12 / 9 / 2013 1.55pm
The Royal College of Physicians has published it’s report “Future hospital: Caring for medical patients”.
The report takes examples from existing services to develop a comprehensive model of hospital care that meets the needs of patients, now and in the future. The report focuses on the care of acutely ill medical patients, the organisation of medical services, and the role of physicians and doctors in training, as well as physical health, mental health and well-being, and social and support needs.
The report makes a number of recommendations, these are:
- Who is responsible for each patient’s care on any given day, seven days a week, should be clear to the patient, their relatives and carers, and this team should be led by a named consultant working with a nurse ward manager.
- Patients should no longer be ‘discharged’ – planning for their future care needs and transfer to intermediate, community, primary, or social care, within a healthcare system, or their return home, should begin on admission.
- Patients should be assessed and diagnosed by a senior doctor on admission, and should see a specialist in their condition as soon as possible. This might mean seeing multiple specialists for some patients, with care coordinated by a single doctor.
- Acutely ill patients should have access to the same medical care at weekends as on weekdays.
- A new Medical Division in each hospital caring for medical patients, with care responsibilities that reach outside the hospital into the wider health community.
- A new Acute Care Hub which will include the acute medical unit (AMU), short-stay wards, enhanced care beds (level 1) and ambulatory emergency care (AEC).
- A Clinical Coordination Centre which will act as a central control room for real-time patient information, handover and transfer briefings, and organisation of care for all acutely ill medical patients , whether inside or outside the hospital.
- A new role – the Chief of Medicine – will have ultimate responsibility for all adult patients with a medical illness and a new ‘buck stops here’ approach.
- A new role – the Chief Resident – responsible for liaising with junior doctors in the Medical Division and help plan service design and delivery, including rotas, duties and workload.
- Consultant physicians in medical specialties will spend time in the acute care hub, providing specialist opinion and care.
Increased roles for both ‘generalist’ and specialist physicians:
- More ‘generalists’ – doctors skilled in the diagnosis and management of acutely ill emergency patients or those with complex medical needs already in hospital – will be needed to better manage these patients across the hospital and in the community.
- Seeing the right specialist as early as possible improves patient care and recovery, and specialist physicians will need to spend more of their time supporting ‘generalists’ in the acute care hub.
Responding to the report, Dean Royles, chief executive of the NHS Employers organisation said:
"It is pleasing to see the RCP supporting our calls for seven day working and the emphasis place on a growth in hospital generalists. It is encouraging to see some innovative ways of working and service design suggested to support this. I am sure that individual employers will want to study the recommendations carefully, as it is important that changes affecting the medical workforce fit well with those moving the whole workforce to 7-day working and will want to ensure they have the right clinical leadership in place to develop services that better meet the needs of patients. We at NHS Employers will work towards agreement on the contract reforms that are a key part of delivering this vision of better care."