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

I think there should also be optional training for domcillery carers to allow us to make basic common sense decisions with our clients.

For instance; Mrs A is an elderly lady with Dementia and is prone to having cuts and grazes as she has a great big dog that bounces all over her.
Company policy is that if i or my colleagues go in for a visit with her, if she has a new cut or graze, we have to call One call 111 to ask a nurse to come and asses it, I'm not saying I'm as good as a nurse but I am sensible enough to look at a very minor abrasion, clean it gently and either dress it or not depending on how bad it is. I'm also sensible enough to know that if it was too big or deep or showing signs of infection that its important to then call for advice.

We're not allowed to do anything for customers, basic BP checks, give paracetamol that's not prescribed, give rehydration fluids if they've had a bout of d&v. It's crazy because in any one day I am calling one call or a GP up to 5/6 times a day for very minor issues that I could sort myself or with the advice of a pharmacist.

I'd happily take an extra training course to be officially allowed to do these things, I feel like a real numpty calling a GP to ask if I can give Mrs A some paracetamol for a headache. 🤦🏻‍♀️

I work in a GP surgery and we have seen many hundreds of patients all the way through. The numbers of those with those with Covid symptoms which need to be seen in our hot hub are climbing again, patients are also presenting with multiple issues.
Demand has always outstripped capacity but the demand is now through the roof. Not enough Gp's, not enough nurses and people living longer and longer and longer.

If I see one more time the suggestion that GP’s are not seeing patients - they are

They are essentially holding onto and supporting the entire backlog of patients who cannot access secondary care (hospitals). All the painful ailments, injuries, MH fall out, all the treatment. Every single person who is sitting on a list somewhere who is in pain is either leaning on their GP (who can’t really help as need specialist care) or people take matters into their own hands and turn up at A&E

Also the most common reason for clogging up GP surgeries is skin rashes. People do not know how to help themselves

I see also blame for GP’s after patients leave hospital too. That’s 100% hospitals responsibility

@Goshitstricky that’s the kind of invisible work added to GPs that the public doesn’t see. I think as a competent adult you should be allowed to do more first aid.

Football = alcohol = problems!

I'm sorry, it is basic adulting to know that sore throats are self-limiting and need a pharmacy,

DD had glandular fever. A few weeks later, she had a sore throat. She couldn’t stop vomiting. After trying 111 and seeing the out of hours GP for several days, she had a seizure in front of us. We called 999. She was admitted, as they found her liver was really inflamed, which caused the vomiting.

A few week later, she suffered the worst sore throat ever. 111 told her to take ibuprofen. However, as she couldn’t swallow her saliva, she went to A & E. They admitted her, to have a quinsy lanced.

Still on the antibiotics from that, she then was in so much pain from her throat, she couldn’t eat or drink for several days. We took her to A & E - she had quite 9 aphthous ulcers. She was put on IV fluids, painkillers, steroids and antibiotics, and admitted. The doctor on the ward round told her, he got these ulcers too and it’s too painful to eat or drink.

Ds (4) was suffering with terrible earache, called GP and was told there was no appointment for 3 weeks. Told me I could call every morning to see if I could get one on the day, but caveats that they had told everyone that. Called over and over with no luck. He ended up in hospital after suffering a infection induced seizure. Now he’s being referred to neurology.

Agree with no GP appointments.

DH has to see the GP for something non-urgent. Phone appointments only, and they will not give him a specific time. Anything between 9am and 1pm on Thursday. Which is hopeless for him as he spends up to 8 hours a day on Zoom calls.

Even more hopeless for other patients who can't drop everything at a moment's notice when the GP elects to call them.

The number of other conditions stay constant even during covid. The difference is that they didn't get treated and they turn into something bigger.

Here the media and government scared people off from getting treatment that heart association had yo make a public service announcement that coming to a&e is safe and necessary.

I feel very lucky reading this. We have a minor injuries unit where I have taken both dds over that past year for x rays and treatments for sprains and a break. Our GP does phone and f2f when needed eg when I had a breast lump. I can and have accessed private care through my work for a concerning issue which needed mri and other neuro tests and when my gp got my results back she unexpectedly phoned me to discuss what I wanted to do next (it was a query medication situation and she talked through pros and cons with me).

for some reason my authority seems to have fairly good provision - I wonder if this is because our county has no city and no hospitals so our funding isn't spread as thin? Does it work like that?

