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

ED nurse here, you are clearly mistaken! Around 60% of patients we see could be seen by a GP. They arrive with colds, which don’t even need a GP a pharmacist can give them advice. We’ve had them come in with false nails hanging off I kid you not! , The clue is in the name accident and emergency, however the issue is the lack of GP appointments leading people with every day illnesses attending ED, taking staff away from those who really need care!

In lots of European countries, they have "street corner" clinics that have small x-ray machines to deal with minor breaks etc. They'll bandage minor sprains and cuts etc.

In the UK, GP surgeries do less and less.

The last time I went a couple of years ago for a severe ear infection, the GP couldn't even find an otoscope to look in it! He first frantically looked through the desk drawers but couldn't find one. Then phoned, who I presume to be another GP, to ask if they had one, but they couldn't find one either. Then he disappeared for ages, presumably rooting through the drawers in the other consulting rooms. After a long time, he came back proudly waving one around, but then realised he didn't have any of those little plastic hygiene covers to put on it, so off he went again. But then he came back deflated - apparently they had none in the entire building, so he just prescribed anti-biotics anyway on the assumption it was an infection, though he couldn't check, but told me to make another appointment if it didn't clear up as they'd "ordered" some hygiene covers so someone would be able to look in my ear next time! It's utterly shambolic - my 10 minute appointment took about 45 minutes in total - not because of my "complicated" conditions, but because of their incompetence!

when I went to a&e I probably looked fine, able to sit up and talk but triaged and in resuss (sp) wishing 10 mins …

I think those who think people are attending cos they can’t get a GP appointment on the day are lucky to have a good GP. In my area people wait months for an appointment, including 2 people whose problem turned out to be cancer.

3 times over the past 2 years my family have had to go to A+E for treatment - suspected broken ankle, actual visible broken arm and a fall injury with gash in eye. Each time we have gone to the GP and/ or local walk in centre for treatment and each time the walk in centre has refused to treat us and sent us to A+E. Apparently the walk in centre 'doesn't have an x-ray machine' (it does but only operates during very limited hours!) and/ or 'doesn't treat head injuries' when all we needed was stitches for the gash (which A+E tried to send us off after 8hrs without even stitching until we pointed out the only reason we were there was for the very much needed stitches which they then did). None of these injuries could have been treated at home BUT none of them needed A+E either! And don't get me started on the triage process - wait to be told you need xray, to then wait for doc to tell you need xray, to wait in xray queue to then be told the doc hadn't hit enter on computer (despite doctor having walked us to xray and verbally handed us over to xray tech) so I was told to go find doctor myself (in a huge hospital!) to get them to hit enter on computer so xray tech could do xray, to wait for result of xray from doc to then wait for nurse to actually do the cast. Over half that time could have been saved with more efficient process....

We have an urgent treatment centre that used to be a minor injuries unit. Now, if you have a minor injury that needs an x-ray or stitches, you have to go to A&E.
The urgent treatment centre is always busy, presumably because people can't get GP appointments but I wonder how many people at A&E would previously have been seen locally.

The GP surgeries no longer do blood tests that are requested by the hospital. You have go to hospital to have the blood taken, which is bloody frustrating. There's hardly any car parking (and it's a minimum of £4.75 to park), and getting there by public transport is 3 buses from where I live, or two buses and a train.

I wonder how many people are sat in A&E because the GP has sent them, when there really should be a way of dealing with these ‘inbetween’ issues, leaving A&E for the genuine emergencies.

Exactly this, I needed blood tests but if the results were bad I needed urgent treatment so the go doing them and waiting a week for the results wasn't going to work. In A&E I was chatting to others, 2 others were in the same boat, needed urgent blood test that no where else could provide. Others were waiting for xrays, that could have been dealt with by referrals and appointments but there is no facility for that. So we all found ourselves sat in A&E for hours. None of us wanted to be there, it wasn't a jolly night out. I would have much preferred to be able to go somewhere get a blood test done and get a call in a few hours time with the results and be called in for treatment if needed. It's not the patients fault for using the only methods available to get help.

Yep.

and if they could get a GP appointment they probably wouldn’t be there.

