College view on Primary Care Streaming and £100m capital investment

13 March 2017

The Royal College of Emergency Medicine welcomes progress towards models of care which bring different professional groups together at the front door of hospitals. These might include primary care providers, mental health professionals, and some hospital specialists.

The College was not consulted regarding NHSE’s recent decision to mandate primary care streaming, according to a predefined model, in Emergency Departments

The College was also surprised at the announcement of a one-off investment of £100 million to support establishment of such models.

The College has recently published guidance suggesting that primary care streaming may be appropriate for some systems, and that the nature of such streaming may vary between units depending on local circumstances. We have estimated that 15-20% of patients could be better treated elsewhere. While GP streaming works well, and is cost effective in bigger systems, this is not necessarily the case in medium and smaller departments.

A one-size-fits-all approach is not supported by the College. Funding streams are not in place to support implementation.

The College welcomes recognition by the Secretary of State, the Department of Health, and the Treasury that ED crowding represents a significant threat to patient safety. However, this intervention is unlikely to significantly impact upon ED crowding. Sustained investment in social care, ED staffing and facilities, along with changes in models of care, are all required to achieve this.