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  1. K Castille1,
  2. M Cooke, A&E advisor2
  1. 1Director of Emergency Sevices, NHS Modernisation Agency, UK
  2. 2Department of Health, UK
  1. Correspondence to:
 Karen Castille, NHS Modernisation Agency, Richmond House, 79 Whitehall, London SW1A 2NS, UK; 
 karen.castille{at}tesco.net

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The advantage of having senior clinicians seeing and dealing with patients at the earliest possible opportunity is virtually uncontested across a wide spectrum of healthcare services. The concept of See and Treat is entirely based on this premise, and it is therefore not surprising that it works. The benefits of See and Treat, as part of an emergency department system are clear:

  • Significant reductions in both the time that each patient has to wait and the total number of patients waiting at any one time

  • Improvement in both patient experience and staff job satisfaction (concerns about staff job satisfaction emanate from those who have not tried it, rather than those who have)

Leaman offers a good description of See and Treat. His criticism seems to be mostly confined to the reasons for its introduction. We have therefore focused our response on his five main points which, in summary, appear to be that See and Treat:

  1. was instigated by a Trust chief executive in response to deteriorating throughput times in A&E

  2. was initiated as the incorrect response to bed blocking

  3. is a single model, constructed from one example, that has been imposed

  4. was not preceded by published research in a major journal. (This includes a perceived lack of a full understanding of the wider implications, such as impact on training, a potential rise in overall demand, etc)

  5. uses modern operations management thinking that regards patients as “units” and, as such, depersonalises their care.

The author concludes that See and Treat should not be introduced and that, instead, the solutions lie in abandoning Manchester triage category 5; using triage nurses to carry out treatments; and postponing minor A&E “cases” when waiting times become excessive.

We will briefly consider each of the criticisms and evaluate the conclusion drawn.

The first of the five …

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