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.

@MinesAPintOfTea

It clearly is not the fault of current medical staff. It’s a long running failure to train enough new staff. I’ve said this before: it’s really hard to get on medical courses, so there clearly are people interested in becoming doctors who we are turning down.

Yes, maybe some of those were badly suited to medical careers, but surely a fair proportion of them would have done a decent job at it. Certainly better than people being unable to access any medical treatment and dying in an ambulance or seriously ill for want of basic antibiotics.

It might take a few years to turn this around, but we need to invest in more medical training.

Hear Hear !

Instead we import doctors who have trained elsewhere and are, in the case of my visit to A & E some time ago, happy to send you off with a dodgy diagnosis and anti-biotics because they can't linguistically distinguish between 2 English language medical terms which sound a bit similar but are totally different things.

As with many jobs, being a doctor has become a much higher pressure job than it ever used to be. The range of drugs available, the range of treatments possible, the patient expectations, the impact of increased life expectancy.

Let doctors work part time, I'm all for anyone having a reasonable work/life balance but for gods sake find a way to train more doctors and fund it better (but only after a root and branch reform to minimise inefficient ways of working).

Oh and seek to reduce the "postcode lottery" of availability of services. It makes me to see comments of "go to your local minor injuries unit" or "go to the local walk-in centre". Some of us just don't have these available to us any more due to cuts under the pretence of "re-organisation of services".

Sunshine there aren't enough staff to have three sets on a rota. Not enough doctors, nurses, receptionists, admin. There are no laboratory collection services 24/7. So we couldn't do bloods, send urine or swabs. No child health, out patient, consultants receptionists or many other allied health services available for queries after 5pm, often needed whilst the patient is with you.
The practice would have to pay staff extra for unsocial hours, so less in their pot for the practice. They'd also be paying for heating, lighting etc round the clock, all more from the pot.
Staff with young DC or no out of hours childcare or those who simply don't want to work unsocial hours like myself, would leave.
And stats show many people don't attend out of hours services despite booking appointments in them! They just don't show up.
I can work all the late Sunday nights you want, but then I,m not available Friday afternoon or Tuesday morning when history tells us Mon to Fri are by far are the most in demand times.

When you are unable to get an appointment, it is because there are none available! How is this so hard to understand.

When you have a UTI and you call up the GP, and they say there are none available, do you REALLY think that there are available appointments, but the receptionists have been instructed not to give them out, because the Dr would rather have a nap than see the patients?

All these stories of A&E Drs 'fuming' when patients turn up at ED because they couldn't get seen by their GP, well I hope they're fuming at a chronically underfunded system in which demand markedly outstrips supply!

That's is what I was trying to get at. Is it just down to not enough doctors to do 24 hour shifts - and clearly that is fundamental so not just - or was there another reason if hadn't been implemented.

I was just trying to understand.

@Spicychickentenders

When you are unable to get an appointment, it is because there are none available! How is this so hard to understand.

When you have a UTI and you call up the GP, and they say there are none available, do you REALLY think that there are available appointments, but the receptionists have been instructed not to give them out, because the Dr would rather have a nap than see the patients?

All these stories of A&E Drs 'fuming' when patients turn up at ED because they couldn't get seen by their GP, well I hope they're fuming at a chronically underfunded system in which demand markedly outstrips supply!

The thing is what do you do then? For me it would have to be a&e as I would need antibiotics. Or 111/OOH (I'm not blaming the staff at all) just musing

@MinesAPintOfTea

It clearly is not the fault of current medical staff. It’s a long running failure to train enough new staff. I’ve said this before: it’s really hard to get on medical courses, so there clearly are people interested in becoming doctors who we are turning down.

Yes, maybe some of those were badly suited to medical careers, but surely a fair proportion of them would have done a decent job at it. Certainly better than people being unable to access any medical treatment and dying in an ambulance or seriously ill for want of basic antibiotics.

It might take a few years to turn this around, but we need to invest in more medical training.

Yes, I agree. 20 years ago, there was a shortage of GPs due to early retirements, emigration and part time working. Blair/Brown didn't increase the number of training places back then which would have helped today's shortage. It's blindingly obvious that you need to train more GPs if more GPs are opting to work part time and/or family friendly hours.

