Inappropriate A and E use letter from GP?

[HurtleTheTurtle]

Opening last week's mail and I've received A letter from the partner's at my GP surgery stating that I have used A and E inappropriately. It notes that I "am a frequent visitor to A and E, and that I must access other resources to treat minor ailments".

Does anyone know if these are sent out after a set number of A and E attendances? I had three attendances in a week last week; I would expect that if there was an issue A and E would have raised it with me? It was on their instruction that I returned.

AIBU to actually point this out with the GP surgery and ensure this isn't placed on my medical records?

Soon not too.

If it's an automatic letter then it sounds a dangerous thing for them to be doing. What if next time you had a seizure you didn't go to a&e as you were worried about being told off?

I really think you should raise this with your GP and also with the ccg who it's likely is the ones pressurising the GP to send these letters out.

From the other side of the fence, there is a huge pressure to " manage the front door" in hospitals,they are simply overfull - theres no increase in capacity, so youcan either limit demand or turn people around quicker in the system.

Sounds like theyre setting the bar pretty high though (maybe using pre existing condition as a criteria for inappropriate )

Thank you for all the well wishes. I am suffering from the world's most amazing brain fog and it's difficult to see if my reaction to be pee'd off and unnerved by this letter is actually a valid emotion, or whether I am just feeling like this due to the brain fog.

I think I will raise it with the GP surgery and see what they say. My GP is ace (they actually called me twice a day whilst this was all going on to see if I was OK, and to get quick updates on what was happening - I did not want to go back onto Sodium sodding Valporate and he was really advocating this was not the first choice of treatment).

The letter feels useless and impersonal. If they want to use such letters in the future, they should A. first talk to patients face-to-face and B. highlight very clearly what the issue actually was.

As others have said, it really depends what you were there for.

I'm a GP, and we are under huge and constant pressure to reduce spending on hospital services. Our referrals are audited, and if we are deemed to be referring too many patients to outpatients we risk being shut down. A GP I knew was a high referrer - he was very thorough and didn't want to leave any stone unturned. He had years of being persecuted by the CCG, constantly watching him and counting the pennies, and in the end it got too much and he killed himself. Anyway, that's not really relevant to your OP, but I thought it would give you an idea of the pressure we're under.

Whilst outpatient referrals can be limited, there is nothing we can do about people taking themselves off to A&E, and those attendances are way more expensive than outpatients. As a result we have to constantly audit out patients' A&E visits, and be seen to be acting on it. That means sending letters to people who've used A&E often, reminding them of alternative options, so when we're attacked by the CCG we can at least prove we tried.

It's all about money these days. As senior partner with 25 years experience I now spend more time ticking boxes to try and save money than I spend seeing patients. It's madness.

Timeforabiscuit I completely realise these points too.

I used to send letters similar to these in my old practice - but it wasn't necessarily the amount, but the reason. I was asked to send the letter by whichever GP had seen it and thought it could have been dealt with elsewhere - HOWEVER A&E attendance letters are short and sweet - they really don't detail the problem i.e I suspect your third letter just said "vomiting" and no reference to anything else - my letters didn't ever say inappropriate attendance though for the very reason others are commenting! Mine simply said dear whoever, we note you attended A&E with "insert reason on letter" - did you know you could have come to us/ walk in/minir injury clinic with details of all. To promote use of those services which people sometimes aren't aware exist. This was about 6 years ago though, don't do anything like that in my current practice (and I didn't like doing it in my old one). I think its inaproppriate of your surgery to tell you "you must" access other services - especially as already mentioned the letters from A&E are so generic. But not wrong to promote other services? Our local A&E has a triage doctor at the moment as a trial, turning obvious not A&E worthy ailments away and calling the relevant surgery and booking them in.
p.s I don't think any of your visits were inappropriate! Hope it hasn't come across that I did!

Mintychoc1

Thank you for taking the time to post - I didn't realise that there was so much pressure on GPs from the CCG for inappropriate A and E attendance - it does make me wonder why the out of hours GPs have been placed within A and E in some areas.

We have a GP in our practice who will also admit to hospital if you are epileptic and have a high temperature. I no longer see that GP because I feel it is totally inappropriate (and I think being in hospital can often elevate your chance of seizures, particularly if you are on a noisy neurology ward and suffering from a lack of sleep!).

Those sound like pretty reasonable A&E visits! It's not as if you went for a cold or sore throat. So many seizures in a week and then vomiting on top of that is hardly something minor.

