AIBU to wonder what the heck is going on in hospitals right now??

[Rinoachicken]

Before I start, I want to make it clear I am NOT blaming the hospital staff in any way.

13 hospitals have declared state of emergencies or whatever it is.

Why is everyone suddenly descending on A&E all over the country all in the same week? Has there been an outbreak of something I don't know about?

I don't get it. A&E is always stretched to the limit, but Why this sudden crisis all over the country?

Am I missing something??

Clam, you're lucky you got your meds on a Sunday. My hospital pharmacy is shut sat afternoon and Sunday so we can't discharge people with medication.

Roonerspism no they are NOT an emergency service. Primary care is a frontline service but it is NOT there for emergencies - that's what 999 and A&E is for. Urgent care needs same day appointments with a GP (which is difficult to provide with limited staff and resources but is a goal) and out of hours care which is available whenever the GP is closed.

If people aren't using OOH that is either a failing of the local provision to advertise that service, or people are not using services appropriately (which happens more often than not). You can't just think "Oh my surgery is closed, I'll go to A&E" but IME this is what people do. They just don't stop and think "how can I best seek help for this problem" whether that's self care, maybe with advice from a pharmacy, or OOH or a walk in centre.

There is a way of accessing a GP 24/7, it just may not be at your own surgery!

I truly believe that part of the problem is that society now is so used to instant gratification for retail, fast food, downloads, online shopping etc they extend their desire to healthcare. It's not realistic and not currently feasible.

sidge
A&E are struggling, maybe because of bed blocking, but GPs near me are still M-F 9 till 5
a neighbor I know had to travel nearly 50 miles round trip to see an out of hours GP last month
60+ hours a week, my local surgery is not even open 40 hours a week, so I fail to see how our local GPs could manage 60, let alone 40
and has been said before, people get ill 7 days a week, not M-F between 9-5

jacob I know A&E is struggling. I see the backlash every day at work.

I KNOW people get ill 7 days a week, I've been nursing 20 years, I'm well aware of that What I'm saying is that there IS provision to see a GP 24/7 and just because it's not provision in your local surgery doesn't mean it isn't there.

Just because your surgery doesn't offer clinics more than 9 hours a day doesn't mean they're not seeing patients - GPs have to visit new babies at home, terminally ill patients, those that are truly housebound, patients of theirs that may be in GP beds in local cottage hospitals (depending on your area of course) as well as those in nursing and residential homes.

I'm not saying there isn't a crisis - there is and the NHS is broken. I'm saying it's far more complex and to say "if GPs were open longer hours there would be less pressure on A&E and hospitals" is simplistic bollocks basically. It's more about staffing than hours.

sidge
you are on the inside track and know more than I do
but the perception is that A&E are struggling yet GP surgeries just appear to be working M-F 9-5, it doesn't look convincing
and there is definitely a direct impact on A&E
just have to agree to disagree
and have full support/admiration for hospital and A&E staff

Still, as Osborne told us just a few weeks ago:

"hyperbolic coverage of spending cuts has not been matched by what's actually happened in our country... I had all that when you were interviewing me four years ago and has the world fallen in? No it hasn't."

Hear them chickens roosting, Gids?

sidge I completely disagree. Previously, GPs did offer an out of hours service and that was your first port of call unless there was a real emergency.

GP contracts changed and that service was no longer available.

So NHS24 was launched. People dislike NHS24 because it can take hours to speak to a doctor. They don't trust a phone based service. (They missed my child being dangerously ill). So they pitch up to A and E. where I live, there is no such thing as a walk in centre.

GPs DO offer a frontline service and this SHOULD be 7 days a week.

So, rooners, what happens if you phone your GP's number after 6pm (or whenever)? With ours, you are transferred to the OOH service. It so happens that nowadays, that surgery is in the same place as the old A&E, which is now Urgent Care. So you can limp in there with a broken toe or whatever, and be waiting in the same space as minor injuries, thinking the queue is horrendous, but actually, you're waiting for a different service.

But it IS 7 days a week, via an Out of Hours service!

(NHS24 is only in Scotland, so my apologies if you are in Scotland. NHS Scotland (and NHS Wales) is a whole different beast to NHS England!)

It's now 111 countrywide, which is the same out of hours service you used to get but rebranded and possibly county-centralised thanks to this wonderful Government.