Your way: the most experienced doctor has to speak to everybody. They are (Like my son) professionals and will do a diligent job. They will burn out within a few hours.
The NHS way: the experienced doctors get to treat the sickest people. They burn out after a few years.

OP, even the top medical professionals in the world can't tell whether there's something wrong with someone just by walking past them in a crowded room. If you can do that, then you need to offer your skills immediately. Resolving the NHS crisis could be down to you.

What if you don't have an urgent treatment centre? Lots of areas don't!

But every time I’ve used 111, they’ve basically always just gone straight to telling me to go to a&e even when I haven’t thought that necessary.

My OH was diagnosed with incurable, but treatable, cancer around 7 years ago. He's on permanent drug chemotherapy, is immunocompromised and both the cancer and drugs affect his bones and organs!

The "helpline" he was given to the cancer nurses in the oncology department which the haematologist told him to ring with "any problems" is completely useless. Most of the time it's an answerphone and they can take 3/4 days to ring back, even during working hours. No hope at all of anyone answering it in the evenings, weekends, nor bank holidays. When they finally ring back, answer is always one of two options - if it sounds serious, they tell him to go to A&E, if it doesn't, they tell him to talk to the consultant about it at the next monthly consultation (by phone of course!). They've never once actually "done" anything, given any advice, etc. What is the point of them!

Same when he's phoned 111 in desperation when the cancer nurses havn't got back to him - the moment he mentions his cancer diagnosis, their advice straight away becomes "go to A&E".

Until you get into their system with a long term serious condition, you don't realise how crap it all is, especially when it's month after month, year after year.

The answer to lack of GP provision isn’t walking into A&E! It’s 111, pharmacy or urgent treatment centre.

Yanbu.

I was in UCH A&E with suspected fracture last year. They came and announced to the waiting room non urgent cases were a 3-4 hour plus wait time and I'm not exaggerating when i say about 40 people stood up and left immediately. It was comfortably more than half the waiting room

Separately, I have had to go in regularly due to a heart condition and regularly get filthy looks as I "waltz through" and get seen almost immediately. I do a small queen wave as I am wheeled past on my guerney

I was actually delayed from treated last time by a man in front who took forever to check in and his medical issue was 💯 non urgent - he was debating /angling to try and get a non urgent day patient type treatment and was just arguing with front desk for ages. They were clear thry didnt know definitive but he probsbly wouldnt get this treatment so he turned around and left!! Not really an emergency then...!
this was at 2am on a weekday.... WHO does that?

I spent a whole day in A &E recently with DD who’d fractured her wrist. It wasn’t severe just a buckle fracture still needed diagnosed though. We were chatting in the waiting room to keep her spirits up and it didn’t hurt thst much as long as she held her arm still but any movement was needed rally painful.

A Gp wouldn’t be able to X-ray so I’m not sure what good sending us away would of done.

@PrettyPleaseXo
Last year I went to A&E with a kidney stone, didn't know that was what it was at the time.
Amongst the pain and throwing up I did manage to notice the waiting room was standing room only, I didn't need a chair as I couldn't get off the floor!
It was 2am and I was basically taken straight to a cubicle.
I was in hospital for 2 days but what stuck out was that I was in a cubicle in A&E for over 12 hours (no beds available on the wards).
I went in just after 2am and went up to the ward at 14:30 the next day.
Not sure if the people in the waiting room really needed to be there, they could be family members supporting a loved one.
What I did take away from it was that the staff were lovely, very caring but the pressure the NHS and the staff are under is immense

You're probably right. But have you tried to get a GP appointment recently, or a referral for further treatment? People feel they have no choice.

I recently broke my foot but knew it was just a top bone that would likely heal and I could walk mostly ok. 2 weeks later and it was becoming problematic to even get a shoe on. I felt it pointless to clog A&E by this point as it wasn’t exactly an accident or emergency 2 weeks later. I got a GP appointment in the hope they could perhaps get me booked in for an X-ray in a couple of days time or something.
But they took one look and told me to go to A&E because apparently they can no longer refer people for X-rays like that. I said it was ridiculous for me to take up space in A&E when I could clearly wait a few days. But no, I was told to go to A&E or a walk-in. I went to a walk-in and was told it was a 5 hour wait for triage and no x-rays were left that day so I’d be called back tomorrow after triage. I told them a GP had already triaged me, but they said it doesn’t work like that. I left. I didn’t have 2 days spare to wait.
I didn’t go to a A&E department because I’d have felt like a fraud. It wasn’t an emergency.
It sorted itself out after 8 weeks, albeit I still have a small lump on the fracture site. At least I can get shoes on now!

