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?

Mintychoc

This is the way it now, you just have to accept it. You can write to your MP if you're not happy.

Not really, you can decide as a carer, you are fed up with additional stress from the NHS on top of everything else, and ask for your relative to be placed in a specialist residential placement! In the case of severe epilepsy, that is likely to be £180,000 pa and that is just for 1:1 care; 2:1 for behavioural problems will be £250,000 and 3:1 even more.

I suspect its far cheaper for the CCG to support carers, than give them even more stress!

Hurtle- I went to a presentation given by the lady who runs Matthews Friends, the charity that promotes the Ketogenic diet for epilepsy sufferers. She was initially told that the diet did not work, that it was not available etc, it took ages but she eventually got Matthew onto a trial of the diet and it transformed his life, hence why she set up the charity. If you are interested in giving it a try I think you need to keep pushing and pushing your GP to get a referral. You have got nothing to lose by trying, I don't understand why it isn't promoted much more widely for epilepsy sufferers.

Glad to have been some help; fingers crossed you can access the trial.

If it is going to work, then it seems to work relatively quickly.

A&E- was it an accident? Was it an emergency?

Yes

Perfectly reasonable.

That is perfectly acceptable you going to a&e.
now should make an apt with your gp and fire back some questions to them. E. G what are they going to do regarding your seizures and how come after two trips to a and e no one at the surgery has referred you to a neurologist!

my (possibly) autistic daughter (waiting for diagnosis to start in about 2 years time) would not go to a and e if she had been told not to, even if she was struggling to breathe or bleeding. she would follow the letter. this is incredibly dangerous.

Even if you go to A & E it doesn't mean you will get good care. I presented with agonising back pain and was told it was muscular and to come back in 2 weeks if it wasn't better. Refused to X-ray my back. Worst pain I have ever had for 2 weeks I then went back and had X-ray and the radiologist asked if I had been in a car crash and to come back immediately if I couldn't feel my legs. 3 days later GP rang to say I had fractured my T12 vertebrae. Care really does depend on who you see. NHS also missed a broken leg in my 6 year old son and sent him home. It really annoys me that it is assumed you are wasting their time. If you are polite you also get treated worse and made to wait longer than someone who is rude and potentially violent.

So pleased there is a real understanding about health anxiety here. Not.

Just want to reiterate that I received excellent care from A and E, the neurology teams, the AMU teams and my GP. This thread isn't about the care that I received, it was about the letter and trying to understand the reasons why it had been sent and to ensure it isn't something that will go on my record.

Not entirely sure why people are alluding to the fact I attended due to health anxiety...

Hurtle sorry haven't read whole thread but wanted to post some reassurance.

My elderly mum got one of these for A&E visits. Each visit was a real life threatening emergency for 2 ongoing conditions (needed admitting and surgery each time). She was livid as she was a Dr and felt it was valid use of A&E. Turned out it was just a badly worded letter and GPs wanted to explore ways of manage conditions better to avoid hospital. Think it's driven by financial pressures as surgeries get charged each time we use A&E.

Hope that helps and sorry if I've just repeated something already posted.

There is pressure from on high NHSE and above to reduce unplanned care attendances i.e. A and E as is extremely expensive one attendance with bloods and X-ray about equals annual amount it costs for one patient to have unlimited access to general practice team etc. A/E are struggling to meet waiting times and so the trusts get fined and attendances are expensive for the trusts. The trusts are requested to alert GP practices of 'frequent users' of the service they don't necessary look and see if they are appropriate. General practice is asked to try and prevent these in those highlighted as 'frequent users' . How this is done varies this will likely be a bog standard letter.

GP practices do not get charged for each attendance as such the CCG does. You can see which practices have high use. This year in England each county now has a capped budget i.e. It needs to balance at Year end for all health in that county. There is pressure on practices with high referrals to change practice regardless of whether it is right or wrong as apparently average is right all else is wrong.