As for medical school places, I do wonder if the admissions criteria are looking at the wrong things. If a high number of newly qualified GPs are leaving or wanting to work part time, then perhaps the admissions officers are choosing the wrong people. There have been reports of some Unis having 2 or 3 times as many applicants (with the right qualifications) as they have places, so the demand is clearly there. Perhaps they need to look at different attributes, instead of concentrating on people who've spent a summer building a well in outer mongolia?

@Spicychickentenders

When you are unable to get an appointment, it is because there are none available! How is this so hard to understand.

When you have a UTI and you call up the GP, and they say there are none available, do you REALLY think that there are available appointments, but the receptionists have been instructed not to give them out, because the Dr would rather have a nap than see the patients?

All these stories of A&E Drs 'fuming' when patients turn up at ED because they couldn't get seen by their GP, well I hope they're fuming at a chronically underfunded system in which demand markedly outstrips supply!

You're missing the point. People don't expect appointments to magically appear. What they want is flexibility. I.e. scrapping the stupid system in some GP surgeries where you have to phone at 8am for any appointment, and then rinse and repeat daily until you're lucky. There should be a system for pre-booking a non urgent appointment next week or next month, especially for those with longer term issues that need regular reviews/consultations. Every GP surgery should be using e-consult and offering appointments a few days hence.

@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.

But it is the GPS receptionists fault for being rude, dismissive and generally unpleasant .

It clearly is not the fault of current medical staff. It’s a long running failure to train enough new staff. I’ve said this before: it’s really hard to get on medical courses, so there clearly are people interested in becoming doctors who we are turning down.

I agree.
My daughter is looking at medicine. Basically she needs four A* plus, some separate exam thing she'd have to take, plus relevant work experience, plus passing the interview. We've heard once you're on the course it's fine, it's just getting a med school place that's massively hard.

There are too few doctors. It does not help that the BMA itself voted to limit the number of medical schools:
www.bmj.com/content/337/bmj.a748

I'm going to be deliberately vague here.

DP is a GP and he recently gave up having a full time job in a surgery to become a locum instead - he's worked like this for many, many years in the past.

He took the full time, fixed job to have security of income, but left after 7-8 months because the workload was intolerable. He also felt that his colleagues weren't always pulling their weight so more work fell down to him. He's incredibly hard working and would pick up any slack so his patients get the care they need and deserve.

He's now taken a locum job in a very remote part of the UK where he's worked before, purely because it's an 8am-5pm job, no evenings or weekends, and the day rate? £900. It's obscene, but who wouldn't take that job if offered? They are just so desperate for GPs there that they have to offer that day rate to get anyone to come! Hordes of GPs are leaving the profession because of the sheer mental pressure of workload causing stress so severe that they are then signed off work!

The NHS is surely broken.

@Kendodd

It clearly is not the fault of current medical staff. It’s a long running failure to train enough new staff. I’ve said this before: it’s really hard to get on medical courses, so there clearly are people interested in becoming doctors who we are turning down.

I agree.
My daughter is looking at medicine. Basically she needs four A* plus, some separate exam thing she'd have to take, plus relevant work experience, plus passing the interview. We've heard once you're on the course it's fine, it's just getting a med school place that's massively hard.

Yep, a number of my DDs friends applied for medicine this year. All top students with stellar results very few actually offered med school places, 2 of them now doing Biomed degrees at top Unis with a view to transferring to Medicine after their first year of study.

@difficultdayahead, I’m a HCP and I agree with your dh. There’s more phoning it in than people realise and it gets on my nerves SO much.

The nice ones who are actually engaged with the patient stand out.

No need to feel guilty about the money, my barrister relative would charge you that for 2 hours work. He’s a bargain really.

One of dhs drs said he’d had an asthma review and was well controlled. I was at the appt because it was about his mh and he wanted me there, the asthma was never asked about and his asthma isn’t well controlled, he was on 2 ventolin a month. Nothing like a bit of fraud to go with your first patient of the day.

I rang my gp 378 times this morning to be told my dd 3 would be on the afternoon list for a call back. 7 hours later they prescribed antibiotics in a 30 second phone call for an infection 'somewhere'. No one has laid eyes on my daughter in 6 months from the gp surgery

Have you gotten medical treatment yet? My husband developed sepsis from a gnat bite.

There are too few doctors. It does not help that the BMA itself voted to limit the number of medical schools:
www.bmj.com/content/337/bmj.a748

Unbelievable! Why do they even get a say? It's up to those in govt to determine what is required in the future. Elitist t**ts.

as an elitist t**t I found that your link didn't work and I was interested to read what it said,

The only article I found on the BMA website was one saying that increased medical school places wouyld be welcomed but that they would need to be supplied with enough and good enough clinical attachments or would not work to produce doctors with adequate skills and training.

