See and Treat: a management driven method of achieving targets or a tool for better patient care? One size does not fit all.

For anyone still uncertain about the concept, See and Treat is a process whereby patients with minor conditions are seen soon after they arrive in A&E by a senior clinician. Providing they have an appropriate problem such patients are given their definitive treatment straightaway and can then be discharged. The Department of Health is very anxious that all A&E departments should adopt See and Treat and has organised a road show that has toured the UK spreading the word. Circulars and emails, arriving on an almost daily basis, have encouraged senior A&E staff to attend these meetings. One recent DoH letter even asked departments when, not whether, they would be introducing See and Treat. The star turn at the See and Treat road show is the Kettering A&E Department. Kettering had its Eureka moment when it found that it’s throughput times were rising because all its cubicles (both major and minor) were blocked by patients waiting for admission. With the encouragement of its chief executive the A&E departments response was to employ its most senior doctors and nurses in offices close to the waiting room where they found they could See and Treat quite a lot of patients with minor problems. This improved their department’s deteriorating throughput times. Many people might think that the proper response of the chief executive in this situation should have been to ask why his A&E department was being blocked by patients waiting for a bed. Furthermore, how representative is the A&E department in Kettering and are its solutions appropriate for more successful A&E departments? Is it appropriate for the most experienced A&E staff to see the patients with the least serious conditions?