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

I think it's so hard to judge - as many posters have said, you can look fine but have a genuine need to be there.

But, last time I was at a&e (with my disabled brother who'd had a seizure), there was a lady there with her 3 kids. The youngest was about 3 and he had an earache. All 3 kids (including the sick one) were running riot through the department and eating copious amounts of snacks etc.

The lady was very vocal and complained constantly to staff about the wait. Her child seemed fine to me. And I say that as a mum to a DS who had repeated ear infections as a toddler, including two separate incidents of a perforated eardrum (with hearing loss as a result too).

The only justification I can think of for bringing that child to A&E on a weekday afternoon is that the family didn't have a GP to prescribe antibiotics. Which begs the question, why not?

I kind of agree but sometimes when the other services are full it's the only way to be seen!

My son (2) had a serious choking incident at nursery this week. They advised being checked over by a doctor. I rang the GP, who agreed he should be seen, but all their appointments were full, so directed me to the urgent care centre. Rang them, they were also full so said we'd have to go to Paediatric A&e. It was frankly a bit ridiculous, as most of the other kids there were obviously sick, and DS looked perfectly fine, but I had tried the more reasonable options.

Believe me, I have no desire to spend an entire afternoon off work, sitting around in A&E either, we really only needed a quick 5 min appointment with a doctor.

Yabvu. Firstly, make your mind up, is it 70% or 80% you think shouldn’t be there? 🧐 Secondly, you have no idea why people are there. You have no idea how people hide or express pain. My family a+e visits include a small open fracture to a finger - no noticeable pain, fractured ankle - no noticeable pain, deep cut with foreign object in wound - no noticeable pain, retained tampon - no noticeable pain, heart palpitations + chest pain - no noticeable pain. I could go on, but really, just stop with your judgement 🤷‍♀️

Please 🙄I have to go semi-regularly to A&E as i have a chronic condition that flares as it wishes and with varying severity. I look fine however ( while I'm visible) but the rest of the time I will probably be stuck in the bathroom unable to keep anything down and horiffically de-hydrated. The GP can do sweet FA, and in the past landed me in resus due to downplaying things.
The local minor injury unit has little provision past putting a sticking plaster on, or (if you are lucky and someone who can prescribe is in) antibiotics. They only have an x-ray tech twice a week, and no provision to actually put a plaster cast on if you have broken something!

My GP surgery also currently only contains 1 locum - of questionable usefulness - known locally as the chocolate tea pot locum, and one poor very overworked practice nurse. There has been 3 new housing estates go up in the last 2 years, and a full hotels worth of imigrants just down the road, who have the "priority appointments" and a weekly locational visit.

you are lucky if you can even get an URGENT appointment for 3 weeks time - and thats for an already nasty oozing infection that needs antiobiotics, as the local farmer found out the hard way. (he went to A&E when the recpetionist told him that, and ended up admited for 10 day on IV antibiotics)

I was suposed to hava a weekly heart monitoring session at the GP, but they cancelled it due to lack of staff, and then i ended up in the hospital.

GPs surgerys are understaffed, underfunded, and over prescribed. and i can think of a few ways to deal with it too.

In the mean time. I will continue to go to A&E when necessary

I think you are right, but I also think that it is the lack of other services that is the biggest problem. When I was a child 30+ years ago, you could:

1. phone your GP, get through within a couple on minutes, and book your appointment to have your regular condition monitored, or your check up before your repeat prescription of your long-term medication.
2. turn up at the surgery, with your child whose sore throat and fever meant that they probably needed urgent antibiotics for their raging tonsilitis, and sit, may for a while and then be seen.
3. Ring your surgery and get the duty doctor to do a same day visit to your elderly mum who was coughing and had a painful chest, and they would check her oxygen saturation and, if it wasn't so low she needed A+E for oxygen, prescribe antibiotics for her chest infection at her bedside.

Now
You keep trying but you can't get through. You are running out of medication and don't know if you are controlling your symptoms well enough.

