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There is an old rule in health policy called Roemer’s Law.
Milton Roemer, the American health-services researcher, observed that increasing hospital-bed supply tends to increase hospital use.
It’s usually boiled down to six words…
‘A built bed is a filled bed.’
Healthcare capacity has an awkward habit of finding demand.
Worth remembering as the NHS presses ahead with another expansion of urgent treatment centres.
UTCs sound like an obvious answer to overcrowded A&Es. Treat the sprained ankles, minor infections, cuts and uncomplicated illnesses somewhere else.
Keep people who do not need an emergency department away from the emergency department.
NHSE wants UTCs increasingly co-located with major A&Es and has an ambition to have one alongside every Type 1 emergency department.
Errr…
…what, precisely, is the problem we are trying to solve?
Is it too many people needing urgent care?
Or…
Is it too many people needing urgent care in one particular place?
They’re not the same problem.
Since 2011/12…
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Type 1, major A&E attendances have risen about 18%, from 14.65m to 17.35m.
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Type 3 urgent-care attendances have risen 47%, from 6.83m to 10.02m.
Yet both are still growing.
In July 2026…
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Type 1 attendances were up 3.3% year-on-year
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Type 3 up 3.0%.
It looks to me, we’ve built a substantial second urgent-care sector… without shrinking the first.
What does that tell us?
If someone who would have gone to A&E goes to a UTC instead, that is substitution.
Good.
If someone who would otherwise have seen their GP, asked a pharmacist, waited until morning or simply got better goes to a conveniently located UTC, that is additional activity.
Not necessarily bad activity, but…
…it is not pressure taken out of the NHS.
Worse still is the patient who touches several parts of the system.
111 to UTC to A&E, or GP to UTC to A&E.
Every additional hand-off means another registration, another assessment, another history, another clinician and another slice of somebody’s time.
Urgent care has at least three possible objectives:
Fewer people needing urgent NHS care.
Fewer people in A&E.
Fewer NHS contacts for each episode of illness.
A UTC may achieve the second while doing nothing about the first and… badly designed, makes the third worse.
Then there is the other scarce resource… people.
UTCs need nurses, advanced practitioners, paramedics, doctors and support staff...
... they come from workforces already under pressure. Nurses, paramedics, advanced practitioners, GPs and emergency clinicians are not sitting around waiting for a new building to open.
They do not arrive with the building.
They come from the same labour market as general practice, community services, ambulance trusts and emergency departments.
Move an experienced advanced practitioner from A&E into the UTC next door and the UTC has gained capacity.
Has the NHS?
Move a GP into urgent care and one service gains a clinician while another loses one.
Which brings us to the question… what is it about the NHS, ministers and buildings?
Buildings are seductive. They have ribbon-cuttings, plaques and nameplates. They can be counted.
A new UTC looks like additional capacity, but… new premises also carry capital costs, depreciation, maintenance, utilities, cleaning, IT, reception and management.
Unless they replace more expensive activity somewhere else, those are additional costs…
…not savings. Perhaps the scarce investment should go somewhere else. Into people…
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More advanced clinical skills.
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More diagnostics available to primary care.
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More community nurses.
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More paramedics able to treat without conveying.
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More experienced decision-makers at the front door.
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More clinicians with the confidence and authority to say...
…this patient does not need hospital.
A minister can open a UTC.
It is much harder to cut a ribbon around better clinical judgement, but maybe… that is where the real capacity lies.
The NHS has a habit of responding to flow problems with buildings, structures and new nameplates.
Sometimes the constraint is much simpler. It’s is the availability of someone with the skill, experience and authority to make the right decision quickly.
Roemer warned us that supply can create demand.
Before we build another urgent-care front door, we should be clear whether we are reducing demand…
…or simply rearranging the queue.
Buildings create places. People and skills create capacity.
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