RADICAL changes to hospital A&E departments have been proposed - including no longer accepting walk-ins.
A leaked health service document on the redesign of emergency care coming out of the Covid-19 crisis outlines a transformation to "ambulance-only access".
Instead, new 'urgent care centres' and 'rapid access assessment services' would deal with around two-thirds of current A&E patients and would also be able to make referrals.
The high-level blueprint, seen by The Irish News, has been distributed among the medical profession.
There have been concerns about the scale of the overhaul, with one doctor, who did not wish to be named, warning that "such a radical change at this stage without proper instruction could create mayhem".
The document notes the level of redesign would lead to "fundamental changes" in the public's relationship with the A&E system.
A timetable has already been drawn up to begin the process over coming months.
Proposals include:
- Out-of-hours GPs and the ambulance service playing a key role in triaging patients before referral to urgent care centres, which would be staffed by senior hospital medics supported by junior doctors, nurses and GPs.
- These centres would open from 8am to 11pm daily and have close links to community specialist services and include minor injury services.
- Mental health teams, paediatrics, cardiology and services for the elderly would also be able to refer.
- 'Rapid access assessment services' would also operate in hospitals and the community. The hospital service would see patients with symptoms suggesting "significant undiagnosed underlying disease" or who have become sick with existing conditions. They will have attended their own GP, who conclude investigations are required within a week.
- A diabetic or respiratory team as well as A&E medics could also make referrals to rapid access, which would operate 9am to 5pm daily.
The paper states: "By designing this new service, the interaction of the public with unscheduled care fundamentally changes. This model envisages multiple interacting routes to secondary care expertise and hospital services."
Belfast GP Dr George O'Neill said there was an urgent need to reduce A&E footfall due to the pandemic and need to protect patients, particularly the elderly.
"I think we have to try something different. The present system has failed at all levels," he said.
"I also think there's a willingness now on all sides to work in a more collaborative manner to get a solution that makes it better for the patient - to ensure you'll see the right person at the right time in the right place."
The Department of Health said the proposals are in "draft form" and its new management board "will need to consider carefully before making a recommendation to the minister".
It added: "It is widely accepted that Emergency Departments will need to change significantly given the ongoing need for social distancing."
