Why are A&Es getting so busy?

[User112]

www.google.co.uk/amp/s/www.independent.co.uk/news/health/hospital-emergency-black-alert-barnsley-hospital-b1870819.html%3famp

A friend’s husband had a serious accident at work and spent months in St George’s on a ventilator. His physio appointment when he got home was by phone. You couldn’t make it up! This is a man who’s had skin grafts on his arm and hand.

@Souther

You've got new housing developments being built but no thought about how these people will access healthcare, or even school places.

This is 100% the issue in our town

Doctors were already struggling to see patients
Nursery places are now like hens teeth
Schools are over subscribed

I can’t get through to my doctors it just rings and rings

I can completely understand why people are going to A & E it’s utter desperation

111 wanted me to take LO yesterday. I didn't think it was warranted but went because obviously I'm not a medic. Wasn't Barnsley but a very close by hospital.

It was absolutely packed! I mean no social distancing, no chairs left, people stood & people outside. Got told it was about a 6hr wait for a doctor. So went home without, and phoned GP this morning instead.

I think the main issue is the 111 service, it can be great but it can also be a bit off. They have a set list of questions to ask, they aren't doctors, and if any of your answers flags up you'll be sent to A&E straight away even if you don't really need it. I think in a lot of situations they don't properly asses (not slagging them off, I can't see any other way to do it either)...

Also to add, there's a lot of talk of GPs here but they've been great for me throughout lockdown. Pretty much always same day telephone appointment which usually results on a face to face the same day or next day. Really quick service here!

@mrsnoodle55

I can’t help reminiscing back to a time when people didn’t feel they needed to ring an advice line to be told what to do for minor ailments. How did our parents manage? Did they rush us to the GP for every temp, vomiting episode or allergy rash, maybe they took us to A+E for every cut/bump or fall?

I bet they didn’t. I bet most applied some common sense, treated at home, and I bet most got better themselves. Of course I KNOW GP’s were more easily accessible, but I know it was a rare thing to be dragged there. Of course there will be rare events whereby serious ailments are picked up by advice lines, but they are dwarfed by the enormous inappropriate use 99% of the time.

I feel whichever deluded fool decided a ridiculously risk averse advice line would reduce the impact on emergency and primary care, should spend a week listening to the never ending ‘111 told me to come/ring for an ambulance/ “ I didn’t think I needed hospital I just rang for advice” on repeat. 8, 10 times a day, hearing the same thing, again and again is soul destroying.

What’s the answer? I don’t think there is one. The need for people to be advised what to do for anything medical is so entrenched now there’s no way out. Charge, maybe? And there goes another can of worms. But what else will feasibly reduce demand? I honestly don’t know.

GPs used to come and do home visits for sick kids! Very convenient! Drs also smoked In the doctors office so some things have improved. And anti biotics were given for everything

For those saying the phone just rings and rings let me tell you the set up at the surgery I work in. There are 3 members of staff daily, 2 all day, one until lunch breaks finish. Between 11.30 and 1.30 lunch break there are two members of staff. One on the prescription line, the other dealing with queries face to face and answering the main phone.

When that person is dealing with a face to face enquiry, they cannot answer the phone. If the prescription person is able to pick up the main phone from their desk then the phone rings again for next person on hold. I could cry with the stress.

So that could be one of the reasons the phone just rings and rings.

@gurglebelly

I'm genuinely curious about how the telephone triage helps? I understand that it stops people that don't need it getting a f2f appointment, but they are still using an appointment slot (on the phone), and people that do need to be seen now have two use 2 appointments instead of one. It seems less efficient

@gurglebelly about half of my calls are for things that don't need to see a GP, that's why triage is important. Or you can arrange care more efficiently e.g do bloods and xray before seeing the person so when they are seen you have all the information to hand. Lots of reasons.

@ConsuelaHammock

A friend’s husband had a serious accident at work and spent months in St George’s on a ventilator. His physio appointment when he got home was by phone. You couldn’t make it up! This is a man who’s had skin grafts on his arm and hand.

Also a man who is extremely vulnerable to infection so it was a far more sensible option to do it by phone during the current pandemic.

I’m post op and all my physio is on the phone. There isn’t a need to touch me, I’m supposed to do the exercises myself. Having been injured before the only time I needed to be touched by a physio was either assessment or acupuncture. I’ve paid for a deep tissue massage before but that’s not what NHS physios tend to do as standard they are to promote your own self care and routine of safe exercises

‘Double triage’ ie 2 appointments has been around since early pandemic. Initially the issue was patients lying about Covid symptoms or close contact with someone with COVID (or not being aware) and taking out whole practices for a few days with PHE guidance to close, deep clean etc.

