RCEM launches ‘A&E Hub’ model to ease pressure on services

20 May 2016

The Royal College of Emergency Medicine today launches its ‘A&E Hub’ concept – calling for the co-location of primary care services to improve patient experience and reduce pressure on emergency departments. 

The A&E Hub concept proposes that additional services such as pharmacies and crisis mental health teams should be located alongside emergency departments to help tackle the increasing rate of type 1 A&E attendances – which has increased by nearly 2 million in a decade.

College research has shown that at least 15% of patients attending Emergency Departments could be better treated by GPs, but frequently choose to go to A&E.

In recognition of this, the College believe that services should be reconfigured to meet patient’s needs, with emergency departments acting as a ‘hub’ around which other key services operate. 

The A&E Hub concept recommends that frailty teams, community pharmacies, out-of-hours primary care and mental health teams be co-located on site with emergency departments.

This model aims to simplify access routes for patients – helping them to get the help they require more swiftly – and help ease pressure on emergency departments, which are already struggling to meet demand. 

President of the Royal College of Medicine, Dr Clifford Mann said: “The relative immediacy of emergency care and the convenient location of emergency departments is a big draw for patients, particularly out of hours, and, understandably, patients go ‘where the lights are on’ to get help when they need it. 

“We know that at least 15% of A&E attendances could be better treated elsewhere, but outside of normal working hours, evidence shows that people are often confused by the various different services available, so they come to A&E.

“This results in higher levels of attendances, which in turn puts greater pressure on staff, causes treatment delays, and can compromise levels of care – putting patients at risk.”

Instead of encouraging patients to seek treatment away from A&E, Dr Mann says a new approach is required to tackle the problem and believes the ‘A&E hub’ model offers a pragmatic solution. 

Dr Mann said: “Over the last 15 years huge efforts have been made to reduce the flow of people to A&E, but none of these have been effective. It is unreasonable to expect patients to determine whether their acute medical problem requires urgent or emergency treatment.

“We believe that locating primary care services alongside A&E departments will allow patients to receive the appropriate treatment more quickly and encourage more collaborative working between community and hospital teams. It will greatly improve patient flows and help to reduce waiting times.”

The model has five key benefits. Co-location will:
  1. Allow patients to be routed to the best place to obtain their care.
  2. Allow the transfer of patients quickly and safely between Primary Care and the ED.
  3. Provide Primary Care Out-of-Hours staff with immediate access to facilities such as radiology, pathology and ECG.
  4. Encourage Primary Care staff and ED staff to share opinions and knowledge
  5. Allow other services such as emergency dentistry and frailty units to be co-located on the same site.

At present around 60% of Emergency Departments have no co-located services at all. 

The Hub concept forms part of the College’s ongoing STEP campaign, which calls for:

  • Safe and sustainable staffing levels to be achieved 
  • Tariffs and funding to be fair and effective 
  • Exit block and crowding to be tackled
  • Primary Care facility co-location

The co-location approach is supported by the Royal College of Psychiatrists, the British Geriatric Society, the Patients Association, the Royal College of General Practitioners and the Royal Pharmaceutical Society. 

The College urges Government, politicians and NHS leaders to work together to adopt the ‘A&E hub’ model and facilitate the co-location of services to ensure a better patient experience and help reduce the pressure on emergency departments.