And please please please don't take up more of your GP's time by writing a letter of complaint. By all means speak to the practice manager if you want, but not the GP. We are drowning. But really, your issue is with the government, who have cut spending back so much we have no choice but to count pennies in this way

"That means sending letters to people who've used A&E often, reminding them of alternative options, "

That's not what the letter said. The letter accused OP of having used A&E inappropriately. Where I lived, I don't think there are other options. My GP no longer does walkins and there are no minor injury places as far as I know.
OP I think you should make a formal complaint. They might find taking the time to deal with that makes writing nasty letters time inefficient.

As a result we have to constantly audit out patients' A&E visits, and be seen to be acting on it. That means sending letters to people who've used A&E often, reminding them of alternative option

'alternative options'
you mean a gp appointment in 4 week's time, a gp who is very dismissive and doesn't even look at the complaint, a walk in centre that doesn't deal with wounds or has x-rays...
I don't blame people to take themselves to a&e for 'minor' things.

" have cut spending back so much we have no choice but to count pennies in this way"

Cutting the pennies but still have money for ink, paper, envelope and stamp to send a letter to upset someone.

I think it's a standard letter.
A few years ago ds was in hospital for 3 weeks with septic arthritis. Two months after this I took him to a kids walk in centre with tonsillitis and an ear infection. Because he was very distressed, his recent history, a suspicion that he now had rheumatoid arthritis and swollen knees.... The walk in centre advised us to pop to A&E which we did. He was fine and we came home with antibiotics. A couple of weeks later I got a snotty Letter saying I "should have accessed GP or walk in for this complaint" I threw it in the bin!!
Try not to take it personally op!

I'd say it's a machine generated letter, and perhaps more aiming at your GP rather than you as it would perhaps suggest that your condition isn't being managed as effectively as it could. If your epilepsy was better controlled, you wouldn't have had any of those visits - in theory. That would be my guess anyway. I hope you're feeling better.

Absolutely it's appropriate to complain. No GP's surgery should set up a system whereby such letters are sent out without someone checking whether they are actually appropriate or not. It's very easy indeed for the system to generate a list of potential candidates to be emailed round to GPs who can then veto any that are inappropriate for any reason.

Our PM is actually one of the loveliest people I've ever met - she's had the misfortune at babysitting me post seizure several times before and so knows what it's like when I am not OK after them.

I'll go and see if I can go in and see her this week, and I'll be sure to take in some chocolates too to say thanks. I don't want to complain, but I do want to ensure it's not on my medical record and give them some feedback about the letters (and also double check that I actually haven't done anything wrong!).

I'm an HCP and I've never heard of this. I think it's appalling. Regardless of why you were there, we cannot start shaming/chastising people for attending A+E. It will result in people with serious conditions not going for fear of it not being serious enough! Yes, people take the piss out of emergency services every day, but this is not the solution.

That means sending letters to people who've used A&E often, reminding them of alternative options, so when we're attacked by the CCG we can at least prove we tried

Automating threatening letters (letter said must) which have no basis in clinical assessment is part of accepted medical ethics now?

Surely there should be some minimal due diligence on the visits beforehand? OP has said her practice were fully engaged during the week so will have their own notes on the events, which makes automated bullying of this kind even odder.

Is it a large practice with multiple surgeries?
You will find they can be quite heavy handed about dealing with these kinds of things and 3 ED visits will be an automatic trigger, unless you are admitted to a ward.

As someone who worked in ED for years I would say your reasons for attending were valid and I would have asked you to return for similar symptoms.

I hope your follow up treatment and medication helps and you have a more balanced time of things.
Please don't feel you can't attend ED.

Letters like that are antagonistic and thus counterproductive. I would definitely be raising it with the practice and letting them know as much. If they don't know or understand the details of the visits, they are idiots to show their lack of understanding of the actual situation by sending rude letters - it's poor medical care to the point of being dangerous. If your attendances were justified and advised by A&E itself, they should not be telling you to behave differently in future. Fair enough to enquire politely why you attended A&E three times in a week, but in no way right to tell you off in ignorance of the full facts.

It was appropriate for you to use A&E. If you had gone to your GP they would have had to send you to hospital to be admitted!

I am hoping it's an automatic letter triggered by the number of frequent attendances in quick succession, rather than anyone thinking I have actually done anything wrong!

I'm pretty sure that's how it happens.

If your visits were all/mainly seizure related then it may help to flag up a need, e.g. medication or Neurology review.

It'll be an automatic letter