You spend ages on the phone and then don't get through or there's no appointments that day so you have to ring back the next day. Your child is in pain and you guess they need anti-biotics. You maybe ring 111, who phone you back hours later, and sends you with a feverish child who just wants to sleep to an out of hours appointment somewhere miles across the city. At least if you just take them to A&E straight away, you are going somewhere you know where it is, you can go in the day time, and there are probably good bus routes to it if you don't have a car and can't afford a taxi.

You can barely get through to your surgery and when you do there's no appointments. If you get triaged through 111 they will probably tell you to take your mum to A&E anyway. When you do there will be a long wait, so you might as well get in that queue.

There is so much focus on A&E, but the real problem is the totally lack of other services.

I heard a recent interview on radio 4 with some government researcher - who when interview started saying vast numbers didn't need to be in A&E actually said figures showed that was wrong and most did now though they were trying to improve alternative provisions.

He also spoke about how paramedics are getting good at treating and stablisng patients at home - which is what first happend with Dad - stablised enough to see GP later on - but I know neigbours had a go at Mum for calling an ambulance in first place as they didn't take him into hospital it must not have been needed. The paramedics and GP said she did the right thing - he was unconscious and have a fit for first time - lots of underlying medical issues and various medications - I think most people would call ambulance in that situation.

Number of GP per hundren thousand of population varies across the UK - as does population demand - age and general health playing a role - it's often harder in rural or deprived area to get GP appointments than in more affulent areas. I suspect that why there's such a variation in posters experiences.

I was there once with quite a big gash in my head having fallen off a ladder. But it was in my hair, so not visible, and I felt fine. My GP couldn't have dealt with it.

However I'm sure you're right about many of the people there.

I’m lucky that we have the same. My GP surgery is brilliant. Online consult then a same day appointment. It’s a busy inner city practice too so I don’t know how they do it.

i live in Cornwall and unfortunately the issue we have is that X ray machines are closed after 5pm in our minor injury units and some don’t have X Ray machines at all. So if you break your arm after 5pm you’re stuck at Treliske A&E unless you drive a long way to either Bodmin or possibly Penzance. Apparently Falmouth has one open until 8pm but it’s sometimes closed due to staff sickness or holiday.

The last time I was in A&E at Treliske (such a sad memory for me!) it literally smelt of alcohol. And was mainly injured drunk people and elderly people who had falls.

It would really help if we had a minor injuries near Treliske. But it has to be open late (11pm) to be effective and have an X Ray machine that can be operated by several trained staff.

Im sure our Newquay MIU is closed on bank holidays. May have changed now though.

It’s just so confusing and disjointed. I guess the lack of money or even problems with recruitment is the problem here. I hate living in Cornwall (I am from Cornwall) so can’t expect others to move down 🤣

I’m an HCP in a team that works with people who use A&E “inappropriately”. It’s really complex. There are many many reasons why someone may present themselves there for reasons that are neither accidental or an emergency. In many cases we are successful in putting things in place to help reduce / stop those clinically unnecessary visits. But it relies on other services being available, such as mental health and social care. We’re also quite an expensive service at point of delivery as we often need to work with people over quite a long time. Although it absolutely saves money in the long run, we are constantly having to justify our worth and explain why are numbers are lower than services that have. Say, six sessions then discharge.

from a personal perspective, I don’t think I or my kids have ever sat in the A&E waiting room wailing, bleeding every where or vomiting, but we still needed to be there. A suspected broken arm, an early pregnancy bleed, a fall from a climbing frame onto bar stomach first.

you really can’t tell just by looking at someone.

Our GP surgery is amazing and just this week I had a callback, appointment and antibiotics all the same day I called. First time I’ve ever lived anywhere with provision like it, I love them in there. Another day and I’d have probably been at A&E with a horrendous infection (it was much worse than I’d thought) so well done them for keeping me out.

I think their secret is a very efficient callback system and good staffing levels.

Yup, it's true. You'd be amazed at the people prepared to sit for hours for the most basic of things 🙃

A couple of months before the first lockdown, I fell on my elbow and fractured it. It wasn't very painful, but I couldn't straighten it and that's not normal. It was out of hours, so I rang 111, who booked me an appointment with urgent care. This is located at our local hospital and is in the same building as A&E. I got a taxi to urgent care, to be told they were sending me to A&E because they have 24 hour access to x-ray (and other imaging services) and urgent care don't. So some of those waiting in A&E with you might not have been in a desperate condition, but they still needed to be in A&E for one reason or another. Or they might have been in an awful state, but it could have been something more insidious than what you had. Kidney stones get right in your face (so do gallstones) but cancer very often doesn't till it's quite advanced. People with potentially lethal heart conditions and acute psychotic crises often look hale and hearty...and so on and so on.

