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

Sidge

Thanks for that info. I am an ED charge nurse, I know we often refer people to practice nurses for follow up wound care, I know you are not a walk in service. Even though the GPs based in EDs everywhere are technically working as a walk in service.

It is all very confusing. Even when we have GPs in the department, what patient one GP will see, another won't! Tbh even after 22 years of nursing it's still all confusing at times!

I would have thought the OPs GP should have advised a walk in centre, minor injury unit over A&E though?!

[quote Libraryghost]@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?[/quote]
Minor injury - no question. So minor injuries unit, or ED (ED docs don't like the term A&E any more).

In general most hospital doctors have no idea what is in the GP contract or even that it exists (that's not a criticism, why would they?).

However what GPs should be doing is relatively well defined, it's been made worse by the fact that historically we've tripped over ourselves to help by doing anything and everything.

But it's time to stop, the £150 per year free for all has to end.

@privateandnhsgp, I’m curious.
If GPs don’t do dressing for chronic issues such as leg ulcers, who is supposed to do it?

@privateandnhsgp that’s when there is a minor injury clinic where you live.

I don’t.

In that case, where do you go?

Because of A&E can’t see someone with a cat bit and GP don’t either, but there is no minor injury Clinic, there there is a huge gap in the care of people really.

I would have thought the OPs GP should have advised a walk in centre, minor injury unit over A&E though?!

I’m pretty sure the OP said there is no walk in centre. I would assume no minor injury clinic either.
In that case, where is she supposed to go bar A&E?

It very much feels like different services are playing pass the parcel until the situation is so critical one of them has to step up.

It depends on what service the local CCG has commissioned. Often it's the district nurses, or a wound clinic in the community hospital. But in many/most areas GP surgeries pick this up because patients would suffer if they/we didn't.

But CCGs love it when GPs do this kind of stuff "for free". The GP surgery doesn't get paid anything extra, it comes out of Partners' income, and they don't have to bother commissioning a proper service.

[quote Libraryghost]@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?[/quote]
We see animal bites in A&E all the time. This is totally appropriate for A&E. sounds like you were unlucky with your WIC. Most have someone who can prescribe appropriate antibiotics.

@MyriadeOfThings

The ED IS contracted for this kind of thing, regardless of what they say or moan about.

And to be brutally honest, the fact that there's no satisfactory service doesn't make it your GP's problem.

[quote MyriadeOfThings]@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 :([/quote]
The hospital is supposed to discharge you with all the tools and dressings you’ll need. In effect we’re “doing them a favour” offering post op wound care, and it also benefits the patient not to have to trek back up to hospital.

However they often don’t send you with anything, and we can only use what we have in our cupboards which is bought by us, on our budget. We don’t have stock cupboards like hospitals do. We buy dressings, forceps, suture removal blades and clip removers. We can’t always afford to buy them in bulk as they often go out of date before we’ve used them.

The number of patients I’ve seen postoperatively, or from ED with no dressings is astonishing. I think ED/hospital staff think we have access to all the kit they do. We don’t. We often have to cobble together the first dressing with whatever we have to hand until we can do a prescription for dressings for the patient to get, and bring with them next time.

We try and keep the basics in our treatment rooms, but it’s expensive and secondary care are supposed to send dressings and supplies.

What is ED???

ED = Emergency Department

I think this is pretty common now. I was recently told to go to a and E when a GP could have checked and then done a referral if needs be. I insisted on a booked referral rather than turn up in a and E and wait hours only to be told no doubt that I should have seen the GP. I had to insist though. The default was to tell me to go to a and e.

I think it’s even more complicated tbh.

All good to send people home with the right type of dressing, but how do you know how long it will take to heal? Of it will get infected etc…?

Ds hurt his face and was seen by A&E (as a child, having had a shock on his head, complaining of headache and double vision).
He had a bad wound on his face but they couldn’t put stitches on.

He was sent back to the GP/nurse who couldn’t care for his wound. (so yes I did at home on my own - the resulting scar on his face might not have been as prominent with better care. Who knows)

As a patient, I actually don’t care who is responsible of what. I shouldn’t actually have to know what ED is and who I am supposed to go and see depending on the type of wound, illness and what not. I’m not a medic. I’m not NHS.
My point of contact (which will be more often than not be the GP surgery) should be able to point me in the right direction. Different departments should be able to know their responsibilities. Including what to do if there is no small injury clinic etc….
Otherwise, the people who suffer are the patients.

@MrsSkylerWhite

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

Yes they would. Foot care is terribly important in diabetics - if you have ever been to a diabetic foot clinic at a hospital you would know why.

When my mother in law was unable to care for her feet, I was quite happy to take over but was told a podiatrist should cut her toenails & see to her feet generally, because of her diabetes. Consequently a podiatrist (she called a chiropodist), regularly came to her house to take care of her feet. My late husband too was a diabetic and went to the chiropodist regularly.

