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 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'

Well no, I believe that advanced nurse practitioners are more than able to issue repeat prescriptions and monitor chronic conditions. Of course hospital specialists couldn't manage primary care patients.

We were seen by an ANP few weeks ago, tests and assessment done in a half the time some GPs can manage and we were referred to a hospital consultant for a paed review. I'm not saying all GPs are useless I just think their place in primary care can be filled by ANPs. Different 10 or 20 yrs ago when nurse just used to do a BP and a urine dipstick, now they have advanced skills and work at GP level. Just employ more and have one GP in charge overall.

I have nothing but respect for doctors and GPs and have been fortunate to have had exemplary care in my life. However, getting a GP appointment at the moment is impossible and getting serious when it starts to effect the care of young babies and children and other vulnerable members of the population. We all stayed home to save the NHS during Covid it’s not looking good is it.

Yeah, it's not great. I called 111 about 20 times for an infected wisdom tooth. Was refused an appointment with the emergency dentist despite clear symptoms of infection. Was finally blue lighted to A&E with sepsis.

@JaniieJones

'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'

Well no, I believe that advanced nurse practitioners are more than able to issue repeat prescriptions and monitor chronic conditions. Of course hospital specialists couldn't manage primary care patients.

We were seen by an ANP few weeks ago, tests and assessment done in a half the time some GPs can manage and we were referred to a hospital consultant for a paed review. I'm not saying all GPs are useless I just think their place in primary care can be filled by ANPs. Different 10 or 20 yrs ago when nurse just used to do a BP and a urine dipstick, now they have advanced skills and work at GP level. Just employ more and have one GP in charge overall.

Ha have you tried recruiting an ANP recently? They are in just as short supply as GPs are. And actually studies have shown that in terms of value for money GPs win hands down.

If you google "infected insect bite" first link is for the NHS page on Insect bites and stings

www.nhs.uk/conditions/insect-bites-and-stings/

When to get medical advice
Contact your GP or call NHS 111 for advice if:

you're worried about a bite or sting
your symptoms do not start to improve within a few days or are getting worse
you've been stung or bitten in your mouth or throat, or near your eyes
a large area (around 10cm or more patch of skin) around the bite becomes red and swollen
you have symptoms of a wound infection, such as pus or increasing pain, swelling or redness
you have symptoms of a more widespread infection, such as a high temperature, swollen glands and other flu-like symptoms

You tried your GP, who couldn't see you today. Yet you didn't call 111, because 'no-one told me to'? Take some responsibility for your own health. The information you need is right there.

YANBU. I have a 90 year old aunt who had a fall last week. She complained about pain and it affecting her bowels and ability to walk. Carer said she should see GP. She rang the GP 3 times last week and was promised a home visit each day she rang. No one turned up. On Friday a nurse from the practice rand her and said she should see how she was over the weekend and ring today if she was no better or 'go to A and E'.
She has been worse over the weekend. I rang this morning and explained and asked for a home visit for her. The GP actually turned up this afternoon and was there 10 minutes. Said she needs bloods, a urine and stool test but would not wait or do any of them- said a nurse would do them but she has to go to the surgery. He will post a stool test out to her for her to post off somewhere. I have said I will take her - but she is in pain and not getting around the house even so she will find it difficult to go. First appointment is on Friday- 4 days away.
He then said she should ring up the surgery and ask for the phone number of the physiotherapists and ring them and ask why they have not been - there has been an ongoing referral to physiotherapy made last March after she broke her hip but they have not been once yet. He was not prepared to follow up his own referral.
I am so angry. She is partially deaf and blind and her mobility is really poor at the minute. This is her first visit from the GP in years.

@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.

I hear you spicy, it’s seriously affected my morale. Im going back to the emigration thread

Blandford Fly? Have known of so many people end up in hospital with serious infections from these dangerous midges. Good luck darling!

Just to give everyone some hope - a few weeks ago I woke up thinking I was coming down with a water infection. My lunch time there was no doubt about it, so I called the surgery who asked me to bring a water sample in. So I did, and within the hour the senior partner from the practice had phoned me, asked questions and sent my prescription to our local pharmacy. He was very clear that if the pain went into my kidneys, I should call them back. By the following morning it was most definitely in my kidneys, I called back, and 20 mins later a different GP called me back and prescribed something different. Within 3 days I was loads better. I hope this wasn’t just a flash in the pan, but I was really impressed. Even pre COVID I wouldn’t need a face-to-face appointment about that so I was very satisfied with the service.

And speaking of Advanced Nurse Practitioners, one of my friends is one and I believe she can also practice as a locum? So ANPs are really highly qualified

I think the UK is becoming broken in general.

And I am not convinced that it is not all being done on purpose..

@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.

Actually that could work well provided that at least one GP was on duty for more serious cases and practice nurses have prescribing powers.

