To think 70% of people shouldn’t be in A&E

I was sent to a&e by an 'associate physician' with a letter for something rare and obscure he decided I likely had after unexplained pain in my face and made an appt at my health centre.

Never heard of it and was terrified I was about to die.

Presented myself with my letter for the doctor to gently say he had seen this three times in his career and never in anyone without vision issues or under the age of 80.

I've got similar although mine is more like a broad bean. It's been there since July 1989! GPs have commented on it over the years when feeling my glands but no offer to remove it.

Yes we have nurse practitioners and a paramedic who can prescribe. Lots of tests done at the surgery, definitely blood and urine but also more unusual stuff e.g. one of my kids had white coat syndrome so had a monitor fitted for several days so they got accurate BP and pulse rate. Also support groups so I get invited to a meet up with tea and cake every month with a carer support worker who can give advice/support or sign post you to services. We also have a satellite surgery which is actually in a hospital so easy to get things done there e.g. they phoned to say they wanted a follow up blood test and I could go to the surgery or the satellite where the results would be faster. I guess we don't know how lucky we are.

I will give you my example.
I went to the doctor because I had a hard lump on my neck the size of a pea. The GP had a look and deemed it to be a skin cyst. But they do not remove them. Neither did he refer me to whoever in our NHS board does this. It is the easiest, simplest procedure. He gave me a card for a private hospital that may do removals. I checked it. It was during the covid tomes and they had zero appointments.
I was quite puzzled, but what could I do?
Well, while waiting it got infected. I was lucky: antibiotics worked, the cyst did open, but not an open wound that needed packing, no further infection and no sepsis.
But you can easily get sepsis from things like this. In my little office, less than ten people, two of them mentioned that they knew someone with similar and who had open wounds that needed daily or almost daily dressing by the nurses. For weeks on.
Now... this is rather silly, is it not? It is literally ten minutes to remove it. Much cheaper to the NHS. Much safer to the patient.

Yeah my friend and I both broke bones during a skiing lesson as children. He was making me laugh so much at a&E even I was shocked to find i.had broken a bone!

Another time I continued skiing for 3 days with my wrist in a bandage because I thought it was sprained not broken. And I am a huge wimp!

Great idea, let's make it harder for people to get an appointment. Not only will they struggle to get an appointment, some people will also struggle to pay.

Same with GPs. It’s about time we charged for appointments

But I would suggest that A&E is not the right place for this.

Last week I was there due to kidney stones – very painful. The waiting room was full with a number of people who were clearly drugged up and were apparently frequent attendees at the hospital. Some of them were going round begging cigarettes from other patients and swearing and shouting when refused. Then a physical fight broke out between 2 of them.

People who are sick, injured or in pain really shouldn't be subjected to that kind of behaviour.

Smart move not including the poll, because you are being very, very unreasonable and I suspect you know that. You have no business scrutinising people and judging whether or not they are entitled to be in A&E.

I think @CassandraWebb’s post cuts through all the crap and straight to the most important point. Nobody, not you or anyone else, has a single clue why any other person is in A&E.

My son went over on his ankle a bit while walking quickly to catch up with me. He couldn’t put any weight on it. At A&E he was white as a sheet, but no tears or much appearance of discomfort. He sat there stuffing a sandwich in his face and laughing at TikTok videos. Left the place in a boot because … oops … broken foot.

You have no IDEA why other people are in A&E and are in no position to judge.
Last time I was in, it was on the instruction of my GP. Yes I looked fine, because the infected bite I had was hidden by my clothes, and had not YET become blood poisoning. I went straight onto a strong IV antibiotic, and had surgery later that day, and walked out once the paperwork was complete. Perhaps you think it would have been a better use of NHS resources to wait until I actually had sepsis and became disoriented, then hope someone would call an ambulance, so I could be rushed to A&E to be stabilised and then up a ward for a few days?

Our A&E and minor injuries are together and share a waiting room, and the same receptionists cover both so you check in and they decided whether A&E or MI is more appropriate.

I forgot to add blood tests to my examples above. (@magequeen reminded me) Yeah those are done at the GPs office here. It would be really odd to be referred to a hospital for this. It’s considered routine. They can also refer for more advanced tests like MRIs, but generally speaking it’s usually specialists so would do that.

