Letter to the editor
Authors:   Acute internal medicine St7, Frimley Health NHS Foundation Trust, Ash Abigail , Capel Ifor ,   Acute Internal Medicine St5, Frimley Health NHS Foundation Trust, Graf Bethan ,   Acute Medical Consultant, Clinical lead for Acute Medicine and Ambulatory Care, Frimley Health NHS Foundation Trust
Published: June 2021

Editor, “Inside the word emerging is emerge, from an emergency new things come forth. The old certainties are crumbling first, but danger and possibility are sisters.’’1 The population burden of SARS-CoV-2, in terms of number of new cases, has declined significantly since the peak of the outbreak. Concerns rightfully persist regarding a possible second wave of infection. We feel the impact upon acute medicine warrants further discussion. Acute medicine by definition; the immediate management of life-threatening medical emergencies, the initial treatment (first 72 hours) of all presenting general medical ailments, and the provision of ambulatory care2 witnessed almost overnight changes in patient cohorts, emergency department attendance numbers,3 service delivery and staffing models. Of the patients presenting with COVID pneumonitis, in our hospital, the sickest were manged by our intensivist colleagues, while those needing respiratory support were managed by respiratory consultants and members of the acute medicine multidisciplinary team. New ways of providing care emerged4 with innovation powered on by collaborative spirit and an infectious ‘yes culture’. Allowing those clinicians with frontline experience to drive through changes to better deliver care for our patients, is the heart of what many of those in acute medicine just want to get on and do. Even against the harsh clinical scenarios witnessed, for many, accomplishing what acute medicine delivered was a silver lining of opportunity, not many will see again. Where does all that tremendous effort leave us now? How exactly do we run two versions of the NHS – a hot and cold, a red and green or a COVID and non COVID – for patients presenting with acute medical problems. How do we ensure we get the right person to the right place, first time?5 Do we need to re-explore our relationship with primary care and the walls within which acute medicine is delivered? Even our medicine has changed – the sequalae of COVID pathology, the delayed presentation of disease states, the impacts of social isolation and the economic fall-out, the tidal wave of undiagnosed, late presentation cancer that is about to befall us. And we haven’t even mentioned winter. Acute Medicine has always been composed of talented, committed people, skills and attributes. Examples of good practice are often shared throughout the acute medicine community, critiqued and then taken home to implement on our own ‘turf’. It is vital that at this time of significant change and reconfiguration that this continues to happen in some way. Dr Sue Crossland (President of SAM) and Dr Nicholas Scriven (Immediate Past President) outlined some of the challenges facing our specialty to the Health and Social Care Committee.6 We hope that by acknowledging that COVID 19 has impacted on the delivery of Acute Medicine, and that by starting a dialogue about how different AMUs have managed such extraordinary times; the good, the bad, and the ugly of COVID 19 can be used to harness the best for Acute Medicine going forwards and ensure it’s place in the heart of unscheduled care.