AIBU to think this is a crazy reason to go to A&E?

[JemimaPyjamas]

Bit of background; I am a (well controlled, no history of complications) Type 1 diabetic. I have had it for 40+ years and the medical assistance I have ever needed is minimal, and I have been at the same GP practice for 14 years.

I am not sure how, but I got a splinter in the end of my big toe. Not a massive splinter, or anything remotely dramatic, but it was hard to see the area where it was. I think I removed it, pretty sure, but the area was sore - probably as it's a very sensitive place - so I called the GP, apologetically, to ask if there was any chance someone could have a quick check to make sure it was okay. (I didn't have anyone else to ask, hence me pestering the GP which did seem like semi overkill in itself.)

I was told they'd call back and then got told that 'nobody at the surgery is prepared to check a wound of that nature in a diabetic and we have been told to tell you you need to go to A&E.' I reiterated that it was a double check, for something the size of a very small papercut, and it was purely precautionary rather than necessary.

I got the same reply.

Needless to say, I have not gone to A&E during a pandemic so someone could double check a splinter had gone from my toe. I have instead soaked it, felt it and double checked it and it seems fine.

AIBU to think the (quite large) surgery was bonkers...? Or

@Tupperwarelid

As a type 1 diabetic I haven’t had a face to face appointment with my consultant or nurse since March 2020 (just before lockdown started). It’s all been by phone so no-one has checked my feet since then. I would go to A walk-in clinic/urgent care/ a&e to be on the safe side. I’ve found whenever I’ve rung 111 or gone to the pharmacy as soon as you say you are diabetic they won’t touch you with a barge pole!

The fact that you have seen any specialist for 18 months is appalling.

This is the very reason A&Es now are been pushed over the edge. It needs to addressed urgently!

Thanks for the responses everyone.

I am very conscious of slating GP's, I have no idea what they are doing but I am sure it is not sitting about, but I also struggle to see why referring a patient in a situation such as myself to A&E is a sensible option.

I could understand it more if it was a few days ago and could possibly be infected, or I had a history of foot issues / diabetic complications so it was best to be cautious.

I don't go to a diabetic clinic at the hospital (long boring story) but instead see a fabulous diabetic nurse at the GP's surgery who I've known a long time. She's so fabulous that she's also pretty booked up; too booked up to have a glance at a foot to make sure a splinter has come out.

This is the thing, it's not specialist treatment I am after, it's someone to double check I won't end up needing specialist treatment!

@marmaladehound I agree with everything in your last few posts.

Husband is diabetic too. Any foot injuries can quickly escalate to infection in diabetics. Our surgery would send to A&E too.

@Theworldisquiethere

I don’t think I would have even called the GP to be honest!

Are you a diabetic? Because if you are and you wouldn't seek medical attention for an issue that could quite easily lead to an infection in your feet that's quite worrying. If you're not then I think telling an diabetic you wouldn't have even bothered the gp with this issue is an outrages comment

@Maryann1975

I phoned the GP a couple of weeks ago for advice on a minor injury. I was told they wouldn’t see me and had to queue for 5.5 hours to see a hospital doctor. As we were triaged, I got a sigh of frustration and a bit of an eye roll that the go wouldn’t see us. The whole system seems to be crumbling at the moment, I’m not quite sure what the answer is tbh (except a lot more money to fund actual nurses and doctors on the wards and in the surgeries).

It may surprise you to know that GP services aren’t minor injury services. We’re not commissioned to provide them, and don’t have the funding, equipment, supplies, staff availability or capacity to provide them.

Many ED and MIU staff don’t seem to realise this either….

I work in primary care. Like @cptartapp I’m not going to go digging in a T1 diabetics toe either - I’m more likely to cause problems instead of resolving them. If I had the capacity to see the OP (unlikely, my clinics are full for the next 12 days) I’d be able to do no more than she had done really.

Obviously if she’d phoned with a possible infection or a confirmed foreign body then we could direct her accordingly, whether to the specialist podiatrist (in our area they will see diabetics urgently for foot problems) or to the GP for antibiotics.

Probably didn't need anybody to see it. However, if it did, minor injuries would be the right place for it.

Your GP surgery isn't required or paid to review this kind of thing. They were right to decline and spend their time on something that they ARE contacted to do.

Minor injuries like this are NOT part of the national GP (GMS) contract.

Most of the people posting on this thread have no idea what they're talking about

That's interesting. The GP contract isn't something aware of, and hopefully you can understand me not seeing the site if a probably removed splinter as a 'minor injury'! To me, it just seemed overkill for something that needed a minute of checking, literally just a minute, if that.

My friend has had major problems in the past with his diabetic feet and nearly lost one. He recently got a tiny blister on it. His GP tried to get him into the diabetic foot clinic urgently. But was unable to, so sent him to A&E. they also referred him urgently. He finally got an appointment on the 2nd august. He e fed up seeing his own podiatrist privately. Fortunately it's now healed. But it's not the point. He needed to be seen in
A specialist clinic urgently not A&E!!

But a GP can't tell if it will become infected just by looking. They don't have magic powers.

If something was then amiss I would, obviously, get it seen to but going somewhere other than the GP (and this includes, say, practise nurses) seemed like overkill and time wasting.

They're probably following a treatment pathway based on the risk of infections in T1D. A lot of things that would normally be covered by a surgery or practice nurse seem to be disrupted by all the COVID mayhem.