YANBU. This is something that less than 10 years ago would absolutely have been dealt with by your GP as a 'sit and wait' type thing if they had no appointments left. They would not have had the receptionist trained to send every patient who couldn't wait a fortnight off to A&E.

ANPs are indeed highly qualified and could certainly take on more of the primary workload if correctly triaged.

But let's not kid ourselves - nurses are also in very short supply, replacing one scarce with another is not a solution.

Id personally gone to an Urgent care/minor injury unit, this is what they are there for.

YANBU.

My practice has the same stupid system. I do not understand why you can’t just book a future appointment now. Even on the telephone.

In your case I’d ring 111 now, and if no joy go to A&E.

I do think it’s the fault of GPS- they seem very loathe to see people. My dad was a GP and is horrified by the new attitude.

@Flixon

how many people do you think a GP should sew in a day ? 20 ? 40 ? 80 ? is there any limit ? should they just work until everyone who wants it has been seen ?

how long should each person have ? 5 mins ? 10 / 20 what?

Because THERE ARE not enough GP'S TO MEET DEMAND. And however mush you offer to pay them most will not work any more because they are exhausted, burned out and cant take any more ....

Stop blaming GP's, stop blaming your surgery. start blaming the people who have underfunded and cut GP services for years , the same people who are threatening and bullying GP's now ...

This.

Also, people have not been voting for a society in which we have a generously funded state health service. So maybe think about how you voted, and whether it has actually been for the sort of system you want and need?

@LadyCleathStuart

Tell me about it, DH had very obvious gallbladder pain for months. Nurse practitioner kept prescribing medication for IBS despite DH repeatedly saying where the pain was and how he had a strong family history of gallbladder problems. He asked to be referred for a scan and was told that if the pain was 'that bad' he should go to A&E.

In the end that was what he had to do and it was them that finally prescribed painkillers and got him referred for a scan.

He didn't need to do that, if he had been able to see or speak to an actual doctor at the GP surgery, and if they had listened to the actual symptoms described he could have had the tablets and been referred without taking up resourcss ar A&E.

Its a farce sometimes.

This happend to my best friend she was in agony for months She went to A&E one night with her bag packed and then they triaged, scanned and admitted her The staff said she'd had waited months had she not come as an emergency This was a legitimate case she was in a lot of discomfort but there were rooms up there just because they couldn't see a GP but it's not their fault they're so stretched

@Malibuismysecrethome

It would seem that most GPs already work part-time so that is the point of my argument. Especially after the cost of training.

Thebsurgeryvwe go to has been short of a doctor for a long time. They have a series of regular locums. One works at another practice and locums at our surgery on his day off. I presume it is a nice earner for him.

It seems very stressful just booking one days appointments each morning. That is a totally chaotic system. It’s like getting through to a radio quiz, hitting redial over and over except the prize is a gp appointment!

They should change that system and allow people to book appointments ahead of time, with a cancellation list of people waiting on an appointment that day if anyone cancels.

If you don’t need an appointment anymore, the cancel it with 24 hours notice or else pay a £50 fee for not showing up.

@Bagamoyo1

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?

It's not in itself. More the issue is that every time you get to the front of the rollercoaster queue they tell you it's full and won't let you wait for the next rollercoaster, which most of us would probably happily wait for. They say off you pop, we're closing for the rest of today, please come back tomorrow and try again.

@HalzTangz

I don't know why people aren't signing up for online services for their doctor's surgery. You can book an appointment online without trying to ring all day.

I can book an appointment for weeks ahead online, but if I need an appointment for the same day I have to ring up at 8.30. We are lucky though, generally I can get through easily and they always see the kids the same day. I rang a few weeks ago at 3.30 when my DC suddenly took a turn for the worse and they said the urgent appointments were gone for the day, but got a GP to ring me anyway because it was a child and they were very unwell. Our practice have been excellent right through the pandemic. I’ve been seen in person myself twice when I’ve needed antibiotics and the DC have been seen a couple of times in person.

Maggie or you get to the theme park that isn’t open.

2. We could try to reduce the UK population. We have 18m more people than when I was born. If we could lose 18m we might start to have a bit more space.

What are you suggesting ? A cull ?

The problem is the ability of politicians to view the issues in the long term, the population has been gradually rising for the last 50 years, it has risen by 11 million in that time. The average life expectancy has risen by about 10 years in that time, although that seems to be plateauing.

Add to the mix the number of hospital beds has reduced by half over the last 30 years.

Also massive cuts to Council budgets, which directly impact social care provision.

Throw in a once in a lifetime pandemic and you have the perfect storm.

@Bagamoyo1

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.

Maybe we should re-define 35 - 40 hours per week for GPs as "full time" and more than that as "overtime"? It would help people grasp that GPs actually do a full working week.