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divdiv class=story-body readability=49 span class=story-date#13; span class=date12 November 2013/span#13;span class=time-textLast updated at /spanspan class=time19:47 ET/span#13; #13;/span#13;#13; #13;#13;#13; #13; #13; span class=byline span class=byline-nameBy Nick Triggle/span span class=byline-titleHealth correspondent, BBC News/span /span #13; #13; p class=introduction id=story_continues_1A two-tier Aamp;E system in England should be created as part of an overhaul of services, NHS chiefs say./p#13; pThe review by NHS England suggested the biggest units - specialising in heart attacks, strokes and trauma - be called major emergency centres./p#13; pIt also suggested changes to the way ambulance crews and the new 111 phone service work to decongest Aamp;Es./p#13; pGreater co-ordination between community services, such as GPs and pharmacists, would also help, it said./p#13; pThe measures have been put forward in response to the growing pressures on accident and emergency departments./p#13; pPatient numbers have risen by 50% in the past decade and last winter the problems got so severe that the NHS missed its four-hour waiting time target./p#13; div class=story-feature wide readability=5#13; a class=hidden href=#story_continues_2Continue reading the main story/a h2What this means for Aamp;E units/h2#13; !-- pullout-items--#13; #13; !-- pullout-body--#13; pThere are about 140 Aamp;E units. The review proposes they be designated into two categories - major emergency centres and emergency centres./p#13; pThe major ones would focus on specialist care, such as heart attacks, strokes and trauma./p#13; pThis has already been done in London for stroke. There are now eight main centres that provide fast access to expert care. The remaining 24 focus on rehab. It is saving 400 lives a year./p#13; #13; !-- pullout-links--#13; /div p id=story_continues_2Extra money has been set aside to help the NHS through this winter and the next one./p#13; pBut this review aims to set out the long-term vision for the service./p#13; pIt proposes designating 40 to 70 Aamp;E units as major centres, which will include specialist services for heart attack, trauma, stroke and critically ill children./p#13; pThe remaining 70 to 100 units will then be known as emergency centres, dealing with less seriously ill patients./p#13; span class=cross-headMore responsive/span#13; pBut the review said there needed to be further changes to the system if pressure was going to be relieved./p#13; pAbout 40% of people who attend Aamp;E do not need treating there./p#13; div class=story-feature wide readability=7#13; a class=hidden href=#story_continues_3Continue reading the main story/a h2What this means for 999 and 111/h2#13; !-- pullout-items--#13; #13; !-- pullout-body--#13; pThe 111 non-emergency service needs to be providing better access to doctors, nurses and other health professionals so patients get the right advice first time. /p#13; pBut perhaps the most ambitious challenge is for the 999 system - and in particular ambulance crews./p#13; pThe review says half of callouts could be dealt with at the scene. Some services, such as South East Coast Ambulance, have already started working towards this./p#13; pThey have given paramedics extra training so they can treat a range of physical injuries and wounds at the scene./p#13; #13; !-- pullout-links--#13; /div p id=story_continues_3What is more, the problems developed by a fifth of patients who are eventually admitted to hospital with emergency conditions could have been avoided with better and earlier treatment in the community./p#13; pThe review said key to tackling these problems was ensuring patients got access to the services that were best suited to them first time./p#13; pTo achieve this, 111, which has been beset by problems since it was launched in April to replace NHS Direct, will need to be much more responsive, giving patients direct phone access to doctors, nurses and other health professionals./p#13; pAmbulance crews will need to treat more patients at the scene to reduce the number of patients transferred to hospital./p#13; pMeanwhile, there needs to be greater co-ordination between GPs, pharmacists and the network of minor injury clinics and walk-in centres to give patients 24/7 access to care outside of hospital./p#13; span class=cross-headIncreased journey times/span#13; pNHS medical director Prof Sir Bruce Keogh, who led the review, said: Aamp;E is creaking at the seams. It is not broken, but it is struggling. /p#13; div class=story-feature wide readability=6#13; a class=hidden href=#story_continues_4Continue reading the main story/a h2What this means for community services/h2#13; !-- pullout-items--#13; #13; !-- pullout-body--#13; pIn a nutshell, greater integration. The review wants to see GPs, pharmacists and the array of walk-in centres and minor injury units working together to provide 24/7 access to care to relieve the pressure on Aamp;E./p#13; pFor example, many pharmacists now have consultation rooms and can give advice on a range of minor ailments and carry out medicine reviews./p#13; pBut key to this will be GPs and the lead they take in co-ordinating the care of the frail elderly./p#13; #13; !-- pullout-links--#13; /div p id=story_continues_4We need to change the way we work. But what we are suggesting here already exists in places, we are just trying to formalise it so it is available for everyone./p#13; pPatients Association chief executive Katherine Murphy said the review had presented a promising vision./p#13; pAt present there is genuine confusion amongst some patients, who then opt for Aamp;E as a safe default option, she added./p#13; pCollege of Emergency Medicine president Dr Clifford Mann welcomed the proposals, although he said NHS chiefs would need to be careful the reorganisation of Aamp;Es did not lead to detrimental increased journey times./p#13; pHe also said: Any plan to provide emergency care must be based upon an adequate number of appropriately skilled clinicians and on this matter the review is disappointingly silent./p#13; pThe changes will now go out to consultation and the review team will spend the next six months looking at the cost and staffing implications before producing another report in the spring./p#13; pIt is likely to take three to five years before the overhaul is completed./p#13; /div/divbrbrcentera href=http://www.wizardrss.comPowered By WizardRSS.com/a | a href=http://www.wizardrss.comFull Text RSS Feed/a | a href=http://www.amazon.com/RFID-Blocking-Cards-Identity-Protector/dp/B00CJHZLEWRFID/a | a href=http://www.wpzonbuilder.comAmazon Affiliate/a/center