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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

Inappropriate A and E use letter from GP?

177 replies

HurtleTheTurtle · 09/07/2017 09:50

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?

OP posts:
HurtleTheTurtle · 09/07/2017 10:53

DJBaggy

The last time I went to the GP surgery after multiple seizures I got a serious telling off for not having called 999 immediately after the third surgery (the telling off occurred a few weeks after, not at the time). I had the GP raise it, and the practice nurse raise it separately.

OP posts:
roundaboutthetown · 09/07/2017 10:55

You would have thought there are human beings capable of intercepting inappropriate automatic letters - or do they go out with electronic signatures printed on the end and a machine that puts them in the envelopes and franks or stamps them?!

HurtleTheTurtle · 09/07/2017 10:56

It has one of the partner's signature on the bottom of the letter. Unfortunately, the partner that I don't really like (and that feeling is mutual), so I won't be raising it with them (along with Mintychoc's advice too about seeing the PM rather than raising it with a GP).

OP posts:
Pheasantplucker2 · 09/07/2017 10:58

I got one for taking my son in when he'd got his hands on my melatonin and eaten half the bottle. I wouldn't mind, but I had rung the GP to ask what to do, and they'd looked up the medication and expressly told me to go to A&E....

HurtleTheTurtle · 09/07/2017 11:01

Pheasantplucker2

Oh no! I hope your son was OK? Did the letter stay on a record anywhere at all?

I never knew these letters existed until this morning. I was expecting to open it and see a copy of a letter from the GP to the Neurologist confirming they'd been following each other's guidance and advice!

OP posts:
GardenGeek · 09/07/2017 11:09

This reply has been deleted

Message withdrawn at poster's request.

HurtleTheTurtle · 09/07/2017 11:12

I actually don't believe the NHS is broken at all; the care I have received over the last two weeks has been absolutely phenomenal.

I am glad your DH is now feeling better.

OP posts:
GardenGeek · 09/07/2017 11:15

This reply has been deleted

Message withdrawn at poster's request.

NotTheDuchessOfCambridge · 09/07/2017 11:23

Do you have to go to A&E every time you have a seizure? My brother is epileptic and when he has a run of seizures he sees his GP as they are the ones who sort the medicine.

NotTheDuchessOfCambridge · 09/07/2017 11:24

I have always had excellent care from the NHS. Ok I sat with my son for 4 hrs before but I'd rather that than be one of the ones rushed in because they have something life threatening.

Mintychoc1 · 09/07/2017 11:24

It makes me despair to see how many people think GPs have such control and power. Trust me, we have practically none. You can rant and complain to us as much as you like, but we can't help. We are pawns in a huge money-saving game. If enough people complain about these letters, it's just possible your surgery will change the wording slightly. But they won't stop sending them.

People need to understand - we have to save money and have to be seen to be playing the CCG game - or we will be shut down, it's as simple as that. As individuals GP have zero control over this. I would like nothing better than a system where people can be seen where and when they like, and not be "punished" for it, but it's never going to happen.

I wish some of you angry people could spend a day with me at work and see how it really is.

HurtleTheTurtle · 09/07/2017 11:32

NotTheDuchessOfCambridge No, I don't. I really hate going to hospital. My guidelines are more than one seizure in a 24 hour period = A and E. More than three seizures in a week = A and E.

I wouldn't have gone to A and E this time if it was just two seizures, maybe after the third one I would have. However, I had a huge lump on the back of my head, a huge lump on my neck and two black eyes appearing from going down the escalator - I also started to panic that I was maybe pregnant, I'd had two seizures, and these were the first seizures whilst awake in several months. I was put straight onto a spinal board and blocks in A and E because of my neck (clearly wasn't thinking straight when I chose to get a taxi in there...).

OP posts:
GardenGeek · 09/07/2017 11:34

This reply has been deleted

Message withdrawn at poster's request.

