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 agree with the poster who said people don’t value what they don’t pay for.

I work in Australia - not a GP - and do both public and private clinics, doing similar work in both. In public there’s not always the same continuity in that many people coming for follow up will have seen one of my colleagues. It’s not the case that people who have more money necessarily go private or vice versa. Many patients will also do a public/private mix depending on their needs and this works pretty well.

In both clinics people are contacted by SMS a few days before and have the option of cancelling/rescheduling. In private people turn up on time and maybe 1-2/week don’t show. In public people rock up 1-2 hours late and frequently don’t bother to turn up at all. 1/3 per clinic don’t bother to show up at all.

@tiredanddangerous

I expect GPs not seeing patients has something to do with it in some cases.

This in bucketloads.

To people who work in GP practices, how can I say thanks? A card of course, and if I sent chocolates will they be eaten? My practice has been pretty good throughout all of this and me and DD have both accessed them quite a lot since the pandemic started and have had good care. I know being a GP is a thankless task and I would really like them to know some of us are so grateful for their hard work.

@sparemonitor thank you so much for taking the time to write such a comprehensive response. It’s really helpful to understand some of the context behind what’s going on.
From what you’ve said it’s seems pretty clear that things aren’t likely to get better without a dramatic change from central government. It’s really frustrating and quite sad for all parties. I have a friend who is currently a trainee GP and feel a bit horrified about what she’s getting into it.

I’ve taken out private health care for me and my family now, but even that doesn’t seem to be set up to alleviate pressure on GPs as all private referrals need to be routed through the GP anyway.

I’m a GP too so nervously poking my head above the parapet. There are clearly stories on this thread that just aren’t good enough. But I assure you that every GP is working their socks off at the moment. We are under-staffed and over-worked - it’s been getting worse for the whole of my 15 year career as a GP (workload increasing, workforce decreasing). The comments that GPs “won’t answer the phone” - I can assure you we’re not sitting around swilling tea. We are chock-a-block, heaving, hugely busy non-stop from the moment the phones go on in the morning until they switch off at night, as are our receptionists, our dispensers, our pharmacists, our nurses, our admin staff and managers.

Also obviously we are mainly doing telephone appts/triage at the moment. This is because social distancing is still mandated in healthcare settings and we don’t have anywhere to put all the patients if we went back to seeing everyone face to face. Nurses are largely doing in person appts because obviously doing a smear/changing a dressing/taking blood remotely is tricky . But their appointments mean that our waiting rooms are then ‘full’. The rest of us have to muddle on. Some telephone appts are appropriate and easy - quicker than face to face and more convenient all round. But actually a lot of them are really really hard. We’re struggling as much as the patient. No one has ever done all medical care by telephone before and there are few guidelines to help us know what is best. I frequently spend 25 minutes on the phone to someone trying to clarify details that would be so straightforward if I were sitting in front of them. But we can’t do it. It’s shit, I know. We bring down those where there really is no other safe option. But that’s essentially our threshold at the moment and so it’s difficult.

All the points that others have made are valid as well. We are swamped in work, and not just that that the public know about. I promise we are working really hard and we want this to end just as quickly as you do.

sparemonitor thank you for your informative posts.

I had to phone 111 at the weekend for a surgery wound infection that required antibiotics. The initial call handler got me a call back from a nurse who then got me a call back from a GP who then prescribed the antibiotics. All 3 calls happened within an hour of my first call and I was able to pick up the prescription an hour later. I was surprised and impressed after hearing about how busy the service was.

Suspect it’s to do with the fact GP’s have been kept under lock and key for 18 months.

We’re struggling as much as the patient.

@Prestissimo I appreciate how hard you're working but comments like this don't help. You think you're struggling as much as the cardiac patient who can't get anyone to take their new symptoms seriously? Or the 85 year old who lives alone and keeps falling? You're doing your job, and that's tough at times, but your struggles are nowhere near those of people who really scared at the lack of care they're getting.

@Prestissimo what would you advise in this situation (from your side)?
I am neutropenic and often get chest infections or tonsillitis that need antibiotics urgently
I ring my GP, no appointments, can't book in advance. Repeat daily. Until I'm so unwell I need a&e
GP has no answers except "call back tomorrow"

👆This explains the situation a lot more eloquently than I could.
Years of running down the NHS has resulted in it falling apart which has been highlighted by the recent crisis.
There is a great video here which explains a bit more about how workload in primary care has increased over the past 20years without the needed staffing/ resources: m.youtube.com/watch?v=4GC8mH6MWzY&feature=youtu.be

@Orf1abc I suppose I mean we’re struggling with the situation. This is not the job we were trained for. It literally changed overnight last March. Nearly every bit of our days is different to what I did for the 14 years before that. We are managing risks that have never previously been imagined, because healthcare has never been done like this before and there is little guidance or support. With every patient contact we have to consider the risks of seeing the patients vs the risks of not seeing them. And of course there’s a perception when things get worse that if only the patient had been seen they wouldn’t have got worse. This is not always the case. But we don’t really know because until last March we just saw people. We’re working in the dark.

I’m not trying to be all ‘woe is me’ - although I can give you plenty of takes if you’d like me to. But do you honestly think we don’t worry about those patients you mention? Of course we do. But we worry while simultaneously juggling the needs of all our other patients and (occasionally) ourselves and our staff as well. Also we do have a limited ability to help the people that we referred 15months ago because they needed specialist input. I can’t speed up their hospital appointments nor can I give them much useful in the meantime other than a listening ear and sympathy. Specialists are specialists for a reason.

