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.

That is awful op. I have this - often a bite on my legs gets infected. I normally tell the receptionist in a firm tone that I need antibiotics and ask her to get the Dr to call.

But in your place I'd go to A&E. in my view, Drs should be charged if a patient they've decided not to see ends up at A&E. the only way to force change is to hit them in the pocket (I know - I used to work for a GP practice).

Although tbh I'd rather go to A&E without need than die... so if the GP or Minor I doesn't work then A&E it is

@knitnerd90 There is not as much inefficiency and waste as some people think.

On the contrary, I think there's more.

My OH has nearly £25k of drugs in his cupboard (as per the NHS drug price website) - he's on long term chemo for a blood cancer. The haematologist keeps prescribing drugs he's not talking, i.e. a particular chemo drug which is prescribed for 3 per month but he only takes 1 per month (on the haematologists' intruction) which are over £1,000 per tablet. Then he has another chemo tablet that are prescribed for 21 days (daily for 3 weeks) but he only has 1 on every second day, so 10/22 per month - they're about £300 per tablet. Added to all that are anti sickness tablets, anti diarrhoea tablets, etc., which, yes, cost pennies, but he's now got 2 years worth of them as they keep getting prescribed but he's never used them. When we've asked the haematologist to prescribe less, she just glibly says "it's too much paperwork to change" followed by "anyway, we've been granted the funding so it doesn't come out of my budget".

Then there are the 5 wasted MRI scan appointments where he turned up only to waste his and the radiographer's time because it needed a dye but was sent to a mobile unit which didn't have staff to administer the dye (time and time again!).

After being under regular chemo treatment for 4/5 years now, we're regular visitors for various tests, examinations, reviews, infusions, etc., and the wasted time/money due to inefficiency and mistakes is absolutely staggering, but what's more is that no one seems to care or be bothered about it, so it seems to be the norm.

[quote Badbadbunny]**@knitnerd90* There is not as much inefficiency and waste as some people think. *

On the contrary, I think there's more.

My OH has nearly £25k of drugs in his cupboard (as per the NHS drug price website) - he's on long term chemo for a blood cancer. The haematologist keeps prescribing drugs he's not talking, i.e. a particular chemo drug which is prescribed for 3 per month but he only takes 1 per month (on the haematologists' intruction) which are over £1,000 per tablet. Then he has another chemo tablet that are prescribed for 21 days (daily for 3 weeks) but he only has 1 on every second day, so 10/22 per month - they're about £300 per tablet. Added to all that are anti sickness tablets, anti diarrhoea tablets, etc., which, yes, cost pennies, but he's now got 2 years worth of them as they keep getting prescribed but he's never used them. When we've asked the haematologist to prescribe less, she just glibly says "it's too much paperwork to change" followed by "anyway, we've been granted the funding so it doesn't come out of my budget".

Then there are the 5 wasted MRI scan appointments where he turned up only to waste his and the radiographer's time because it needed a dye but was sent to a mobile unit which didn't have staff to administer the dye (time and time again!).

After being under regular chemo treatment for 4/5 years now, we're regular visitors for various tests, examinations, reviews, infusions, etc., and the wasted time/money due to inefficiency and mistakes is absolutely staggering, but what's more is that no one seems to care or be bothered about it, so it seems to be the norm.[/quote]
If you go to collect them the pharmacy can put them back into stock as long as you haven’t taken them away. Just ask them to check through with you. They should also be able to
Sort out the issues with the Dr prescribing. Hospitals have their own contracts for medication, and they’re often a lot cheaper, the system is different to if you go to a GP.

@BungleandGeorge If you go to collect them the pharmacy can put them back into stock as long as you haven’t taken them away. Just ask them to check through with you. They should also be able to
Sort out the issues with the Dr prescribing. Hospitals have their own contracts for medication, and they’re often a lot cheaper, the system is different to if you go to a GP.

Nope, he's asked that a couple of times and has been told that they've been issued to him and he either takes them or they would be disposed of rather than put back on the shelf for issue to someone else.

@BungleandGeorge (It's the hospital's own pharmacy - the haematologist says they can't be issued via a "normal" pharmacy due to the nature, i.e. one being a chemo and the other being a thalidimide derivative, neither of which are handled by "normal" pharmacies)

[quote Badbadbunny]@BungleandGeorge (It's the hospital's own pharmacy - the haematologist says they can't be issued via a "normal" pharmacy due to the nature, i.e. one being a chemo and the other being a thalidimide derivative, neither of which are handled by "normal" pharmacies)[/quote]

Exactly right they are cytotoxic drugs, definitely not something a normal community pharmacy is able to dispense.

I've had the same issue, expensive drugs and dressings which can't be given back, which I kind of get but which you also seem not to be able to turn off the tap of supply for - surely this should be able to be fixed!

On the appointments system I don't know why more Drs don't do what my previous surgery does.

They have open surgery every morning. You go down and queue up and have to be there before 10am but you will be seen that morning. 3 Drs on and if you're happy to see anyone then it's really quite quick.

Afternoon is for booked appointments for chronic stuff. But it means that if yuu need to go then you go and wait but you will be seen. It also means that you can take a specific day off work knowing you will get to see a Dr, rather than ringing at 8am and trying and failing to get through. It honestly works so well - not sure why other places (including my new one) don't do it that way.

