The must-read stories and debate in health policy and leadership.

A new six-hour target to either move people out of accident and emergency or give them treatment should be introduced, a chief executive of a trust trialling new emergency care standards has said.

North Tees and Hartlepool Foundation Trust is one of 14 trusts which has been trialling new measures to replace the four-hour target as part of the Clinical Review of Standards.

Now, its chief executive Julie Gillon has told HSJ a six-hour target would be beneficial amid a “body of evidence” that patients are at increased risk of deterioration if they wait in A&E that long.

Evidence on this includes a peer-reviewed study in the Emergency Medicine Journal and separate analysis by the Royal College of Emergency Medicine, which both indicate increased risks of mortality among patients who face long stays in A&Es.

NHS England said the standards review is in its  “final stages”, while the Department of Health and Social Care said a decision would be made in “due course”. 

Already out-of-hours

As part of changes to the national GP contract, NHSE told primary care networks to offer “enhanced access” appointments outside core hours from this October.

This would be from 6.30pm to 8pm, Monday to Friday, and then from 9am to 5pm on Saturdays as part of NHSE’s pledge to reduce variability of access to services across the country.

However, senior primary care leaders in London have said they already commission more out-of-hours access than is provided for under the new specification.

One told HSJ that, unless more funding was provided to top-up services to cover the gap in hours, it could lead to a reduction in access during this autumn and winter.

They said: “There has been a bit of short-sightedness and there needs to be a recognition of that.”

Although they were confident a solution would be found for London, they warned it would come at “quite a high cost”.

NHS London said it was working to develop plans in response to the publication of the new access specification, but details are yet to be revealed of what they specifically entail.

Also on hsj.co.uk today

The Care Quality Commission has written to providers of non-emergency patient transport over concerns related to treatment of mental health patients identified in recent inspections. Meanwhile, Spire Healthcare’s group HR director has told HSJ, while the private provider is facing the same staffing difficulties as NHS providers, it credits its apprenticeship scheme for a “robust” pipeline of nurses.