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.

The problem is the 'part time' GPs are actually working 40-50 hours a week...

@ADreadedSunnyDay

IMO medical students should be forced to undertake at least 3 years work as GPs before being allowed to specialise as consultants. That way they get to deal with people on the ground and gain a broad understanding of lots of conditions.

Being a GP is a specialty, albeit a general one. You can't just jump straight into being a GP from medical school. The amount of risk involved in GP is enormous.

@ADreadedSunnyDay

IMO medical students should be forced to undertake at least 3 years work as GPs before being allowed to specialise as consultants. That way they get to deal with people on the ground and gain a broad understanding of lots of conditions.

But I do agree that all junior doctors should have to do a training job in GP, to better understand how primary care works.

@Xenia

There are huge demands from very competent 18 year olds to read medicine. If we could weed out at age 18 those who will be wanting part time work we could then just hire the full timers and take them into university on the basis and with a contractual obligation to work full time in the UK NHS .

But 18yos don’t know. They may well have every intention of working full time. Then get married, have kids. If they have the misfortune to marry another medic you have two parents with competing and short notice shift patterns and no guarantee of finishing on time and something has to give.

I had to take DC to A&E recently. (It's also a minor injuries)

It wasn't the GP in his case as ours are very good.

But trying to get an appt with an OOH at weekend is difficult. Got passed over to pharmacist but since discovered he probably wasn't able to prescribe.

So basically 8 hours trying to get an appt with OOH GP meant my DC was really pretty poorly.

All he needed was an antibiotic. That's all.

A&E were brilliant and passed us over to GP after me telling them what I thought the problem was.

Less than 30 mins later we were leaving with an antibiotic prescription. If we hadn't went to A&E when we did I think he may have been hospitalised as his temp was dangerously high.

We shouldn't have had to go to A&E. It was not life or death at that time. But I am also not going to watch my child get sicker and sicker because I can't access the healthcare he needed.

But mostly, of course they need resourcing better, it's about the system, not the GP or the receptionist.

If only it were that simple! The problem is that there aren't enough GPs, and there are far too many patients. It takes over a decade to train a GP, you can't just magic them from thin air.

Many GPS are leaving the profession due to stress and overwork, so I'm not sure that asking them to 'just squeeze in' these extra patients is a good solution.

Totally understand the frustration though

@Xenia

There are huge demands from very competent 18 year olds to read medicine. If we could weed out at age 18 those who will be wanting part time work we could then just hire the full timers and take them into university on the basis and with a contractual obligation to work full time in the UK NHS .

This is impossible. At 18 you don't know what life will throw at you. My husband and I have both worked full time as doctors for the past 4 years. He is an A&E trainee and I'm a GP trainee. I'm currently pregnant and when I come back from maternity leave I'll be going part time, probably 60%. DH and I barely see each other as it is, there's no way I will be able to juggle childcare (working that around 2 conflicting rotas), managing a household and actually maintaining a level of wellbeing/social life whilst working full time. What about people who have caring responsibilities or end up with health problems? How can they predict these things at 18?

Maybe we need to ask why so many GPs end up working part time and what the part time actually entails hours wise? Is that more because of the stress and the workload that it’s actually the only way they can do the job and look after their own well-being too?

There are huge demands from very competent 18 year olds to read medicine. If we could weed out at age 18 those who will be wanting part time work we could then just hire the full timers and take them into university on the basis and with a contractual obligation to work full time in the UK NHS

Or we could expand the intake so we have more qualifying, so those who wanted to go part time can, and we have enough qualified dr’s to fill the gaps.

I never understood why, when medical schools are hugely oversubscribed, and there is a huge shortage of doctors, we don’t train more.

We could also look at fast track for graduates in other related disciplines, nurses etc so they can graduate in 3 or 4 years rather than 5 or 6. Or same as nursing, develop specialist degrees so you train faster in your chosen discipline- midwives and mental health nurses train differently to paediatric or elderly nurses.

My husband and I have both worked full time as doctors for the past 4 years. He is an A&E trainee and I'm a GP trainee. I'm currently pregnant and when I come back from maternity leave I'll be going part time, probably 60%. DH and I barely see each other as it is, there's no way I will be able to juggle childcare (working that around 2 conflicting rotas), managing a household and actually maintaining a level of wellbeing/social life whilst working full time

Genuine question, and slightly irrelevant to the thread, but why are you going pt and not your dh? Or both of you cut to 70 or 80% and both have a better balance, better shift patterns etc?

I work part time. 3.5 days per week. That’s 42 hours

@Xenia

There are huge demands from very competent 18 year olds to read medicine. If we could weed out at age 18 those who will be wanting part time work we could then just hire the full timers and take them into university on the basis and with a contractual obligation to work full time in the UK NHS .

When I was 18 I was a very healthy 18y old who fully intended to work full time. Unfortunately multiple chronic illnesses since I’m only able to work part time - but still work 50% + over my on-paper hours most weeks. I think I’m a fairly good GP and forcing me to work full time would simply mean I couldn’t work at all.

Interesting that bubble has managing the household down has her job not her DPs or a split role.