There’s a definite gap between GPs and A&E, and walk-in centres are just overloaded with people who can’t get GP appointments (it’s a nightmare getting one at my practice)

I wonder how many people are sat in A&E because the GP has sent them, when there really should be a way of dealing with these ‘inbetween’ issues, leaving A&E for the genuine emergencies.

My son "looked" fine and was chatting away during a long wait in a&e but 12 hours later was in PHDU and the doctors were debating admitting him to PICU.

I "looked fine" when my GP sent me because he was very worried after examining me and the tests needed to be done urgently and could only be done in hospital

Some people are very good at carrying on looking fine even when they are very ill.

I once got discharged from hospital because the doctors decided I couldn't be that ill because I was chatting to my friend and giggling away. I was readmitted the next day and needed emergency surgery

It’s very easily resolved. I live in a country where most A&E departments have a primary care general practitioner facility in a different building but on the same site. It opens 24/7 the same as the A&E dept and patients get sent there at triage if the problem is too minor for A&E.

I agree - but I also think that’s caused by the fact people can’t access any medical attention, often for weeks.

My GP’s standard offer is now a phone call in two weeks. That’s not much good if you are in pain or it feels serious and needs more immediate attention.

DH had to go to A&E recently. He probably looked "fine". He had dislocated his toe, it had gone a funny colour indicating that blood supply was being restricted. He needed x ray and then a doctor to manipulate it back into position followed by another x Ray. After that, just painkillers fir a few days.

Minor issue, but untreated he could have list his toe...which would have been serious treatment.

The hospital triage into minor injuries and a&e on arrival

Apologies for merailing a thread with a personal experience....

I developed excruciating tooth ache last year, I suspected an abscess or some kind of infection. I contacted the dentist who couldn't see me because they had no emergency apps, I went to the GP surgery, they don't do dental, I spoke to the pharmacist who couldn't deal with 'dental' either. I phoned 111 in the hope they might be able to direct me to an emergency dentist who wasn't my own, I waited 24 hours and hadn't received a call back. By that time the side of my face was so swollen I couldn't open my eye. I went to the local minor injuries clinic, they don't do dental either so I went to A+E. I was mortified to be taking up time just to get a prescription for antibiotics but it's not as if I hadn't tried literally everything else. I wonder how many other people have similar experiences.

The NHS is run entirely on "gate keepers" whether the GP receptionist or the A&E triage nurse or other health care professionals actually having the "face to face" contact with the patients. And yes, it does cause a lot of time wasting, appointment wasting, etc., as patients have multiple appointments and multiple long waits, going through all the various stages, until they finally get to where they should have been in the first place, i.e. face to face with a doctor or in an x-ray or scan unit!

I actually agree it should be turned around, but it's like turning around a giant oil tanker - there's too much momentum to stop the way it works.

When you go to clinics abroad or private in the UK, it's the opposite, you see the "big man/woman" first, and then get directed to the right person/equipment.

Basically, the NHS has been flooded with "cheaper" staff who are thrown out to gate-keep and fend-off patients. You see it in most out patients clinics. A receptionist, then a HCA picking up your form to take it somewhere else. Then a different HCA calling you through to sit in a different waiting area. Then another different HCA weighing you (whether relevant or not). Then another different HCA taking you through to the inner sanctum of the waiting area outside the consulting room, then called through to see a junior/trainee doctor who takes history, etc., then finally called through to see a registrar who takes more notes, and makes you wait in the corridor while he chats it over with the consultant, who may or may not grant you an audience if he deems you worthy! If not, you get called back in by the junior/trainee doctor often just to tell you they're going to refer you for an x-ray or MRI scan or whatever, which is what was blatantly obviously going to be required from the moment the GP referred you months ago!

This. My GP receptionist told me on the phone that the GP is for routine appointments and not for anyone who’s ill. Couldn’t believe my ears! They made me go to A&E instead so I could wait 8 hours overnight with my toddler just to get an antibiotics prescription.