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?

mrstiggy being sick after head injury should always warrant a trip to the ED. Being sick after head injury and an epilepsy sufferer - my advice would be 999.

I no longer ask my pharmacist after being told I had a stomach bug. I ended up at A & E with acute pancreatitis caused by gallstones.

To be honest, if I'd asked on here I would have probably been told not to waste time at A & E. I knew something was wrong though so got DH to take me, not expecting it to be quite as serious!

Is it possible your GP wants to see you to talk about managing your epilepsy? Though if so you'd expect them to say so.

She is constantly at the GPs for COLDS and since being PG has visited A&E about 5 times (nothing ever found to be wrong) and constantly slags off the NHS on FB (I have deleted her).

Thing is it's people like her who are bringing the NHS to its knees

Sabine Possibly, not sure though. I have spoken to them several times so you hope they would have said, however, saying that, I can't really remember things to well during the last couple of weeks. The only written instruction I have from them is to see them this week.

Girl I have a colleague like that. We did share a GP surgery but I think they have banned her now. I think she's addicted to antibiotics.

It's frustrating isn't it?

I'm surprised I've never had such a letter. My car practically drives itself to A&E on account of accident prone DS. He has broken his finger and required plastic surgery on another finger. Required an op to reset a broken wrist and has broken both thumbs (total 3 broken bones), had his foot x-rayed when A&E thought he had broken that (whilst he was recovering from 1st broken thumb). Not to mention allergic reaction to some seeds whilst v poorly with tonsillitis. Not to mention all the trips due to asthma. Finally topped off with a trip in an ambulance when my poor car couldn't drive him there as was involved in an accident that sent poor car to that scrap yard in the sky. Poor DS thought he might have broken a rib but no x-ray this time. I think the NHS has done a wonderful job with DS. Poor DD tries hard but germs take one look at her and run for the hills.

Never had a letter like that and I had a month where I was in a&e twice a week every week. The fear of a letter like that is why I spend my time constantly apologising to the Drs when I'm in there though, it's a really dangerous thing to send out.

With all due respect to our hard working GPs - letters should not be sent out from the practice under the name of a GP unless that GP has actually sat down and looked at what they are signing. AN automated system is not an excuse. So if you have letters about A&E use you need to have the notes of the patient in front of you and to ask why they accessed A&E and if it was necessary. If you are allowing letters to go out in your name without bothering to look at them there is something wrong with the way you run your practice (as well as the system that allows you to run your practice this way). I say this as someone who frequently worked 80+ hours a week in the City earning less than my local GPs ( who make 180K+) and had personal financial liability for everything I signed - if I made a mistake that was my house on the line. If your CCG is sending out letters you don't see you need to stand up and say you won't allow it. So in the OPs case a sensible GP would see 2 A&E referrals for epilepsy and head injury in short succession and one for vomiting and know that this was a sensible use of A&E and shred the letter rather than send it. I say this knowing that A&E misuse is a big issue. My housekeeper comes from another EU country and uses A&E as an out of hours service (and also books regular GP appointments "just in case" and then doesn't bother to turn up if she doesn't need it - so please don't tell me that EU services are necessarily the way to go). She and her friends who all do the same are also the reason why, needing to see my GP for important but non-urgent reasons I was told today that the next appointment is in 4 weeks time - it isn't an emergency but needs to be dealt with in 48 hours max so my choice is walk in or A&E ...).

You have done nothing wrong...

Dont worry

My practice does have a high percentage of misuse of A and E probably; it is possibly part of a wider issue. I'm going to go and see the practice manager today.

I think this is worthy of a letter of complaint. People (inc GPs) have to be held responsible for the letters they send out. This sort of letter is dangerous if sent out to the wrong people - it could prevent someone who genuinely needs A&E from using it.
Apart from anything else the fact that this letter has been sent is on the OPs records. They are saying her use was inappropriate and that is untrue - incorrect info on someone's notes could negatively affect how she is seen and treated in future, if they think she is some kind of hypochondriac for ex.

I received one of these letters not so long ago and I know the rage you feel.
My local A&E also has a walk in and out of hours service. On 3 occasions over a month I went to visit the walk in as my GP either couldn't give me an appointment or was closed. I went to Reception and advised I wanted to be seen at the walk in. They triage everyone through A&E first so I had to sit and wait to be triaged and then on 2 occasions sent to sit and wait at the walk in and once to be treated in A&E.

