway which will take more time and the consultation will quite possibly involve an unsupervised Romanian doctor with a poor understanding of English, whereas if the same doctor is employed at the same price for the same number of hours in an A&E department he will a) have at least some supervision by the A & E consultant and b) will usually be observed by an experienced nurse or similar and c) will have access to better equipment used more cost effectively and d) a sick infant who needs urgent care is more likely to be triaged earlier while sitting in an A & E waiting room than when sitting with parents at home waiting for the overstretched doctor to arrive.

    All of which states the fairly obvious but needs to be repeated frequently.

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