Aibu to think a minor injuries unit at a hospital should be staffed with people can prescribe medication?

[Theincidental]

I have a nasty insect bite with bad swelling and this morning I went to my local minor injuries unit 15 min drive away to check it wasn't infected (which I think it is) and to see what I may be able to take to ease the swelling. My whole upper arm is a balloon and blistering.

The place is only staffed with non prescribing nurses who offered me only off the counter strength piriton which renders me insensible.

There was no examination of the bite, and no other treatment available because the staff were not qualified to prescribe anything at all. I was effectively told there's nothing to be done and don't worry about it, despite giving a history of allergic reaction to bites.

My ooo gp is 45 min drive away and a & e is about 1 hour 20 mins.

Aibu to think that in an area so far away from emergency services (we have helicopters for dire emergencies) the hospital unit for cases just such as mine should have properly qualified staff to help people?

OP, I have some inflamed bites at the mo - not as huge as yours but certainly of the "I want to itch my skin off" variety. Pharmacist gave me some Eurax hc cream which works albeit not for very long, and DM suggested a paste of bicarb and water (with a drop of lavender oil if you have it) applied for ten mins. This did soothe the itching and inflammation for a while. A cold flannel with lavender on also lasts long enough for you to get to sleep!

Hope it calms down soon.

So then you would employ doctors on - arguably £1000- a shift to triage calls? From 'I've pricked a finger on a rose bush/I want to know correct dosage of calpol to give my baby/ need a death notification/ need a catheter to be reinserted to 'the call taker has taken my name and number but actually it's my neighbour who is currently unconscious that I'm calling about"

How many calls could a doctor triage in a 12 hour shift? Say scottish service takes 5000/weekend how many doctors would you need to employ?

I would have GP surgeries open at weekends. I would have 24 hour surgeries. And pharmacies too fir that matter

Macdoodle, a net salary of £40 an hour for a 48 hour working week equates to a gross salary £168k a year. That is without including any contribution to a pension. The gross salary would have to be higher if there was also pension provision.

I would say that is a very high salary indeed. There will be few salaried employees in the UK earning that much.

Ambulance service also work with algorithms as do the nurses. They are used worldwide. They are a blunt tool but they do work.

The call centres also allow fir planning and management of volumes - so ca handlers can direct to alternative centres or away from an A&E if has had to close.

But I think people find the ooh service confusing esievialky the elderly, and it's hard fir people to have to explain complex medical history to call taker and nurse, it's hard to go through ooh call centres fir palliative care, management of serious illness like pain relief fur cancer patients. That surprised me. These people should not have to do that .

I don't have any axe to grind. I used to work part time as a call handler while studying and felt it worked well most if the time.

I'm glad OOH can sort you; I am foreign so don't understand the OOH service at all.

Macdoodle, give up. People will only realise how cheap GPs are when they don't have any. If you want 24/7 GP services, be prepared to pay, and pay A LOT. People don't slog for AT LEAST 13 years, pay significant defence and registration, plus exam fees and student debt, to get to be in a profession no one respects or values. Medicine recruits the top of our school leavers/graduates, but if the package at the end isn't inviting, they will go elsewhere.

Pay peanuts, get monkeys.

Good luck with your health system that pays senior, well trained, doctors less than £40/hour, you'll need it!

I'm puzzled by minor injury units and walk-in centres. We don't have either in this area. I would have expected them to either be necessary or unnecessary, but that clearly isn't the case if some areas have them and others don't.

Whoever wanted a 24/7 GP LED service, good luck with that. Thats 189 hours week, current core GP hours are 8:30-6:30 thats 50 hours a week, so just over 25% of the week. So you need hmmm well I guess 75% more GP's? or at least 50% surely? At the moment, practices cannot recruit GP for love nor money in core hours, OOH services are desperately trying to fill shifts.
I am curious where you think the funding and manpower is going to come from for a 24/7 hr GP service?
I would have no problem at all working OOH well funded and managed, but my "part time" work currently is in excess of 40hours a week, so if I work more OOH I would expect more funding and time off in lieu. As would all other GP's. Good luck with that.
I ask how many people are happy with current dental service, because that is where we are heading. A privatised service with minimal care for those who cant afford to pay and very little OOH access?

Macdoodle, a net salary of £40 an hour for a 48 hour working week equates to a gross salary £168k a year

Jelly how did you get to £168k a year?!?
£40 multiplied by 48 is £1920 gross a week. Which is £99,840 for a 52 week year, even without pension contributions,I can't see how it comes to £168k a year.

Most people also don't work for 52 weeks of the year. 46 might be more likely. So even less.

