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

It can be a frustrating system. My ds has a serious but managed health condition. He has regular hospital stays, however if he gets even a small fever we have to go to hospital. We have to “check in”’at a&e the then his medical team come and check him out. We can’t just go to the ward. We normally ring ahead to his team and someone come ones down quickly but it’s frustrating. Also had people shout that he’s jumping the queue!

I asked an A&E doctor on Tiktok roughly how many people shouldn't be attending A&E and he reckoned about 50%

I had 3 trips to A&E recently. The first one I didn't have to wait at all, I was in emergency surgery within an hour of rocking up, I looked like and was very close to death.

The second time was because I had had emergency surgery 4 days prior my GP wanted me to have blood tests to make sure the symptoms I was having wasn't sepsis as I have a history of sepsis. I looked fine, maybe a bit uncomfortable because of my surgery but fine.

The 3rd time again referred by my GP as I had pain in my leg, I needed blood tests and a scan to rule out a clot post surgery. Again I looked fine but the tests couldn't be done anywhere else.

The problem is the lack of alternatives to A&E not the people who look fine who are using it.

My last trip to A&E:

• Antibiotics prescribed for a chest infection ran out while infection not cleared
• Phoned GP surgery asking for prescription renewal, advised would need to see the GP
• No GP appointments available until following week, told to phone 111
• Phoned 111, spoke to someone, described symptoms (chest pain, coughing up mucus with blood)
• 111 told me to go to A&E
• Went to A&E, six hours later, emerged with antibiotics

Clearly, if people have a low-level problem, they shouldn’t be in A&E. But I had bad wind once that felt like I was about to die or have a burst appendix, and it wasn’t until I let out the largest fart that I knew that’s what it was.

YABU - yes there are some malingerers I am sure but the majority of people don’t want to spend 12 hours of their day having something minor checked out and we are not our own personal x-rays.

I used to kind of think like that until one of the chatting and joking but look fine people were me and my mum. She had had worsening symptoms for weeks and the GP was pretty much ignoring them. Saw a private GP who advised to go and sit in a&e to get seen. We did wonder if we should but decided to just take their advice. It took 10 hours but after finally being seen was admitted to a ward for tests. She was dead 5 weeks later. So while the ideal route would have been GP, referral, appointment, it doesn’t always work like that especially when someone seems fairly “well” and they don’t get taken seriously. But my mum was incredibly unwell with aggressive cancer that has spread and killed her 5 weeks after diagnosis.

There is a point there though right? You can't tell by looking. You have absolutely no way of knowing whether the people who were in a&e at the same time as you needed to be there or not - not by sight anyway. They would have had to share their medical history with you.

I had a minor biopsy on my face. The nurse at the GP removed the stitches. The wound opened less than an hour later - GP refused to treat it and said I should go to straight to A&E. Tried a private GP who had no space and also said the only option was A&E. Both the Gp and the private GP said that I needed to go in order to prevent infection.

i did manage a rather unorthodox way to see a nurse who took pity on my - 5 minute job to clean and apply steri strips.

Some years ago I helped an old man who’d had a fall which happened to be 100 yards from the GP surgery. He was bleeding from a few cuts. helped him to get there but they refused to see him to clean his cuts and referred him to A&E. We managed to get him to his house.

in both cases just a few minutes of preventative treatment would have helped to avoid possible worse issues and work out cheaper and more efficient than tying up resources at A&E

Edited to add that in both cases we wouldn’t have looked as if we needed A&E but that this was the route recommended by the GPs.

When my husband had a TIA we probably presented (to you, at least) as not having anything wrong and we chatted to each other while waiting.

Oh I wasn't being sarcastic. I am genuinely in awe of your ability to tell just by looking at people whether they are ill or not even though many conditions have no visible outward symptoms

Whilst there is a sense of entitlement in general nowadays, I don’t think that necessarily applies in this situation. It’s often that people can’t get an appointment with their GP for literally months. And then when their appointment comes, it’s cancelled and they have to wait ages for another one. Some areas are worse than others.
Yes, some people use A&E when it’s not necessary. 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.

I would never judge.

I looked incredibly well at hospital yesterday but I was there for something serious found by other doctors and I’m now looking at having heart surgery.

I was also fast tracked and didn’t wait more than 5 minutes so I probably got alot of what the hell comments but it’s nobody’s business.

Just because a person looks fine, and can talk doesn't mean they're absolutely fine and shouldn't be there. I looked fine and could talk when I went to A&E with severe abdominal pain.
It came in waves and at times I felt no pain at all and felt like I was a fraud being there. Turned out I had acute pancreatitis and was admitted, spent 2.5 weeks in hospital, and had my gallbladder out.

Recently, we attended a non emergency walk in centre for an urgent but comparatively minor health issue.
We were seen quickly and a prescription was sent to our local pharmacy for collection the next day.
The whole process was quicker and more efficient than A and E would have been, minus the guilt about possibly attending unnecessarily.
We live rurally and travelled about fifteen miles to the small market town where the centre was based.
We didn't know it was there until a friend told us about it; our usual action would have been to travel fifteen miles the other way, to the A and E in another town, waited hours and perhaps take up time needed for more urgent cases.
I read that more of these centres are planned, which seems like the way to go.