It is worrying

Don't get me started on A&E or 111 or medical 'streaming' in general.
They have failed my child massively, twice in a few months.
Got a formal apology for the first one, where I was told dc did not need to be seen and could contact GP within 24 hours...thankfully I ignored and within one hour she was admitted to hospital for a week with scepticaemia. The next she had broken her arm in two places...and had gone into shock. Fainted repeatedly upon trying to stand. School rang 111 and they deemed it not an emergency. See gp within 24 hours. That was their response. The more I hear of this ridiculous system, and the people being wrongly affected when they need care the most, I am utterly dismayed. Especially when I hear my teenage daughter recounting the number of blue lights that have turned up for some of her drunken class mates...it all just beggars belief.

Firstly, sorry to hear of your recent ailments. It's sounds like you've had a rough few days. Secondly It sounds like an automatic letter sent. Can I suggest a call to discuss with the practice manager. He/she will explain and probably put your mind at rest. No need to escalate, get angry and start bashing NHS/GPs etc as probably a reasonable explanation. I'm a nurse in the community and there are so many new schemes and ideas at the moment to try to make things more manageable for A&E and community services, due to pressures..it's probably one of those

Is it an accident and/or an emergency? On this basis 1st event & visit = very appropriate use of resources, 2nd visit could go either way - same day GP, would do hospital referral if necessary, 3rd visit same day GP more appropriate than A&E. Don't worry too much about the letter though. You (and those advising you) were just being a bit over cautious. Understandable, you had a head injury and a nasty shock with the first incident. Concentrate on recovering and don't be so concerned about having done something "wrong". A&E is an expensive misused resource in general, hence the need for letters to try to discourage it.

The 'old' helpline had trained healthcare professionals who could deviate from algorithms, unfortunately this is not the case with 111

Are you absolutely sure the letter was sent by your GP? It may have been sent by your local CCG but just with your own GP name and address at the top. Quite a lot of letters are sent out in this way.

Sorry you've had a rough few days Hurtle. Hope the ketogenic diet might help you.

Please do complain about this letter. I always think letters like this bother conscientious patients/ recipients more than those who might actually be mis-using the system and so do more harm than good.

I know it would bother me and I'm the type who'd rather sew my on leg back on before going to A&E and bothering a doctor! It is horrible to be made to feel like a time waster.

I dunno but I wish SIL would get one

Why what has your SIL presented at ED with Girl?

People do misuse A&E and i suppose the letter gets triggered if they think A&E is being used inappropriately. For example being sick could have been a GP telephone appointment?
One woman at our local hospital A&E said she was there to have her ears syringed! Another needed toenails cut!! Do you have a Walk in Centre? They can take the strain off A&E.

Also your local pharmacist is very well trained in all medicines, tbeir knowledge is often much better than a doctor's and they can talk to you about your medication...whether it's likely to cause sickness or if the dosage might be wrong.

Blueink

Seizure 1 resulted in a head injury - I think that is why I was told to go back through A and E. My GP cannot do same-day referrals to the neurology team. Not entirely sure anyone was being over cautious I had my head and neck crash down the bottom of an escalator after seizure 1. I then had seizure 2 within 6 hours.

Ocies Yes, it was signed by one of the partners.

"For example being sick could have been a GP telephone appointment?"

Well yes, if it was just that I was being sick. I had however had a pretty nasty bang to the head and several seizures by this point. I was told to go back immediately if I started vomiting (amongst other things) by the A and E team, the neurology team and my GP. I did call 111 and they wanted to send an ambulance. I declined the ambulance because I hate them and they always make me sick I thought that was an epic waste of resources.

Perhaps surgeries need to make their services more accessible then.

As I've said above not one GP at my surgery works full time. They earn £79k plus each via the NHS. Each of the partners is also doing at least two clinics out of hours at our local private hospitals.

The limited services are all due to NHS overwork aren't they

Leafy surrey here. It's not the old gin and jag belt who are suffering. The family Drs are very quiet about reality. And still we are supposed to respect them. I think not.

"Do you have a Walk in Centre? "

Our walk in is triaged through our Accident and Emergency department - you see the same nurse. Even if I had wanted to go to the walk in, it wouldn't have happened because of how I was coded / prioritised. I was taken straight a bed and seen immediately (third visit).