SaHF DMBC Volume 1 Edition 1.1.pdf - Shaping a healthier future

Figure 4.6: Emergency general surgical admissions reviewed by a consultant within 12 hours
(London) 26
It is known that in NW London, four hospitals are not always meeting the best practice
guidelines of emergency general surgery admissions seeing a consultant within 12 hours.
The Royal Colleges have recommended increased consultant presence, in particular to
cover emergency and maternity services. Achieving such increased coverage is a huge
challenge nationally as well as in NW London:
Units need to serve a sufficiently large population so that they are busy enough out-ofhours
for staff to maintain their skills in dealing with complications. This is a particular
issue for senior staff who must also spend time fulfilling other responsibilities
Only larger units can afford to employ an increased number of senior staff, with many
smaller units already being on the margins of economic viability due to junior doctors
now working fewer hours
There is insufficient staff available to provide such increased cover across all units,
even if it could be afforded and skills could be maintained.
Just as staff need to maintain their skills, so specialist teams gain skills because of the
increased numbers they treat. It is well established that the more specialised doctors and
other professional staff become, the better the results for patients 27 . For example, patients
treated by a specialist surgeon are at a lower risk of death, are likely to have fewer
complications and are likely to benefit from shorter stays in hospital 28 . Specialists become
proficient by dealing with large numbers of similar cases. By being located in specialist
centres and working as part of a network of specialist staff, specialists can access the best
equipment and develop their skills by working alongside other specialists.
There are some excellent specialist centres and networks already benefitting patients and
carers in NW London. However there are other areas of clinical practice which would also
benefit by being centralised in a few centres of excellence, such as specialist laparoscopic
(keyhole) surgery 29, 30 . Laparoscopic surgery is associated with faster recovery times and
26 Source: Survey of London acute trusts (2011)
27 Hall, Hsiao, Majercik, Hirbe, Hamilton, The impact of Surgeon Specialization on Patient Mortality; Annals of
Surgery 2000
28 Chowdhury, Dagash, Pierro. A systematic review of the impact of volume of surgery and specialisation on
patient outcome; British Journal of Surgery, 2007.
29 NHS London, Adult emergency services: acute medicine and emergency general surgery, 2011
30 Profile of health and services in South West London, Report of the Clinical Working Groups, July 2011
4. The Case for Change 39