I will also note that some insurance plans require a referral to a specialist to be covered but generally speaking you can get that referral without having to have an appt (or a quick virtual consultation) and some specialists you can self refer (gynecologist as an example).

That was one battle that health insurance companies lost. When the referral rules came out a lot of women just named their OB/Gyn as their Primary Care Physician/GP. So they could go to them for their annual exam, then if they needed a referral for another specialist it was just a phone call.

Just goes to show how the postcode lottery affects all kind of things I guess. Health care provision is clearly not equal all over the country. There is a GP practice in my county that has 16,373 patients to one GP - that is one Doctor not one GP surgery - that is simply insane. It is very much down to house building with no infrastructure of any kind. The population growth here is 10k-15k per year. It would require an additional 7 GPs per year (that's new additional GPs not replacements for those leaving) to have any reasonable chance of offering an adequate service. I can't see that happening in my lifetime (and I'm not that old).

I was chatting to an actuary working in pensions and insurance at an event the other day and we were talking about the models insurers use to plan for longevity and what the impact of the fat drugs might be. He told me that the thing they watch extremely closely is the NHS - productivity or investment increases are the biggest single factor to move their longevity models ie those are what drive people living longer.

One thing I find odd is how little many GP surgeries are able/willing to do. Ours is really good so we can get blood tests there, and they'll usually contact us directly with results. ditto we can drop of urine samples and get results. But even in my area, I hear people complaining becuase their GP wants them to have a blood test so they have to go up to the hospital and sit for 2 hours.

Our surgery also now has a number of nurse practitioners/physicians assistants which seems to be great. They can prescribe antibiotics for minor issues etc and it frees up doctors' time for other things.

These are basic productivty things that CAN Be better everywhere, not just in isolated spots.

I remember cutting my head open as a child and my parents taking me to the regular GP who stitched it. Ditto as a teenager I had a very small mole removed by my GP because he was a bit concerned it might be becoming a problem. NOne of that seems to be possible anymore?

Just seeing how they look does not mean you could tell how ill someone is or is not.
Some people ride pain better than others; I cry and moan with discomfort. OH is a stiff upper lip type!
the trouble these days there is so much trouble getting to see a GP; in desperation, some people go to A&E instead, right or wrong?

It's impossible to know. Anyone who's ever ended up in A&E with a child with croup knows this.

Some of this does sound ridiculously inefficient.

Some of these problems sound fairly easily fixed though. Some examples where I live.

• Xrays/Ultrasounds - Mobile units that come the patient in the ER. These are dedicated units for the department so it’s much quicker to get the procedure and results. My husband unfortunately had to use this when he thought he was passing a kidney stone. All in we were there for 4 hours and that included all wait times, testing, ultrasound, consult with the ER doc + the on call specialist
• Urgent Care - again has X-ray equipment and ability to splint/cast a break or sprain. They are generally staffed and equipped as a mini ER dept. Anything that turns out to be out of their scope has an ambulance called. My second hand knowledge indicates they are pretty good about only doing this in legit situations.
• A lot of hospitals have an A & B side to the emergency departments. One side treats emergency care (stroke, heart attack, trauma, etc.) and the other side treats the more minor situations (stitches, breaks/sprains, flu/cough, etc.)
• In general there is less gatekeeping where I live. If you think you need to see a specialist you just make an appointment with them. Your appointment may be a few weeks out but you’re not waiting for a GP appt and then have to wait for a specialist appt.
• Virtual appointments have exploded since Covid. All major health groups offer them and they are super quick and take care of those minor but need a doctor situations (sinus infections, bad cough, conjunctivitis, etc.)
• Rehab hospitals- not strictly an ER related thing but I often hear that it contributes to your long wait times. So people who are admitted and treated but fall into the category of not sick enough for a hospital but too sick or need additional treatment to go home are transferred to what is called Transitional Rehab Units. These are either dedicated facilities or housed within Nursing homes. It’s for people who need OT and PT after injuries or surgery or need maybe a little more time before going home. Generally the stays are measured in weeks. This keeps beds in hospitals open and available for admissions. It’s also good for the patients who go there because it’s generally a more relaxed atmosphere with less ‘hands on’ nursing like the vitals checks at all hours and beeping machines keeping you awake all night.

