Urgent update, immediate priorities and recommendations from the Royal College of Emergency Medicine (RCEM), Royal College of General Practitioners (RCGP), Royal College of Physicians (RCP), Royal College of Psychiatrists (RCPsych) and the Society for Acute Medicine (SAM).
In 2020 as we learned from the pandemic, we said that urgent and emergency care in the NHS needed transforming immediately and made 10 recommendations for UK governments, the NHS, and local systems. These recommendations remain pertinent and appropriate, but the situation for patients and services has become even more critical.
RCEM, RCGP, RCP, RCPsych and SAM have today published Rebuilding the NHS: better medical pathways for acute care 2022. It includes an urgent update on the situation facing acute care services, and lays out the priorities for patients with acute medical presentations and 10 updated recommendations to hospitals and integrated care systems (ICS).
The RCP and its partners feel we must be honest with the public and patients that, with current workforce constraints, NHS professionals cannot always provide the care that they would want to, and that we are prioritising those with greatest need. This is in line with the winter pressures letter to the medical profession from the GMC and chief medical officers:
“In such challenging times, when you may need to depart from established procedures to care for people, we understand some could be fearful that they will be referred to your regulator. Please be assured that your professional code and principles of practice are there to guide and support your judgments and decision-making in all circumstances. This includes taking into account local realities and the need at times to adapt practice at times of significantly increased national pressure. In the unlikely event that you are referred to your professional regulator, they will consider the context you were working in at the time, including all relevant resources, guidelines or protocols.”
The RCP knows this is an extraordinary and uncomfortable time for all doctors and healthcare professionals. During the COVID-19 pandemic we produced several pieces of guidance which they may find useful now:
- Conversations for ethically complex care provides a framework to support discussion and documentation of decision making for levels of care in clinical practice. It includes a quick guide and decision-making record.
- Ethical guidance for endemic COVID-19 covers the ethical dimensions of providing care in a system under pressure. It includes appendices on vaccines and ambulance-based clinical assessments.
- The NHS ‘Road to Recovery’: Ethical guidance for endemic COVID-19 covers patient-centred care and decision making, reducing health inequalities, resumption of ‘non-clinical’ care practices and more.
Ultimately, the NHS workforce needs more investment. The RCP will continue to make the case for a raft of short and medium term measures to help address the workforce challenges facing the NHS, and keep up the pressure on government to publish a fully comprehensive workforce plan for the long term as soon as possible.