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

@FrankiesKnuckle

. The problem is successive years of underfunding, but the inability of the general public to look after their own minor self-limiting illness is also a factor. *@sparemonitor* this with bells on.

Im a paramedic, we've seen call rates take a massive increase in the last 3 weeks to what they were at peak covid times.
The majority of calls are frankly utter shite. There is absolutely no ownership of mild to moderate health problems, no self care, it's always someone else's problem.

Back pain for 4 weeks? Ask a patient if they've taken any analgesia, usually met with a perplexed 'no' or 'well I took one paracetamol yesterday but it didn't help'
Vomiting for 3 hours is deemed a medical emergency.
I could go on but you've heard it all before.
It's absolutely soul destroying knowing that the 85yof with a probable #nof that's been on the floor for hours will have to continue to wait whilst we clear a backlog of capable adults who call to be 'just checked over, had vaccine, feel a bit funny' usually comes down as chest pain or SOB which in turn are higher priorities than said 85yo whose mortality takes a nosedive.

It's just so fucking morale sapping.

All those that point their fingers at woeful GP services/long ambulance waits/a disgrace of a MH system need to look not to those that provide it but the successive governments that are like death eaters to the NHS.

so true @FrankiesKnuckle. I remember one day when I worked in A&E when I saw a young person who had called an ambulance because her fingernail fell off and my next patient was an 85 year old having a heart attack who had struggled in on the bus because they didn't want to cause a full.

[quote HereBeFuckery]@sparemonitor
"I don't have to imagine the number of people who ring me up for a sore throat of 3 hours duration, athlete's foot, conjunctivitis or a myriad of things for which the pharmacy is far more appropriate."

you know this. You have years of medical training to allow you to distinguish between a sore throat and tonsillitis. Your patients don't know this - nor should they. GPs are forever whinging about patients self diagnosing via Dr Google; now you're criticising your patients for not having your level of expert evaluation. How are they supposed to know what's wrong with them? Are we all meant to go to medical school?

When people get sick, they get scared. If you don't understand why patients come to you with minor ailments wondering if they are about to cark it, you shouldn't be a doctor.

Oh, and as for your 'IF' GPs aren't seeing people face to face - do fuck off. I had an ectopic pregnancy in May which my GP failed to pick up over the phone (surprise surprise). As a result I had an emergency salpingectomy. As I was being consented, the GP called back - five days after he'd promised to call back that afternoon to see if things had changed. Don't you dare say 'if that's true'. My GP practice were negligent because they are flat out refusing face to face appointments. [/quote]
I'm sorry, it is basic adulting to know that sore throats are self-limiting and need a pharmacy, that dry skin doesn't need a doctor etc etc. Millions has gone into public education. Pharmacists are highly trained HCPs who are there for advice. If you lift a heavy box and your back is sore the next day then for goodness sake start with some over the counter painkillers.

@Frogshoe I just saw your post. I’m so sorry to hear about your sister. 💐 She should have been seen sooner.

[quote HereBeFuckery]@sparemonitor
"I don't have to imagine the number of people who ring me up for a sore throat of 3 hours duration, athlete's foot, conjunctivitis or a myriad of things for which the pharmacy is far more appropriate."

you know this. You have years of medical training to allow you to distinguish between a sore throat and tonsillitis. Your patients don't know this - nor should they. GPs are forever whinging about patients self diagnosing via Dr Google; now you're criticising your patients for not having your level of expert evaluation. How are they supposed to know what's wrong with them? Are we all meant to go to medical school?

When people get sick, they get scared. If you don't understand why patients come to you with minor ailments wondering if they are about to cark it, you shouldn't be a doctor.

Oh, and as for your 'IF' GPs aren't seeing people face to face - do fuck off. I had an ectopic pregnancy in May which my GP failed to pick up over the phone (surprise surprise). As a result I had an emergency salpingectomy. As I was being consented, the GP called back - five days after he'd promised to call back that afternoon to see if things had changed. Don't you dare say 'if that's true'. My GP practice were negligent because they are flat out refusing face to face appointments. [/quote]
I'm sorry to hear about your ectopic @HerebeFuckery. As a GP if someone rings and tells me that they are in early pregnancy with abdo pain I would either see them or arrange a same day early pregnancy unit admission. I agree it isn't suitable for phone management.

