TY - JOUR T1 - Front door surgeons: the rise of consultant-delivered acute surgical care JF - British Journal of General Practice JO - Br J Gen Pract SP - 234 LP - 235 DO - 10.3399/bjgp16X684889 VL - 66 IS - 646 AU - Caroline Rance AU - Sarah K Richards AU - Alun E Jones Y1 - 2016/05/01 UR - http://bjgp.org/content/66/646/234.abstract N2 - Over the past decade there has been a rapid and dramatic increase in the number of patients presenting to acute care services. This includes a >30% increase in the number of emergency admissions to hospitals.1This has created an unsustainable rise in pressure on both acute medical and acute surgical services. It can be explained by a multitude of factors, including an increasingly older and comorbid population, a shortage of GP appointments, and higher patient expectations. There also appears to be a lack of public understanding about the provision and role of urgent and out-of-hours services.Many acute medical services (notably stroke and cardiology) have stepped up to this challenge to provide safe, rapidly accessible, and high-quality multidisciplinary units to address two of the biggest causes of mortality in the UK: stroke and myocardial infarction. However, acute general surgery still lags behind its medical counterparts.The traditional NHS model for acute admissions has followed a ‘consultant-led’ or ‘consultant-based’ service. In this model, although patients were admitted under a named consultant, the majority of daily patient care and interaction was delivered by junior members of the team, with a variable degree of consultant supervision and input. For surgical specialties, emergency services were not prioritised and so elective commitments ran side by side with emergency on-call because trusts feared losing out financially by abolishing their profitable elective services. In this model, the duty consultant may not have personally reviewed the patients admitted acutely under their care until 24 hours later, and thereafter in many cases will have had no further contact with them. The consultant would typically be kept informed of their patient’s status by their juniors while they carried on with elective work.However, there is now good evidence pointing to significant benefits for both trusts and patients by prioritising … ER -