Surgeons asked to staff hospital front doors to head off emergency pressures this winter

The leaders of the Royal College of Surgeons (RCS) have written to surgeons in England, encouraging them to provide support at hospital front doors (e.g. rapid outpatient clinics and A&E) over the coming months as the NHS faces arguably its toughest winter in modern times. The surgeons have also called on government to make further funding available to the NHS in next week’s Budget. 

The RCS says there is strong evidence that having more senior decision-makers at the front door of hospitals reduces unnecessary emergency admissions and delayed discharges, thereby freeing up beds for genuine emergencies and patients needing planned operations.

The President and vice presidents of the RCS warn that they expect a significant number of planned operations to be cancelled over the winter as hospitals are swamped by emergency pressures. They argue that having consultant surgeons spend proportionally more of their time over the winter supporting colleagues in emergency departments – the front door of hospitals - will help patients receive treatment quickly and give surgeons and their patients the best chance of returning planned surgery to a more reliable footing in the spring.

In recent years, a number of trusts have introduced successful consultant-led surgical assessment units, rapid access outpatient clinics, as well as having senior surgeons support A&E departments. The RCS leaders are encouraging this approach to be adopted across England over peak winter periods to minimise the long waits for treatment and cancelled operations many patients experienced last winter.

The surgeons say the ultimate solution to these pressures lies with the Government’s readiness to tackle the problems in the wider system.  They say Government needs to provide further funding for staff, hospitals and social care, as well as protecting hospital bed capacity. 

Professor Derek Alderson, President of the Royal College of Surgeons, adds:

“Surgeons are on standby to help deal with the intense emergency pressures we expect to see this winter. We believe further help at the front door of hospitals will help reduce unnecessary admissions to hospital and long lengths of stay, thereby freeing up space to enable patients to continue to receive planned operations. While the evidence suggests this will help pressures this winter, ultimately our efforts will only be effective in the long run if it is supported by a commitment from Government to fund the NHS properly and sustainably. 

“In the run up to next week’s Budget, we call on the Government to do their bit and deliver on wider improvements and funding for the NHS and social care.”

Professor Keith Willett, NHS England’s Medical Director for Acute Care, said:

“The NHS has a tradition of showing it can meet a challenge, as demonstrated this year by the way A&E staff, paramedics, doctors and nurses responded to the terrorist attacks in London and Manchester, and the Grenfell fire tragedy. 

“Pressures on these frontline services during winter need to be met in the same way. It’s not just surgeons, it’s everyone’s responsibility to meet the challenges of winter - and I include the public in this who can play their part by using A&E and 999 services only when it’s a genuine emergency.

“I strongly welcome this RCS approach to its skilled professional workforce – this will be much appreciated by other NHS staff and patients.

“Identifying and streaming patients presenting with urgent surgical problems direct to surgical teams will benefit patients and be efficient for hospital services – whether that’s though making it easy for GPs to directly access senior surgeons for advice, or following presentation at A&E.

“That, combined with rapid access to same or next day surgical clinics, all helps emergency staff to treat other patients who need to be in A&E.”

Notes to editors

The Royal College of Surgeons of England is a professional membership organisation and registered charity, which exists to advance surgical standards and improve patient care.

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