Ambulatory emergency care: how should acute generalists manage risk in undifferentiated illness?

The recent editorial on ambulatory emergency care is long overdue. Largely due to the NHS reorganization in 1989 (which created an internal market) medical entrants over the last 25 years could be forgiven for believing that the objectives of primary and secondary care are different. They are not. Both seek to offer our patients appropriate care in the right setting. This is easier said than done.

 

Accident and emergency departments are at breaking point. In a number of reports and publications the Royal College of Physicians acknowledges the need for generalists in the acute setting but in some instances general practice is not considered.

 

I was fortunate enough to work in a practice which allowed me time to pursue my interest in primary/secondary care communication. As this evolved I became a GP with special interest in acute medicine. My job description was flexible, my learning curve steep and my role not always understood. At times, I learned the hard way and even after four years I considered my radiology, for example, barely adequate. I do believe however that the majority of patients benefitted from our encounters and that consultant colleagues and I gained mutual insight into differing thought processes.

 

On retirement, I was appointed the RCGP lead in a collaborative project with the Royal College of Physicians to establish some form of accreditation for GPs (especially s...