To think 70% of people shouldn’t be in A&E

[PrettyPleaseXo]

Recently I was admitted in excruciating pain to A&E due to kidney stones. Over the time I was there it got progressively busier as expected and there was corridor care (I was stuck in a corridor without pain relief and crying in pain for two hours) and ambulances backed up out the door.

When I was discharged and went back out through the A&E reception/wait room I couldn’t help but notice
that 80% of the people sat there looked perfectly fine, chatting etc and didn’t appear to be in either an accident or emergency.

AIBU to think that unless you’re seriously unwell, in acute pain or have an injury that needs immediately addressing you should be turned away from A&E and told to go
to the GP instead?

I was in A&E recently with an injury that turned out to be a fracture - I'd not realised how serious it was before going to hospital. Sitting in the waiting room I'd have looked, to you, like one of the people that didn't need to be there. Appearances may not be accurate.

I hate this attitude. Nobody sits in A&E for hours just for fun. It's not entitled to want to be seen by a doctor if you're unwell. Plenty of GP surgeries it's almost IMPOSSIBLE to get an appointment at. You call in the morning, by the time you get through all the urgent ones are gone and they don't pre-book. So what are you supposed to do? I have a friend who died of melanoma after first struggling to be seen at all and then being tolld (repeatedly) that it was a fungal infection and made to feel like he was "entitled" for wasting the doctor's time. By the time he was ill enough to be taken seriously it had already spread. He was 31 years old when he died and had a toddler. And I can guarantee you his was not a one-off. There will be plenty more like him, sadly. So you can keep your "entitled" comments to yourself thanks

Some definitely do this. The hospital my friend works at has the consultant doing triage and he’s not afraid of telling people it’s neither an accident nor an emergency!

Lots of people do visit the NHs when they don’t need to (former GP receptionist- although I was a nice one). I hate to say it but it was the people with the most time on their hands - older retired people and stay at home mothers. If I ever got a person in FT work coming in for an emergency appointment I’d put them top of the queue as they’d have to be ill to take the time off IME.

There are people who probably shouldn’t be there, but very much doubt it’s as many as 70% of patients booked in.

Some people seem to have a ‘family day out ‘ type mentality. That clogs up the waiting room with people who aren’t even there to be seen.

Ultimately it’s not possible to tell by looking, hence they are triaged first.

There are people who seem to turn up there mob handed. There will be one patient, plus a crew of ten plus others just hanging out, keeping them company. I'd say that's quite annoying.

Frankly if someone isn't in absolute agony they'd have to be a sadist to to sit there for twelve hours. But when they seem to have an audience with them it's a bit strange.

I was with someone in resus who nearly died and the waiting area was crammed full of people, chatting, going for a smoke every two minutes, there was about 35 of them. All there for one person!

They were having a great time, laughing etc. in a life threatening situation that did feel a little upsetting.

DH once took someone to A&E on a Sunday morning. This person had fallen and had a head injury which was going to need stitches. A&E was busy and a call came in about a car crash. A senior doctor then appeared in the waiting room to triage the people waiting. Various people were told to leave and either see their GP on the Monday or to go to a pharmacist.

That’s amazing and that’s exactly how it should be to relive pressure on A&E and actually get people medical help quickly

I can only assume you are living in some sort of protective bubble away from what most of yhd rest of yhd populism is experiencing in primary access to healthcare.

I currently have a bad prolapse. It took me two attempts to even get a go appointment : 1st time I was 13th in the queue at the 8am Hunger Games style scrabble to get a go appointment - I was told all yhd appointments for the entire day were takeb

Nect day - 8am Hunger Games style phone call (bearing in mind my actual bladder is partially hanging outside of my body) - 17th in queue - nope, all appointments gone.

IF you’re lucky to get an appointment you have to hang around up till 5pm WITH YOUR PHONE ON YOU. Most people will struggle to do this (or even answer their phone on the Hunger Games appointment making call back - if you’re lucky enough for your GP to have a queue call back sustem) - during which time most peopld are going thd school run/trying to get to work. Abc oh no!!! You’ve been driving because you still have to get to work or get fired or still get your child to school or get labelled a shit parent - and then once again, YOU CANT GET AN APPOINTMENT.

Clearlg you’re incredibly coddled and cushioned and have no idea just how difficult it is to even see your GP these days.

as an aside - my Gp won’t allow any appointments except ON THE DAY appointments.

Completely unreasonable. DH and I would have been those people you refer to just five weeks ago. For your information he’d had a stroke, the tingling one side of his body was a major alarm to me, but we sat and chatted and walked into triage and out again, eating sherbet lemons and looking 100% fine.

