The Royal College of Physicians has called for an expansion in the range of services, providers and facilities offering patients immediate acute medical care outside traditional hospitals, to help the growing demand for better out-of-hours care provision.

The call was spurred by the College’s new report, Acute medical care: The right person, in the right setting, first time, which stressed that out-of-hours care in the UK is “largely inadequate and inflexible,” and that this has led to a situation where patients are going to hospitals “because there is nowhere else for them to go to get the reassurance and care they need.”

Before 2004, GPs were responsible for the provision of care outside normal working hours, but a radical change was introduced into the GP contract that allowed doctors to opt out of this for a pay cut of just 6%, leaving primary care trusts with the responsibility of dealing with the approximate nine million who require such care in England every year.

Critics of the move claim that the standard and accessibility of out-of-hours has since taken a nosedive, and that it has led to an increased flow of unnecessary traffic into already stretched A&E departments.

The report suggests that to help ease the pressure patients should immediately get to see the most relevant clinical decision maker, which would speed up initial diagnosis and treatment, and that this should be able to happen at any time of the day, via a local "navigation hub" accessed by a local phone number to direct patients to the most appropriate service.

It also suggests that, in large acute hospitals, front-line services should comprise an “emergency floor” housing the A&E department, acute medical unit, critical care and ambulance services – which, it says, will make it easier for patients to get to the right place quickly.

In addition, the report calls for “nationally-standardised assessment, documentation, and clinical management of common acute medical conditions to reflect best practice”, including a national NHS Early Warning score (NEW score) to help determine the severity of illness and the appropriate level of response. This would improve clinical practice, support clinical governance, and make case reviews, clinical audit, and transferring clinical information easier, it claims.

’Far-reaching effects’

“Implementing the recommendations in this report could have far reaching effects on the organisation of acute medical services, and this should be welcomed by NHS staff, the public and patients alike,” commented Claire Perry, Chief Executive, University Hospital Lewisham, and a member of the Acute Medicines Task Force behind the report.

Professor Ian Gilmore, RCP President, said that “great strides” have already been made in “reorganising services around the needs of the acute patient, with the introduction of acute medical units and the development of the new specialty of acute medicine and training curriculum.”

But he went on to say that the report “builds on that work and presents us with a challenge - to change what we do, when we do it and how we do it. For doctors, nurses, managers and all those involved with the care of acutely ill patients, this task will not be easy, but the status quo is not an option if we are to give these patients a consistently high standard of care.”