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?

It's not good enough to say that it's an automatic letter, or indeed for GPs to say the government makes them send them. It's perfectly possible to set up a system whereby the letters only go to those patients who actually need them, and indeed to change the wording.

It seems to me that there is a distinct danger otherwise with these letters that people who genuinely need to go to A&E won't go, with potentially really serious consequences. Therefore I really question whether they are in accordance with basic medical ethics.

Minty The quote is pretty much what is said, apart from it uses I.
They then tell me about the emergency services at the clinic, and the walk in GP service, which is accessed through A and E (where I went).

I do feel it was an automated letter, or it has been sent by mistake now that I've read other responses on here - thank you.

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.

Yes, but we are not talking about reminders to bring back library books! Surely, it is inappropriate to send out letters without even looking for 30 seconds at the patient's file to see why - that in this instance, they have epilepsy and attended A & E for seizures? What would happen, if the person or parents did not go to A & E next time, and the patient suffered brain damage or died from convulsive status epilepticus?

My experiences of a&e not that great either. When dd had a reflex anoxic seizure and bumped her head on the plane to holiday in Europe, she had every test going in 4 hours and discharged. It took longer to get admission to the ward, let alone be allocated to a bed and be seen by a doctor for an ecg in the uk.

I'd also like the continental style system be introduced. I used to live in various European countries.

Oh I forgot to comment about your letter. What a waste of resources to do the darn thing.

The letter was unjustified in your case, but I didn't think you could get anything taken off your medical records? An idiot GP once prescribed the wrong thing, which a pharmacist picked up. Could I get that med off my records? No. Now I have to double check every bloody time that a subsequent GP isn't prescribing me the same erroneous medicine because it's still there on my list of drugs as something that they might like to prescribe me.

I had one of these letters when I went to a&e because I couldn't breathe, I'd called the surgery and they'd told me to ring 999, I didn't and just drove myself. I had whooping cough and was given IV antibiotics.
I rang the PM to complain and she apologised, and told me it was automatically generated.

As someone pointed out earlier, A&E reports to GPs often contain minimal info, so your 3rd visit may just have said "vomiting". Without knowing more details, that would look like an inappropriate use of A&E.

A few months ago I was asked to provide an explanation for the A&E usage of our top 20 frequent users over the previous year. This involved contacting the A&E departments, getting copies of the records, matching them up with corresponding GP attendance and patient records, finding out what subsequently happened to each patient, reviewing what had happened to them previously - all to draw up a list of those visits which were justified and those which were not. This process involved about 15 hours of work. In that time I could have seen nearly 100 patients, but no, it's deemed more important that we GPs produce this evidence to the CCG, to secure our funding and viability.

This is the way it now, you just have to accept it. You can write to your MP if you're not happy. But as long as things stay the way they are from a funding perspective, we will be doing whatever it takes to ensure our patients cost the NHS less money. It's not why I went into medicine, but after 26 years I've given up trying to change it.

Yes like the EU where there is a small up front charge reclaimable usually. We have a home in France and the difference not least via a via attitude is staggering.

I can give two examples.

DD broke her wrist in France. XRay, full temp cast, reviewed by consultant again two days later for stability and swelling. 1/2 cast put on. Full = full length, 1/2 = below elbow.

DS broke just above wrist in UK. A&E seen by nurse. Half cast put on. Orthopaedic clinic apt twelve days later. Consultant recommends surgery to reset because break unstable largely due to a half cast being administered when the break was 1.5 inches above the wrist. DS required surgery and to be In a full cast for a further six weeks.

Example two. DS had a perforated ear drum. In the UK Dr refused anti biotics and showed no concern even though the ear was weeping huge amounts of yellow liquid. Said it didn't require further treatment.

Same ear perforated again in Ausria where the following is routine. Immediate referral to ENT consultant who thoroughly cleaned the ear and prescribed anti biotics and recommended consultant follow up.

At home GP refused ENT NHS referral because once burst that was it. Drum just grew back. I had d's referred privately. He had a congenital condition caused choleostasis (from memory) where tissue and bone were holding up and causing the drum to regrow at an angle making future perforations more likely. If this had been left he would have required major surgery and may have lost his hearing in that ear.

The NHS is not good and issues are not recent or just funding related. Both those examples are more than ten years old, occurring in the pile in the money Blair years.

The sooner the NHS is replaced the better. It is no longer something to be grateful if thankful for. Those within it have largely been the architects of its decline I'm afraid.

mintychoc, please may I ask how many times your frequent users have attended A and E approximately in the last year?