All followed by a doctors examination, a CT scan, a stroke nurse visit, an MRI and an admission (all done outside the A&E waiting room).

How on earth do you know why people are presenting there?

I've spent many hours in A&E with my elderly mother, who was eventually admitted ( twice) and also with a poorly daughter. It was always rammed and most people looked really ill - overdoses, broken bones, falls etc. I've also seen some people who looked OK collapse and fall off their chairs and require emergency attention. Nobody goes to A&E for fun. Also most people are too ill to be on their own and they need a friend or relative with them to make sure they don't pass out etc, so it gets very crowded in there.

The thing is it’s easier for posters to blame the general public than admit that their is a problem with their precious NHS.

We should all grovel for crumbs and be jolly grateful for the opportunity to wait 12 hours in pain from a broken leg don’t you know.

My mum’s UTI progressed to a kidney infection which was diagnosed in A&E. she wasn’t bleeding or crying or had broken bones. But did have a potentially life-threatening infection. I think a lot of people dismiss just how serious infections can be because antibiotics do their jobs so well. Those people absolutely have to be seen by a doctor in a very timely manner, and in most cases that does end up having to be A&E because who can manage to get a GP appointment within a few hours of their symptoms these days?

I wouldn't judge. I know a child who went to A & E as struggling to walk, and feeling incredibly poorly. They took bloods and it was leukaemia. Someone might have looked at this sleepy pale child being carried in, sitting on their mums knee and assumed they were making a fuss and it wasn't serious.

I hate to say it but it was the people with the most time on their hands - older retired people and stay at home mothers.

Could it be because their partners were working?

You hate to say it yet ignore simple logic?

Also patients and their helpers have to be prepared to help other patients if necessary. A man came in begging for help to get his elderly mother ( covered in blood) out of the car. The paramedics would not help. Another patient had to.

You have answered your own question there-GPs are the starting point, and until the government sorts primary care services out then A&E will continue to be treated as a GP service because GPs and 111 push patients to use A&E to get them off their hands.

I agree with you but the problem is services being unavailable.

My son recently had an infected thumb that needed lancing, the GP surgery wouldn't do it, neither would minor injuries so we had to sit in A&E for 6 hours. Once we saw the doctor is took 5 minutes max to sort. That's the kind of thing that takes up valuable time etc and isn't an emergency but we had no other option! If it happens again though I will be doing it myself!

Trouble is the imaging centres,minor injury units and walk in centres might have the machines but they don't have enough trained operatives to use them. My daughter had a bad fall in a PE lesson and hurt her wrist. Initial thoughts were just a sprain but she said it hurt so much hours later that we asked Our GP to take a look. She said it needed an x ray. (430pm) and wrote out a chit for the local scan centre. When we got there they said it was too late to get a scan and they would be closing soon. We then drove to the local minor injuries unit but they had no radiographer due to illness so they couldn't do it. We then drove to the minor injuries unit in the next town. Again, no radiographer as it was now after 6pm. They said the only place that could help would be the City Hospital A&E.
After a 3 hour wait there we finally got an x ray but then still had to wait another hour for a doctor to look at it, agree it was broken and finally get a plaster put on.
All the time we were there the waiting room was packed.Presumably many people with the same X ray problems that we had .
We did not want to go to A&E but had exhausted all other possibilities.
There really needs to be some sort of fast track training for radiographers to increase this skill pool and allow Minor Injury units to be fully operational on a 24 hour basis.

There are 2 main problems in our area which lead to lots of people in A+E.

1. Inability to access a GP in a timely manner.
2. Crap referral process.

There have been 1000s of houses built in our area and yet no extra GP provision seems to have been made. - other than funneling them into existing GP practices. Paired with an aging population. This has increased the pressure on services. Almost all the GPs round us only offer same day appointments so if you don't get in then you have to try again tomorrow. At any given time of day you are at least number 50 in the queue, the first hour the phone lines open you can be anything over number 84 in the queue. Our GP group has introduced an online system to try and help with demand. However many of the elderly are really struggling to use the online system (despite numerous outreach sessions been given locally at the pop in shop and churches) and so are still ringing up. The online system opens at 7.30 am, the phone lines now open at 9am. Our Drs surgery have also got all reception staff answering phones in the back so check in before 10am is via the screen and ring the bell for assistance. Receptionists on the front desk are also not allowed to make same day appointments as people were queuing up outside the GP to get an appointment when it opened and apparently the staff were getting abused. Almost all appointments are gone by 9am as triage of the online system begins at 8am and if you need an appointment you are phoned and offered one so many elderly are struggling to get appointments. The telephone waiting line message says "If you are able to use the app, please do, the app opens at 7.30am and appointments are offered from 8am. If you cannot get an appointment and need treatment today you will need to phone 111 or attend A+E". Untreated conditions (especially in elderly or vulnerable patients) can and do get worse and worse until they actually need hospital care.