Sorry for any confusion, Macdoodle was saying that £1000 for a 12 hour shift wasn't actually that much because it is only around £40 an hour net (after all tax and national insurance and pension contributions have been taken off). She said that lots of professionals earn that much.

Actually £1000 for a 12 hour shift is £4000 for a 48 hour week. Assuming that you work for about 45 weeks a year (5 holiday and 2 off sick) that is £180000 a year. If you take off the 10k Macdoodle estimates for insurance then that leaves £170 k a year. This is way in excess of the salary of most professionals.

My figure of £168 k came from a website that does net to gross calculations. But to be honest it is much easier to just take the gross salary and allow for holiday etc and you end up at roughly the same figure.

Um

You've said 111 is shite and the only credible triage system is one where a call taker takes demographics and then warm transfers 35 year old with hayfever to one of highly qualified drs.

Obviously that is completely unrealistic. That is the point I was making.

So what is the alternative? How do you triage 5000 calls in a weekend? Does it need a dr to organise a Cather to be reinserted? To organise death notification? To refer to ooh GP for ABX fir uti? Or could a nurse do
It? Or a call handler? Because as a call handler I did all those things.

What do you suggest? What does the suicidal/ terminally ill person/ frantic new mother do at night?

Cather? Catheter

You're a call handler making decisions about who gets abiotics, ok then says it all really

No

I'm the call handler who refers someone with utinsry symptoms to ooh to have urine tested before seeing GP who decides whether pt gets ABX

There is a difference

(Although no longer call handler

But that would imply that there are some you don't refer ie effectively triaging? Which is what I don't agree with, a lot of uti's don't actually need abiotics or to be seen certainly ooh, do you know how to asess who does?

How do think the system should work then, macdoodle? Where are you going to find the doctors to triage 5000 patients in a weekend? Those people aren't going to go away, they will still need triaging and pointing in the direction of the correct service.

Non referrals go in the queue fir a clinician to assess. Call handlers never ever close a call without a team leader (that is an experienced nurse practitioner) giving permission. That would be viewed very, very seriously.
Our service was nhs-run though.

The problem is if the least qualified person is "triaging", then an excessive amount of patients will be seen unneccesarily. Somehow the demand for instant/early/cant be too careful etc care needs to be stemmed, people need to be re-educated to self care, to use common sense, to wait. But the government has pushed the mememe/nownownow/acopic population.
This can only be done by someone capable of weeding out those actually ill and in need of urgent care. 111 and NHSD are notoriously bad at this.
No other country has such an abused and overused OOH system, in fact I dont think any other country seriously believes that GP should be available 24/7 (GP by definition is neither urgent or an emergency). In fact I dont believe any other country has such a freely available OOH GP service. In most countries it will be A+E or pay for a OOH service.
I dont believe our system can cope with the 5000 calls a weekend (we take may more actually), for sore throats/insect bites/high temp for 2 hours/sore knee etc etc etc etc.

Ah bogqueen, so you dont actually decide who gets abio? You put them in a pool for a clinician to call back? Which is what I had said, that clinician needs to be someone experienced and capable. 111 is not clinician triaged AT ALL. And the utter shite they send 999 to or book a FTF appt is ridiculous, and the stuff they miss even more so.
Ask any single GP, they have serious concerns about 111.

I agree with you mac doodle ( I don't work in England)

"Somehow the demand for instant/early/cant be too careful etc care needs to be stemmed, people need to be re-educated to self care,"

Yy to this - but there are sections of society who honestly do not know how to self care -themselves or their children. But what do you do?

I don't want to give you a false impression though, In most cases call handlers do not refer patients, the nurse practitioners refer patients.

Anyway I am out of it now but as a layperson it was an interesting insight. We sometimes wondered whether ooh is a monster that has been created or whether it was a necessary and life saving part of the nhs. I still don't know.

Good question? I suspect the former sadly, a full triage pool will be the majority < 40years old with minor self limiting problems. The elderly with multiple complex problems are mostly absent, and if they do call it is their younger relatives panicking. The end result of a nanny state sadly. Honestly the amount of advice I give on managing a temperature is crazy.
The solution? Well not one this government wants.

And I'm not in England either thank goodness.

Sorry x - post

I worked fir 111 in Scotland which us run by some really scary nurses the NHS and yes calls go in a queuing system and are picked up by drs and nurses.

Call handlers do a small number if routine referrals - v straightforward stuff, but anything amiss and iwe speak to nurse.

I'm shocked that they are allowing call handlers to triage anything but the most routine of referrals that's not fair on call handler or patient.