I would love to see stats on the disparity of GP appointments. So many people saying they can't get appointments, yet 370 million appointments were seen last year. I'm not here to defend GP practices, they are obviously a shit show in many areas, but other areas are doing so much better.

Ours is not perfect, but at the risk it repeating, it seems much more seamless than other regions. We get Econsult call backs/texts same day, prescriptions same day. We get forms to get blood tests and x-rays at the hospital, if urgent, you just turn up and wait, or there is an on-line booking system to several local diagnostic centers if you have more time.

Our A&E is still pretty awful, but that seems to be due to lack of staffing/beds.

I agree with every comment about a&e having to substitute a lack of GP appointments and closure of walk in centres but please don't judge someone's medical needs purely off how they look.

I'm not sure if lack of obvious pain = doesn't need to be there. Thinking back to the times I've used A&E or taken the children in:

1. Sent in straight from GP surgery for an abscess. I was putting a brave face on so probably didn't seem too ill. Was admitted for surgery the next day (ruptured in the night, but that's another story!)
2. DD, broken arm. She would have looked pale and quiet, but otherwise normal. Was admitted for surgery.
3. DS, GP sent him in for a suspected broken thumb (getting worse 3 days after injury). Sat happily on his phone looking fine. Was in fact fine but needed an x-ray to confirm.
4. DSS, suspected concussion. 111 advised he be taken in (vomiting after hitting head). Was sat happily watching YouTube. Was triaged as non urgent so spent most the night there. Was fine, no concussion, but told we did the right thing.
5. DSS again. Suspected broken arm. Did not seem in pain at all, but was adamant it felt broken. It was broken and needed a cast.

Our a&e have cracked this! I’m actually quite proud of it.

They moved a walk in centre opposite the a&e site (15m walk between the two).

The walk in centre can do X-rays for minor uncomplicated breaks for adults / children and is fully staffed.

A&E is then for emergencies only. If you arrive at a&e and get triaged they will make you go over the the walk in the centre if needed

There are 2 main problems in our area which lead to lots of people in A+E.

1. Inability to access a GP in a timely manner.
2. Crap referral process.

There have been 1000s of houses built in our area and yet no extra GP provision seems to have been made. - other than funneling them into existing GP practices. Paired with an aging population. This has increased the pressure on services. Almost all the GPs round us only offer same day appointments so if you don't get in then you have to try again tomorrow. At any given time of day you are at least number 50 in the queue, the first hour the phone lines open you can be anything over number 84 in the queue. Our GP group has introduced an online system to try and help with demand. However many of the elderly are really struggling to use the online system (despite numerous outreach sessions been given locally at the pop in shop and churches) and so are still ringing up. The online system opens at 7.30 am, the phone lines now open at 9am. Our Drs surgery have also got all reception staff answering phones in the back so check in before 10am is via the screen and ring the bell for assistance. Receptionists on the front desk are also not allowed to make same day appointments as people were queuing up outside the GP to get an appointment when it opened and apparently the staff were getting abused. Almost all appointments are gone by 9am as triage of the online system begins at 8am and if you need an appointment you are phoned and offered one so many elderly are struggling to get appointments. The telephone waiting line message says "If you are able to use the app, please do, the app opens at 7.30am and appointments are offered from 8am. If you cannot get an appointment and need treatment today you will need to phone 111 or attend A+E". Untreated conditions (especially in elderly or vulnerable patients) can and do get worse and worse until they actually need hospital care.

Second is the referral process. It may only be our area but there seems to be an inability to be referred to hospital departments by other departments. Here are several examples I know of:

I miscarried last year, presented to Early Pregnancy Unit with suspected miscarriage. EPU confirmed the miscarriage was occuring. I hemorrhaged during the process, again went to EPU as instructed if bleeding became very heavy for monitoring. They confirmed very heavy bleeding and possible hemorrhage and I would need to go to gynecology. However, due to their system they could not send me up to gynecology. Instead I had to go to A+E to be triaged to be referred to gynaecology.