OhTheRoses · 09/07/2017 11:36

The NHS has become ridiculous. It spends more money on red tape and are covering than it does on prevention and care. Case in point.

DD went to GP on 19th June 2015 because she was cutting and taking small od's. GO called me and we visited together a few days later. GP assured emergency CAMHS referral within two weeks. BUT we were moving.

New GP refused emergency apt until notes arrived. Saw GP late July. Clearly didn't bother reading notes and wrote a pathetic referral to CAMHS say I g they were useless and would 't see her. Really helpful on all sorts of levels. Refused to refer privately and told me to get a counsellor off the internet.

Chased CAMHS who made an apt when I called. Assessed by a gum chewing PMHW. Said she needed CBT and I had to pin her down re when she would respond. She didn't because she lost my number. Dd then offered groupntherapy in the middle of the school day during the first term of a new A'Level at a new school. When refused they refused an alternative and closed her case. Although they noted in writing that DD's issues were achievement related and due to unhappiness at old school and while the new school might be stressful short term probably better in long term. Insufficient intellect to work out that what they were suggesting was settingbher up to fail and to escalate.

No acknowledgement of referral no timescales set out no clarity about what might be offered. This wasted two months in seeking alternative help.

I found counsellor one. Dd didn't gel. Escalating. Found dd a private psychiatrist. Made some impfovement. GP refused to help with recommendation so had to do own research.

Made some improvement but escalated at exam time. She took 11 antihistamine at 12 noon on a Thursday and then got worried on Friday and phoned childlike who told her to go to a&e. She went to make sure she hadn't harmed herself so pretty clear no suicidal ideation.

A&E didn't bother phoning me for four hours by which time her psychiatrist was unavailable. Meanwhile they had booked an overnight MH nurse, wanted to admit dd overnight and had reported us to SS. This was due to protocol and to facilitate a CAMHS review the following morning because of course CAMHS don't work outside of 9-5. They did not explain to dd that once she agreed to this she would be unable to leave just said they thought it was a good idea and might she agree so she said ok.

It was disproportionate and unacceptable in the context of transparency. She wanted to come home. Further upon questioning because she was 16 she could be assessed by adult mh liaison who were on premises until 3am but the nursing staff and consultant didn't know this was available.

She was assessed and cleared as good to go.

The NHS refused preventative care but then had money to spend on an overnight admission, 1:1 nurse and unnecessary emergency CAMHS assessment. She was assessed by CAMHS on the following g Tuesday. They wrote a grosly inaccurate report and said they'd arrange counselling over the summer with a partner. The partner then assessed her and said she could wait 10 weeks.

Meanwhile she saw her psych, ADHD was diagnosed which was the root of the problem, private counselling was arranged.

If the NHS got itself organised was more competent and did something about prevention it would have a lot more resources T it's disposal.

The NHS ultimately assessed dd four times were prepared to spend money on an unnecessary admission but provided fuck all in the context of prevention or care. If we'd relied on the NHS dd would ga5ve dropped out in the first term of a new 6th form.

I am sick and tired of gearing about lack of resources. The NHS us just grossly mismanaged.

Devilishpyjamas · 09/07/2017 11:40

Do you have to go to A&E every time you have a seizure? My brother is epileptic and when he has a run of seizures he sees his GP as they are the ones who sort the medicine.

At that time my son wasn't diagnosed with epilepsy, was on no medication and we were told we had to go to A&E every time he had a tonic clonic. So we had been twice the previous month and twice that day.

Now he is diagnosed with epilepsy we have to go if he has a tonic clonic lasting more than 5 minutes. I would go if he had one twice in one day as that is considered clustering and is abnormal. He also hits his head very hard and I would probably go (or at least get paramedics out) if he had a seizure following hitting his head. He can't have an EEG so they don't really know what is wrong with him. He is at high risk of SUDEP so I don't mess around with it TBH and I have found hospital consultants etc don't mess around with it either.