None of the issues were an accident or emergency but none could wait the weekend or 6 days for a GP appointment. Both times after sitting in the walk in I was admitted to a ward for surgical treatment the next day. In A&E I was surgically treated there and then.

I have a history of skin infections that start as nothing and end up being a very large and painful abscess very quickly, if not lanced and treated with antibiotics, usually via IV, I become very ill. My GP knows this but the surgery can't offer me an appointment any quicker, so I have to use the alternative services available.

I received the letter because I was triaged via A&E even though I only actually attended A&E once. I had intended to visit the walk in on all 3 occasions as that it what I have been told to do if I can't see my GP in a timely manner because of the risk of sepsis. Beggars belief it really does.

*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 hmm*

You do realise that the 'contact' hours GPS work are just part of the job don't you? Our senior Partner theoretically works three days a week. Realistically he works at least another three doing his patient related admin, practice business and CCG work.

Ocies

I think that contact and non-contact hours are both included in the publication of a part-time employee or full-time employee though?

Our GPs publish their hours including their non-contact hours - it's not just their clinic hours. We have full-time doctors and par-time doctors, mostly part-time but that's because they have families and that works for their childcare arrangements (I have no issue with this, I will be doing the same).

ocies yes I do appreciate that. 4 clinics of three hours each = 12 hours. Add in 1w hours for other duties and that makes 24. About a 0.7 fractional appointment. I imagine It's a bit like academia on a 1:1 rating. Not sure all the clinics are as long as 3 hours to be honest.

A hospital I attended for emergency tests wrote to my GP to tell them I was wasting their time and there was nothing wrong with me. Fortunately my locum GP didn't believe this and after 9months I was eventually diagnosed with Multiple Myeloma, (an incurable cancer of the bone plasma which is notoriously difficult to diagnose without the right tests ), but it made me feel vulnerable and a burden at the time. It took a complete collapse in A&E before the right tests were done during which time the note on my file was available for everyone to see.

I've noticed that many people are comparing and saying that hospital care is more efficient in the EU, with a small charge involved. However, I do wonder how this will change post Brexit?! We've yet to see, but I suspect that the 'minimal charges' will rise...

Mintychoc1, personally due to having worked as a nurse in the past and the fact that I have developed MS and several other immune sytem related conditions and have a lot of hospital contact I think we are enormously lucky to have our NHS. Too many people abuse it and I'm not pointing fingers at anyone on here by any means. It's something I observe when in A&E myself. I have a great deal of respect for 99.9% of all health staff. I say that figure for good reason; I was sexually assaulted by a male member of staff who obviously committed this attack upon me in a side room where he pulled all the blinds down. It was a premeditated attack, obviously. Needless to say, I still feel traumatised by it and have since been admitted to other hospitals in an emergency. The ambulance crew have been more than understanding as to why I just can't face staying at that hospital at the moment.

I do think the staff do a brilliant job with minimal resources a great deal of mental pressure exerted upon them and little fallback if any. I know it is a fact that some GP's develop mental health problems or develop addiction problems, usually alcohol related. It is a strenuous job in many ways because you have to be on the ball all the time and not, god forbid, miss something vital. Tragically, our GP did pricisely that and as a result my sister tragically died. We didn't sue because no amount of money would bring her back😢.

HurtleTheTurtle, I too think YANBU. I think it was purely a computer generated letter. I would be very tempted to discuss this with PALS (patient and liaison services). I have found them to be very helpful in the past. Write a list of points you wish to discuss prior to your visit. Also, as others have suggested, speak to your practise manager. Then you've addressed both ends so to speak! It must have been extremely painful falling down an esculator😵! My heart goes out to you.

I know if I received such a letter it would really make me think twice about calling an ambulance. That is despite my GP's telling me that I never visit the practise with a boring problem like a cold or blister! When I've called an ambulance several times in the past I've ended up in Resus; which means that you've developed heart problems of some sort. In my case I developed taxhycardia due to septicaemia, pneumonia and pyelonephritis. Hardly a waste of time... A letter like this would seriously make me think twice before calling an ambulance and very possibly cause my death. Apparently though my GP has a marker on my file which alerts them that if I phone with a problem, I almost certainly need an appointment that day, as happened mid day on Friday. I explained the reason I had net phoned earlier was that I was receiving hospital treatment in London, but could I speak to a GP. He phoned back very shortly after and queried admission, but I turned it down, in facou4 of being assessed by a paramedic. He checked me over and he said it was extremely evident I had pyelonephritis. He took specimens but put me on antibiotics immediately. Got a phone call today from same GP who told me that I needed to change my antibiotic immediately as current one wasn't the correct one for the particular infection. It had started to dawn on me as I was feeling no better and in significant pain, the same conclusion...

