Keogh review – it’s the system!

We welcome Sir Bruce Keogh’s determination to look at the urgent and emergency care system as a whole, in his report for NHS England written with Professor Keith Willett.  That is at the heart of the Urgent and Emergency Care Review, published yesterday – read it on the link.

Through our clinical advisor Dr Steve Laitner we have been part of the process.  The report states p24 “The evidence for prompt telephone consultations is compelling, and can free up appointments to spend with those patients who would benefit from face to face care.”

Hear hear.  However, as a full explanation of this evidence would state, this is in the context of a whole system of organisation in general practice, whereby a GP responds rapidly to all patient demand with a phone call, and that consultation either resolves the problem or they decide on a face to face which can be offered that same day.

Our primary evidence is on our research papers page.  It’s crucial to note that merely adding some telephone slots to the day has very little effect on A&E, and may well increase GP workload.  Changing the thinking comes first, from thinking about supply (of slots) to thinking about demand and how to meet it.  The system design then makes very rapid response possible, and depending on both demand and careful tuning, usually in less time (see our case studies).

The system works only as a whole



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