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??

But well enough to sit in the waiting area ??

Part of the problem, like Sidge mentioned up thread, is that so many people on here, and no doubt other sites, Facebook etc tell people to go to A&E for every single minor ailment, that doesn't always need a GP let alone anything more. You see it time and time again, "DS2 has vomited twice" "A&E now!" It is absolutely ridiculous!

The hospital I attend is the one asking for staff to come in on Twitter. I was sent to A&E there last May by my GP. It was ridiculous, I needed seeing but couldn't be sent straight to my consultant or the team on call, I had to go via A&E. You couldn't fault the staff, they were hard working but stretched to the absolute limit, not only that they had the most abusive, violent drunk in there, screaming and shouting his head off. That took more nurses than a more run of the mill patient would.

DS2 has his application in to be a nurse. He wants to do A&E! Every university we have been to has said they could fill the course 3 times over, so why have they cut training places? None of it makes sense.

Having said all that, I do think we have to start taking some responsibility for ourselves, and remembering A&E is not an extension of the GP it is for Accidents and Emergencies.

I was wondering whether declaring a 'Major Incident' means that waiting times etc are excluded from the calculations as to whether they're meeting their targets etc?

No

Social and nursing care = poorly paid, expected to work 24/7 365 days a year, sometimes for less than min. wage, so naturally there is a shortage of it.

Thefairy - I so agree, let's go back to making nursing a career rather than employing nurses from abroad, I am staggered they don't need to have perfect English and are not tested!

The hospital covers a huge rural area, the woman lived an hour away and trust me when I say there are no taxi companies that would take anyone there at any time of day, let alone 3am

The poor woman didn't look well enough to be sat in A&E by any means.

1. Lack of GP appointments- we wait 4-7 days for a routine appointment
2. Pared down social care whereby elderly who clearly can't cope with living alone don't get enough help and become ill usually due to missing medication, dehydration and not eating enough
3. bed blockers in hospital due to problems discharging vulnerable patients
4. ageing and increasing population
5. people who think every thing needs to be seen by a doctor
6. politicians messing about and reorganising the NHS who actually don't have a clue about patient care

7. oh and all the drunks who frequent A& E. Last time I went to A&E 3/4 of all the patients was there due to some drink related problem. One woman came in as she had a gashed head due to a drunk throwing a bottle at her!

Fair enough moomin I live and have always worked in London.

Hillingdon I think we should go back to having registered nurses and enrolled nurses so more people can become nurses in the first place. I don't necessarily agree that all nurses have to have degrees, and certainly don't think we should be stopping people in this country training to be nurses and then bringing them in from abroad.

Sorry but its just all a bit too well timed and I am deeply cynical of the way the public sector works

You can be as cynical as you like but I have left a department later than I should have finished looking like it has at least half a day's if not more work still to be done. And that's before another day's work gets added to it tomorrow morning. My guess is that we're about 50-60% up on what we would normally expect. One or two items that are automatically reordered on a weekly basis because we use a consistent amount of them ran out yesterday. They aren't things we urgently need and we can source them from elsewhere if need be, but it is an indication of how much more work we are doing.

And FWIW our Christmas leave restrictions were the same as they always were. I was the only person to have taken any and I had 3 days. 2 of which I worked the equivalent of in overtime the week before I took them. So I very much doubt it's been manipulated by shift patterns. And despite pretty much every member of staff in the department currently being knocked for 6 by this god awful bug we've not lost any time in sick leave either. We're about as staffed as we're ever going to get.

I agree, SRN and SEN. Labour should never have tried to give everyone a degree. In my younger years I was interested in becoming a nurse, it didn't happen but it could be such a great career and so portable.

i love the off beam ramblings of conspiracy theorists
Just think if nhs could organise and coordinate such major incidents for sheer devilment what could be done for greater giod

Agree with rafa - I've worked in A&E for the last 18 years, and can categorically state that I've never seen it as busy as it has been the last couple of months. It resembles a war zone most days at present, with patients queuing on trollies up the corridor. We are trialling a number of things to try and get people in and out, rapid assessment clinics staffed by consultants who assess patients immediately and get their investigations etc started asap; senior nurses seeing patients at the point of booking in to ascertain whether they really need to be seen in A&E or diverted to primary care, out of hours, pharmacy etc. We have GPs and Nurse Practitioners from primary care working for 14 hours of the day in ED to take diverted patients too.

We are seeing on average 180+ patients booking in every day, a really busy day used to be 120. Add to this the bed crisis - we have something like 50 patients ready to leave on wards but can't get them out due to social care cuts/families not wanting to move them out, and you have a major crisis on your hands. We haven't declared a major incident yet, but have missed the four hour target almost every day for the last few months, it's just not possible.

The other problem is staffing, the nurses are burning out, I've never seen them so busy. We have vacancies for 3 consultants but no one wants to work in A&E any more. Other medical staff vacancies are covered by locums who don't know the system and so take longer to see patients.

It is absolutely the worst I've ever seen it and I don't know what the answer is.

