Emergency medicine in the UK has undergone many changes recently. This article describes how these changes, and the current reorganisation of emergency services (and of acute hospitals), may threaten the future of this specialty.

REBADGING

In 2004, members of the British Association of Accident and Emergency Medicine voted to change the name of their specialty from accident and emergency medicine to emergency medicine. The reasons for this included a desire to use the same title as that used in other countries, and because many hoped that UK emergency departments might come to resemble their Australian counterparts (where emergency departments have accredited emergency physicians on duty at all times and where definitive care is provided for most medical emergencies).

However, some were concerned about losing the title “A&E”, which was a term widely understood by the general public and by healthcare purchasers. Others feared that the new title would signal further disinterest in the trauma side of the specialty.

At the same time a new specialty was being developed—acute medicine. Specialist acute physicians had become necessary to lead the medical assessment areas that had developed in most hospitals, and to compensate for the many cardiologists, gastroenterologists and respiratory physicians who were no longer interested in the emergency element of their specialty.

The unfortunate consequences of these developments are now becoming apparent. Many outside observers now believe that emergency medicine deals principally with medical emergencies, and that emergency medicine and acute medicine are synonymous. This in turn has led to a flawed (but widely quoted) concept of what support specialties an emergency department requires.¹ Furthermore, the public is also now confused about exactly what …