The one thing that I didn’t know about is the cancer center in my hospital has a separate 24/7 ‘clinic’ for their patients. Any cancer patient under their care is directed to call the nurse line first if there is something going on. Then they will be directed to attend their clinic first to keep them out of the general ER.

Of course the trade off to this is that you have to pay for this and I know that according to some it’s the devil’s system 😉 but honestly some of these things should be doable under your NHS.

It isn't everywhere. I'm in England and can get an appointment with my GP, sometimes it's online or by phone but I almost always get a same day appointment.

Yesterday I did an online enquiry about something. Five minutes later I had a text from the pharmacy to say they had my prescription, a few minutes later I got a call from the surgery to say prescription had gone to pharmacy and information about what I needed to do particularly if x y or z happened.

I still remain confused by the idea you can tell just by looking at someone whether they are ill or not.
Rightly or wrongly, in a stressful or unpleasant situation my default is to often to make light of it.
Before an exam I am the same, I seek out anyone who will chat about something random. I was never someone frantically running through flashcards.

It's just my coping mechanism. I am not dramatic when ill. I just tend to keep surface level chat going.

To the untrained eye, my symptom has no visible outward signs most of the time (although family and close friends and my neurologist would all be able to spot the signs I was flaring).

It's really ignorant and harmful to imply that illness is somehow visible (or audible).

I’m just astounded at the length of time waiting for a GPs appointment in the UK. Here (in Ireland) you can generally get a GP appointment within a few days though I’ve been lucky and gotten one on the day.

But to add to that it doesn’t fix the problems in A&E as people who just don’t need to be there still go. I recently went to A&E here (as an urgent referral from GP who’d I’d managed to get a same day appointment with). I couldn’t go to an urgent care center or a private hospital due to the nature of my symptoms. I was triaged (incorrectly but that’s another story) before I waiting 20+ hrs to see a doctor. I saw so many people who didn’t need to be there. I’m not talking about the people like me sitting there quietly not obviously ill who you can’t ascertain by looking what their complaint is. It’s the people with the sprained ankle or cut on their thumb who could have went to a GP or care center where they could have been treated/assessed first.

Absolutely right- a mixture of those who cant get a Dr's appt, some stupid, some attention seeking. But mainly people have no skills in managing minor illness.

I honestly think the solution is GP services should be 24 hour everywhere.

Mondays as by far the busiest day in A&E, as, patients who have had bloods done in primary care on a wed night/thurs/fri, all get resulted over the weekend, something abnormal flags, GP's contact them and send to A&E. Patients who fall ill on the wekend wait till monday to call GP, receptionists redirect to A&E. People dont want to waste their weekend, but happy to take the monday morning off work, come to A&E. Now the latter wont change, but the first 2 could be solved if GPs were available 7 days a week, i think all surgerys should now be made to open 7 days a week, and some nights later into the eve.

Onsite GP clinics, without the faffing of 111 referrals like OOH clinics, should be at every A&E 24 hours. Ours is staffed by some locum GP's, then F1/F2s from A&E, advanced emergency practitioners. ED employed HCAs rotate going over there to do obs and bloods etc. The model works, and should be rolled out everywhere.

The problem is that it can be impossible to get help anywhere else. If i need a gp appointment i have to phone at 8 am. It can take 2 hours to get through on a good day and there are never any appointments left on the same day. They don't let you book a gp appointment for a few days time. Yet if i want a smeer it is easy to get in. 111 are no better. A few years ago i had raging toothache. There were no emergency appointments at the dentist. I phoned 111 as i wanted an emergency appointment with a dentist. I was on hold for over an hour. When i finally got through i was told that i would get a call back. The call back never came.

I disagree.

The only way I could get my son seen by a Dr was to take him to A&E despite my very polite protestations to the Drs receptionist that he had all the symptoms of type 1 diabetes, that I was an ex nurse etc etc

I was just told no doctors were available, not even for a quick phone call and to call back tomorrow morning.

I took matters into my own hands, took him up to A&E where the sister was horrified at our treatment and it was quickly discovered he had a blood sugar of 35mmols.

We've since left that particular surgery due to the impossibility of speaking to, let alone actually seeing in person a Dr.

As our old (excellent if you could get access to him) GP used to say 'The NHS is broken' and as a result we have a situation where people use A&E like a GP drop in service.