To think the a&e crisis is largely our own doing

[Diemme]

So much on the news at the moment about unacceptable waiting times in a&e departments. And it always makes me think about the few times I've been to a&e in the past few years, and noticed that the waiting room resembled a social club! Full of people eating, drinking, chatting and walking to and from the toilet, vending machine etc. Aibu to think that educating the public to stop inappropriate a&e attendances would come pretty close to sorting the problem?

My dentist sends me a text a few days before an appointment that says text yes to confirm or no to cancel. Would that work for GPs?

The drop in system works well at my surgery as I've said. You can make appointments too, but if you go to the drop in you know you'll be seen that day. There might be a wait but if you go early enough you'll be one of the first to be seen.

A large GP practice locally 'lost' 55,000 GP hours in no-shows last year.
That's horrific.

Years ago my ds1 had regular paediatrician appts at a local hospital
Other parents regularly joked with each other in the waiting room that they "couldn't be bothered" to attend their last appt and thought it funny that others had been refused an appt that day
Honestly
Every fucking time
No idea what the solution is but as I've gotten older Ive realised that people
Simply do not value what they do not pay for

We are just setting that up this week hopefully it will make a difference.

Mine is a bloods clinic so possibly different to the GP's but it so frustrating when we're turning people away when there's a strong possibility the next 2/3/4 patients won't turn up

I get reminder texts from dentist, gp practice and hospital for appointments. I assumed everywhere did them.

Blaming the patients is a bad thing.

Blame the government, and perhaps also the previous government for saddling the NHS with PFI schemes, for the insufficient funding. Insufficient number of GPs, social care provisions, allowing fast food chains in large numbers and indeed cheap supermarket booze are all contributors.

The only patients who should be blamed are those who voted this government in.

Sorry forgot to add- a fair few are repeat offenders, rebooking their missed appointment for the next day and still not turning up.

Anyway, that's just a very small part of it but frustrating all the same.

a fair few are repeat offenders, rebooking their missed appointment for the next day and still not turning up.

Can your clinic institute a DNA removal policy? Both the consultant I regularly see at the hospital and my GP surgery are really hot on that kind of thing and they have been known to remove people from their list if they regularly DNA.

People initially get a phone call either at/just after their appt time saying "Hello X, are you aware that you havemissed your appt today with Dr Y at Z time? Just to make you aware that in future, if you know you won't be attending then you really need to let us know so that we can free up the appt slot for someone else who might be in need of it more urgently. Do you still need an appt? The next available appointment is at X time on Y date but we can also put you on the standby list** if you like?"

If they do it again then they get the phone call followed by a letter basically saying "You booked an appt then DNA. Don't do that as it affects other people and wastes everyones' time and NHS resources. If there was a genuine reason or you think this letter is an error, please call us to discuss it, but otherwise, be aware that we do keep a record of DNAs and if it happens again then further action may need to be taken. If you do find you can't attend, this is the process to cancel/rearrange your appointment "

**My surgery has a "standby list" to try and offset the DNA rate so that if your appt isn't for a while they give you the option to go on the list and if any last minute cancellations come up, they work their way down the list to see if someone is free to come in. Though it can be at v short notice - like 15/20 minutes till the appt time - it means less time is wasted, because if people with later appts are already in the waiting room, they just bump a couple forward and then slot the standby appt into the time freed up later.

Having a standby list is an interesting concept.

Hotels and airlines just blatantly overbook to many people by 10% and rarely run into problems. Though when you have 90 bedrooms and 99 bedrooms booked out it is a worry until 18:01 ( when the small print kicks in) though we would pay for accommodation at another hotel - usually it meant town was busy so a 30 mile drive.

Doing this with doctors though would in a GP scenario, be pressure making with 10 minute slots that run over anyway. 5% over booking maybe acceptable, in a I don't mind waiting if everyone did miraculous turn up.

Hospital appointment times can be linger so not sure how I'd be waiting?

www.theguardian.com/society/2017/jan/11/nhs-crisis-20-hospitals-declare-black-alert-as-patient-safety-no-longer-assured?CMP=Share_AndroidApp_Tweet

Of course there is a problem with A&E, but stop judging by the fact that they are walking, talking, eating and drinking. You have absolutely no idea why they are there and whether or not it's serious.