Second is the referral process. It may only be our area but there seems to be an inability to be referred to hospital departments by other departments. Here are several examples I know of:

I miscarried last year, presented to Early Pregnancy Unit with suspected miscarriage. EPU confirmed the miscarriage was occuring. I hemorrhaged during the process, again went to EPU as instructed if bleeding became very heavy for monitoring. They confirmed very heavy bleeding and possible hemorrhage and I would need to go to gynecology. However, due to their system they could not send me up to gynecology. Instead I had to go to A+E to be triaged to be referred to gynaecology.

GMIL in care home had a fungal foot infection. GP had prescribed treatment but it wasn't clearing up. GP said she needed some swabs doing at hospital to confirm strain of infection and treatment. GP could not refer to hospital direct as an outpatient, instead GMIL had to present to A+E and then A+E would refer her.

Nephew had an asthma flare up, wasn't responding to his inhalers as well as usual. Went to GP to see about needing different strength inhalers or review. Asthma nurse had no appointments for a few weeks so nephew sent to A+E.

There have been several other examples of people sat in A+E when I have had to attend, knowing who they needed to be referred to but having to be referred by A+E. If Drs were able to do timely direct referrals to certain departments then these people wouldn't be at A+E.

It would also be really helpful if we could have some sort of walk in x-ray service (even if they only did arms, wrists, ankles and legs) in most towns (either provided by 1 GP surgery or walk in centre) without having to attend A+E. So many people with suspected broken bones that are just a sprain all sat in A+E -mainly arms and legs. Then this service could feed into the hospital fracture clinic for those who had actually broken a bone. Same with gluing/ steri stripping and stitching of minor wounds. In our area it's A+E. If you could attend a walk in or GP surgery for minor cuts then again that would reduce pressure. Of course limbs hanging off or very deep severe cuts would be an A+E job.

Our a&e have cracked this! I’m actually quite proud of it.

They moved a walk in centre opposite the a&e site (15m walk between the two).

The walk in centre can do X-rays for minor uncomplicated breaks for adults / children and is fully staffed.

A&E is then for emergencies only. If you arrive at a&e and get triaged they will make you go over the the walk in the centre if needed

I'm not sure if lack of obvious pain = doesn't need to be there. Thinking back to the times I've used A&E or taken the children in:

1. Sent in straight from GP surgery for an abscess. I was putting a brave face on so probably didn't seem too ill. Was admitted for surgery the next day (ruptured in the night, but that's another story!)
2. DD, broken arm. She would have looked pale and quiet, but otherwise normal. Was admitted for surgery.
3. DS, GP sent him in for a suspected broken thumb (getting worse 3 days after injury). Sat happily on his phone looking fine. Was in fact fine but needed an x-ray to confirm.
4. DSS, suspected concussion. 111 advised he be taken in (vomiting after hitting head). Was sat happily watching YouTube. Was triaged as non urgent so spent most the night there. Was fine, no concussion, but told we did the right thing.
5. DSS again. Suspected broken arm. Did not seem in pain at all, but was adamant it felt broken. It was broken and needed a cast.

I agree with every comment about a&e having to substitute a lack of GP appointments and closure of walk in centres but please don't judge someone's medical needs purely off how they look.

A couple of months before the first lockdown, I fell on my elbow and fractured it. It wasn't very painful, but I couldn't straighten it and that's not normal. It was out of hours, so I rang 111, who booked me an appointment with urgent care. This is located at our local hospital and is in the same building as A&E. I got a taxi to urgent care, to be told they were sending me to A&E because they have 24 hour access to x-ray (and other imaging services) and urgent care don't. So some of those waiting in A&E with you might not have been in a desperate condition, but they still needed to be in A&E for one reason or another. Or they might have been in an awful state, but it could have been something more insidious than what you had. Kidney stones get right in your face (so do gallstones) but cancer very often doesn't till it's quite advanced. People with potentially lethal heart conditions and acute psychotic crises often look hale and hearty...and so on and so on.

I would love to see stats on the disparity of GP appointments. So many people saying they can't get appointments, yet 370 million appointments were seen last year. I'm not here to defend GP practices, they are obviously a shit show in many areas, but other areas are doing so much better.

Ours is not perfect, but at the risk it repeating, it seems much more seamless than other regions. We get Econsult call backs/texts same day, prescriptions same day. We get forms to get blood tests and x-rays at the hospital, if urgent, you just turn up and wait, or there is an on-line booking system to several local diagnostic centers if you have more time.

Our A&E is still pretty awful, but that seems to be due to lack of staffing/beds.