This is why A&E is overwhelmed

[PackedintheUK]

And it's nothing to do with over anxious patients seeking "unnecessary" medical care.

I have a very sore very swollen ankle as a result of an insect bite. I've asked advice at the pharmacy and been told it looks nasty, see your GP, you probably need antibiotics.

So I've tried. I've been calling GP surgery all morning and finally got through to have receptionist incredulously say "you want to see a doctor for a gnat bite?" and then be told the next appointment is 16 Nov.

Me: but pharmacist said I need seeing urgently.
Receptionist: All the emergency appointments are gone for today. You'll have to call back tomorrow.
Me: but I've been calling all morning, won't the same thing happen tomorrow?
Receptionist: Well I can't do anything about that, if you're that worried go to A&E

So,I'm not sure that I am "that" worried, but I have been told by someone better qualified than me that I should be seen. We lost a colleague to sepis this year, a fit young woman and it happened incredibly quickly, plus I have a friend currently in hospital on intravenous antibiotics from a very similar looking bite he got at the same park.

I also don't actually feel that well.My body aches and feels heavy and I'm a bit queasy, which could be coincidence or my imagination.

Probably/hopefully it is nothing that won't heal itself in a few days but it feels irresponsible not to take the advice I've been given. Also to go to A&E

So A&E for something that could (probably) have been dealt with in a matter of seconds in a GP (telephone/video?) appointment?

There's no walk in or minor injuries here.

"I don’t think it’s just a lack of qualified GPs so much as a lack of GP positions being made available by the NHS. I’m sure if there were more surgeries allocated and more roles became available, the qualified GPs would materialise."

Absolutely wrong, the problem of GP surgeries being unable to fill existing vacancies has been ongoing for quite a few years now.

This article sums the situation up well:

https://hunter-ahp.com/why-is-there-a-gp-shortage-in-the-uk/

@Rassy

I haven't RTWT but I thought pharmacists can prescribe antibiotics for insect bites?

No you can’t buy antibiotics over the counter in the UK

I think the problem is calling and then being told you need to start from scratch the next morning. Why can't they book appointments for the following day/week?

In Scotland pharmacists can now give you antibiotics for an uncomplicated urine infection. Our gp receptionist DID signpost this. However if you have a temperature with it they'll ask you to consult the gp.

For something like that I would go for an online consultation. I've found they respond very quickly; I've sent a photo that way, and been dealt with well.

Does your surgery do that?

" show up with chest pains and you'll be seen straight away"
Not in Scotland you wont. First hospital refused to even examine ds (19) saying they didnt have an A and E and second one saw him after an hour and a half!

@Staffy1

*There are not enough GPs

This government has not done anything about increasing course numbers to increase those qualified*

I don’t think it’s just a lack of qualified GPs so much as a lack of GP positions being made available by the NHS. I’m sure if there were more surgeries allocated and more roles became available, the qualified GPs would materialise. Also there jobs would be less stressful and horrible if there were more of them to go around, so some of those who have gone private full time might be tempted to work for the NHS again.

There are GP vacancies in my health board, but they don't get filled and more retire or leave than get employed apparently. For example locus gp post pays £80 per hour for a 30-40 hour week, mon-fri between 9am and 5pm.

They struggle to fill these jobs.

I'm not sure what the rules are for starting a new practice but I guess the days of having a surgery with two or three doctors is long gone.

[quote silveryslade]**@Bagamoyo1 no, the process just needs to be followed correctly p. Every request for GP appointment within hours needs to be triaged. Out of hours the triage happens at the out of hours place. [/quote]
Triaged by who? And what if it's deemed that the patient needs to see a GP, but the GP slots are all full?
A&E is different - there are multiple doctors and nurses working on a shift system, hence the ability to staff it 24-7. GP surgeries aren't like that.
If every patient who wanted to be seen by a GP was seen, then surgeries would also have to be 24-7. And that's not an option as primary care doesn't get enough money to pay 24-7 staff.

Please can someone tell me what they would do, if they were given the job of running general practice? What would you do when all the slots were fully booked by 9am?

I have not read the whole thread. But just the last few posts @Musicaltheatremum I'm with you. This is the absolute pits. So far today ( I am the duty doctor in a GP practice) I have had 46 'urgent' telephone consultations. I have seen 12 people in addition. I have reviewed 135 blood tests result and acted on the abnormal ones. I have read about 60 letters and similarly actioned what needs to be done - arranging tests and prescribing medication I have another 16 people waiting on my duty list. I have not left my desk except to go to the loo or to collect a sample pot form another part of the surgery. I have had no lunch. I cannot, simply cannot, work any longer hours or any harder than I am. This is day after day after day. I have been a GP for more than 20 years and I am at breaking point,

The ignorance and stupidity of people saying ' GPs should do what they are paid for' I wish you could come and sit with me for just one day. I wish you could get inside the stress of making decision after decision about peoples lives and health. I wish you could try and fit the demands of 100's of people into the small number of appointment slots.
Last week another GP in my surgery a resigned as she is emigrating to Australia. I don't blame her. But that's one less to carry the weight, and its impossible to recruit replacements. Is it safe for me to have 100 + patient contacts in a day ? of course not. Who will support me if I make a mistake ? no one. Would I work less if I could ? Of course I would. I cant wait to retire.
we are trying as hard as we can. working a s long and hard as we can. doing the very best we can. the system is broken. we are broken.

@Malibuismysecrethome

Bagamoyo no one is saying GPS and nurses should work into the night. However, it is extremely hard post Covid to get a GP appointment at all. It is not acceptable to wait days or even weeks to see a GP whatever you may think.

how would you solve this?

