New guidance for A&E departments

The Scottish Government has published new guidance for emergency department teams to ensure people are being seen by the right person in the right place for their healthcare need.

It has been developed in response to a request from NHS Boards to support hospitals to safely refer people to the most appropriate place for treatment, if they do not need emergency care.

With the level of people self-referring to hospital emergency departments returning to pre-Covid levels, hospitals are seeing more patients whose needs can be better met closer to home by local pharmacies or GP practices.

The new guidance draws on established good practice in NHS Tayside and NHS Grampian to inform a Scotland-wide approach developed in partnership with NHS Boards, Health and Social Care Partnerships, Primary Care services and the Royal College of Emergency Medicine (RCEM).

NHS Greater Glasgow and Clyde has put measures in place to support this new approach – and reported positive results on reducing pressure on A&E departments. The board’s local team has offered to share its experience with other boards.

Health Secretary Humza Yousaf said:

“It is widely recognised that more people could be better seen away from hospital and closer to home by a more appropriate care provider such as a pharmacy or GP practice or indeed, managed with self-care guidance. 

“As part of the NHS Recovery Plan we have invested £27 million towards the Redesign of Urgent Care to ensure people receive the right care, at the right place. This guidance will form part of this work and will help our healthcare staff safely signpost people to care more appropriate to the their need in the right place and at the right time for their condition.

“By adopting a consistent approach across Scotland, we can reduce delays in assessment and treatment, prevent overcrowding in emergency departments and ultimately release doctors to deliver emergency care to those who really need it.”

Royal College of Emergency Medicine Vice President (Scotland) Dr John Thomson said:

“Emergency department resources are not infinite. As the demand from patients continues to increase, it is essential we have the capacity to care for those who require the skill and expertise of the emergency department team. This guidance will help our NHS staff safely redirect those who do not to the best place for their healthcare need.

“To ensure everyone receives the right care, at the right time, in the right place, it will on occasion be appropriate to signpost or redirect some people who have presented to an emergency department - but do not require after an assessment to be seen there - to another part of the healthcare system.”

Emergency Medicine Clinical Lead for NHS Tayside Dr Alison White said:

“NHS Tayside has had a redirection policy since 1998 as a long-term improvement to our service.

“This provides people with better care than could be provided by Emergency Department staff. It also ensures specialist emergency medicine skills are directed towards those who need us such as people who have suffered a stroke, significant injury or heart attack, so care is delivered in a timely manner.”

Deputy Medical Director for NHS Greater Glasgow and Clyde Dr Scott Davidson said: “We already work closely with NHS 24 to direct people to the right place from their own homes. This new guidance enables us to support people who have attended an emergency department but who do not need to be seen there to be directed elsewhere with appropriate advice.” 

Background

Read the guidance in full.

The Scottish Government recognises all health boards have their own unique pressures and will implement this guidance as soon as possible. Every health board has been redirecting patients to more appropriate care wherever possible – but this guidance will ensure consistency across Scotland and make it easier to get people to the right care as quickly and safely as possible. 

The guidance forms part of the Redesign of Urgent Care, and will encourage those who think they need A&E, but do not have an emergency, to first access care through NHS 24 111.