To think this is why our A and E are failing?!

[DaisyLilyFlower]

Currently in A and E with suspected ectopic pregnancy (told to come here from 111) and current wait is around 4 hours, already been here two.

I’ve been sat by triage next to the reception desk, so not deliberately being nosy but in the last hour two patients have come in with

One with an ear infection
And another with a ingrown toenail

Cannot believe it! Reception asked them both if they’d been to see GP or rang 111, tried overnight pharmacy etc and both said no!
I do not doubt that both of those conditions are extremely painful, but I sort of can’t believe that people turn up to A and E without trying other methods first?

I’m probably just being wingy as I’m in pain and the wait is long and ABU, but I guess my question is,

What’s the worst thing you’ve seen at a and e?

Also Name change as don’t want this linked to my other posts but reg poster.

@AllDoneIn

I never thought I would say this but I'm sick of the NHS. Sick of it. It makes me miserable to think how much Bojo and American med insurance companies would love reading that but it is broken beyond repair. It is virtually impossible to see a GP here. That is one of the big roots of the problem.

We need a complete and utter rip it all up and start again reform of the NHS. Basing it on countries like France and Germany, and with a big focus on regular preventative care.

This! My grandmother has a issue which massively effects her life. She was told by a consultant it was an easy fix. Her GP has told her to live with it

The issue will end up costing her life.

@HUCKMUCK

When I worked in a practice we did some in depth analysis of our patients going to A&E. Many of the people we spoke to had not contacted us prior to going to A&E with very minor issues.

Several had called us in the morning, were offered an appointment that day but had gone to A&E anyway. They seemed to prefer to go and wait in A&E for 2-3 hours rather than wait 4 hours, come to us and be seen within 10 minutes of arriving. I know that's not true of all practices but the way we ran our on the day service meant people rarely waited very long.

There are so many factors and it's reaching crisis point at the moment because so many people have put things off during lock down. (Understandable)

I know GPs get a bad rep on here and in the media and I fully agree that there are some practices that are either very short of clinicians or just badly managed. However, there are plenty more who are doing absilutely everything they can to get patients sorted in the best way possible. I don't think there's been enough media coverage of just how much they've done by running massive vaccine clinics and still providing a decent service to their patients day to day. I get so angry when I see people posting on social media tha they have all been shut for a year.

Most of the people I know who work in primary care are working their arses off and have almost just had enough now.

Sorry for the waffle - I know this was about A&E but I sometimes feel the need to defend Practices!!!

I used to phone patient’s GPs in front of them and get them a same-day appointment. Funnily enough, every practice I phoned had an appointment available. And many patients were not happy with that, because of course the problem wasn’t that they couldn’t get to see their GP, it was that they wanted to be seen on their way back from the shops/after Strictly/whatever other vital commitments they had that day.

Their time is too important to waste going to the GP to get a repeat prescription, but apparently my time is not to import to waste on that, and it doesn’t matter if genuinely sick patients wait longer, as long as they aren’t inconvenienced themselves.

And it is a very small minority of patients - something like 100 patients made up over 50% of our attendances (we see a couple of hundred patients a day). Some of them would come in on a weekly or even daily basis.

But yes, definitely no piss-takers/totally the GP’s fault

The thing is though - I’ve ended up at A&E with fairly minor stuff because no-one else will deal with them.

DD as a toddler rammed half a crayon up her nose, I mean, so it needed some sort of implement to get it out, not just in her nostril.

DS had a very minor cut on his elbow, anywhere else it would have been, oh, that’s a bit deep, I’m sure it’ll be fine though, but it was right on his elbow and wouldn’t close because of it and just needed some glue.

Both times I was of the opinion that the nurse at the GP could have done it and was told on the phone, nope, that’s A&E... so...

This happened to me a few years ago. Newham Hospital, suspected ectopic. Sat there for ages whilst loads of other people were seen before me.

A guy came in after being stung by a bee. He wasn’t in anaphylaxis or anything, just had a sore arm. Even he was seen before me!

That said, I tend not to criticise the NHS after living in countries without free healthcare.

@AllDoneIn

I never thought I would say this but I'm sick of the NHS. Sick of it. It makes me miserable to think how much Bojo and American med insurance companies would love reading that but it is broken beyond repair. It is virtually impossible to see a GP here. That is one of the big roots of the problem.

We need a complete and utter rip it all up and start again reform of the NHS. Basing it on countries like France and Germany, and with a big focus on regular preventative care.

@AllDoneIn You can do all the reforms you like but that doesn't alter simple facts like the lowest numbers of Nurses, Doctors, GPs and beds per head of population in Europe.

Funding to recruit and keep staff has to massively increase but its a very long term aim but they need to start v soon or we will be left with a USA style system... which is the Tories aim, the NHS is a basically a socialist model, and they want it gone but without us realising it.

