Richard Smith: Dumfries and Galloway NHS 3: Accident and Emergency—meeting targets but “hand to mouth”

richard_smith_2014Richard Smith visited and wrote about the NHS in Dumfries and Galloway in 1980, 1990, and 1999, and this series of blogs describes what he found in 2016. A feature article provides a summary.

Accident and emergency is a pressure point in many hospitals with rising attendances leading to failure to meet the four-hour target for everybody to be seen, but in Dumfries accident and emergency has good outcomes and is meeting targets. Attendances “topped out” four to five years ago, and there seem to be few patients whose condition could be adequately treated in primary care. The service is, however, the consultants told me, “hand to mouth.”

The College of Emergency Medicine recommends that a department like that in Dumfries should have 10 consultants. In fact it has 4.6 full time equivalents supported by middle grade staff and trainees. There is also strong support from nurses, and despite the considerable shortfall in consultants the department works effectively.

The A75, which runs from Stranraer round Dumfries to meet the motorway North to Glasgow or South to England, is notoriously dangerous with many big lorries travelling to and from Ireland and little dual carriageway. All the doctors seemed to know somebody who had been killed on the road, including a GP from Stranraer last year. The Accident and Emergency department in Dumfries has dealt with major trauma, but there is now a trauma centre based in the south of Glasgow. Patients may be stabilised in Dumfries, but—driven by evidence of better outcomes and the organisation of surgical training—patients with major trauma will be managed in Glasgow.

The consultants in Dumfries are responsible for the accident and emergency services provided in Stranraer but don’t feel comfortable with the responsibility. Two of them visit each week but can have only so much influence on a department 73 miles away that is run mainly by locums. The hospital in Stranraer doesn’t provide emergency surgery, but medical emergencies are admitted. There is a CT scanner so patients with thrombotic strokes are treated quickly, more quickly than in many teaching hospitals. The accident and emergency department does have fully equipped resuscitation bays, but patients with major trauma will either be taken directly to Glasgow or transferred quickly.

Richard Smith was the editor of The BMJ until 2004.