To think 20 hour waiting time in my A and E is crazy...

[Meltinthemiddle]

What the hell is happening to our NHS? Is this all down to covid and GP's not seeing patients face to face or people mis using the system. There's been alot of GP bashing recently and I do feel sorry for some of them as no doubt they are working flat out but their appointment system is shocking!

@YearsSinceISawYou

It is wrong to use A&E like a doctor's surgery.

But everyone, A&E staff included, are aware that until GPs go back to work, this will continue.

Before anyone with a skin in the game jumps in, GPs are not working hard.

Blimey! I must have imagined the 60 patients seen in our urgent care clinic yesterday then! 15 of which were seen by the GP on duty. Seen. With their eyes. Face to face

Worked in A&E for many years, the amount of people coming through the doors who would come and wait 4 plus hours to be sent home with paracetamol that would cost them 49p was unreal.
Doctor - "When was the last time you took pain relief?"
Patient - "Oh! I haven't taken anything yet, I don't want to mask the pain..."
Seriously, you would not believe the shit people would turn up with. I will write a book one day, I swear. Had a young girl turn up with a broken acrylic nail, screaming the place down when she was told to go back to her technician to have it soaked off but refusing to as it would cost her £15. There was no injury to her nail bed it hadn't broken in the middle, it was literally the tip. Then at the opposite end you've got a little old lady coming in on the bus after falling 3 days before hand with an arm shaped like a blackened banana but she didn't like to bother anybody or the man who thought he just had a little bit of chest pain with indigestion who didn't want to ring for an ambulance so his friends brought him in a taxi, stood and waited in a 20 minute queue to get booked in while pissed/drugged up arseholes shout and scream at the reception staff, proceeds to get booked in and then collapses with a cardiac arrest hitting his head also in the middle of a packed out waiting room less than 10 minutes later.
He died and I still see him every day nearly 10 years later.

Sons partner waited in A&E for 7 hours a fee evenings ago

No food or drink, felt so sorry for him

@BingBongToTheMoon

If you have to wait 20 hours to be seen in an A&E then you don’t need to be there.

Can’t say I disagree

@JaniieJones

'She didn’t say they were in a corridor - she said on a trolley. A cubicle wait of 26 hours for a bed is pretty appalling.'

It really isn't. She implied the ambulance had dropped them off and they then waited 26hrs.

If they were seen, examined, treatment initiated, they were fed and monitored then no it isn't 'appalling'. It is not ideal but depending when this allegedly happened I would expect the hospital probably had significant bed pressures anyway due to covid.

Waiting for a bed is not the same as waiting to be seen and treated is it?

It’s far, far away from the 4 hour target which has been forgotten, and means that people are backed up in ambulances. Those ambulances are not then available to go to emergencies. This is the consequence of bed pressures caused by mismanagement of Covid and lack of investment in the health service since 2010.

It is appalling.

I was at my local A&E the other week, my GP told me to go urgently due to heart/breathing issues and needed to get urgent scans. I was seen immediately for triage, had the tests/scans, given meds and advice and sent on my way within 3 hours.

Listening to some of the conversations of people around me, I honestly was shocked at the complete pointlessness of their visits, stuff that you wouldn't even bother a GP with - one man started kicking off because I was seen first. Yes mate, your bruised ankle is more important than my inability to breathe properly.

Just wanted to say severe period pain and bleeding can 100% be an ED issue (in response to comment on p1). Ectopic pregnancy, burst cyst, ovarian torsion etc. I've been blue lighted in by my GP more than once because of the impact of pain and bleeding (Endo related) on my pulse and blood pressure and they wanted me on morphine to bring it down.

There's an important balance here - no don't go to ED with a minor infection but don't wait until you're actually dying of sepsis.

@User134342134

Friend of mine worked as a doctor on A&E and 90% of cases were not true emergencies. They were usually long-standing health problems that escalated to the point where people panic and go to A&E. There is also the mistaken belief that going at crazy time (eg 1am) helps you escape the faff of making appointments and waiting and you skip the queue to see a doctor. A&E are not equipped to provide treatments or diagnosis for many things, they can only offer pain relief/antibiotics and make sure you're not dying at that point in time.

This is an unpopular opinion but I feel the NHS is broken to the point that people need to go private if they're truly worried about their health. Why put your own life on the line just to prove a point that healthcare should and needs to be free? In the vast majority of other countries, healthcare is not free and people accept that. The "free" version of healthcare for uninsured patients is so poor that it's normal for people in many countries to pay for doctors.

There's a bizarre entitlement in the UK that medical care NEEDS to be free which is very strange for people who have lived in other countries. Paying for healthcare is seen as a perversion but if your car or washing machine breaks then you obviously need to pay for that too. A private consultation is about the same as car repairs, one night's hotel or other unexpected expenses that should be budgeted for in an average household. I know friends who doggedly wait months for their NHS appointments whilst in ever worsening health but refusing to contemplate spending that £100 to get an answer immediately.