My issue though is minor issues. The posters above who mention self care and pharmacy and mocking the advice to 'get things checked'. I have a peri menopausal niggle. It's unpleasant and I don't want it to get worse but it is not important. It requires medication which I need a prescription for then by all accounts it should ease. I am putting off making the appointment with the gp because it is minor and I don't want to waste the space etc. It feels indulgent and wasting time and after this thread I now feel even more like this. So do I try and get the work private gp to prescribe for me (and feel very lucky I have that option) then pay for a private prescription or do I try and 'self care' by buying drugs through the internet? Do I put up with it because women always have even though it sounds like there are options not to? Health care as moral conundrum eh.

Because primary care is broken

@Intercity225

I'm sorry, it is basic adulting to know that sore throats are self-limiting and need a pharmacy,

DD had glandular fever. A few weeks later, she had a sore throat. She couldn’t stop vomiting. After trying 111 and seeing the out of hours GP for several days, she had a seizure in front of us. We called 999. She was admitted, as they found her liver was really inflamed, which caused the vomiting.

A few week later, she suffered the worst sore throat ever. 111 told her to take ibuprofen. However, as she couldn’t swallow her saliva, she went to A & E. They admitted her, to have a quinsy lanced.

Still on the antibiotics from that, she then was in so much pain from her throat, she couldn’t eat or drink for several days. We took her to A & E - she had quite 9 aphthous ulcers. She was put on IV fluids, painkillers, steroids and antibiotics, and admitted. The doctor on the ward round told her, he got these ulcers too and it’s too painful to eat or drink.

I'm sorry to hear about your DD. but that is very different from a normal sore throat - she was vomiting and clearly unwell. I'm talking about adults with a normal sore throat, no fever, no other symptoms, who call their GP within hours, having taken nothing over the counter.

Same for rashes. I had an angry lady on Monday yelling at me because a GP didn’t call her back about her rash in the timeframe she thought was acceptable, a receptionist had suggested she go see a pharmacist. She did, and the rash cleared up and then she put in a complaint to us about it

@DinosaurDiana

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

Exactly.

As for hospitals being responsible for discharge care, they are, but not for something like needing extra painkillers or a dressing looked at or stitches removed. Yet if you call the GP and ask for help and say the consultant told you to call, they still tell you to bog off.

Primary care is broken and the whole system needs a revamp. Effectively GP practices take the view that everyone is wasting their time until proven otherwise.

Shocked at the post above about the 4 year old - even the worst GP practices usually make sure they see young children. That is really shocking.

Consultants shouldn’t be offloading you onto your GP. You see your GP when you are discharged from specialist care or under a shared care agreement. Consultants are CF’s, demanding Gp’s carry out blood tests and follow them up and review, adjust medications when it is their responsibility to do so! People do not realise this though

Not being able to see GP for ages and then it getting to a point where A and E is the only option!

@Poppins2016

My GP sent me to A&E during the first lockdown because they couldn't/wouldn't see me the same day in order to prescribe antibiotics for an infected wound. I made sure to tell the A&E department that I was there because the GP sent me rather than because I felt it was appropriate use of the service (but I did attend because the signs of infection were getting worse and the A&E staff reassured me that it was the right thing to do in the circumstances, antibiotics were duly prescribed).

Our gp rang recently after a blood test and was adamant that a trip to a and e was needed for another blood test as a matter of urgency. It was 4pm by then a d the person needing it is disabled and the afternoons and evenings are when their mobility is at their worst.

He was adamant and panicking almost, literally saying if it isn't done that person could DIE!

So we went to a and e and explained the circumstances a d that the doctor had some paperwork we had picked up en route (that we had had to wait 15 mins at the practice for as it wasn't ready, despite ringing them as we set off in a taxi and being told on the phone it was ready...)

Turns out that their potassium was a huge 0.1 below what it should normally be.

Hospital did the test but didn't wait for results and sent us back home with a diagnosis of "eat a banana".

Two days later we have a nurse practitioner appt where its followed up.