It’s not that GP’s cba it’s that they’re massively over-run.

The reason you have to wait 2 weeks for an appointment is because our GP/patient ratio is low compared to other countries.

If we had more GPs and more minor injury units there would be less pressure on A&Es.

Xpost @jasjas1973 snap.

The problem is that gps are not open for long enough or at weekends

They seem to have not progressed like any other service and still are shut and people re directed to ooh or a and e when usually if they could just see their gp these other more expensive options wouldn’t be needed

@Gladimnotcampinginthisweather

My most puzzling experience in A and E was seeing a woman sitting quietly while her child (probably about 6 or 7) ran round playing aeroplanes, trying to engage with anyone who would smile at him. She didn't try to stop him so I assumed she was feeling too ill. I was really surprised when they were called and he was the patient. Every now and then I wonder what could have been wrong with him that warranted an evening trip to A and E.

Could have been a head injury/suspected concussion. I brought in a three year old once (to be fair he did have a proper gash on his forehead so hopefully it was obvious) who had fallen of a chair and cracked his head on the side of the table. I have never seen anyone go so pale so fast. Silent for about a minute although it felt like longer. So went in to AandE - they saw us quite quickly and then we had to wait around in the childrens waiting room for 2 hours before seeing him again - I guess so that they could be certain he was OK. By then he had completely perked up and was zooming about (dripping blood) with not a care in the world.

But I wouldnt want to not take a child that had had a potential serious head injury (maybe they fell of the monkey bars upside down onto tarmac etc) to be checked.

Also, on the flip side, I've twice been told to take DS into A&E for something I judged to be pointless, and so did the doctors when he got there. But when a medical professional says to take your child to A&E you do that. The second time was during covid, we got seen by a nurse then checked by a paediatric doctor still in reception and out the door within 6 minutes, all friendly just efficient. They were equally impressed with their new streamlined system; nurses were splitting the queue rapidly at reception into 1) emergencies, 2) quick chat then home, and just a few into the 3) waiting area for tests and other diagnostics. The nurse said everything was working much better, but also not allowing a host of family and friends in with patients reduced disruption significantly - I hope A&E can be allowed to keep to that in future.

Yes @jasjas1973 I understand that and that's why we need to start having really difficult conversations as a society about what we need to pay for the services we want to access, either through taxes or directly. If we are making healthcare such an unattractive profession then we need to be finding solutions to it. But at the minute changing healthcare in this country is like trying to turn the world's most lumbering tanker.

@TheMirrorofHerDreams

I was assaulted by a lady who was outraged at the wait time for the ongoing cramp she had in her big toe. She had decided to take it upon herself to slip through the waiting room doors and come to the back to see what was taking so long.

I was taking blood gasses from a very very unwell baby up to the ICU unit and she decided to grab me an demand she be treated. She refused to let me go and it got quite nasty. Six weeks later I had to sit in a meeting with PALs/management because she made a personal complaint against me and the Dr that dragged her off me.

Whilst she didn't actually cause the issues that led to the death of the wee child we weren't allowed in the meeting to tell her the circumstances as 'not to upset her'

I was livid.

I was 'livid' that I wasn't allowed to speak to the doctor responsible for not referring my father to the appropriate department after commenting on his scan that he had a kidney tumour/cancer - after I complained to PALS. Due to this he was completely unaware he had cancer and received no treatment.

Ten months later we found out it had spread to numerous other places after he had another scan after contracting hospital acquired pneumonia

After a serious incident investigation it was found that there were four opportunities in that ten month period in which to inform my father he had cancer - which were also missed.

We were assured the doctor in question had had to give an explanation of this incident in front of colleagues. I doubt this took place. I think the doctor 'got away with IT'.

Whilst my father died in A&E.

I think the receptionists at the A&E are doing a great job. I was in with chest pain and irregular heartbeat and they arranged for me to have an ECG within 5 min, then I was taken straight to majors (ECG was wonky to say the least). I was admitted later.

Less impressive things I have seen in the A&E.

A family taking their son in the middle of the night as they were concerned that he was overweight.

A man wanting a repeat prescription.

A drunk man with a head wound from a fight with a bottle. Fair enough. However, I was pretty cross that he tried to press ahead of my 4 year old DD (broken arm). He was arguing that he needed to have it fixed quickly so he could go back out drinking before the pubs closed.

Once we were also refused to be seen at our GP as they “were busy” (pre Covid ) and ordered to the A&E as youngest DC had above 40 C for the fifth consecutive day. They said it needed investigation but that they couldn’t do it. Unfortunately (as it was the flu) I had two other sick children with similar temperatures (only 2/3 days though) so we sat waiting for about 6 hours. The children were so unhappy and felt so awful. Probably gave the infection to half the waiting room as well.