It's good that you have a diabetic nurse at your GP practice, op, but not much use if you can't get an appointment with her at the moment.

Still you sound very sensible and it seems your foot is OK, thank goodness.

@Psdoff

How utterly incompetent! Their district nurse could have done this, heck a GP! Report to CQC

We would bounce that referral right back to the GP or pods. There's absolutely no chance we would go out for that, especially someone who isn't housebound.

It is fairly obvious that there is a need for walk in minor injuries clinics to free up A and E for the more serious cases. We did have one but it was closed. Many of these which had x ray facilities kept the A and E dept functioning correctly as all the sprains and non serious injuries were diagnosed quickly without them blocking the a and e dept. Similarly, animal bites etc could also have been seen there.

[quote privateandnhsgp]@MyriadeOfThings

The ED IS contracted for this kind of thing, regardless of what they say or moan about.

And to be brutally honest, the fact that there's no satisfactory service doesn't make it your GP's problem.[/quote]
No it’s not the GP problem as such.

But I suspect it’s not A&E either etc…

So whose responsibility is it to ensure that patients are seeing by the the right person at the right time?

Clearly there is a lot of issues of unclear responsibilities there. From surgeries taking on a role they shouldn’t be to departments not taking the responsibilities they should do.

The bottom line is all the same though. Lack of funding.
I would have thought it’s something that GPs would be feeling is important to them (regardless of who is getting that extra funding)

Sidge

I know most don't give dressings. I always give enough for a couple of dressings. But this is probably because I worked for a brief time as a community nurse in a DN team so know how limited ad hoc dressings are in the community.

Get magnesium sulphate (dirt cheap). It’s a paste which draws things out. It is my stand by remedy for things in feet or hands. It works. It really does.

I’ve known a patient have his thumb amputated before from a simple splinter - he had diabetes too x

My stepdad knocked the underneath of his foot on the bedside table in May last year. Just a tiny knock. He now only has 1 full leg/foot and his right leg is amputated just below the knee. His diabetes was in full control too.
If you've soaked it and it feels fine then I'm sure you'll be fine!
You did the right thing by calling the GP, even if they were useless!
Do you have a diabetic nurse? Could you call them directly?

@marmaladehound thank you!

We also get some patients getting stroppy when we tell them we need to give them a prescription for dressings, because they’ll have to pay for them. We prescribe as many as is feasible to reduce their costs but a lot of people aren’t expecting to have to buy dressings.

All good to send people home with the right type of dressing, but how do you know how long it will take to heal? Of it will get infected etc…?

That’s why the hospital should advise a PN appointment when the dressings are due to be changed. We can assess the wound, decide if further dressings are needed and which type, prescribe them and monitor for infection.

@MyriadeOfThings I’m sorry to hear of your son’s experience. Why didn’t ED suture it?

You are right, there are a lot of grey areas around many aspects of health care that are very poorly defined. Wound care been one, mental health another. I can believe that GPs do a lot of things that are beyond their contractual duties. There is no such contract in A&E however we also see and treat a lot of patients that are not wholly appropriate for us. It's not the patients fault. Signposting to correct services is appealing, but also funds have been so badly cut that many services are scarce. Podiatry been one, sexual health. Mental health is an enormous problem. You either are low risk and GP can help you, or you are in a crisis and end up on A&E for days on end! Where is the middle ground? This is pretty much how many aspects of the NHS are now functioning, and only just on a very thin thread.

[quote Sidge]@marmaladehound thank you!

We also get some patients getting stroppy when we tell them we need to give them a prescription for dressings, because they’ll have to pay for them. We prescribe as many as is feasible to reduce their costs but a lot of people aren’t expecting to have to buy dressings.

All good to send people home with the right type of dressing, but how do you know how long it will take to heal? Of it will get infected etc…?

That’s why the hospital should advise a PN appointment when the dressings are due to be changed. We can assess the wound, decide if further dressings are needed and which type, prescribe them and monitor for infection.

@MyriadeOfThings I’m sorry to hear of your son’s experience. Why didn’t ED suture it?[/quote]
Yes I can imagine people would not expect that. It's the same when we charge prescription charges in A&E for medication. Sorry you have to pay for it here too!!

@MyriadeOfThings

"But I suspect it’s not A&E either etc…"

It's specifically A&E's (ED) role to treat this.

It's the CCG's role to make sure that adequate services are provisioned, and the problem is that historically any gap in services has been picked up by the GP (or often ED).

But increasingly as Mumsnet demonstrates perfectly, there are complaints about the waits for GP appointments, lack of capacity etc.

Well part of the solution to this is for us to stop doing stuff that we're not contacted for and to focus on stuff that we are contacted for.

It's also about time that the public realised how much they were getting for their £150 per year (an average of 6-7 GP visits per person per year).

The system is decompensating. You're not happy, we're not happy. It's time to start again. But it won't cost £150 per year.

To compare, on the days that I work privately it's £125 per 30 minutes appointment. And I'm not short of takers.