I think it starts with over stretched GP's.
I struggled to get an appointment and got so desperate I was at the door at 7:45am in tears begging to be seen only for the receptionist to act like she was doing me a favour

I work in a non-emergency service (but walk-in service), and we have lost 5 from our team of 19 in the last 6 months through resignations and retirements, and their posts have all been frozen. Only in the last 4 weeks because our Manager managed to get hold of some Winter staffing money have we now got 2 agencies. We are at crisis point. Patients are waiting for up to 2 hours. Something has to give...probably the physical/mental state of my team.

I don't think there's enough money in the world that would make me want to be in A&E at the moment, furrymuff. I'm imagining it's an absolute nightmare.

The PP who said a routine appt was 5-7 days away - I phoned in mid-Dec to ask for a routine appt and the earliest one I could have was Jan 15th! No specific doctor, either. (Having said that almost all the GPs at my surgery are lovely and efficient when you do see them.) Btw, all I want it for is to get the mini-pill - couldn't things like that be handed over to pharmacists?

How are GP surgeries funded? Someone upthread said that GPs have to pay the nurses etc themselves - how does that work? Why is it set up like that? How do you go about starting a new GP surgery - or expanding your own one?

Too extra. Tutorial on GP pay
GPs get paid about £70 per patient per year. This is what is called the Global sum. This accounts for about half our income. This is purely dependent on list size.
The rest of the money, about another £60-70 per patient comes from all the different targets we have to hit plus payments for immunisations, extended hours, smears, daft long projects we have to do on access and producing reports. If we have time we can get paid for IUD insertion and nexplanon and minor surgery but we can only do so much of this as it all takes time.These things are optional but it is half our income. The government every year says "we're not going to give you any more money, in fact we will take £ x 0000 away and you will only get it back if you do x y and z

Out of this we have to pay

All our staff including employers superannuation and NI, all our practice nurses, all our locums all the phone bills postage heat light repairs on the surgery refurbishments, cleaners. Maternity and sickness benefits and we have to pay our own employer's superannuation. We pay for cleaning the windows, painting inside, new furniture etc. we pay for our courses, our medical defence fees, we pay for cover for our out of hours. We pay for all the staff for tea and coffee and bacon rolls on a Friday because goodwill costs very little. Oh we pay for all the urine testing strips and the dressing packe and the bandages that we use on our patients too (not all of them, but we pay for the Elastoplast that goes on your arm and the cotton wool we use on you too)
Computers are provided for us thank goodness as they are procured centrally.

Once all these things have been paid then whatever is left is divided up between the GPs usually in proportion to the number of sessions they work. Eg our full time GP does 9 sessions and I do 5 so I earn 5/9 of what he does. So GPs I come depends

To expand your surgery you have to find finance or take out a loan. Where I am they are desperate for expansion so the health board are hopefully funding new premises in the area and will fund an extension for us but to get more GPs we have to take a pay cut or increase our list size to get more money in.

So as a GP I have to understand the finance side of things too.

It's fun, I love my job but it is stressful and the demands on us are increasing daily.

GP income depends on a lot of things I meant to write near the end.

TooExtra you shouldn't need a GP appointment for your contraceptive pill. The practice nurse should be able to see you for that.

I think the gp contract lies at the heart of a lot of this. A great deal of gp activity is motivated BT the payment received, which given the post above I can understand. So if a gp gets extra payment for some things where's the motivation to treat stuff that doesn't get paid for (apart from altruism which tends to only last so long). Along with this gps are expected to have ongoing responsibility for complex patients living at home, without the multidisciplinary support they need to do that.

NHS is trying to turn off the tap by fiddling at the edges and using short term funding to increase the preventative approaches, but we've still got very ill people to care for. Can't win.

A lot of the stuff we do as extra in the GP contract is very good. And a lot of it we were doing before the contract came in which is why the government got such a shock in 2005 when we all scored so highly. I think the government thought that we would take years to get our targets hit but as we were doing it anyway we did very well which is where the £250k per GP income rumours came from.

We have a system of reviewing frequent admissions and patients at risk of readmission but instead of just letting us get on with seeing the patients and spending time with them we have to trail through lists finding a certain number of patients then fill in care plans some of which are very useful but some are not worth the paper they are written on then, instead of just having our meetings as required to discuss these patients which we used to do with each other informally we now have to have formal meetings and minute them and write reports for the health board. Tell me if you got 150 reports would you read them but we have to do them. During these meetings I could be out visiting. It's daft but if I don't do it I would loose £ooo of pounds.

A lot of stuff we do now used to be done in the hospital 30 years ago. When I started the diabetics were usually seen at hospital, now all of them are seen in GP except the insulin dependent ones. There is a lot more chronic disease management done by us and the nurses and so fewer appointments for the acute things.

I have a patient at the moment who is unwell. She has a complicated medical history and has developed some worrying blood results. She needs a whole host of investigations and what I could do with is a general physician to see her maybe even admit her, get all the investigations done in a week and sort her out. That is what happened 25 years ago. Now I have to refer to 3 different departments for 3 different scans or investigations which all need to be followed up and then if I do find anything I then have to refer her on to someone to sort her out. As GPs we are being expected to have more and more specialist knowledge and whereas we used to have to know enough about a lot we now have to know a lot about a lot. This all takes time and I will go to the ends of the earth to help the patient but the beaurocracy gets you down sometimes.

I just think we are being squeezed from all sides as are the hospitals and we need some support and sadly the BMA our union is not supporting us and not speaking out for us. They have been so quiet.