Acute and General Medicine

AGM represents the single largest group of inpatients in hospitals, with approximately 2.5m emergency internal medicine admissions every year in England.

The number of non-elective internal medicine admissions to hospital has been increasing year-on-year over the last decade, with an almost 30% increase (c.600,000 patients) between 2011-2020.

There are 191 acute medical units (AMUs) in England within 131 trusts (2019/20).

The GIRFT review of AGM services focused on improvements to patient pathways, improving data collection and clinical coding to enable trusts to develop a better understanding of inpatient demand and pressures.

The GIRFT national report for AGM was co-written by Dr Mike Jones and Dr Philip Dyer.

Dr Mike Jones

GIRFT Clinical Lead for AGM

Consultant acute physician and senior lecturer at the University Hospital of North Durham and University of Durham, and medical director of training and development for the Federation of Royal Colleges of Physicians

Dr Jones practised as a consultant in renal medicine in Tayside from 1992 to 1999. He became involved in acute medicine in 1994 and has been central to the development of the specialty including becoming president of the Society for Acute Medicine from 2005-2008.

Dr Jones is a fellow of all three Royal Colleges of Physicians and has been involved in a variety of national initiatives, including education lead for the Acute Kidney Injury programme ‘Think Kidneys’, and lead clinician and editor of ACUMEN, an e-lfh project.

Dr Philip Dyer

GIRFT AGM clinical advisor

Consultant physician in general medicine, diabetes and endocrinology at the Heartlands Hospital, Birmingham

Dr Philip Dyer qualified in 1991 and has been a consultant physician in general medicine, diabetes and endocrinology at the Heartlands Hospital in Birmingham since 2001. He was appointed to Heartlands Hospital to develop its acute medical service and therefore developed its AMU from scratch. He was on the council for the Society for Acute Medicine (SAM) for 11 years, culminating in becoming president from 2009-2011.

Dr Dyer was involved the development of Acute Internal Medicine (AIM) as a specialty. He was a member of the special advisory committee (SAC) for GIM and AIM, as the curriculum lead for AIM. He is a Fellow of the Royal Colleges of Physicians of London and Edinburgh.

Useful information

What kinds of procedures does AGM include?
AGM services include the assessment, investigation, diagnosis, and management of patients who have an acute medical illness – either the first presentation of an illness (eg; chest pain requiring investigation) or the worsening of an underlying condition (eg; a flare-up of the symptoms of chronic obstructive pulmonary disease).

What is the purpose of the GIRFT AGM report?
A key objective of the report is to standardise processes and patient care in AGM care in England. By working closely with clinicians and managers across AGM and related services, GIRFT is working in the NHS to identify ways of improving patient care. Its recommendations aim to reduce unwarranted variations in both data and practice to enable AGM teams to aim for excellence.

Workforce and data collection in sharp focus in GIRFT report for acute and general medicine

Practical measures which can help improve NHS care for millions of patients with an acute medical illness are outlined in GIRFT’s national report for acute general medicine.

The team found significant variation across many areas of the specialty, with 19 recommendations made in the report to help trusts support an increasingly elderly and frail population.

Key aspects of the report focus on workforce (to support a multidisciplinary team approach), location (to support patient handovers, staffing and accessibility), the treatment for sepsis (reduce over-diagnosis) and use of terminology (standardise terms/acronyms used across AGM units).