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British Journal of General Practice

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Editorials

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

Elizabeth Cottrell, Christian D Mallen and Daniel S Lasserson
British Journal of General Practice 2018; 68 (666): 12-13. DOI: https://doi.org/10.3399/bjgp17X694001
Elizabeth Cottrell
Research Institute for Primary Care & Health Sciences, Keele University, Keele.
Roles: NIHR Academic Clinical Lecturer in Primary Care
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Christian D Mallen
Research Institute for Primary Care & Health Sciences, Keele University, Keele.
Roles: NIHR Research Professor in General Practice
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Daniel S Lasserson
Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham.
Roles: Professor of Ambulatory Care
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  • Ambulatory emergency care
    Michael P. Houghton
    Published on: 29 December 2017
  • Published on: (29 December 2017)
    Page navigation anchor for Ambulatory emergency care
    Ambulatory emergency care
    • Michael P. Houghton, Retired GP and GPwER Acute Medicine, None
    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...
    Show More
    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 soon after training) to act as acute generalists in secondary care.
     
    As a result of this role I discovered a number of likeminded enthusiasts around the country. Although I only have anecdotal evidence it is my impression that general practice would be less “scary” and perhaps less typecast in the eyes of junior hospital doctors if they were able to work not only in “the community” but also in acute medicine. Perhaps it could even help catalyse GP recruitment. It is unfortunate that the aforementioned project was shelved. Perhaps it is time to approach the RCP once again to reconsider?
     
    Show Less
    Competing Interests: None declared.
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British Journal of General Practice: 68 (666)
British Journal of General Practice
Vol. 68, Issue 666
January 2018
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Ambulatory emergency care: how should acute generalists manage risk in undifferentiated illness?
Elizabeth Cottrell, Christian D Mallen, Daniel S Lasserson
British Journal of General Practice 2018; 68 (666): 12-13. DOI: 10.3399/bjgp17X694001

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Ambulatory emergency care: how should acute generalists manage risk in undifferentiated illness?
Elizabeth Cottrell, Christian D Mallen, Daniel S Lasserson
British Journal of General Practice 2018; 68 (666): 12-13. DOI: 10.3399/bjgp17X694001
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  • Article
    • A PROCESS-DRIVEN SERVICE
    • ACCESS TO AMBULATORY EMERGENCY CARE
    • ACUTE GENERALISTS
    • OPTIMISING DIAGNOSTIC CAPABILITIES
    • IDENTIFYING SAFE DISCHARGES
    • ACUTE CARE EPISODES OR ONGOING CARE?
    • IDENTIFYING AEC SUCCESS
    • MOVING FORWARD
    • Acknowledgments
    • Notes
    • REFERENCES
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More in this TOC Section

  • General practice — the integrating discipline
  • Inclusion and diversity at the BJGP and BJGP Open
  • People, humility, and ambition: our vision for the future of general practice
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Print ISSN: 0960-1643
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