@RomComPhooey

Our GP surgery was really well organised before the pandemic and we’ve always been able to get a same day appointment for emergencies/urgent problems. They also allowed advanced bookings for less urgent problems and there was nearly always an appointment within a week if you were happy to see any doctor in the practice. They have continued throughout the pandemic with a mix of phone appointments and F2F with decent availability. They are all excellent doctors, so we have no problem getting good care at our surgery.

This is not typical in my area. I have friends and neighbours who struggle to get seen at other nearby surgeries and often wait for 4-6 weeks for an appointment. Our surgery seems to have nailed it and it’s not about list size or population - they are all running with near full lists and working with the same population. I wish others could learn from them. I know from talking to a GP friend in another area how tough primary care has been over the last 15 months, so I have no doubt all surgeries are running at full pelt.

We wrote our surgery a card at the start of the pandemic to tell them how much we appreciated them and to wish them well for the looming emergency. I can feel another thank you letter coming on, as they’ve provided excellent care for DS during the last year and recently referred him on to a consultant for further investigation.

So, to @sparemonitor and any other GPs reading - many of us do appreciate what you do and understand the pressures you are working under. Thank you.

To those of you complaining, maybe look for a different surgery that runs its appointments system and service differently if you are unhappy with your current one. Surgeries organise themselves differently and you may find one that better meets your needs.

@RomComPhooey thank you. Please go onto nhs choices and leave a positive review for your surgery as well. And thank you for sending a card - they are really appreciated.

My 94 yo dad ended up at a&e the other week. Last year he ended up being admitted via a&e 5 times in 3 months diluent to the GP not seeing him f2f and misdiagnosing. The last time he was in for a fortnight and we thought his time was up - that's fun when you have to explain to an old lady with dementia that her husband will probably die but no she can't visit as they aren't sure. I had to do it as the consultant realised she wouldn't understand if it wasn't a f2f conversation. 3 times the consultant wrote to the GP and said that suetonius his complex health issues and hearing loss phone conversations were unlikely to ever be appropriate but still they carried on. He has been suffering acute pain for mo the and still phone consults yielding nothing. "Luckily" he had a bad fall and had a wound that needed dressing by the practice nurse.she was so concerned by his condition that she insisted the GP saw him there and then. Sent him to a&e, not onlyis he now on suitable pain relief but they realised one of his drugs was causing major issues with his kidneys and needed changing urgently. GP, over the phone, has been saying that problem was his enlarged prostate.

@sparemonitor Thanks for the response. you know I would just be happy with an acknowledgment & an apology & don't really want to escalate but it's ridiculous after my DM nearly dying the hoops we had to jump through just to speak to a GP & get medication.

And don't bother suggesting making a complaint, done and letters to his MP with zero effect. If even a cardiology consultant can't get anywhere no one will.

[quote persnickle]@sparemonitor Thanks for the response. you know I would just be happy with an acknowledgment & an apology & don't really want to escalate but it's ridiculous after my DM nearly dying the hoops we had to jump through just to speak to a GP & get medication. [/quote]
It's perfectly reasonable for you to expect a reply.

This is a good explanation of some of the pressures, it isn't long

GP’s still hiding behind Covid when other health services are getting on with it, and have been doing throughout Covid.

traumatisednoodleDM had recently been discharged after emergency open heart surgery & has to be on blood thinners for life plus a number of other drugs for about a year. We couldn't get in touch with the GP, what would you suggest?

I would perhaps phone the ward she was recently dis harged from, contact the pharmacy who last dispensed the meds, call her consultant's secutary. I would also wonder how it became an emergency? Was this the first perscription from the GP after the hospital discharge perscription ran out ? Most practices suggest putting perscription requests in in good time. I am sorry you were unable to get through to the GP, but attending accident and emergency is completely inappropriate.

@DinosaurDiana

GP’s still hiding behind Covid when other health services are getting on with it, and have been doing throughout Covid.

Sigh. Have you read any of my posts? We're really not.

I had to take my child to AE twice with a minor injury that got infected. Both times was through 111.

I would have loved to have taken him to a GP or a minor injury unit but the GP just wouldn't see him and thereis no minor injury unit in my area.

