Acute medicine: making it work for patients

increased specialisation and the need to retain high quality general medical skills to manage the emergency workload are well recognised. These pressures, coupled with an aging population and rising numbers of medical emergencies, have led the Medical Royal Colleges to consider how the needs of patients might best be met in several reports over the last few years. In 1996 the Royal College of Physicians of London (RCPL) reviewed different models of care 1 and concluded that emergency care provided by specialist teams would only be possible in very large hospitals covering large populations. The report recommended that in the majority of hospitals, care would continue to be provided by consultant physicians with specialty training, who participated in the on-call rota for acute medicine and practised their specialty in parallel. Interestingly, an alternative possibility was outlined: ‘ a new type of physician with specific responsibility for the care of medical emergencies’ . This was noted to be ‘ a radical proposal which requires specific study and thorough evaluation in initial trials before it could be implemented.’