Two more days later the doctor wants to see us so we go in... Turns out it was to follow up the appointment that had already been followed up with the nurse practitioner 🤦🏻‍♀️

What a huge waste of their time, our time, nhs money and our taxi fare for each journey

....and the number of patients who would usually attend hospital for specialist bloods etc told to have them done at the GP's instead because they're trying to reduce interactions. Yet our clinics are rammed.
Impossible too to stick to planned timed phone appointments, because you regularly end up dealing with three issues for the patient booked in with one. Or they turn up late and put you way behind. Or you get a walk in with no appointment at all! Or you have to keep re-phoning patients that don't answer, even when you have phoned on time.....

@Robostripes if an incision was made then this was completely appropriately dealt with by the minor injuries unit - GPs are (in most areas) not commissioned (paid) for managing minor injuries, and often will not have the equipment to do so e.g. wouldn’t have local anaesthetic, often wouldn’t have scalpels etc. Sounds like it needed to be seen but not by your local GP. I am a GP and would expect to see this during my shifts in a&e and urgent care, but not in my usual practice setting. Glad it got sorted.
Appreciate there are lots of other examples on this thread that should/would have been seen by GP in the past, but sadly capacity is currently being exceeded throughout all areas of the NHS and I don’t see things improving any time soon unless there are lots of doctors somewhere I/the government don’t know about.
There is huge backlog in secondary care as well at the moment which means GP appointments are taken up with patients asking me when their appointment is going to happen (months to years in some specialties) or asking me to trying to solve a problem I have already referred to a specialist for advice as it is not a problem that can be managed in primary care.
We manage all our appointments on a same day basis at the moment, and access is actually great at my practice and all the gps and nurses have seen face to face patients throughout. However now there is an increasing expectation that a minor rash/sore throat which started that morning, or a fungal toenail (not hyperbole - genuinely) should be dealt with that day, rather than the 3 week wait we had pre pandemic.

I suspect its down to GPS which vary a lot by practice. Mine is good at same day telephone appointments but does try to avoid seeing in person (they did let me go in to check a breast lump but it was a week later). Luckily not had a huge concern with DD so haven't had to test if they'll see her in person (they won't for her eczema problems but that's clearly not an a&e issue!). Telephone consults probably allow them to be much more efficient but they do need to start seeing people in person more again too I think. At one point I had a possible blood pressure concern and they didn't want me to go in to check that

We have to book an appointment to book an appointment at our surgery! (Ie “call back next Thursday (9 days hence!) when we will be releasing slots”
No urgent face to face appointments available, directed to walk in centre, which then sends serious matters straight to urgent care at a and e.

@Yellow85

Ds (4) was suffering with terrible earache, called GP and was told there was no appointment for 3 weeks. Told me I could call every morning to see if I could get one on the day, but caveats that they had told everyone that. Called over and over with no luck. He ended up in hospital after suffering a infection induced seizure. Now he’s being referred to neurology.

I hope everything goes well for you and little legs! Good luck 🙂

My mum is a frequent sufferer of ear infections to the point her ears literally leak fluid and infection every time. Before covid the gp wasn't great at treating them but it was a bit easier to get in. So ce Sept 2019 up to December 2020 she has had 15 ear infections. Sept 19 to Feb 2020 she got appts for them with the nurses and occasionally the doctor. The doctor wouldn't see her after march 2020 or let her have a nurses appt. (he had referred her for microsuction that happened Dec 2019 but she got another infection 3 weeks after) after a couple of calls for one infection he prescribed broad antibiotics that didn't work and would t follow it up.

Finally in Dec 2020 her Sept 2019 referral to ent came through and we had a telephone call with the consultant who booked her an emergency ent appt within 2 days to see her a d was absolutely astounded at our GPS lack of care as he told us a constsnt build up of infections as bad as hers were could cause meningitis and the very least the doctor could have done was look in her ear and prescribe meds!

He had set her appointments up so that when she has them now, touch wood she hasn't since Jan 2021, we bypass the doctor entirely and make an ent appointment and see one of their staff 👍🏻

@Yellow85

Probably because GP’s are saying, and I’m quoting mine specifically here - ‘we have no appointments to see your child for 6 weeks, we advise you take them to A&E if you are concerned’

Mine used to do this pre-covid too. Since March 2020 they've shut up the surgery never to be seen again. You can eventually get through on the phone but getting a telephone appointment is almost impossible. I have wondered if they were going bust but presumably the NHS would always prop them up?