Perhaps a new way to describe part time of it is already full time hours ? Full time could become “double time”

I had similar - a swollen ankle which made it very painful to walk, which the pharmacist said was probably an insect bite and I might need antibiotics if using anthisan didn't work. We usually have a long wait to get a GP appointment and I wanted it looked at - not discussed over the phone. I went to A&E (I decided a Sunday afternoon would be the best time to go). I was triaged at A&E and the receptionist said they could deal with it quickly by making me an appointment with my GP! I said that I would prefer to wait so someone could look at it. I waited an hour or so and was seen by a doctor who was very thorough and prescribed antibiotics, which cleared it up.

A&E is overwhelmed but so are GPs. The number of GPs has fallen by a fifth since 2015. 5 years ago, the average full-time GP had 1,800 patients, now it's over 2,200. Despite that, we're actually providing more appointments than pre-Covid.

Sorry that you had a bad experience but blame the government for repeatedly failing to make good on its promise to recruit more GPs. Stop blaming the GPs who remain for the fact there aren't enough of us.

I work part time as a GP. It's about 40 hours per week. I don't want to work more than 40 hours per week, so why should I ? If I was told I had to work an extra day (ie an extra 10-12 hours per week) I'd quit.

@Hodgehog

Interesting that bubble has managing the household down has her job not her DPs or a split role.

It is a split role, I should have clarified. DH does roughly 50%. But it's still a big job!

OP, this discussion has become rather theoretical.
i'm concerned about you, now.
i have known people with soft tissue infections that have become critical. one barely escaped with keeping her limb, well most of it.
she had to consent to poss amputation. which was a shock.
she now has impaired function, but is grateful to be alive.
and we were in A&E, begging for action, for several hours.
go now, get someone to drive you/take cab.
good luck.

@Nomoreusernames1244

My husband and I have both worked full time as doctors for the past 4 years. He is an A&E trainee and I'm a GP trainee. I'm currently pregnant and when I come back from maternity leave I'll be going part time, probably 60%. DH and I barely see each other as it is, there's no way I will be able to juggle childcare (working that around 2 conflicting rotas), managing a household and actually maintaining a level of wellbeing/social life whilst working full time

Genuine question, and slightly irrelevant to the thread, but why are you going pt and not your dh? Or both of you cut to 70 or 80% and both have a better balance, better shift patterns etc?

We will both go part time at some point but his training is much longer than mine so he plans to work full time for 2 more years then go LTFT.

Ireland it’s €60 to see a gp but you will get an appointment the same day or the next day at the latest.
Under 6 and elderly people are free.

If you go to A&E it’s €100 charge, unless you have been to the GP first and then it’s free of charge at A&E if you have a letter from the gp.

There are also walk in clinics that you can really walk into, they are €50/€60 and you can see a gp within a few minutes.

The A&E is totally overwhelmed in Ireland because the beds in the hospitals are blocked by people who are not being moved out as there is nowhere to go. It’s a bottleneck too but a different section.

Do any other countries in Europe have these huge problems?

To the above poster, 4 years is not a lot to have worked full-time, especially after training.

@MidnightMeltdown

But mostly, of course they need resourcing better, it's about the system, not the GP or the receptionist.

If only it were that simple! The problem is that there aren't enough GPs, and there are far too many patients. It takes over a decade to train a GP, you can't just magic them from thin air.

Many GPS are leaving the profession due to stress and overwork, so I'm not sure that asking them to 'just squeeze in' these extra patients is a good solution.

Totally understand the frustration though

Ok so the system needs to become more efficient, perhaps by having someone other than GPs collect patients from the door, as they do at my surgery.

There are a million ways it could be better. Book that emergency appointment today instead of insisting I call back tomorrow. Have a proper telephone triage system and have nurses deal with appropriate patients. Let patients self refer without seeing a GP for some specialists. At my GP you have to see a doctor before getting a referral to a physio, for example (I know that's not the case everywhere). The GP never actually looks at anything, just sends the referral. The same when I had a concerning mole. The GP didn't think there was anything wrong but "I'll refer you to be sure". Lovely, but if you're going to do that, why not just refer at the triage/reception stage and save the GP appointment for someone else?

I know some practices are making steps in some of these areas but it needs to happen quicker and be more widespread.

In the meantime all I was asking is that people stop blaming a worried mother for the crisis when she takes her sick child to A&E.

@MissLucyEyelesbarrow

A&E is overwhelmed but so are GPs. The number of GPs has fallen by a fifth since 2015. 5 years ago, the average full-time GP had 1,800 patients, now it's over 2,200. Despite that, we're actually providing more appointments than pre-Covid.

Sorry that you had a bad experience but blame the government for repeatedly failing to make good on its promise to recruit more GPs. Stop blaming the GPs who remain for the fact there aren't enough of us.

I didn't once blame the GP

Absolutely right! Same happened with me for a VERY painful tooth infection. Out of hours gp won’t prescribe for a dental issue and no out of hours dental care unless you pay over £100 call out fee.. according to NHS website if it was painful to swallow (I was almost delirious from the pain) go to A and E and that’s what I did!! Ridiculous!!!