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.

@bubblepond Many don't just work in the practice, they often do commissioning work or teaching GP trainees or medical students, or working in A&E or urgent care as well. Days in the practice will often be 10-12 hours plus admin from home on "days off".

But presumably they get paid for those different jobs on top of their GP wage/profit share?

'This was the start of the slippery slope with GP services. For a few years we did have the buffer of walk in centres but many of these have since closed down.So, where do we go now?'

This will be an unpopular opinion but we need to recognise advanced nurse practitioners can do the role perfectly well. Some GPs seem to have abysmal time management skills and without sounding too derogatory it is really a referral service, a 'wait and see' service or issue a prescription and hope for the best. GPs should just be primary assessment units staffed by nurses. Which many UTCs are and they manage absolutely fine.

[quote Badbadbunny]**@bubblepond* Many don't just work in the practice, they often do commissioning work or teaching GP trainees or medical students, or working in A&E or urgent care as well. Days in the practice will often be 10-12 hours plus admin from home on "days off".*

But presumably they get paid for those different jobs on top of their GP wage/profit share?[/quote]
Yes, as they should. I was just making the point that some GPs can be seen to only work 2-3 days per week in the practice but still be working full time hours overall.

@bubblepond Yes, as they should. I was just making the point that some GPs can be seen to only work 2-3 days per week in the practice but still be working full time hours overall.

So it's their choice if they feel overworked due to having more than 1 job?

[quote ChequerBoard]"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/]][/quote]
The stats for GP training specifically resulting from those medical students are even less promising, with 1 in 3 specialty GP trained doctors not going on to work as an NHS GP

This is a quote from your link. I think specialty trained GPs should be required to work for the NHS as GPs for a minimum time period, wonder why they aren’t.

Do you have e-consult or Livi at your practice? Can usually see a GP via that straight away or within a few hours.. evenings too.
But in your shoes I would go to a minor injuries, even if somebody has to drive you. They have GPs usually who can see you there if needs be.
Otherwise go down to the GP surgery in person in the morning as soon as it opens and say you’re worried about cellulitis/sepsis and you want to be seen that day.
I’d only go to A&E as a last resort - that truly os for life-threatening emergencies. A serious infection would give you a high fever

Unless you have access to a&e records for analysis I don’t think anyone can possibly know whether and why they are ‘over run’. If you have a leg that appears to have a spreading infection and can’t get an appointment at the GP and can’t travel to a walk in. Centre it’s not wildly inappropriate to go to A&E. that doesn’t negate the fact that there are a significant number of people who turn up there totally inappropriately when they had the option to go elsewhere or don’t actually need treatment.
Some GPs will not make urgent next day appointments because of the number of people who don’t turn up as their condition has resolved or they’ve obtained treatment elsewhere

@JaniieJones

'This was the start of the slippery slope with GP services. For a few years we did have the buffer of walk in centres but many of these have since closed down.So, where do we go now?'

This will be an unpopular opinion but we need to recognise advanced nurse practitioners can do the role perfectly well. Some GPs seem to have abysmal time management skills and without sounding too derogatory it is really a referral service, a 'wait and see' service or issue a prescription and hope for the best. GPs should just be primary assessment units staffed by nurses. Which many UTCs are and they manage absolutely fine.

I think that’s a perfectly sensible idea. A large proportion of appointments could be just as well dealt with by a nurse, who could refer on to a GP if it was something they couldn’t deal with. The only thing is they would have to be given prescribing powers. The nurse in our GPs practice has to run off a GP to get any prescriptions approved by them.

There is a massive amount of GP work that is totally unseen by the general public and it’s a lot of that I do on my days off or at weekends- results, letters, emailing specialists, referrals, teaching, admin for the GP trainees, responding to complaints, practice development work, as well as admin for actually running the small business that the practice is (we are lucky our manager does most of this). Once the phones ‘go through’ we start on that and most nights it’s a minimum of 2 h paperwork to get through plus back in on other days to clear the decks. That’s how a GP working 2-3 days can easily be working 40 hours these days.