I think it is a combo of GP failure and time wasters.

Ingrowing toenails may sound harmless to those who haven’t had them but if they get infected you will have the same risks to health as with any other bacterial infection. Perhaps the person at A and E was concerned about that.

I do think walk in and minor injuries services are part of the way forward. GPs could focus on management of longer term health problems rather than immediate acute issues like ear infections and UTI.
When DS1 broke a finger playing sport on a weekend our local UCC couldn’t have been better. It didn’t need A&E but it did need an X-ray and referral to the fracture clinic.

Two people using A&E who should have gone to the GP doesn't constitue an explanation for the challenges in the NHS or even all A&E

My cousin’s 20 year old son died of meningitis caused by an ear infection, as per PP “trivial” reasons for attending A & E may be far from trivial and have grave consequences.

Even in normal times most GP practices round here have a 3-4 week wait to see a doctor, I was very ill in September and it took 6 phone calls (including 2 to 111 who couldn’t help me as my surgery was “open”) when I was struggling to breathe with low oxygen saturations to even speak to a nurse practitioner, to get an antibiotic prescription. I have had a similar episode in March, I am an asthmatic and was seen then at out of hours as it was a Sunday, so I was better off when my own surgery was actually shut!! I saw a consultant for a different issue and described my experience in September and he said I should have gone to A & E in an ambulance and must call one if my oxygen sats ever went that low again.

These episodes were accompanied by negative COVID tests but due to the current situation I wasn’t able to get the attention I needed in the appropriate place. I last had a routine asthma nurse check 2 years ago, as even in 2019 they were being put off as the nurses were constantly fully booked.

Primary care is dangerously under capacity and it suits the government’s agenda to blame inappropriate use of A & E for problems in hospitals.

@AllDoneIn

I never thought I would say this but I'm sick of the NHS. Sick of it. It makes me miserable to think how much Bojo and American med insurance companies would love reading that but it is broken beyond repair. It is virtually impossible to see a GP here. That is one of the big roots of the problem.

We need a complete and utter rip it all up and start again reform of the NHS. Basing it on countries like France and Germany, and with a big focus on regular preventative care.

The issue with that, is that you need about four times as many doctors and nurses, and many more hospital beds.

If we had that in the NHS, the standard of care would be similar. You can’t get to see your GP because we don’t have enough GPs in this country. This is a funding/investment issue (staff retention, training new clinicians, not closing hospital beds to save money).

In France or Germany, GPs encourage you to attend with minor illnesses because they get paid every time you do. In the UK, your GP gets a flat £60 per year for you, whether you are there once a year or once a week. So of course there is no incentive to encourage people to attend.

I used to work in Canada, which is also a european-style fee-for-service universal insurance model. We kept all kinds of rubbish on our books in secondary care, that we would have discharged back to the GP years ago in the UK, because every time I saw somebody with very mildly impaired but stable kidney function, I was personally paid $175. There are no waiting times initiatives, so it is common to wait a couple of years to see a nephrologist over there. You can be closed to new referrals once you feel your practice is full. That is not an option I have in the NHS.

I’m not convinced that is actually good for patients either - people who really didn’t need to see me were being dragged back (from several hours’ drive away in some cases) to have me do absolutely nothing a decent GP couldn’t do (blood pressure check and blood tests). Patients who I could potentially intervene on and prevent from needing dialysis were waiting a couple of years to see us.

My working life was significantly quieter than it is in the NHS, and I was much better paid, so I have no vested interest in the NHS staying as it is. I’d have no issue with moving to an insurance based system in principle. I just don’t think it would work without significantly better investment and staffing than we have currently, and we risk patients being disadvantaged by the perverse incentives to keep “easy” patients on the books, and not take on complex expensive patients.

In the 1980s I was fostering for Save the Children. At one point I was caring for a six week old baby. The parents came to take him home for the weekend, when I'd had him for a week. When they arrived back on the Sunday evening, I asked if they had a nice weekend, and she said "No, yesterday we had to wait 8 hours at the hospital with the baby." I was shocked and said "Why? what was wrong with him?" and she said "Nothing, I wanted to check you are looking after him properly".

@81Byerley Was that in the U.K., or overseas?

I totally see how it happens. This morning it took 216 attempts to get through to the GP, only to be told to call back tomorrow. I've been in so much pain for days walking to the surgery wasn't going to be possible till today. I just needed a couple minutes on the phone and a prescription putting in to the local chemist. But no. So my options are to wait 2 hours on hold for 111 triage then wait a mystery number of hours for a nurse to call, go to Minor injuries and see if they'll look at back pain(baring in mind the car park is a long walk from the clinic) or go to A+E where the car park is nearby and know I will definitely be seen. Or the option I'm stuck with, take all the otc pain killers I can and try not to cry on the school run this afternoon.