JsOtherHalf · 09/07/2017 11:40

Just in case it applies to anyone reading this thread, sodium valproate is not recommended in the first instance for women of child bearing age now; ie for women who are or could become pregnant.

www.epilepsysociety.org.uk/sodium-valproate-guidelines#.WWIHXmVLOrU

Devilishpyjamas · 09/07/2017 11:44

Just read your reasons hurtle and I would have gone as well (or taken my son as he is the one with seizures).

Before dx we were told we had to go every time he had a tonic clonic. Even now he's dx'd if there was anything different about the seizure or he sustained damage during it or he had damaged himself prior to it I would take him.

You were right to attend.

HurtleTheTurtle · 09/07/2017 11:44

JsOtherHalf Yes (sorry I should have clarified when I made my Sodium sodding Valproate that I'm running out of medication options, but the reason SV is not being prescribed is due to me wanting to have children).

I think Lamictal (Lamotrigine) is currently the safest medication for women who want to try to conceive.

OP posts:
C8H10N4O2 · 09/07/2017 11:50

If enough people complain about these letters, it's just possible your surgery will change the wording slightly. But they won't stop sending them.

Which in itself is probably enough.

"We want to let you know these other services may get you quicker treatment" is a very different message from "you must not go to A&E" which is downright unethical if the circumstances haven't been checked.

I've worked in this sector, many of my family do as HCPs.

I know there are massive problems. But the rigid reluctance to address basic business process modernisation is a part of the problem. That isn't always about money, as I'm sure you know there are some big vested interests in resisting change - some of the business practices and procedures in the NHS are mediaeval which helps neither patients nor staff.

Mintychoc1 · 09/07/2017 11:53

OP what exactly did your letter say? Word for word.

wibblywobblywoo · 09/07/2017 11:58

Am I the only one that thought this was going to be a thread about bad spelling....... Blush

Hedgehog80 · 09/07/2017 12:05

I had an a + e consultant have a go at me years ago for what he thought was 'a waste of time' he wanted me to leave and see my gp on the Monday. I refused. He was livid.
I could barely speak or breathe and he was telling me I shouldn't be there it was awful. Turned out I needed strong antibiotics and to be monitored as I had some kind of infection/reaction (never did find out exactly what caused it) and my uvula had swollen so much it was blocking my throat

C8H10N4O2 · 09/07/2017 12:08

Minty the OP quoted the letter in her OP - unless those quote marks are just randomly inserted.

BewareOfDragons · 09/07/2017 12:13

It's crap and poor form in a lot of cases. We got a letter like that from our GP when it was our GP who sent our child in for x-rays! I let them know exactly how I felt about that.

The underlying issue is that GPs get billed for their patients' trips to A&E. But trips are sometimes necessary. I've been in the reception area and had the GP's receptionist tell me they wouldn't see my child that morning when he couldn't even open his eye (he'd taken a direct hit to it), so I told them flat out that I would be taking him to A&E if they wouldn't see him. They saw him. After one look at him, the GP then called A&E FOR US and made us an appointment with the eye specialist at the hospital.

OhTheRoses · 09/07/2017 12:16

Oh the good old sacred cow. I had to take ds to a paediatric clinic as a baby because he developed chronic asthma. Walked in to see the paed registrar who didn't look up and barked "you all turn up late and now you are all here at once". I just said I'd go to reception and ask to see the consultant because I wasn't prepared to accept her rudeness. Reception couldn't let me see the consultant without a note from rudity so I went home and phoned the CEO. The consultant phoned me the next morning but by then I'd got the GP to refer privately. That was 22 years ago and even then there was a perpetual whinge about resources and how we should be grateful. During the last 22 years I've heard very little argument from HCPs about how things could be better organised for the benefit of patients. It's always about how they are impacted by lack if resources and let's not forget It's the brightest of minds who fail to challenge letters like that - the challenges left to the patients.

The NHS has always contained rude staff who think they do patients a favour and we should be grateful for shite.

I'm afraid I'm sick of it and want to see a continental system introduced.

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