As the title suggests, if more people went private they would be doing their own health a favour as well as relieving the collective burden on GPs and A&E. The problem is obviously not enough doctors to begin with so the free services are stretched to the limit. This is common across many countries, including highly taxed German and Scandinavian countries. In many European countries it's perfectly normal to use insurance covered doctors if you can but also pay for private care if you need it. You don't need private insurance either. If it's just 1-2 appointments per year then it's cheaper to pay out entirely out of pocket. The major advantage is that you get your health seen at a point where hasn't escalated into something more serious and you also helped relieved pressure on the system for other patients.

You talk as if there’s 10,000 GP’s, A&E doctors waiting twiddling their thumbs in the empty private hospitals next door. That’s not true is it?

I’m sure if someone had to pay £50 to see a GP if they felt it was urgent, I’m sure they would, but the set up the way it is now, that’s not really an option.

The issue is there isn’t enough doctors full stop.

I agree paying to see doctors might be something for the future and it would make money available to train more GP’s etc…. But in the short term it’s not the solution

The ambulance crisis isn't helping.

All the ambulances are queuing outside A&E (they can't just offload patients and go to the next one, as there's nowhere to put the patients)

Patients who need to be admitted can't be, because wards are full. Covid really hasn't helped on that. But neither has the social care crisis - there are patients who don't need to be in hospital, but end up stuck there because they cannot be discharged safely as the support provision they need can't be provided (in many cases, backlog means they can't be assessed)

So with A&E doctors trying to make sure there aren't tragedies in those waiting ambulances, there is precious little to tackle those who can wait.

Having a drop in GP collocated with A&E can help - but tends to get clogged OOH by patients who need painkillers following their A&E discharge (eg broken limbs) because A&E can't provide them, and the hospital pharmacy (where they'd get them in working hours is skeleton staff overnight, and urgent dispensing means others don't get a look in)

All that said, some pathways do work faster than others. If you rock up with a possible fracture, you might be lucky and be sent straight to X-ray (especially if you are able to walk) and then it's pretty quick to stabilise and sort a fracture clinic referral. But a PITA to also have to go to the hospital GP for a green script to take to an all-night pharmacy

I think the system is overwhelmed and there are a number of reasons for that.

My GP surgery is extremely difficult to get an appointment with, emergency, telephone, in advance or any other version! There simply aren't enough GPs for the numbers of patients.

The town had a walk in centre which was well used but that closed last year and isn't reopening.

I do feel though that some people could take a bit more responsibility for themselves and use self care/pharmacy/out of hours but they choose to rock up at A&E instead. This then increases wait times in A&E and so the cycle continues. Obviously, many people attending genuinely need A&E.

Mental health services again are over stretched. I know someone who is on a waiting list for mental health support. I can't give details but it's a very genuine need and they have times when they don't feel safe/are distressed. But the waiting list is 6+ months. They are not someone who would go to A&E when distressed so they suffer with whatever support family/friends provide

The issue is underfunding causing shortages of staff and then remaining staff are overworked and become sick etc.

The NHS is no longer fit for purpose and it's high time that we as a nation have a sensible discussion about how to reform it. I'm sick of being made to feel constantly "grateful" for the crumbs off the table that is healthcare in this country, a system I pay a significant amount of tax for. There needs to be another way.

@takemetomars

An urgent care clinic is not a routine GP appointment.

Are we supposed to stand up and applaud because a GP saw 15 out of 60 patients?

That's his/her/their job! Anyway, only 1 GP-where were the rest of them?

[quote YearsSinceISawYou]@takemetomars

An urgent care clinic is not a routine GP appointment.

Are we supposed to stand up and applaud because a GP saw 15 out of 60 patients?

That's his/her/their job! Anyway, only 1 GP-where were the rest of them?[/quote]
Funnily enough, all the other GPS had clinics too, seeing 'routine stuff' as you call it. Have you any idea how long it takes to see an average patient with complex care needs? The GP in question worked from 8 until 1.30 to see those 15 patient. She then grabbed some lunch - hope that is ok with you- then drove to the branch Sugery where she did an afternoon F2F clinic, paperwork etc. This is typical of most GPs. Bet you don't work that hard. See how annoying it is when people make assumptions about your working life even though they don't know you? Yes

GPs are the new teachers. Vilified on social media for doing their best with limited resources. No wonder we don’t have enough of either.

@Fallagain,

There are GPs and GPs. Some are great, too many have realised how little they can get away with.

It was the same with teachers in the lockdowns. Some worked themselves to the bone to support the children, others took advantage of the lack of oversight to do very little.

And GPs get paid an awful lot more than teachers.

