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BMC Emerg Med. 2019 Jul 26;19(1):40. doi: 10.1186/s12873-019-0257-y.

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

Author information

1
Department of Health Services Research, and CAPHRI School for Public Health and Primary Care, Aging and Long Term Care, Maastricht University, Maastricht, the Netherlands. marjolein.kremers@mmc.nl.
2
Department of Internal Medicine, Máxima Medical Centre, Postbox 90052, 5600 PD, Veldhoven/Eindhoven, the Netherlands. marjolein.kremers@mmc.nl.
3
Section Acute Medicine, Department of Internal Medicine, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands.
4
Department of Medicine, University College London Hospitals NHS Foundation Trust, London, UK.
5
NIHR CLAHRC Northwest London, Imperial College London, Chelsea and Westminster Hospital, Fulham Road, London, SW10 9NH, UK.
6
Department of Health Services Research, and CAPHRI School for Public Health and Primary Care, Aging and Long Term Care, Maastricht University, Maastricht, the Netherlands.
7
Department of Internal Medicine, Máxima Medical Centre, Postbox 90052, 5600 PD, Veldhoven/Eindhoven, the Netherlands.
8
Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands.

Abstract

BACKGROUND:

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. 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.

OVERVIEW:

Despite 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.

CONCLUSION:

The 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.

KEYWORDS:

Emergency care; Health care quality; Organisation of care

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