Strengths and weaknesses of the acute care systems in the United Kingdom and the Netherlands: what can we learn from each other?

Marcel Levi,Harm R Haak,Prabath W B Nanayakkara,Derek Bell,Marjolein N T Kremers

doi:10.1186/s12873-019-0257-y

Abstract

BackgroundThe demand on Emergency Departments and acute medical services is increasing internationally, creating pressure on health systems and negatively influencing the quality of delivered care. Visible consequences of the increased demand on acute services is crowding and queuing. This manifests as delays in the Emergency Departments, adverse clinical outcomes and poor patient experience.OverviewDespite the similarities in the UK’s and Dutch health care systems, such as universal health coverage, there are differences in the number of patients presenting at the Emergency Departments and the burden of crowding between these countries. Given the similarities in funding, this paper explores the similarities and differences in the organisational structure of acute care in the UK and the Netherlands. In the Netherlands, less patients are seen at the ED than in England and the admission rate is higher. GPs and so-called GP-posts serve 24/7 as gatekeepers in acute care, but EDs are heterogeneously organised. In the UK, the acute care system has a number of different access points and the accessibility of GPs seems to be suboptimal. Acute ambulatory care may relieve the pressure from EDs and Acute Medical Units. In both countries the ageing population leads to a changing case mix at the ED with an increased amount of multimorbid patients with polypharmacy, requiring generalistic and multidisciplinary care.ConclusionThe acute and emergency care in the Netherlands and the UK face similar challenges. We believe that each system has strengths that the other can learn from. The Netherlands may benefit from an acute ambulatory care system and the UK by optimizing the accessibility of GPs 24/7 and improving signposting for urgent care services. In both countries the changing case mix at the ED needs doctors who are superspecialists instead of subspecialists. Finally, to improve the organisation of health care, doctors need to be visible medical leaders and participate in the organisation of care.

Highlights

The demand on Emergency Departments and acute medical services is increasing internationally, creating pressure on health systems and negatively influencing the quality of delivered care
The Netherlands may benefit from an acute ambulatory care system and the UK by optimizing the accessibility of general practitioners (GP) 24/7 and improving signposting for urgent care services
Care provided by the GP or out-of-hours GP services is covered by compulsory health insurance without an initial deductible

Summary

Conclusion

Acute medical care in the Netherlands and the UK face similar challenges: an increased pressure on the acute care system due to an increased number of (older) patients attending the ED over the last years, combined with high bed occupancy levels and the increased complexity of care. The increased number of patients visiting the ED combined with high bed occupancy levels and the increased complexity of care, leads to crowding which may potentially affect the timeliness and quality of care. Given the increased complexity of care, experienced consultants need to be present at the ED, providing optimal care pathways, training junior doctors and improving timely and right decision-making and patient flow.

Background

Findings

Funding None