Viewpoint: A&E crisis needs more than sticking-plaster solution

Writing for GPonline, BMA deputy chairman Dr Kailash Chand says his personal view is that NHS England medical director Sir Bruce Keogh's calls for a two-tier A&E system may not be the answer to pressures on the health service.

Dr Kailash Chand: one size does not fit all

Although there is good evidence that patients do benefit from going to specialist centres for treatment of heart attacks and strokes, for example, one size doesn't fit all.

While the focus of attention has been the pressure felt by A&E services, there is no single cause or solution to this crisis; pressures are caused by factors across the entire healthcare system. A ‘sticking plaster solution’ will not solve the A&E crisis.


Political mismanagement has increased pressure on the system by making cuts while demand on the service is increasing by the day.

It’s an unavoidable reality that the combination of rising patient demand and fewer resources has put intense pressure on emergency care/GP surgeries, and as winter approaches it is expected that this pressure will only intensify and place further strain on already overstretched services.

The recent report from the National Audit Office points out that the number of hospital emergency admissions is rising, and it rightly suggests that the key challenge is to reduce unavoidable admissions and ensure that as many patients as possible are treated in the appropriate setting.

In order to do this, however, the government must develop both long- and short-term strategies to address the widespread staff shortages across the NHS, and invest in systems and measures which help to direct patients to the NHS service or setting that is right for them.


Too often, the NHS faces unnecessary political pressures, including pointless politically-driven targets, which do nothing to benefit patient care. Doctors and other healthcare professionals must be trusted to use their clinical expertise and judgment to treat the individual patient in front of them.

If we are to tackle the increasing demands of an ageing population, we need a considered, holistic solution that is backed by an unambiguous, well-resourced plan produced in consultation with patients and healthcare professionals.

Concentrating on prevention through public health measures that involve regulating the tobacco, alcohol and food industry will have the greatest impact on the population's health, even within a few years.

Starting point

Furthermore the medical profession needs to seriously consider the best way to reduce the over-medication of millions of people with drugs they don't need. Up to a quarter of hospital admissions in the elderly are due to drug interactions, and this problem is also the trigger for many visits to GP practices.

Sir Bruce Keogh is a brilliant technical/medical bureaucrat. His proposals provide a starting point for a rethink of how we deliver emergency and urgent care, and as doctors we would very much like to work with NHS England to put in place a system that is fair for doctors and provides the right level of care for patients and offers lasting solutions.

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