Doing this with doctors though would in a GP scenario, be pressure making with 10 minute slots that run over anyway. 5% over booking maybe acceptable, in a I don't mind waiting if everyone did miraculous turn up.

IDK the ins and outs of the specifics of my surgery's standby list, but it's not like an airline where there are 100 seats but they sell 110 seats and hope 10 people don't turn up. The GP isn't overbooked, the "correct" number of appointments are given out but, if people don't turn up on the day, or cancel last minute, they see if anyone can come in at short notice.

So there is a list of people who were given the "next available appointment" wen they booked in to see the GP, which might be for next Friday, but then today Mrs Jones calls at 11:00 to say that she can't make her 13:30 appointment. Rather than that appointment going to waste, the receptionist will get on the phone to Mr Smith, who is top of the standby list, and say "Hi, this is You have an appointment for next Friday, but we have had a cancellation today, would you be able to come in for 13:30? You can make it, great we'll see you then/You can't make it, no problem, we'll see you next Friday and get back to you if any more cancellations open up before then". If they can't make it then they move to the next person on the list and so on until the appointment is filled.

Or say Mrs Jones just doesn't turn up for their 13:30 appointment, but at 13:28 Mrs Cooper and her 7 yo DD who have a double appointment at 13:40 are already in the waiting room .... they will be bumped forward and the receptionist will call Mr Smith to say ""Hi, this is You have an appointment for next Friday, but we have had a late cancellation today, any chance you can come in within the next 20 minutes or so? Great, if you can get in by 13:50 we can give you that slot but if you can't make it, no problem, we'll see you next Friday anyway"

I would assume that if the GP has been really held up by over-running appointments or it was an unusually busy day and there is maybe one or two cancellations, they might use the freed up time to let the doctor catch up with the appointments that were already waiting before they start re-filling the cancelled slots but I like the fact they are trying not to waste time and give patients that option.

if you are waiting for a hospital appointment then it's always worth asking if you can be called if there is a cancellation.

Feeling pretty fed up today of the suggestion that gps working a bit later is somehow going to make a difference to people lying on trollies in corridors waiting for a bed or this poor child who had to rest on chairs www.telegraph.co.uk/news/health/10691684/Sick-child-on-a-drip-was-forced-to-sleep-on-plastic-hospital-chairs.html

All this government wants to do is distract attention from the problems, no desire to fix them. We have low numbers of beds www.independent.co.uk/news/uk/politics/hospital-bed-shortage-uk-europe-capacity-chart-one-bottom-european-countries-eu-worst-jeremy-hunt-a7517541.html

Sigh
We have the fewest hospital beds in
Europe
Social care funding has been slashed
Most elderly people in Hospital are medically fit but there is nowhere for them to go

Amazed that anyone can think immigrants are to blame. Were it not for the Nigerian nurses, I'm reliably informed that the NHS would completely collapse.

Whilst the studies show that time wasters aren't causing the collapse, they sure aren't helping. My DM went to the GP with a cold. I was cross with her. She knows better.

The hospital staff refused to release my mil because they thought she wouldn't cope at home. My bil persuaded them, she's fine. They wanted her bed moved downstairs (no downstairs loo) and SS involved. We got her a carer instead.

The whole GPs need to work weekends thing today has made me so angry. How dare the Gov blame GPs for this crisis. Look at how much the UKS spends on healthcare compared to other countries. Think how fabulous it could be if better resourced.
The GP surgery i currently work at is a single partner practice. He has a part time salaried GP, a vacancy for another part time GP and a part time nurse practitioner which I am currently filling as a locum.
At the moment he is working 12 hours a day 5 days a week.
I suppose you could squeeze a further few hours out of him at the weekend however, tired GPS make mistakes just like tired Jnr Drs.
Truth is there is just not enough resource in the system. Too few nurses and Drs. There are not enough being trained and the ones we have are so pissed off they are moving on to pastures new.
Please mums enters show some support for your NHS. You don't know what you've got til it's gone.