I for one do have the occasional hiccup. It happens when staff are overtired doing 12 hour shifts+ (yes, 12 hours+) I can't fault my GP, the paramedics, ambulance crew (yes, they've had to cut the hose of the gas and air because I wouldn't let go of it😂! It was the first time I'd been relatively pain free for over a week tbh! Plus, I can't fault the doctors, nurses and all the othe health care staff come to that. There's always going to be a tiny majority wherever you go.

If you've got a planned operation, maybe research it. This is because in my particular case I'd have had an 18" incision because they didn't have the resources for specialist equipment. We researched (thx google!) and found another hospital which did and could do the op laparoscopically. Much better all round. Including a shorter stay in hospital.

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?

Angel that's ridiculous. The NHS does use the DPA and states that a patient's information will only be used for specific purposes and only disclosed to relevant professionals. As A&E will be billing the GP for the episode of care they have to tell the GP (and CCG) when and why the patient attended. If they don't do this they can't reclaim the cost of the episode. You can't refuse consent to this and people do try and commit identity fraud to get around this.

Speaking as someone who works with the DPA in the NHS on a daily basis, you really are talking out of your arse.

As long as the NHS organisation sticks within the 8 principles of the DPA then you really shouldn't refuse to share this kind of information - it is the barest minimum required to keep you safe and to secure payment to the NHS. You will be asked for consent to share anything deemed to be 'extra', but in general information will be sent to you GP, the referrer, anyone you're being referred to, yourself and any other agencies involved in your care (so SS if appropriate, HV or SN for children etc.). Some services deemed more 'sensitive' (such as GUM clinics where you dont even have to give your name) may ask for your consent and you don't have to provide it, or they will have their own budget so they don't have to contact your GP, but these are exceptional. In all other cases, the NHS has a duty of care to treat you and you don't have to give your details, or give false info, but beware that the NHS Counter Fraud service is now getting pretty hot on investigating all suspected identity fraud cases - mostly because of health tourism - and they are taking action against people.

www.gov.uk/data-protection/the-data-protection-act

"As A&E will be billing the GP for the episode of care they have to tell the GP (and CCG) when and why the patient attended"

Wait, I thought this was debunked as untrue further up the thread.

Do GP surgeries get billed for A and E attendance / care?

At one time, if I had followed the emergency protocol laid down by the regional consultant neurologist of 10 seizures in 20 minutes, I would have been calling 999 every day to DD. I told him I had 2 other children, and could not spend 4 hours a day in A & E. He told me to call 999, "when we were worried!" That for us was 12 seizures in 20 minutes (because we knew the seizures were not going to stop) still upto 3 times a week, and not including all the trips for the injuries to her head, broken bones/teeth, etc from drop attacks.

Actually, GPs are not really involved in her care at all, beyond prescribing anti biotics for infections, because nobody wants to prescribe her anything, except consultant neurologists. Its on every discharge letter:

*....IT IS OF UTMOST IMPORTANCE TO CONTACT [SPECIALIST EPILEPSY CENTRE] ON NUMBER PROVIDED ABOVE ASAP.

THEY ARE BEST PLACED TO ADVISE ON MANAGEMENT OF THIS HIGH RISK EPILEPTIC AND HAVE ASKED US TO CONTACT THEM IF THIS PATIENT COMES INTO HOSPITAL WITH SEIZURES.*

Do GP surgeries get billed for A and E attendance / care?

If you have more than a basic attendance and tests (ie. Admitted, advanced tests etc) then yes.

Currently, the cost of an A&E attendance ranges from £63 (in a minor injuries dept) to £322.

If anyone is interested in current NHS charges they're all publicly available at improvement.nhs.uk/resources/national-tariff-1719/#h2-annexes

I've worked out from it that I've had literally tens, if not hundreds of thousands of pounds of care in my lifetime. Quite humbling really.

My medications cost the NHS a few thousand a month never mind the specialists involved in my care and the a&e attendances and admissions...ill never ever pay enough tax to cover it!