The BMA is just a union, it doesn't get a say, but it can point out that training a doctor is not as simple as just admitting people to university...it's a practical subject

sorry i can't put in link but was from 6th August 2021 from BMA media centre and can be searched.

Is there a high drop out rate at Medical School?

Seems you can study medicine in Europe in English and your qualification is then recognised in the UK. Its cheaper and easier to get a place apparently.
I suspect this will be yet another opportunity Brexit will fuck up for our young people though.

www.medify.co.uk/admissions-guide/plan-b/medicine-outside-the-uk-applying-to-eastern-europe

Not sure who you were responding to, but I was referring to a BMJ article from July 2008. Not sure why the link won't work.

For the record, DH is in primary care and I would never (and didn't) call anyone elitist.

I am not missing the point. Whatever appointment booking system a surgery has settled on, the likelihood is that they've trialled lots of different systems, and this is the one that is most fair/generates the least complaints.

There will inevitably be complaints as no system is perfect, but one has to be chosen.

If patients are given 'the next available appointment' when they call up, appointments would be booked up MONTHS in advance. Does this make sense? Say for example, 100 patients call up a surgery daily asking for appointments, and are immediately given the next available one, the by Friday, the patient who calls up will be being 401 on the list...this effect is cumulative, so it will eventually get to the point where the next available appointment is 2 months away.

So when OP for example asks why they couldn't just be booked an appointment for the next day, surely you can understand if they offered an appt to everyone who called for 'the next day', well there would be none left?

Most practices have a mixture of on the day and advance appointments, but then that just limits the available amount of each, and the problem still remains that when there are no appointments left, there are none left.

Yes, it is very very expensive and time-consuming to put people through a medical degree and then to give them post-graduate attachments. The senior doctors' time is scarce and expensive (it takes that much longer to do an outpatient clinic if you have juniors to teach). It isn't possible to have too many juniors in a clinic.

For example, I remember a dermatology lecturer who used to sit a patient in the lecture theatre and then get literally dozens of students to go and look at them with a magnifying glass. I thought it was terrible, imagine being that patient (mind you this was ahem, a few years ago)/

There have also been attempts to expand the number of medical students without expanding the funding to medical schools and clinical departments teaching them. The funding for clinical teaching is less than the cost of the teaching anyhow, as I remember. Increasing the number of medical students without setting up more resources to teach them properly would be likely to result in a poorer quality of education overall (and might possibly detract from the clinical care, if more time was being given over to the teaching).

There are also increasing monitoring of performance and checks on student portfolios etc in the past few decades; it is understandable that this is wanted, but it's time-consuming and there's a cost involved. The more medical students there are, the more assessments and grading the seniors are going to do. If you can't get a GP appointment as it is, are you happy for your GP to see slightly fewer patients per clinic for the next few years so that, in 10 years time or so we have more GPs? Or what?

This problem doesn't just go back to Blair/Brown (who did open new medical schools, the first since the 1970s)--but back decades. The medical pipeline can't be turned on and off like a faucet; it needs to be opened gradually over time. Labour gets slammed for PFI (and it wasn't the best way of doing things) but there's economists who reckon that the system couldn't really have absorbed more money at the time; it didn't have the capacity. It was beginning to catch up when austerity hit and then Brexit and then Covid. There was no spare capacity in the system for it to absorb those shocks.

In order to have medics now, you need to have trained them a decade ago. In order to have trained them then, you need to have hospitals and senior doctors to train them. So the pace has to be gradually increased, over a very long time. That wasn't done. Thatcher's damage to the NHS was significant.

So the UK took the expedient route of importing doctors and nurses, while also exporting them to countries with better pay and conditions. Then the whole shell game collapsed.

There's a lot of focus in the UK on private vs. public provision of services. The NHS does get more care per penny than anyone else, and I don't think it could get much more for what it spends. There is not as much inefficiency and waste as some people think. But private isn't inherently bad--plenty of countries have mixed provision of services. For example doctors might be self-employed or hospitals not directly owned by the government, but they receive payments for service. The issue is when large scale for-profit businesses move in.

France and Germany spend far more per capita than the UK--one reason you can just get referrals for specialists, go into a clinic, etc.

I tend to go to Minor Injuries units