I would also love to know, do other countries have a dire shortage of GPs? If not, what is going wrong here?

@DGFB

Do you have e-consult or Livi at your practice? Can usually see a GP via that straight away or within a few hours.. evenings too. But in your shoes I would go to a minor injuries, even if somebody has to drive you. They have GPs usually who can see you there if needs be. Otherwise go down to the GP surgery in person in the morning as soon as it opens and say you’re worried about cellulitis/sepsis and you want to be seen that day. I’d only go to A&E as a last resort - that truly os for life-threatening emergencies. A serious infection would give you a high fever

Not all areas have a minor injuries unit.

Our GP surgery don't have e-consult or online booking and still aren't allowing "walk ins" into reception, so you're only way to get a consultation is to try phoning at 8am.

The real problem is lack of consistency of services between NHS areas and between GP practices.

@checkedroses

There is a massive amount of GP work that is totally unseen by the general public and it’s a lot of that I do on my days off or at weekends- results, letters, emailing specialists, referrals, teaching, admin for the GP trainees, responding to complaints, practice development work, as well as admin for actually running the small business that the practice is (we are lucky our manager does most of this). Once the phones ‘go through’ we start on that and most nights it’s a minimum of 2 h paperwork to get through plus back in on other days to clear the decks. That’s how a GP working 2-3 days can easily be working 40 hours these days.

The admin of "running the business" is what nearly all self employed people do outside normal hours, i.e. evenings and weekends. It's one of the consequences of running a business.

Not sure where you are so apologies if this isn’t available in your area but in Scotland if a pharmacist thinks you need to be seen for something that they cannot prescribe then they can make contact with out of hours for you to stop this kind of thing happening.

They just don’t advertise it because it would add to their work load.

[quote Badbadbunny]**@bubblepond* Yes, as they should. I was just making the point that some GPs can be seen to only work 2-3 days per week in the practice but still be working full time hours overall.*

So it's their choice if they feel overworked due to having more than 1 job?[/quote]
It is their choice, they are all still necessary jobs though. Someone has to do them.

@Staffy1

I would also love to know, do other countries have a dire shortage of GPs? If not, what is going wrong here?

I think most countries have at least a partially private health service, so that limits demand, as people can't all afford to pay.

@Staffy1

I would also love to know, do other countries have a dire shortage of GPs? If not, what is going wrong here?

Loads of GPs in Belgium even with government caps on the numbers going to medical school (a lower cap than in France so lots of French students used to come over). There can be long waits for specialists, but it's usually pretty easy to see a GP. If you're not fussy who it is (you can go to anyone) or time of day, you can get one same or next day, which is good because many employers demand a sick note for 1,2, or 3 days off.

"I think most countries have at least a partially private health service, so that limits demand, as people can't all afford to pay."

Hmm. I'm not so sure of that. Many European countries with paid systems have extremely cheap options for poor people. Only the very poorest and marginalised (eg illegal immigrants) would be left with nothing.

This thread is so, so enlightening and also so disheartening. It reveals just how little the general public thinks of GPs. Of course this is clear with all the 'just a GP' comments received on a daily basis.

If you're unable to get an appointment at the GP, is it honestly, because they think the GP is lazy, or needs to pull their finger out. Do they think they are spending the time they could be using to see that 'squeezed in patient' dancing round their rooms.

A typical Gp day involves about 70 critical decisions. These are decisions that if gotten wrong(which often happens, because, humans), could have a serious effect on someone. Some could even DIE. An average GP day is about 10 hours. Even approving medication requests of which there are 100s a day takes HUGE brainpower.

Surely it is understandable that they doing 5 days of this would be a speedy route to burn out. Surely it makes sense that an individual limits their working hours to a point that is safe for them?

It is not the GPs fault. Yes they system could be more efficient, true of any system. The OP seems to have lots of snidely delivered 'suggestions' which if implemented could overhaul the GP system and solve the A&E crisis.

Not understanding that whilst things may seem obvious may on the surface, unless you have a complete picture of the inner workings of an organisation, it's impossible to understand why things which may seem evident, are not.