@privateandnhsgp

Your GP surgery isn't required or paid to review this kind of thing. They were right to decline and spend their time on something that they ARE contacted to do.

Minor injuries like this are NOT part of the national GP (GMS) contract.

Most of the people posting on this thread have no idea what they're talking about

I would not expect a GP to see this but I would expect a practice nurse to be able to do this.

@JemimaPyjamas

That's interesting. The GP contract isn't something aware of, and hopefully you can understand me not seeing the site if a probably removed splinter as a 'minor injury'! To me, it just seemed overkill for something that needed a minute of checking, literally just a minute, if that.

It's not your fault, in the past GP surgeries have happily taken on with that they didn't need to - for example undertaking blood tests, ecgs, post-op stitch removal etc - all NOT in the GP contract.

However things are 30pc busier than pre-pandemic, there are fewer GPs than a few years ago and the system is crumbling.

They're quite right to stick to delivering core contract.

The issue is that type 1 diabetics are more likely to receive lower limb amputations due to small injuries (resulting in infection) than other groups. Type 1 diabetes causes nerve loss, with toes being the first to go.

Whilst you have well managed diabetes (well done you) you are still more likely to get a foot infection and that infection us more likely to cause long term damage.

I'd get it checked.

"I would not expect a GP to see this but I would expect a practice nurse to be able to do this."

The GP contract covers GP practice nurse activity.

It doesn't matter what you expect, the service is NOT contracted to deliver this.

My Auntie a diabetic lost her foot to a tiny cut that she left. Get it seen to.

@privateandnhsgp

"I would not expect a GP to see this but I would expect a practice nurse to be able to do this."

The GP contract covers GP practice nurse activity.

It doesn't matter what you expect, the service is NOT contracted to deliver this.

On a side note. Does the GP contract cover ongoing wound care for practice nurses? For either acute or chronic wounds?

I have a friend with diabetes. She had similar and didn’t realise how serious it was until she had sepsis. Had to have her foot amputated.

@cptartapp

Our four GP's are seeing patients every ten minutes, interspersed with telephone consultations, visiting care homes, home visits, etc. Their clinics are all full for at least two weeks. Some more. So even if they were all in today, again, no appointments soon enough. We are not a walk in service.

I work in a surgery but not a GP. Our doctors are all working at full capacity too, as are the nurse practitioners and others. We have a triage system so anyone who rings in the morning gets a call back from a clinician and is assessed if they need to be seen, signposted elsewhere or advised over the phone We do not do first aid or wound care but I suspect OP might get a routine appt for someone to check

@privateandnhsgp I visited a walk in centre for a cat bite and waited 4 hours to be seen only to be told walk in centres cannot hand out antibiotics. I ended up going A&E when it inevitably got horribly infected because I couldn't get a doctors appointment. A&E went absolutely wild and said it was a GP’s job. So my question is who was right? Classify bites for me please, where do you go?

I would not expect a GP to see this but I would expect a practice nurse to be able to do this.

Practice nurses are employed by the GPs (not the NHS) and are bound by their GP contract.

Of course they can do it, professionally speaking. But it is likely to be outwith their remit in terms of their surgery’s provision under their NHS contract terms.

There are lots of things I’m clinically professionally capable of but do not do as my employers are not contracted by the NHS to provide them!

It’s admittedly quite complicated.

@marmaladehound where I work we are contracted to provide wound care postoperatively for secondary care (eg surgical wounds, including clip and suture removal) and for chronic wounds such as leg ulcers. We also manage wounds that aren’t healing, or for follow up that might have been seen initially in MIU or ED. What we aren’t contracted to do is to provide minor injuries care. So no immediate lacerations, sprains, strains, suspected fractures, foreign bodies, eye or dental problems.

We also don’t provide emergency care for suspected strokes, hearts attacks, blood clots, bleeding emergencies, pregnancy related issues, trauma.

We are not a walk in service.

@cptartapp

I would class this as an emergency. GP surgeries are not emergency services. Ring them.

Aren’t they?

Do you mean that it’s ok to leave people wait for two weeks always or they need to go to A&E?

I think it’s bonkers. The role of the GPs is primary care, not chronic illness can wait a bit more care.
There are many instances where people can’t wait but aren’t A&E material. The case of the OP being one of them.

I appreciate that GPs are under strain and not coping atm. But the answer to not coping isn’t by reducing the type they are giving by stealth whilst hoping someone else, somewhere is going to pick up the pieces.

@marmaladehound

There seems to be some debate about this. In general, acute wounds (not post op) that can be covered in a single appointment probably fall under the GMS contract. Chronic wounds do not, and GP practices are quite within their rights to decline dressing of things like leg ulcers - although of course in reality most practices undertake this work even if they don't have to.

There was some discussion of this issue here: www.lmc.org.uk/visageimages/guidance/2006/gpclegulcersanddistrictnursesmar06.doc

@sidge, I don’t want to say but my surgery is allegedly also offering post operative wound care etc… they have no choice, hospitals don’t it.

But even before covid, they didn’t have the tools to do. And by that I mean simply an array of size of dressing to actually do the stitches removal and then covering them up again.
I’ve been told by the nurses to please go to the chemist to buy stuff for my child because they just don’t have the right sizes there. (The nurse was most apologetic about it too).

I haven’t seen anything yet that makes me say they are able to provide that sort of care appropriately :(