@Courtier

I tend to go to Minor Injuries units

As said by several others, not all areas have them.

Well, our local surgery at one point had 1 doctor covering the whole practice (normally about 6) as they had a lot of staff of sick (they seem to have had a tough time). We seem to have a lot of locums now.

A close friend told me that their main GP took his own life. Very very sad and understandably their surgery has struggled hugely.

Not all surgeries have 3 doctors able to see patients one after another every morning.

I don’t understand why you can’t prebook appointments as normal even if they’re telephone appointments.

The cynic in me thinks the half eight free for all puts people off. I have anxiety which I need more medication for; a painful knee and a weird mole, but cannot face the rigmarole

@ChequerBoard
There is no ban on community pharmacies dispensing cytotoxic tablets, they do this routinely. It depends which medication you require. There are 3 main reasons things might need to come from the hospital pharmacy:

1. A few medicines are hospital only and not available outside the hospital
2. Some medicines are a lot cheaper to provide through a hospital. The contracts are different, the drug costs can be much cheaper and there are economies of scale (eg if a community pharmacy has to special order for you they will pay a large courier cost each time)
3. The consultant may be the only one with the expertise to prescribe for you so the prescribing can’t be transferred to your GP.

It’s mainly to do with cost and being routinely held in stock in the hospital

How are you ordering your medication? If you order online you should be able to only select the items that you want and nothing else can be issued if you didn’t request it.

@herecomesthsun

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?

Well if the number of gps per person keeps going down this is only going to get worse. So we need to find a way to train more doctors (and other medical staff), starting gradually and building up over the next decade.

It might help if we also joining a large economic area where people can move freely for work so immigrating is appealing and easy.

[quote Badbadbunny]**@BungleandGeorge* If you go to collect them the pharmacy can put them back into stock as long as you haven’t taken them away. Just ask them to check through with you. They should also be able to
Sort out the issues with the Dr prescribing. Hospitals have their own contracts for medication, and they’re often a lot cheaper, the system is different to if you go to a GP.*

Nope, he's asked that a couple of times and has been told that they've been issued to him and he either takes them or they would be disposed of rather than put back on the shelf for issue to someone else.[/quote]
No pharmacy is going to keep such expensive drugs in stock, so if they've ordered them because the consultant has prescribed them and it's too late to send them back then the pharmacy are going to have to claim for them.

Rather than a 13 year old article from the BMA (which can’t be accessed freely, and from a trade union, and when did the government ever care what they say?), I found a more recent analysis of workforce shortages here publishing.rcseng.ac.uk/doi/pdfplus/10.1308/rcsbull.2020.78

@Staffy1

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

I don't know, but I can't help feeling that it has something to do with our culture, and consequently, the aspirations of young people. In Asian countries, education is valued and everyone want to be a doctor because it's seem as a huge honour.

Here, too many kids aspire to be footballers, glamour models or influencers instead. Our society places value on the wrong things.

@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.

She can qualify abroad without 4 A*

It might help if we also joining a large economic area where people can move freely for work so immigrating is appealing and easy.

Not sure about that. We get many, many, more patients than doctors, which is one of the many reasons that we're in this mess. It may have have helped if in the past, immigration had been restricted to specific skills shortages.

Many of the people who are the most unwell will not have the physical or mental strength to battle it out with a gatekeeper receptionist, whereas the sharp-elbowed hypochondriac gets seen the same day

It's nothing to do with the prestige of medicine. Medical schools have far more qualified applicants than places. The Tories actually cut places after 2010.

No system is perfectly efficient, but the NHS really is good value for money. Decisions about waste also consider the cost of reducing it--at some point the effort expended outweighs what's recouped. The big issue is that the UK spends less per capita than most comparable countries and has failed to invest in staff and services for too long.

To bring it back to OP--she's not the problem for going to A&E (if she ever did!), and the problem isn't the overworked GP. It's the system. It's like squeezing a balloon full of air.

It might help if we also joining a large economic area where people can move freely for work so immigrating is appealing and easy

Our local A & E seems to have many such EU migrant doctors/nurse practitioner types.

I was misdiagnosed/issued ABs by one such doctor because their grasp of English ) especially medical terms) was not good enough.

Importing foreign trained medics is just papering over the cracks in the NHS.

Well some of the best physicians I have encountered have been foreign and trained in other countries. I think it is arrogant to think the NHS training is superior to other countries. What about Indian, American, Israeli or Egyptian doctors. Not to mention European ones.

@PackedintheUK

How is your ankle?

Not sure about that. We get many, many, more patients than doctors

Well that's just an outright lie (which I'm sure you 100% believe and lapped up from some racist rag).
Immigrants from the EU are almost all young healthy adults and hardly use medical services.

www.edp24.co.uk/news/health/patient-ies-in-back-of-addenbrooke-s-mbulance-8441246

This is worrying. And as we barrel towards the actual winter pressures this could be more than a one off episode.
During last winters second wave peak, it was not uncommon to be held on an ambulance for several hours - and this was also for priority calls in (blue light calls) I recall many 'big sick' covid and non covid patients being held for anything up to 4/5 hours on an ambulance. There was no space then, there is no space now but the difference is that we are not in peak wave. We are not in peak winter.
Terrifying.