@Spicychickentenders

This thread is so, so enlightening and also so disheartening. It reveals just how little the general public thinks of GPs. Of course this is clear with all the 'just a GP' comments received on a daily basis.

If you're unable to get an appointment at the GP, is it honestly, because they think the GP is lazy, or needs to pull their finger out. Do they think they are spending the time they could be using to see that 'squeezed in patient' dancing round their rooms.

A typical Gp day involves about 70 critical decisions. These are decisions that if gotten wrong(which often happens, because, humans), could have a serious effect on someone. Some could even DIE. An average GP day is about 10 hours. Even approving medication requests of which there are 100s a day takes HUGE brainpower.

Surely it is understandable that they doing 5 days of this would be a speedy route to burn out. Surely it makes sense that an individual limits their working hours to a point that is safe for them?

It is not the GPs fault. Yes they system could be more efficient, true of any system. The OP seems to have lots of snidely delivered 'suggestions' which if implemented could overhaul the GP system and solve the A&E crisis.

Not understanding that whilst things may seem obvious may on the surface, unless you have a complete picture of the inner workings of an organisation, it's impossible to understand why things which may seem evident, are not.

Snidely?

Ok then we'd better leave everything as it is.

"A large proportion of appointments could be just as well dealt with by a nurse, who could refer on to a GP if it was something they couldn’t deal with. "

I'm really not sure about this. Even a lot of the things people go to GPs for, the GPs with all their training, have to do a lot of googling. It takes a lot of knowledge and it would be selling the patients short to have nurses doing what doctors should be doing.

I’ve just sat in a crowded paediatric a&e for 5 hours with DS because she was hysterical, vomiting and skin blotchy. She’s 16mo. 111 weren’t answering. I’ve seen a tiny baby stop breathing today. I feel beyond angry and very very emotional. DS is fine, could have been sorted with a GP prescription. Horrendous.

I'm not saying leave it, I will be the first to acknowledge the entire NHS system is not fit for purpose. I'm saying understand that the situation is nuanced. It's not the GPs receptionists fault that A&E is overwhelmed.

@Spicychickentenders

I'm not saying leave it, I will be the first to acknowledge the entire NHS system is not fit for purpose. I'm saying understand that the situation is nuanced. It's not the GPs receptionists fault that A&E is overwhelmed.

I didn't once say it was. I said it wasn't the patients' fault

@JaniieJones

'This was the start of the slippery slope with GP services. For a few years we did have the buffer of walk in centres but many of these have since closed down.So, where do we go now?'

This will be an unpopular opinion but we need to recognise advanced nurse practitioners can do the role perfectly well. Some GPs seem to have abysmal time management skills and without sounding too derogatory it is really a referral service, a 'wait and see' service or issue a prescription and hope for the best. GPs should just be primary assessment units staffed by nurses. Which many UTCs are and they manage absolutely fine.

I don't think you understand the complexity of what GPs do especially in managing chronic illness. If you did this, all the patients (especially the elderly) with chronic conditions would need to be managed by specialists for everything. British GPs do a lot that is managed by specialists in other countries.

The USA actually has a shortage of primary care physicians. Private isn't a guarantee. In fact there is a bottleneck there because most residency programmes (North American equivalent of registrars) are funded by Medicare, and the cap on places hasn't risen since the 1990s. But the USA attracts a lot of foreign graduates to family medicine residencies. One thing the USA does do is they have substantial use what they call mid-level providers in primary care, both advanced practice nurses and physician assistants. Many primary care practices use a mix. And both the USA and Canada have walk-in or urgent care centres, some of which can handle quite a variety of things (they have doctors, X-ray, etc).

Israel has an interesting system. If you go to the ER, and you don't have one of a list of specified conditions or a referral from a doctor (out of hours you can get one over the phone), and you're not admitted to hospital, insurance won't pay for the visit. It's quite a bit of money.

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

Well, do you acknowledge that the reason A&E is overwhelmed, is because primary care is overwhelmed, and that maybe, the reason why there was no GP to deal with your medical problem in seconds(seconds??!!!) is because there were none available?