@JaniieJones

It is because people treat A&E like a walk in gp surgery. Look at mn for a snapshot 'I have severe period pain and heavy bleeding should I go A&E?' 'Yes it would be sepsis, or a life threatening hemorrhage, go NOW!'.

All practices offer econsults and phone consults and will then see those who require examining.

If this is based on the post yesterday or day before - that was a genuine a and e case. The op was also told to go to a and e by the doctor she spoke too.

And severe bleeding, even if linked to periods, most definitely can be an a &e case.

A&E doesn't have to mean life or death situations. Yes, a lot of people do misuse it but in some cases it's not the case, as was the case in the above mentioned post.

@YearsSinceISawYou

It is wrong to use A&E like a doctor's surgery.

But everyone, A&E staff included, are aware that until GPs go back to work, this will continue.

Before anyone with a skin in the game jumps in, GPs are not working hard.

Wow! Do you work in a GP surgery Because I do and everybody is working incredibly hard and have been throughout the pandemic including the GP’s! Jesus no wonder staff are leaving primary care in droves…..

@Mybalconyiscracking

Not sure why people are so fixated on face to face GP appointments. I find that telephone consultations at least initially, are much more convenient.

I have no issue with telephone appointments.

I do have an issue with the way my surgery is dealing with the telephone appointment system.

It's very easy for those people who have surgeries who are doing them well. But for those who don't it's hard and yes, patients will complain. It isn't necessarily the GP they are complaining about, but the outdated system.

Our surgery turned off the app appointment shame when Covid hit and never turned it back on fully. I can do a repeat prescription through it and that's all now.

To get an appointment you must call same day at 8:30am. If they answer you may or may not be offered a call. This can be at any time of the day. If you don't answer, they don't return the call and you start the system again the next day. Most appointments have gone soon after lines open.

There are no video calls. They is not online system. There is no text system. There is no way to send photographs etc.

If you do speak to a doctor then they will decide if you need to be seen. If you do, you are expected to be able to get there as soon as possible, ideally within 30 minutes or so. This is fine if it is the type of thing you are ill and at home, and can get yourself there. Difficult if at work or have no transport option.

I'd be happy to keep telephone options for most types of doctor visits. I am not happy to return the way my surgery handles them though.

I work in A&E. The wait all depends on what else is going on. We have people who will be in the department who are waiting on beds but because we haven't got enough people being discharged because they are waiting on care in the community. So the poor patients end up in A&E waiting for a bed and the poor staff are then giving ward-based care alongside emergency care. On top of that the more acute a patient is the more staff they might need to stabilise them, meaning fewer to try and treat the less urgent ones. Additionally we are seeing 30-40 patients turning up every hour at stages during the day. So if all of those people need investigations they all take time to be processed which adds to the wait. People seem to think it's a bit like ‘stars in their eyes’. Walk-in sick and rotate through the door cured in minutes. It's complex and it's a big issue but when you're left with 130 patients at any given time I'm not sure what the public are expecting. I wish their was a magic wand because I have never seen so many staff leave nor look so burnt out.

Our GP surgery is directing patients to A&E for minor ailments.

Our GP told us to go to A and E because she couldn’t get her head around making a proper referral!

When we got to A and E (another day) they sorted the referral really quickly but they shouldn’t have had to. Dd does have cardiac issues so I can see why they wanted her seen urgently but a quick, planned appointment would surely be better?

Locally our A&E is stacked up because there are very limited beds within the hospital, ( over the years many have been closed an hospitals rationalised) but in recent weeks it is the lack of carers available in the community to support at home or in care homes adding increased pressure as patients can not be discharged home.

Many many carers locally have not had the vaccine and have instead handed their notice in. It is likely to get worse in the coming weeks once we hit the magic date in November.

@Fallagain

GPs are the new teachers. Vilified on social media for doing their best with limited resources. No wonder we don’t have enough of either.

Spot on. I wonder which public service employees will be next in line for a slating?

In recent weeks, I have had surgery as an in-patient, been referred to A&E by 111, where I was seen in under an hour, and had an appt with a nurse at the GP surgery. Every one of these interactions has been excellent, I've been seen promptly and things have been resolved swiftly.

While waiting for results at A&E, I had the opportunity to observe the staff and they were really busy, but unfailingly efficient, polite and cheerful. I was in awe of the lot of them.

I had cause to go to my GP this morning to collect a blood test referral.

At 11am there was not one single person in the waiting room. It is a big surgery, with probably 6 Gp's. I was there for 20 minutes (much looking for piece of paper that was misfiled). When I left there was not one person waiting and not one person had come out. That appeared very at odds with the items I read that GP's are on their knees.

So, my question is why can I not get an appointment until 19th November to discuss a matter with my GP?

@LakieLady I wonder if the difference is because you were in the system, thus the dots were able to be connected.

The issue is getting into the system, which should be via GP but issues at that enter point are creating the issues at A&E.