Shortage of emergency doctors will take eight years to rectify
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《英国医生杂志》
More than 96% of patients now spend fewer than four hours in accident and emergency departments, says an interim report, on progress in reforming NHS emergency care. In a briefing held earlier this week, Professor George Alberti, national director for emergency access, added that the figure will reach 98% by the end of the year.
Central to this achievement, he said, had been the collection of better information about the causes of waiting times—specifically, shortages of beds and specialists, and delays in diagnostic testing. Tackling these should bring still more improvements.
The present strategy was first outlined in the government's 2001 blueprint Reforming Emergency Care. The new interim report comes two years after Professor Alberti's appointment by the Department of Health as emergency care "tsar"—a post that has changed his previous dislike of targets in medicine. "I'm a total convert to targets as far as emergency care goes," he said.
On bed numbers he pointed out that availability is not solely a consequence of what happens in emergency departments. "Simple things like making decisions on discharge before 10 am can free a bed at the beginning rather than the end of the day."
Professor Alberti conceded that some problems remained. "We are aware of certain patient groups who are still not getting good care," he said. These include children, the elderly, and people with mental health problems—all of whom will be better catered for in the future.
"We are also very short of acute physicians. The Royal College of Physicians wants three per acute trust by 2008." As elsewhere in medicine, the roots of the problem lie in the claim advanced 15 years ago—and now demonstrably incorrect—that Britain already had enough doctors.
Although confident of eventual success, he admitted that, in the short term, bridging the gap will be difficult. International recruitment has been moderately productive but not always in the most needed specialties. "It's probably going to be eight years before we hit the desired numbers," Professor Alberti believes. "But things will improve year on year."
Speaking of the success of emergency nurse practitioners, he pointed out that not everything done to patients required a medical degree. But when a specialist opinion was essential, "anyone who needs to see a specialist should be seen within one hour."
He applauded the "see and treat" principle. This arrangement, under which patients are seen first by a clinician with the competence to begin immediate treatment, had probably been the biggest single factor in reducing waiting times.
Commenting on the report, the shadow health secretary, Andrew Lansley, said: "At the moment the opportunity to improve emergency care alongside out of hours services for GPs is being lost because the government is not engaging GPs sufficiently in ensuring a GP lead service in the community."(Geoff Watts)
Central to this achievement, he said, had been the collection of better information about the causes of waiting times—specifically, shortages of beds and specialists, and delays in diagnostic testing. Tackling these should bring still more improvements.
The present strategy was first outlined in the government's 2001 blueprint Reforming Emergency Care. The new interim report comes two years after Professor Alberti's appointment by the Department of Health as emergency care "tsar"—a post that has changed his previous dislike of targets in medicine. "I'm a total convert to targets as far as emergency care goes," he said.
On bed numbers he pointed out that availability is not solely a consequence of what happens in emergency departments. "Simple things like making decisions on discharge before 10 am can free a bed at the beginning rather than the end of the day."
Professor Alberti conceded that some problems remained. "We are aware of certain patient groups who are still not getting good care," he said. These include children, the elderly, and people with mental health problems—all of whom will be better catered for in the future.
"We are also very short of acute physicians. The Royal College of Physicians wants three per acute trust by 2008." As elsewhere in medicine, the roots of the problem lie in the claim advanced 15 years ago—and now demonstrably incorrect—that Britain already had enough doctors.
Although confident of eventual success, he admitted that, in the short term, bridging the gap will be difficult. International recruitment has been moderately productive but not always in the most needed specialties. "It's probably going to be eight years before we hit the desired numbers," Professor Alberti believes. "But things will improve year on year."
Speaking of the success of emergency nurse practitioners, he pointed out that not everything done to patients required a medical degree. But when a specialist opinion was essential, "anyone who needs to see a specialist should be seen within one hour."
He applauded the "see and treat" principle. This arrangement, under which patients are seen first by a clinician with the competence to begin immediate treatment, had probably been the biggest single factor in reducing waiting times.
Commenting on the report, the shadow health secretary, Andrew Lansley, said: "At the moment the opportunity to improve emergency care alongside out of hours services for GPs is being lost because the government is not engaging GPs sufficiently in ensuring a GP lead service in the community."(Geoff Watts)