Change A/E from time targets to clinical need

At the moment everywhere in the NHS clinical care is provided according to need, if you need a hip operation you join a queue, if you need a dressing it will be arranged when necessary, if your GP thinks you might have cancer he can refer you urgently, counsellors ring you up and asses your needs before timetabling sessions. If you phone your GP for an appointment for an itch you've had for 3 years they will likely schedule an appointment for next week or the week after. If you report your child has a high temperature, a purple rash and a headache they'll respond immediately.

Everywhere except that is, in A/E departments. There, because of a ministerial target introduced 16 years ago, long before the change in GP out of hours contracts, everyone has to have their problem dealt with within 4 hours. There has never been any scientific basis for this target. This means your piles you may have had for 4 years, a muscle sprain that happened 6 weeks ago on a run, or your hay fever that you have had every year for a decade will be dealt with inside 4 hours. No matter how minor, no matter how long you've had your symptoms.

This is care being directed for purely administrative reasons, not clinical.
Because it is a political target it becomes a political football, Secretaries of State will divert hundreds of millions of pounds into these departments to avoid lurid headlines of "long waits in A/E". Please do not misunderstand I am not advocating 82 year olds with broken hips having to wait, what I am advocating is treatment on clinical grounds. The diversion of all this money and resource is robbing the NHS of valuable care that could be delivered elsewhere. Because the target is so widely publicised the public are aware of it and not unreasonably use it to their advantage, why wait for a GP appointment when you just pitch up at A/E with a guarantee of being seen. No wonder more and more people turn up. Whats even better is that you decide when to turn up. It is a fact that A/E attendance rates can be tracked against major events such as football matches, or climactic events in TV series .
This results in yet more money being poured in to bolster the target, its a vicious cycle without end. Since its introduction in 2000 no end of new ideas; Walk in Centres, Darzi Centres, Minor Injury Units, poly clinics, GP led Health Centres etc and no end of new money has been able to reduce the inexorable rise in A/E attendances.

Care in A/E departments, whilst of high quality, is not appropriate for many of the conditions they deal with. The chances of having tests and investigations is much greater than when the same condition is dealt with by a doctor who knows you, rather than the next one on the shift. They deliver formulaic protocol driven care which again encourages patients to go there - if I go to my GP with a cough I get advice, if I go to A/E I get an e-ray, an ECG, a blood test and an antibiotic. You can treat 4 or 5 cases of Hay fever at a GPs surgery with the money an A/E department would use to asses and treat one patient with the same condition.
The 4 hour target is a political target that leads to a distortion of clinical care and can only ever result in more and more resources being diverted into them.

If patients were treated on a clinical need basis, so with your 4 year old piles you will be seen but no guarantee of when, then departments could begin to allocate resource more effectively and patients might think twice about turning up in the first place. The saved money could then go to GPs where it would be more cost effectively used.