I appreciate it's not the same OOH we used to have but you can't deny you have the potential to see a GP 24 hours a day 7 days a week.

The fact it may be a poor service or people don't trust it is a whole different debate...

Sidge 'Potential to see a GP 24hrs/day'?!?! are you kidding me! This might be true in a major city but this is not the case for the majority of the UK.

Where my father lives the weekend provision extends to Saturday morning 9-12.30pm. After that you have to go to Manchester to get access to a GP. The A&E is 5mins down the road. If my father is sick he is hardly about to drive 1 hour to manchester when he can easily call a taxi to take him to A&E 5 mins away. It is over GBP100 to get a taxi to Manchester and he is hardly going to take the train when dealing with an upset stomach.

IMO the whole GP structure needs to be overhauled with appointments available at every practice from 7am-9pm with overnight telephone coverage either provided by one of GP's in the practice or by a service in another country (doctors in Israel/Russia are/were used by some GP's because of the time difference). Anyone going to A&E outside of a major accident or emergency should have called their GP first. If not, they should have to pay for their A&E visit if that visit was not necessary. Here in the US the insurance companies retain the right to not pay for an unnecessary A&E visit. What they define as unnecessary is based on the decision the GP makes or would have made. I don't like most of the US system but this is fair.

They also need to get some more beds. As an accountant I can see how they have taken the average number of beds needed not realizing that you can't work like that. You need slack in the system so you can make it through peak usage.

Any hospital that calculated their number of beds based on an average number required over a year is asking for trouble. I seriously doubt that any hospital has done that. Although there is always room to be surprised. Usually there's some sort of winter capacity plan for increasing the number of medical beds.

Not keen on your suggestion for primary care. I don't live in a major city and that would leave me with fewer options for out of hours care than I have now.

Look I'm not saying GP services are great, or as accessible as they should be. They're not, primary care is in crisis as much as secondary care (if not more so) but I do not believe the pressure in hospitals is entirely down to the lack of GP surgeries being open 24/7.

Travelling to OOH is not ideal, of course it isn't, here in a small deprived suburban town we have to travel up to half an hour to see a GP OOH. What I'm trying to say (obviously badly because it's not getting understood) is that there IS provision to see a GP 24/7 and going to A&E shouldn't be a default setting because you can't be arsed to travel or wait.

(Disclaimer - I'm not saying that's your Dad's case Want2be but is the case for a lot of people)

Well in fairness, I am in scotland so perhaps it is different here. No walk in centres for a start.

There is, it is true, potential 24 hour care via NHS24 but it just is not a great service for a number of reasons. The one time I did use it, they missed a serious heart problem in my daughter. My GP surgery is open only until 6pm. People pitch up at A and E and I am sure some pressie could be alleviated by a comprehensive GP service

There are a few problems with GPs opening for longer hours

1. Increasing the number of hours the surgery is open without extra GPs will not create additional appointments, only spread them more thinly.

2)where is the funding going to come from? As musicaltheatremum explained so well the funding for GPs is complicated and opening for longer hours means increased heating/lighting/staffing costs even if there are the same number of GPs.

3. There is a recruitment crisis in General Practice. Increasing out of hours work is going to worsen recruitment.

It would be nice to have GP practices open for longer hours, but I don't think it's possible without very significant investment. GPs are available out of hours, but it seems many people aren't available.

There was a person up the thread who said her GP was shut between Christmas and New Year, and another who says hers is only open 9-5 M-F. If this is the case then the GPs are breaking their contract, which is for a minimum of 8-6 (and often until 6.30) every day except weekends and bank holidays. However GPs are very often working outside the times that they're sitting in surgery, for example attending clinical and management meetings, writing reports, signing scripts, reviewing results, home visits, teaching students, attending educational events and actually running the surgery (like recruiting staff, practice policies, accounts etc).

Thats the thing... GP's should change their opening hours so they have their appointments during non-office hours. There needs to be a rethink about medical schools. We need many more doctors and rather than importing them there should be a plan to increase the number of spaces available for home students. To encourage all to stay in the UK and working for the NHS they should waive the tuition requirements but make them sign that they will work for the NHS for 30 years. If they leave or work part of their hours privately they have to pay for their education in full. It would make those jobs in places like Australia, the US, Canada and New Zealand a lot less attractive.