@Staffy1

*There are not enough GPs

This government has not done anything about increasing course numbers to increase those qualified*

I don’t think it’s just a lack of qualified GPs so much as a lack of GP positions being made available by the NHS. I’m sure if there were more surgeries allocated and more roles became available, the qualified GPs would materialise. Also there jobs would be less stressful and horrible if there were more of them to go around, so some of those who have gone private full time might be tempted to work for the NHS again.

there are many unfilled GP posts. No one wants to be a GP. Surgeries are closing as a result, and their patients (2000 per GP on average) are joining other surgeries. Then everyone wonders why they can't get an appointment.

@StupidPhones

I think you are missing the point: people are being blamed for going to A and E for issues that could be dealt with by GP. Op and others are explaining why, in their experience, they may be forced to.

Yes. My husband had a bad insect bite a few years ago, in the days when you could still see a GP and he got a same day appointment and was prescribed a cocktail of things. He was better 48 hours later.

It certainly saved the NHS money and on a visit to A&E; it may have even saved his life if the bite had been a bad one.

Receptionists fobbing people off is extremely short-sighted. It amazes me that people still seem to be able to get for appointments for coughs and colds (someone mentioned on MN a week or so ago that they were a nurse practitioner and seeing people with respiratory conditions they could manage from home) but not for insect bites and dodgy moles.

I don't know why there aren't more walk in options, staffed by nurses or paramedic practitioners. I would have thought they were a good alternative to seeing a GP or going to A&E with more minor things. There is one near my mum that she's been to a couple of times and it seems to work really well. Once they told her to go to A&E, the other time they were able to treat her.

@Flixon

I'm 35 years qualified. Worked 120 hours a week as a junior doctor. This is so much worse. I want to cry every day I'm in. If it wasn't for issues with our surgery finance (yet another stress) I'd be off tomorrow.

I have just searched online and as of eaervthis year it would appear, in Scotland at least, that an infected insect bite could be
dealt with by antibiotics via the pharmacist too.

Earlier this year..

I just don't know why it's so hard for people to understand.
If you go to a theme park and queue up for a roller coaster, when all the seats are full, they don't let more people on. It doesn't matter how much you want to go on the roller coaster. When it's full it's full. People can understand and accept that. So why is the concept of fully booked appointments so tricky to grasp?

We had a similar issue recently. Pharmacist said GP. Couldn't get GP app, pain worse so 111.

I am so sorry to all of you working under such enormous pressure.

I also feel sorry for people that desperately need the nhs and it can’t help them.

I’ve seen the way it’s been going over the last while and taken our private healthcare including GP cover because I’m so concerned about not being able to get appropriate treatment if I need it.

I feel so sorry for those that cannot afford this. I don’t know what’s going to happen but if something doesn’t change it’s going to be something very serious.

@BungleandGeorge

If all the appointments were booked I’m not sure what you wanted to happen? Should the GP have to stay there all night to see all the ‘extras’? Either it’s an emergency (a&e) or you could wait another day?

I don't think I said I wanted anything "to happen", except for people to stop blaming "us" for over whelmed A&E depts, although I do think that having been told I needed an appointment tomorrow it shouldn't be beyond the wit of man to book me an appointment for tomorrow without sending me back into the endless telephone loop which may or may not be successful.

Have you done anything further op?

I'm increasing grateful that my employer provides gold standard private health insurance for me and my family. I've had it for many years and never really bothered to use it but this year, the GP service alone has been worth its weight in gold.

How lovely for you @ChequerBoard. My work policy won’t cover my daughter because of the pre-existing condition she was born with. Because she has cerebral palsy, they won’t treat her for anything. That’s the biggest problem with thinking we can supplement the NHS with work provided healthcare policies.

tis is what Babylon and GP at hand provide. simple appointments with simple solutions for the generally fit and well. Leaving anything remotely complex, remotely difficult to the NHS. I fear for the kids with disabilities, the elderly, the mentally ill, pregnant women, and anyone with preexisting condition when the private companies come an pick off all the basically well who have an insect bite or a bout of tonsillitis ...
and its coming. very very soon ...

@BoredZelda

I'm increasing grateful that my employer provides gold standard private health insurance for me and my family. I've had it for many years and never really bothered to use it but this year, the GP service alone has been worth its weight in gold.

How lovely for you @ChequerBoard. My work policy won’t cover my daughter because of the pre-existing condition she was born with. Because she has cerebral palsy, they won’t treat her for anything. That’s the biggest problem with thinking we can supplement the NHS with work provided healthcare policies.

That's a shame for you @BoredZelda but I'm not sure why it's my fault?

I referred to being grateful to my employers for the private healthcare provision as it is gold standard because it is - it covers me and my family for everything including existing conditions. My DH has been living with heart failure for 25 years and has had cancer in the last 3 years as well but he is covered for everything.

I'm not suggesting everyone should have private health insurance either just remarking that those of us that have it are now seeing the need to actually use it . This is the first year I have felt the need to use it extensively to manage basic primary care needs for my family.

I am a strong advocate for the NHS, but recognise that it is a system that is buckling under extreme pressure. There are no simple
fixed here, every care setting from primary to acute to community and mental health is crumbling and the crisis in social care is impacting patient flow putting even more pressure on the system.

I would go. Something like this can quickly turn to septicaemia especially with the other symptoms. I know someone who this happened to and who then went on to need IV antibiotics.

Afterwards I would put in a complaint to the practice manager and take it further if you get no joy.

[quote Moonopoly]@Spicychickentenders At my surgery they hold back emergency appointments. Receptionists are not medically trained to make these decisions. They should at least be asking a medically trained colleague if OP can wait or not. They are a Dr’s surgery not a hairdressers. They have a duty of care to make sure their patients have their medial needs met.[/quote]
No, they are not properly trained to do it, but doctors tell them to do it. It's not their fault.