GMIL in care home had a fungal foot infection. GP had prescribed treatment but it wasn't clearing up. GP said she needed some swabs doing at hospital to confirm strain of infection and treatment. GP could not refer to hospital direct as an outpatient, instead GMIL had to present to A+E and then A+E would refer her.

Nephew had an asthma flare up, wasn't responding to his inhalers as well as usual. Went to GP to see about needing different strength inhalers or review. Asthma nurse had no appointments for a few weeks so nephew sent to A+E.

There have been several other examples of people sat in A+E when I have had to attend, knowing who they needed to be referred to but having to be referred by A+E. If Drs were able to do timely direct referrals to certain departments then these people wouldn't be at A+E.

It would also be really helpful if we could have some sort of walk in x-ray service (even if they only did arms, wrists, ankles and legs) in most towns (either provided by 1 GP surgery or walk in centre) without having to attend A+E. So many people with suspected broken bones that are just a sprain all sat in A+E -mainly arms and legs. Then this service could feed into the hospital fracture clinic for those who had actually broken a bone. Same with gluing/ steri stripping and stitching of minor wounds. In our area it's A+E. If you could attend a walk in or GP surgery for minor cuts then again that would reduce pressure. Of course limbs hanging off or very deep severe cuts would be an A+E job.

Trouble is the imaging centres,minor injury units and walk in centres might have the machines but they don't have enough trained operatives to use them. My daughter had a bad fall in a PE lesson and hurt her wrist. Initial thoughts were just a sprain but she said it hurt so much hours later that we asked Our GP to take a look. She said it needed an x ray. (430pm) and wrote out a chit for the local scan centre. When we got there they said it was too late to get a scan and they would be closing soon. We then drove to the local minor injuries unit but they had no radiographer due to illness so they couldn't do it. We then drove to the minor injuries unit in the next town. Again, no radiographer as it was now after 6pm. They said the only place that could help would be the City Hospital A&E.
After a 3 hour wait there we finally got an x ray but then still had to wait another hour for a doctor to look at it, agree it was broken and finally get a plaster put on.
All the time we were there the waiting room was packed.Presumably many people with the same X ray problems that we had .
We did not want to go to A&E but had exhausted all other possibilities.
There really needs to be some sort of fast track training for radiographers to increase this skill pool and allow Minor Injury units to be fully operational on a 24 hour basis.

I agree with you but the problem is services being unavailable.

My son recently had an infected thumb that needed lancing, the GP surgery wouldn't do it, neither would minor injuries so we had to sit in A&E for 6 hours. Once we saw the doctor is took 5 minutes max to sort. That's the kind of thing that takes up valuable time etc and isn't an emergency but we had no other option! If it happens again though I will be doing it myself!

You have answered your own question there-GPs are the starting point, and until the government sorts primary care services out then A&E will continue to be treated as a GP service because GPs and 111 push patients to use A&E to get them off their hands.

Also patients and their helpers have to be prepared to help other patients if necessary. A man came in begging for help to get his elderly mother ( covered in blood) out of the car. The paramedics would not help. Another patient had to.

I hate to say it but it was the people with the most time on their hands - older retired people and stay at home mothers.

Could it be because their partners were working?

You hate to say it yet ignore simple logic?

I wouldn't judge. I know a child who went to A & E as struggling to walk, and feeling incredibly poorly. They took bloods and it was leukaemia. Someone might have looked at this sleepy pale child being carried in, sitting on their mums knee and assumed they were making a fuss and it wasn't serious.

My mum’s UTI progressed to a kidney infection which was diagnosed in A&E. she wasn’t bleeding or crying or had broken bones. But did have a potentially life-threatening infection. I think a lot of people dismiss just how serious infections can be because antibiotics do their jobs so well. Those people absolutely have to be seen by a doctor in a very timely manner, and in most cases that does end up having to be A&E because who can manage to get a GP appointment within a few hours of their symptoms these days?