I don't disagreevthat sorting out the shambles that is GPs will be costly. But sonus having A and E services not coping. We need to solve the root of the A and E crisis and that very obviously appears to rest largely with problems with social care and GP availability.

I wonder if this problem might be better understood if the media hadn't labeled it an A&E crisis but had correctly called it a bed crisis. It seems to have confused two different issues in people's heads. Hospitals didn't declare major incidents because lots of people who couldn't get a GP appointment turned up to A&E instead.

how many ppl are turning up at a&e with minor injuries or undiagnosed issues because they can't get an appointment with a GP for a week or its after 5 on a weekday or the weekend, (M-F 9-5 is 40hours in a 168hour week < 25%)

my GP surgery has a four week (yes I really did say four week) wait to see a GP which is fine for routine appointments where you can book in advance, but if you have an actual medical need that needs seeing to within 4 weeks by a doctor rather than a nurse you need to skip the surgery and go to 111, if 111 can't get you in with an emergency doctor else where your last option is the walk in centre which due to staff shortages had reduced hours. I'm not remotely surprised about the effect this has on A&E's

Want2bSupermum if you put those conditions on medical school entry they you'd get no applicants. Who in their right mind would sign up for that? Those who really wanted to do medicine would go to a private medical school either in the UK (the first is opening in Buckingham) or abroad (eg Prague) instead.

There would be nothing wrong to insist that all new medics should do a 2 year stint in A and E though! Or some other poorly staffed area of the NHS - Geriatrics maybe. Ultimately, Doctors are well paid and the NHS should get some of the benefit after their very expensive training. Believe me, Buckingham will be training in NHS hospitals. There is only a geriatric rehabilitation hospital in Buckingham and not enough for medic training purposes. Who would want to be in Buckingham anyway????

I think too many people use gps when you should see a pharmacist, coughs, colds, flu virus etc. There's been a cold going round at work, three people went to see their gp for antibiotics I hope the gp sent them packing.

I have a friend who went to the gp for hand cream, as she wanted a free prescription rather than paying £5 over the counter. Time wasters clog up the system.

I agree the just increasing the hours GPs work is not the whole answer... At my surgery we've changed our appt system so we phone all patients before appointments and see them that day if they want to be seen. I start at 7.40 to do extended hours before 8, and we also have late appointments until 7.30 on 2 days a week... Honestly, we can't get patients to come in at those times! I often offer and the answer is "oo that's a bit early/late, haven't you got anything else".

If we have all GPs doing 8-8 7 days a week, all that will happen is that people have less opportunity to see their own preferred GP in normal hours, which patients won't like.

And there is no way we could go back to doing our own on calls, general practice has changed beyond recognition since the days of phoning your own GP OOH.

It's always an absolute beast getting discharged from hospital if you are disabled/long term sick. I generally start banging the drum the day before it looks like DH will get out. The fastest I have ever gotten him out was 5 hours and the named nurse actually applauded me as we left the ward.

You need to:

1. WAIVE PHARMACY - you have the right to do this, you can get the prescription off them or you can just get it from your GP later, but never wait on a ward for the hospital pharmacy as they won't dispense your meds til after the patient transfer ambulances stop running.

2. Make sure you or your DH are named to the Ward Manager/Matron/Whoever as the Care Manager and repeat, robotically, there is a care package in place, I manage this care and can sign off on it (sign anything they want).

3. Remind them every 45 minutes that you are not waiting for Pharmacy or else you will just get dumped back in the holding pattern

4. Go down to the transport lounge and butter up any ambulance drivers you find. If there's a complex discharge team then find them, get their names, ask for those names when the nurse is calling down and they will sometimes just come up and get you.

5. You must do all these things before 3pm and before noon on a Friday. Don't bother trying to get out of hospital at the weekend. It's impossible.

What about increasing other medical services availability outside of 9-5 Monday to Friday? When I worked on the wards all the OT's, physios, dietitians, etc etc all clocked off on Friday afternoon not to be seen for two days. Same on bank holidays.
I now work in general practice. Again, it is all well suggesting we open evenings and weekends but for example, there is no service available for transporting samples to the hospital at these times, no health visitors, no community matrons around, not all pharmacies open.
Not only has social care been cut in recent years, recruitment and retention of district nurses has dropped dramatically (I quit this myself due to non family friendly working arrangements years ago). No easy answer.