Wow @PrettyPleaseXo ... You may be able to resolve the NHS single handedly if you can tell just by looking at someone that they are "fine" ..what a magical skill set

Not helpful to consider them all feckless.

fwiw, the official statistics are that about 40% of people in A&E 'could' have been treated in primary care. "Inappropriate presentations" etc. We find maybe 30% (of that 40%) didn't try to get care elsewhere. The reasons given by "inappropriate presentations" (I spend time researching this) are roughly in this order from most to least (plenty people have multiples of these reasons)

*Someone vulnerable is unwell like small baby or frail adult & the carer can't tell how bad it is (& maybe carer couldn't reach GP)
*Tried and tried to get GP appt for hours or maybe days and now gave up, especially if pain increase or severity has changed
*Told by GP / pharmacist / NHS111 to go to A&E
*Told by A&E to come back after previous treatment in A&E
*The patient never sought medical care before, they don't know about any NHS options; maybe they come from a country where all health care happens at hospitals where you just turn up (eg China)
*On holiday/far from home & problem is worrisome
*Perception that they have seen GP about this problem before but it never gets better, now desperate to try to progress treatment somehow, maybe A&E can offer something
*Perception that all the tests happen at A&E, things just happen, it's "better"
*Experience knowing that if they talk to GP about their problem, GP always sends them to A&E anyway
*Urgent need for medication that must be prescribed
*Friend told them about good walk in service & they don't even want to take hours trying to reach GP, or they can't get on phone at 8:29am.
*Anxiety driven yes: convinced they have severe problem & refuse to believe otherwise

I was in a&e on Friday night
It was surprisingly quiet
But 4 people including me had been called by the OOH dr after having bloods done that day by the GP
All of us needed emergency infusions and to be kept in.
All of us had been trying to get GP appointments for weeks.
Cant be 100% sure if id been seen by a GP weeks ago that I wouldnt have ended up taking up a&e and hospital resources, plus 2 outpatient clinics since Friday....but im 95% sure I wouldn't

If you are registered at a GP surgery that only lets you ring on the day, has no online or econsult service and you can't ever get high enough in the queue to be answered but you have an issue that could be cancer like a lump or bleeding and it goes on for weeks getting worse?

If you can't find a dentist that will let you register but you have toothache that is getting worse and you now have an abscess and a temperature?

If you have a long term condition and need regular meds but no pharmacy in a 20 mile radius can get hold of them to fill your prescription and your condition needs management or it could become life threatening?

You have been bitten by a human and need PREP and it's out of hours.

There are so many reasons why people can look ok but still need what only a&e can provide.

Whole many patients may not be there for what a&E was originally set up to provide, we have also reduced our health service to such a poor shadow of itself where desperate people can't access the right service like pharmacy or go or dentist, and are left with no option but to go to the place that is actually open.

That is a massive issue, and people are at fault, but it's not the desperate patients to blame.

And I want to be part of a society where everyone is deemed worthy of help with their concerns, and that you shouldn't have to get to the point of screaming in pain and lying on the floor to qualify.

DP cut his hand last year at work, and we started off at minor injuries where they deliberated for a while then insisted it needed to be stitched at A&E instead because they wanted orthopaedics to look at it first due to possible nerve damage.

So off to A&E with a deep but clean cut we went. DP was fine in himself, just needed a few stitches! 7 hours later, a junior doctor who had never stitched a real person before did it. No orthopaedics input.

He didn't want to be there, he didn't need to be there, the experienced nurse in minor injuries could have done a better job 7 hours earlier! This is the sort of shite that clogs up A&E in my experience.

I don’t doubt you’re right.

But there will be a chunk who:

1. Dont need A&E, but do need medical advice and it’s the only route whereby if you wait long enough you’ll see someone. GPs don’t have that provision.
2. Don’t need A&E, but need something beyond GP and reasonably swiftly. Eg. Certain checks for certain chronic conditions. There should be better routes for these things but there aren’t.
3. Do need A&E, even though they look ok. I’ve been there with husband, we were chatting away and probably looked fine. He was in hdu with sepsis 10 hours later. I knew he wasn’t fine. Same with friends child, playing with the toys looking fine, while staff discussed whether to admit her.

I do suspect a few of the standard patients just need a 1st aid kit at home, a bit of common sense/Google search of symptoms/remedies on the internet, and a sympathetic ear from a friend or neighbour.

We have 3 new building estates going up, housing thousands, all will probably go to the local GP that is already struggling. No infrastructure is built to support the housing estates.

I could have been one of those people OP.

I have Crohn’s disease and was experiencing a flare up not long ago, the IBD nurses - after liaising with my consultant - told me to go via A&E in order to be admitted. Once I got there, the gastro team were contacted and I was seen very quickly and had bloods / imaging HOWEVER I was sat in A&E for 18 hours waiting for a bed to become available. I ended up spending 9 days in hospital and having surgery so obviously I had a very real need to be there however just from looking at me, you would never have known as I too was having a good old chat with other people who were also there for hours waiting for a bed.

Things aren’t always as they appear so I wouldn’t judge.

I’m sorry @PrettyPleaseXo i don’t think it’s a fair point.

I think people have taken it upon themselves to decide that whatever their complaint, no matter how minor, that their doctor’s surgery should see them TODAY - in one day - without fail.

anything which isn’t same day is then treated as “right, off to A&E” and some people even treat it as a bit of an adventure, it makes them feel important etc

Ive seen entire families waiting in A&E chatting away and sharing snacks , the patient themselves looking very happy and comfortable, no ostensible issues. Most of us have seen this. When will it end?