Surgeons to guard hospital doors this winter in bid to stop overcrowding

Surgeons should be posted at hospital front doors this winter to turn away non-urgent patients from A&E, the professions leadership has said.

In an unprecedented appeal, the Royal College of Surgeons (RCS) said even its most senior members should volunteer for new “rapid assessment” units in a bid to prevent overcrowding.

Supported by the NHS leadership, the RCS said the only way to prevent the cancellation of routine operations, which happens increasingly as hospitals become busier, was to channel manpower into making sure A&E is only attended by those in the most need.

A letter to members warned the health service faces its “toughest winter ever” and that waiting lists are “growing at an alarming rate”.

“We recognise that we, the surgical community, must continue to do everything we can do to help manage pressures this winter,” it said.

In the Budget last March, Philip Hammond announced an extra £100 million to place GPs inside A&E units to weed out all but the most seriously ill.

Royal College of Surgeons

A small handful of hospitals have already tried deploying surgeons.

But, if heeded, this new warning would mark the first time surgeons face being widely deployed in roles.

Professor Derek Alderson, RCS President, said: “We believe further help at the front door of hospitals will help reduce unnecessary admissions to hospital and long lengths of stay, thereby freeing up space to enable patients to continue to receive planned operations.

“While the evidence suggests this will help pressures this winter, ultimately our efforts will only be effective in the long run if it is supported by a commitment from Government to fund the NHS properly and sustainably.”

The letter forms part of a growing wider recognition that traditional staffing configurations often lead to overcrowding because there are too few sufficiently senior clinicians at the entrances to hospitals to turn away those who could be treated elsewhere.

Trusts which have previously introduced consultant-led surgical triage teams at the front door have shown that 30 per cent of acute surgical admissions can be avoided.

In trusts such as Bath, Derby and Blackburn, senior surgeons in forward units communicate by phone with colleagues in GP surgeries in an effort to divert those who unsuitable for A&E.

The RCS letter recommends that surgeons also station themselves within the departments, where they can undertake quick ultrasounds, blood tests and x-rays.

At Nottingham University Hospital, this approach showed a 15 per cent reduction in inappropriate referrals and a 57 per cent increase in same-day discharges.

The RCS recommends surgeons make themselves available for front door duty from Christmas to Easter next year.

Professor Keith Willett, NHS England’s Medical Director for Acute Care, said:

“Pressures on these frontline services during winter need to be met in the same way. It’s not just surgeons, it’s everyone’s responsibility to meet the challenges of winter - and I include the public in this who can play their part by using A&E and 999 services only when it’s a genuine emergency.

“I strongly welcome this RCS approach to its skilled professional workforce – this will be much appreciated by other NHS staff and patients.

“Identifying and streaming patients presenting with urgent surgical problems direct to surgical teams will benefit patients and be efficient for hospital services – whether that’s though making it easy for GPs to directly access senior surgeons for advice, or following presentation at A&E.