As time has gone on it’s now need vs want - a lot of people want or expect a face to face, but possibly do not need one. Where I work there is a list of automatic face to face bookable conditions (if you will tell a receptionist….) and I think this will slowly become more commonplace. It can be seen as a waste to have 1 telephone and 1 face to face but essentially that is the safe guidance NHSE and PHE provided and actually, it works out ok. You can actually deal with a lot more patients per day using phone consultations (from an eConsult you already have a lot of detail). You know what’s in your waiting room.
I’ve been here a long time and seen a lot of people waste face to face appointments on admin requests which could have been done on the phone. Once they are in the room it’s harder to wrap up the consultation and you have a waiting room full of sick people coughing all over each other

I wouldn’t want to sit in a GP waiting room unless I really had to

@gurglebelly

I'm genuinely curious about how the telephone triage helps? I understand that it stops people that don't need it getting a f2f appointment, but they are still using an appointment slot (on the phone), and people that do need to be seen now have two use 2 appointments instead of one. It seems less efficient

Our GP has always done telephone triage, we’ve been patients for 12 years but it was around before that. The triage runs from 8-10 every morning and there is a GP designated each day. You call and ask to be put on the list and the receptionist takes your name and the best number to call you back on. The GP then calls you back and that usually happens within 15m. The GP then can prescribe, offer advice or book you an appointment that morning either with themselves or the nurse practitioner who have from 10:30 to 12:30 left free for the appointments from triage.

I have used this service hundreds of times over the years because I have an autoimmune condition and now 2 cancers. I have rarely needed to have a f2f appointment with a doctor because the nursing team are better in many cases.
3 weeks ago I had the nurse practitioner do an ECG because my HR and BP had been high at my chemo appointment and my next day injection and the nurses were concerned. I called triage, spoke to my GP, had the ECG and got a prescription within 3 hours.

I think a lot of physio out patient depts are doing the first appt over the phone now as they have a lot of screening questions to be asked which can take up the majority of a F2F appointment. Particularly if it goes like..."Do you have a family history of rheumatoid arthritis" and the patient answers......"well when my uncle Albert was in the army in 1947....he was out in Burma with old Gunner Richardson from Crofters cottage"
However if these questions should be asked at all when physios (mostly) have access to GP shared records, is another efficiency saving that needs to be looked at.

GPs are consultant grade. People don't need to be seen by a consultant level doctor for a cut finger, a verruca, a sore throat or a bit of a rash. It drives my GP colleagues mad that they seem to spend half their time signing sick notes.

Thanks @sparemonitor, @Menora and @MrsPnut. In times before covid I'd often asked for a phone appointment (as it was quite difficult to get to the surgery during the day as I'd have to take a full day off work due to work location) but often got told no as it was a waste of an appointment if it turned out they needed to see me - granted that is probably surgery specific but I was interested in why the U-turn!

@gurglebelly
There has been an investment due to the pandemic which we didn’t have before - CCG’s paid for licences and software and a O365 upgrade etc. Previously a phone consultation might have been clunky but now they can ping you a SMS and you send back a photo of your ailment.

My daughter had a vomiting bug and I wanted some advice as she wasn't drinking and hadn't passed urine in 18 hours... I couldn't get through to the GP (50min on hold) so I called 111 and they advised A&E....

I didn't go to A&E but instead insisted on 111 contacting my GP (it worked and we got an appointment).

People not being able speak to a GP and over dramatic advice from 111 is what is making a&e's busy

GPs deal with 90% of NHS contacts, tests and treatments on 7.5% of the NHS budget, their budgets have been slowly eroded for over a decade. Resulting in diminished resources to deal with an explosion in demand. Hospitals shut to everything but life threatening conditions and covid created so much more work. Add on to all of that GPs have run the majority of the hugely successful vaccination program, whilst not cutting their usual hours at all. Yes GPs have been working like trojans all through the pandemic, yes the Daily Mail etc likes to pick on them unendingly. And yes your friendly GP's morale is at an all time low, so many wanting to quit and find other jobs, other careers, because a good pay packet doesn't come into it when the job is destroying every other aspect of your life. Everyone in the NHS knows that general practice is the backbone of the NHS, if it fails the NHS will go under, it will fail. As the biggest employer in the world if the NHS crashes the UK economy will follow and who knows where that would lead. So.....value your GP, don't allow others to malign the service, rather than criticise see how you can understand, help and support, you will miss us once we are gone.

Our GP surgery has been good. DH has a cyst on his back that burst, I was cleaning and dressing it everyday but it wasn’t healing that well. He went through ‘Ask my GP’, GP asked him for a picture, he then said he needed to be seen and was given antibiotics and referred to the hospital surgical unit as an outpatient.

I developed some MH issues and had a phone appointment with a nurse and was prescribed Sertraline. Two days after starting them I had one of the worst headaches I’ve ever known, I get migraines so I’m no stranger to them. I also had extreme difficulty urinating. It was on a Sunday so I phoned 111, they decided I needed to speak to someone and a nurse phoned me back. Decided I was OK and could take my regular meds for migraines but that if my headache didn’t clear/got worse/I still couldn’t urinate then I’d need A&E. Thankfully, I was OK after some tablets, fluids and sleep.

I’ve had phone reviews with the GP since and our practice allows you to put in the notes preferred times to call and they endeavour to keep to that.