The NHS in England needs to provide a much simpler and co-ordinated system of round-the-clock urgent and emergency care, a review of its services says.
It also warns that many patients are confused about who to turn to when they need urgent medical help, so too often they go to A&E units.
The review – led by NHS medical director Sir Bruce Keogh – says there should be a much simpler 24/7 system.
Sir Bruce said the review offered an “excellent opportunity” to improve.
Urgent or unplanned care leads to around 100m NHS calls or visits each year, the report says.
A growing number of frail elderly patients, more long-term illnesses, new treatments and “increased public expectations” have all contributed to increased demand.
Sir Bruce was asked to look at the issue by the NHS Commissioning Board.
Concerns have been raised recently about A&E care – deemed to be on a “cliff-edge” by one NHS leader. GP out-of-hours services have also come under scrutiny.
However this review looks at all kinds of urgent and emergency care – including walk-in centres, telephone advice lines and minor injury centres – and concludes there is pressure throughout the system.
A key issue is “fragmentation and variation” in services.
This leads to confusion among patients who are then likely to “default” to A&E because they know where it is, that it will be open and offer a full range of care.
The report says: “The fragmentation and diverse nomenclature of urgent care services across England causes confusion amongst patients and healthcare professionals in terms of services offered.
“This can lead to patients presenting at services that may not best suit their needs.”
It adds that there is an increasing reliance on telephone advice.
But the report warns that some patients “lack confidence” in such care and says they will often seek a second opinion anyway, leading to a “duplication of service provision”.
Other issues identified include a lack of patient-awareness about the care which community pharmacists can provide, and the need for senior staff to be on duty more of the time, such as at weekends.
Prof Keith Willett, who is chairing the review’s steering group, said: “We know that A&E is the pinch point of the health and care system and that staff are working very hard to provide the care they know the public need.
“To relieve the pressure and design a system that is sustainable and fit to meet future challenges, we need as many patients, doctors, nurses and NHS colleagues as possible to get involved.”
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