I have to see a consultant every six months to help manage my medical condition. These appointments are over a video call.

Even though I am double vaccinated and the consultant probably is too, here is no option for a face-to-face appointment and it is just not as good as a face-to-face appointment. Things could and maybe are being missed.

I think it is time for GPS surgeries and non urgent NHS services to reopen their doors and let their parents back in.

GPs need to ppe up and get on with it
Dentistry is a much higher risk for contagion ( generally not just covid) and we’ve been back a year now

If it’s safe for us - it’s safe for doctors

@traumatisednoodle We couldn't get through to the consultants secretary. I did phone the ward & the nurse told me to come to the A&E dept who saw us, did some checks & arranged a prescription on site. Yes this was after DM had been discharged with some initial medication on the proviso of being seen by the GP for a check up to then get more medications. How could I put in a prescription in good time when we weren't sure what dosage she should be on? At that point she was taking about 8 different drugs.

persnickle- that is completely different if the ward told you to come to A&E, I do wonder if you couldn't have picked it up from the ward ? I think it sounds as if your GPs is overwhelmed and haven't processed the discharge notification (which to be fair on them may have been delayed itself). Your DM should also have a copy of the discharge letter stating which meds she is on, has she not recieved this ?

I will get flamed for this but here goes;

The 85 years old struggling on on the bus having a heart attack remembers life before the NHS.
If you were poor, and ill and didn't have the money for a Dr or treatment you generally died. People only called the Dr in dire emergencies.
Self care was the main treatment. My grandmother made bread poulticess fir things like boils.
Also, this was prior to antibiotics.
You got an infected tooth, you died.
The people going to a&e due to 3 hours of vomiting have never known anything else but a free at point of service health care system.
people do not value what they do not pay for
Added to this, the NHS no longer works.
It just doesn't. It's being held together by goodwill and duct tape ATM.
Maternity care is woeful. Yes, it's free but the experiences of some women are utterly harrowing. Preventable baby deaths, horrific birth injuries, little or no pain relief.
Social care, mh provision...its all really really poor.
When Labour introduced the welfare state in 1948 they could never have forseen ivf, bariatric surgery, gene therapy, cancer treatments, gamma knife surgery etc...
We don't pay enough in taxes to the keep the NHS running and we keep voting in the tories who are on record as stating they want a privatised healthcare system.
Go figure.

I also think there is no reason GPS cannot see patients again.
Open up the surgery's.
I can see a dentist, an optician, but not a GP?

As usual lots of blaming of NHS staff ffs! try putting the blame where it belongs - years of Tory disdain for the NHS.

And stop reading the Daily Mail!

My GP surgery is excellent usually get an appointment the same day and if it's a child within the hour! Fantastic service! My friend 10 minutes down the road at another GP surgery, was told her son who could have Croup couldn't be seen in the surgery for over a week snd advised my friend to take him to A snd E. . They differ so much !!

FIL has a complicated urology complaint which requires surgery. He's on a waiting list but obviously things have been delayed in the last year.
Last week he went to A&E saying he thought he was in retention. He wasn't, all of his complaints are chronic (not taking away from how bad it is, it's painful and difficult) and not new. He was hoping to be admitted and to be able to queue jump for surgery by coming in. They checked him for retention and sent him home.
Another example of a chronic problem being presented to A&E inappropriately, due to patient desperation and backlogs. He hasn't attempted to address any of these things via his GP/Urology consultant, despite my advice to.

I can't work out who is to blame, but his A&E visit was definitely inappropriate regardless.

I've seen A&E correspondence and recently scanned broken bones into onto 11 patient's records. Also seen foreign bodies, sprains and severe mental health crisis correspondence. None of these would be dealt with by a GP.

My GP is doing face to face appointments - but you can't get one
I spent an hour and 15 mins in the queue and got to number 1 and got cut off. By the time you get through there's no appointments
My condition means I need urgent antibiotics if I get an infection, so if I get one, 111 will probably send me to OOH or a&e as I can't see my GP

Our GP practice were brilliant before the pandemic and have carried on all the way through. They’ve always done a telephone triage system because so many things can be diagnosed over the phone or a request for a prescription done without an appointment.

This frees up f2f appointments for those that need them, and I’ve had plenty of those over the last 15 months.