Of the top of my head - between 5 and 20 times .
It's not just frequency that's flagged up though. It's mainly the time ie when the GP surgery was open.

I have been a frequent a&e user and never had a letter. I did go 3 times in a short space of time this year - first I needed an MRI as q cauda equina, second visit I wasn't coping with the pain so examined again and given morphine, third was because I felt like I was wetting myself (that was cauda equina and they operated 2 days later)

I don't know much about the continental system, but anything with a "small upfront charge" would not be acceptable to many people in this country. You only have to read MN to see that there are plenty of people who can't afford the next £1 to buy some food. Whether it's reclamiable or not is irrelevant if you haven't got it in the first place.

How did your GP know you went to A&E? Did A&E ask for your consent to disclose information to your GP? If not, send a shitty letter to the hospital about them breaching privacy, confidentiality and the Data Protection Act.

I wouldn't say that sounds inappropriate use OP.

The NHS is far from Broken but it is shockingly abused.

attending frequently isn't necessarily a sign of misusing the service.

Exactly. Its usually a sign that they've fucked up a diagnosis, fucked up a treatment or sent you home too early. They get in trouble for someone returning to A&E, so its obviously easier for them to blame the patient rather than sort themselves out.

Mintychoc1 I have possibly triggered something in my surgery over a twelve-month period then, thanks for the reply. I'm going to speak to the PM. Also possible that it's the timings thing- two out of three were during their opening hours.

My GP receives copies of my discharge summaries from Accident and Emergency automatically, I didn't realise that consent was needed for that. It's really not something that bothers me - my GP is my advocate and needs to know what is going on with me medically, particularly if I have accessed emergency care elsewhere.

This sounds like some sort of local project in an attempt to reduce unnecessary attendances but it has been poorly executed in your case.

We have done this in the past and in
My experience it doesn't work. With the benefit of knowing the outcome, some attendances can seem unnecessary but at the time probably seemed entirely appropriate.

I'd ignore it.

MintyChoc1

I am horrified and saddened by your post. I understand resources are tight but GPs should not be afraid of being hounded by referring patients. And it must be some level of hounding if it caused a GP to commit suicide. Someone who it sounds like was genuinely concerned for his patients. I hope there was some sort of inquiry?

No wonder there are so many patients out there that feel fobbed off by their GP. What an awful position to put someone in - hounded for referring patients, but if something happened to a patient because they didn't receive appropriate care that would also be on the GPs head. That sort of practice will cost lives. And make GPs lives a nightmare on the process.

Everyday I hear another horrific story about what a state the NHS is in.

It would be insanity for anyone to prevent A&E sending a report to the GP! Surely that doesn't need to be explained?

Those on benefits have exemptions minty. Have you read the two examples I have provided. Can you not see how the NHS costs itself more in the long run by providing poor care?

Don't you think that if those in the NHS were not respectful to patients there would be fewer frustrations and fewer frayed tempers. Can you not see how not providing something "free" crystallized the mind

It would be good to see some comparisons of outcomes between UK and France I think. In both my examples there was a significant cost due to failure to treat properly in the first case. Not least in the example of dd's mh. She'd have dropped out of school so think forward to an Oxbridge candidates potential earnings and contributions. But no, that can't be done because she's lumped in with the great unwashed outside healthcare who should be grateful for the NHS. Damn the individual.

Actually you know what I'm going to put my name forward for a non exec post and exert some non bum chum muscle to this shambles.

Mintychoc1

It doesn't need explaining to me - I actually ask for things like blood results to be printed so that my GP gets the full set for my notes. It would be very disjointed care if they were not in communication.

minimum you are absolutely right. We're damned if we do, and damned if we don't.
This month each surgery in my area is being given a list of 50 patients referred by another surgery to a particular speciality. We have to review the presenting symptoms, the tests the GP did, the reason for referral, what was done in outpatients, what the final diagnosis was - and then decide whether the referral was justified. They call this "peer review", but of course it's all about flaming the GPs who are deemed to have, with the benefit of hindsight, referred unnecessarily.

No additional time or payment is offered for this review process. We are expected to just assimilate it into our day. Again it's probably about 30 hours of work, so we have had to block off some appointment slots in order to fit it in.

Another example of how cutting costs dictates our working day.

I know this isn't strictly relevant to OP, but it's really to give you an idea of what is actually going on. Your GP isn't being mean, or slack, or uncaring - our hands are tied much of the time.

It would be insanity for anyone to prevent A&E sending a report to the GP! Surely that doesn't need to be explained?

I didn't say that. I said they should ask for consent to send it. As required by the Data Protection Act. But then the Data Protection Act doesn't apply to the NHS, does it?