My point really is that these threads always descend into a discussion of how lazy GPs are, how they don’t even bother to answer the phones, and how we’re hiding from COVID. I just wanted to give the other side and to assure people that none of this is true. We are working harder than ever. I tend to agree with PPs who say that the whole system is broken. But believe me, we’re not sitting with our feet up.

@Theweedonkeeey

The hospital you had surgery in should take responsibility for any infection post op really. I was told by my ward to ring them if I needed help.

I really resent the inflammatory language many of you are using.

“Refusing to see patients”

“When the GP elects to call them”.

Do you honestly think they’re sitting locked in a room drinking tea and reading Take A Break?!

On Monday my GP colleague had 17 calls listed for her morning session, by 0945. She knew they would take her hours. Some of them would need to be brought down for F2F. She can’t tell Mrs Bloggs exactly what time she’ll receive a call as she doesn’t know if Mr Jones, on the list before her, will take 5 minutes on the phone or 15, and if he’ll need to be seen that morning, or referred to hospital or social care, or another call will need to be made to a family member. She’ll see him and decide he needs an ECG and some bloods, so will come and ask me if I can squeeze him into my already full clinic (but before the courier comes to collect our samples obviously) and he’ll then be reviewed by her again after.

So sorry we can’t tell you Mrs Bloggs exactly when you’ll get a call about your earache or skin rash or ingrowing toenail.

Honestly, no wonder she’s handed her notice in.

Last week in my telephone triage clinic I took 4 calls from people worried about post Covid vaccine side effects. They all had minor issues such as a sore arm or a slight temperature. All things they would have been told about, and that are listed in the leaflet they’re given. But no, they had to phone the surgery “just to double check”.

I love my job but sometimes I despair.

@PawsQueen that sounds dreadful. I don’t know your practice’s set-up, obviously, or your own circumstances. I wonder if, going forwards, you could have a rescue pack of antibiotics at home so that you don’t need that vital on-the-day appointment that they may just not be in a position to give you every time. We have some patients who have this system and then let us know when they use them (or obviously are spoken to/seen urgently if they’re very unwell) and can reorder the antibiotics on their repeat prescription. I wonder if that would be an option for you? (Obviously needs you to be able to speak to a GP at some point though…)

I'm a nurse practitioner in GP surgery and although not sounds like some unacceptable examples of poor care, as with all areas of healthcare, I can assure you we are all busy, appointments full (nurses, NPs and GPs) every day. I only started in Sept (A&E previously) but we were all full then too. Doors have never been locked, telephone triage then F2F if needed as per priority, but all that week. Home visits and F2F never stopped. Vaccine clinics weekends and on days off. Come in to work early, leave late. Constantly stressed that I've missed something important. We are exhausted, but as with everything it's high demand, not enough staff to cope with it. Really demoralising that that people write us all off as rubbish.

This is pretty much accurate

Our GP has offered face to face for a long time now. DS1 had dizzy spells recently - we were offered a telephone consult with nurse health practitioner, she sent him for blood tests a couple of days later, then we had a face to face for results (and further treatment) from the GP within the week.

Not to mention running covid assessment hubs and seeing Covid Face to face, caring for them at home etc. We haven't opted out!

Yes @Sidge agree it’s the language that’s upsetting. I think we can all agree that the current situation is dire, but it does feel as though GPs are really facing the brunt of the criticism from everyone from the Govt/NHSE downwards.

Every time I see these threads I think I won’t look. And then I do, and I regret it.

Takes over an hour and a half to get my GP to pick up the phone since covid started. Seems to be getting worse not better, impossible to see someone in person, phone appointments few and far between.
. If you call 111 they usually send you to A&E if in doubt.

Was anyone aware that 111 now have access to GP appointments, where they can now also dump their workload? And that for everyone who has been to A&E or called an ambulance, those reports all have to be looked at the next day and dealt with?
And all the patients waiting to see a specialist in hospital have no one to help them manage their care apart from their GP?
And hospitals send patients back into the community constantly without proper medication and it’s expected the GP will do it?
And for the past year the GP’s have been managing COVID patients in the community and also mass vaccination?

@Prestissimo I will ask my consultant. It's not even the on the day thing, I can't get an appointment at all. Mostly just crossing fingers I don't get unwell!
If you ring at 8am there is more than 20 in the queue it cuts you off. Or you are number 19 and none left when you get through

I do wonder if what GPs see as efficient telephone triage, just results in some, probably not all of those patients, turned away as it’s something minor, just going to A & E instead? If so, it’s costs the NHS more for people to walk into A & E and be seen, than a GP appointment, doesn’t it? (A doctor in the family tells us from time to time, how much all these things cost the NHS).

The nhs is always on its knees. As a doctor (hospital based) I am absolutely dreading this winter. It’s always horrendous. But if June is this bad I dread to think about the future.

The govt don’t want to fund a proper healthcare system. And crucially they don’t want to fund the care sector. We have many patients “bed blocking” because they have nowhere else to go and no one to look after them. They then are vulnerable to hospital associated infections whilst they wait for a bed. This means A&E stays overflowing and inefficient as we can’t move the patients to a ward.

We’re all living longer, we need to (if able) pay for our care in our old age. The current situation is untenable.