Reconfiguration of surgical, emergency, and trauma services

Editor—The editorial by Black on the reconfiguration of surgical and emergency services in the United Kingdom exudes common sense.¹ Lomond in Scotland has lost accident and emergency surgical services in the past four months, and local general practitioners have had difficulty in securing safe services for the population. This comes on top of loss of maternity services last year at the local district general hospital.

We have been badly served by surgeons who, with their royal colleges, insist on retreating to so called centres of excellence, with little thought of the price paid by the population deprived of hospital services. Administrators have no choice when surgeons cannot or do not have the will to think “outside the box” for rural or small town communities, but they could support general practitioners trying to provide safe cover for their patients.

Such support is not always forthcoming, and general practitioners are left struggling to provide a service with colleagues in the ambulance service, themselves not adequately consulted on proposed changes and their effect on the locality. Important groups such as the police are not even consulted on proposed changes to local emergency services.

Patients are waking up to the reality of loss of services and are voting out politicians, with examples in England, Scotland, and Northern Ireland. In the west of Scotland general practitioners are working with patients' groups, hospital consultants, and ambulance staff to discuss how local services can be delivered. Patient power has delayed the closure of emergency and surgical services in Fort William, which may be the way forward for coordinated action by concerned communities.