I'm a practice nurse who won't be working 8-8 and a seven day week. I only work pt anyway, who will pick up my extra hours? The majority of my patients don't work or are elderly, so when I'm there at 7.30pm on a cold Saturday evening, who is working my Tuesday morning instead? What will I do on that Saturday when I need to speak to a health visitor or child health with a query before I immunise your child? What transport service will take your blood samples I take to the lab? How can I check with the cervical screening lab an issue before I do your smear? Oh no, I can't because there's no funding to pay for this '24/7' service to function effectively. Let alone who will be sorting out my DC. I can't do it and I won't. Utter nonsense.

My DS was in hospital last year, When the surgeon told the nurse he was going down to surgery as soon as he had not eaten for the required hours she said how surprised she was as he was bouncing around the ward. I am sure he would of been on your list of time wasters too.

The 7 day services this bonkers Government keeps promising the public can't happen without massive investment. The resources are not there it's as simple as that. The GPs can't provide what's being demanded without a lot more staff and that's not going to happen anytime soon! It's not just money either, there is a shortage of GPs and a shortage of lots of other specialist Doctors too.
My husband is a hospital Consultant, he works weekends but that means he needs to cancel weekday sessions because he can't physically work 7 days a week! The hospital advertised for two more Consultants to join his department, they didn't have a single applicant!

it's not a pittance. They get more than me and I'm senior Sister in A&E!

corythatwas That happened to a little old boy I met in my GP surgery a few years ago, his taxi was late and he was late for his appointment, the bloody rude receptionist shouted at him told him that he would have to wait until the end of surgery, he went and sat down and I realised to my horror he was CRYING don't know about everyone else but it broke my hearty to see an old man in tears and I was going to do something about it

So I went and had a chat, turns out his appt was the one after mine the GP was running late and I knew there was at least one other person waiting to see the same GP (they were in the queue in front of me )

So i asked the receptionist if the man could have my appt slot and I would wait until the end of surgery, she told me to sit down and mind my own business (COW)

When the GP came out called me in I explained the situation, naturally I realised that the GP had probably looked at my record before calling me in and it would be too late to see another patient there and then, but I asked if would be possible that the man could still have the appt slot after me. GP had a word with reception and told me it was all sorted, BUT I did hang around afterwards to make sure the man was called in next (he was)

I wonder if the Gov have a secret plan to push push push servics til they nearly break then say, oh well, all the public are asking for it so we will put up taxes.
I can't see that they are doing anything else as they are offering no more money and the aging pop is still growing. It is obviously not going to get better.

I think that's what it is. So when we are even skinter in the next decade they will say, Well, you asked for it!

Oldsu that's terrible - and how kind of you.

I do think some receptionists add to the problem with their rude and unhelpful attitude. I know resources are limited but in the case you describe, they displayed zero compassion and zero common sense. If a taxi is late it's late. You can always rejig the appointments round a bit - as you requested.

I'll just leave this here

Makes my blood boil when the chiefs at our local CCG/Hospital spout in the local papers that we should all use the alternatives to A&E. Where I live, we are 22 miles from the nearest A&E. Our local (5 miles away) Minor Injuries unit is only open Mon-Fri from 9.00 - 5.00 and closed on BAnk Holiday Weekends, the 'late' pharmacy opens until 5.30pm and is open for 1 hr on a SUnday (nearest Supermarket pharmacy is 15 miles away), our GP practice has 1 late night per month when it stays open until 7.00pm and you have to prove you are working during usual opening hours to get an appointment then (usually closes at 6.00pm). We do have an out of hours GP service which does have a good reputation but call back times are lengthy at peak times. The nearest walk in centre is co-located with the A&E - 22 miles away.

I live in a large village 5 miles from a main market town with 2 major A roads running less that 1/4 mile away. We are a rural county but many people do not live out in the sticks but accessing the services of which the powers that be speak of and tell us we should be using is virtually impossible, especially if you don't have your own transport. How do they expect people to avoid calling ambulances and keep out of A&E?