Firstly, Happy New Year to you all!

A new year always gives us a little time to ponder on what the future might hold for the year ahead. Along with the rest of the NHS, Monitor has been thinking about how to reduce the growing demands on A&E.

Monitor has recently published the results of its investigation into how other comparable health systems work. Monitor found three specific service models in use abroad that might be able to offer benefits if used more widely by the NHS:

  • patients who need urgent treatment at night or weekends first contacting an out-of-hours GP, based in a specialist clinic that is often co-located with an A&E department. Fewer than half the number of patients per thousand (around 120 per year) in the Netherlands attend A&E compared with England (around 278 per year). This already happens, for example, in Cambridgeshire where patients undergo a triage from a qualified nurse and can access out-of-hours GP services, some of which are co-located in A&E.
  • a 3-tier network of maternity care with more structured links between maternity and paediatric services and agreed protocols for transfers. Under this approach the lowest-risk mothers-to-be give birth close to home, while higher-risk patients are treated at more specialist units, for example with neonatal intensive care beds or facilities for premature babies. The NHS already uses this sort of “risk-tiering” approach in services like stroke and A&E, but the report says the NHS could learn from the experience of Stockholm in Sweden, and Ontario in Canada.
  • patients who have complex care needs, but live in rural areas, using technology such as video links to access highly specialist care from the kind of expert doctors that might not be available at their local hospital. This is happening in areas such as Surrey, where a telestroke service currently operates.

Monitor has already identified some local models of out-of-hours care that are working well, so no doubt it will be pushing for these to be rolled out more widely during 2015.