Please keep A&E for just that; Accidents and Emergencies

[Happytodayhappytomorrow]

A&E and Urgent Care centres where I live are at crisis point and it is similar all over the country.

It seems that people are going to these places to ensure that they get seen in person, diagnosed and treated all in one go rather than have telephone or zoom appointments with their GPs and perhaps wait for referrals to specialists at the hospitals.

Please, don't be the person who goes to A&E when a trip to the chemist or a phone call with the doctor will suffice.

My local NHS team are racking their brains to put systems and procedures in place to ensure our A&E departments don't crash, as they are needed for some genuine cases.

Of course, if you have an accident or an emergency, you must go to the hospital but if you even think that a chemist might be able to help, please go to the chemist first.
Likewise, try your GP. You might be surprised how quickly you get attended to if your case is urgent.

TIA

Are they missing the great big GP surgery sized elephant in the room?

This in spades

I totally hear you OP but when the rest of the system is on it’s knees, it’s hardly surprising nor is it fair just to blame the public.

I don’t work in a&e but my role does cover a&e patients. Things we have a lot of are 111 referrals, lots of whom would see a GP or a nurse in a walk in centre if those things were available. Surprisingly number of UTIs, but again, if people could get a prescription from their GP before it became unmanageable then they wouldn’t be there. Older people with falls - could maybe be reduced with better social care. As an aside, speedier response would avoid long lie ->pneumonia-> lengthy admission. Minor accidents and injuries which technically aren’t emergencies but may need imaging (which GPS don’t have) or stitches (which GPS don’t do). Also LOADS of mental health, some of which need treatment for wounds or overdoses. Collapse of mental health services leave patients with nowhere to turn to beforehand and nowhere to be discharged to afterwards. Also lots of things like post surgical complications, unwell cancer patients, urine retention and problems with catheters etc. All need sorting, most aren’t “emergencies”.

I do agree, but my recent experience is that I simply can’t get through to a GP.

My daughter has Tourette’s and she has a tic where her hand locks into a fist, usually with her fingers entwined. It’s extremely painful, her fingertips end up blue and they can last anywhere from an hour to a week.

18 months ago our GP prescribed low dose diazepam - it relaxes the muscles so she can open up her hand. We were running low so I tried to get through to the GP for a new prescription (she’s under 16 so they won’t give us a repeat prescription. I rang for weeks and weeks and weeks. Tried to contact through email and e-consult. Tried to get the prescription through her paediatrician - but he wouldn’t as it was the GP who prescribed it in the first place.

We ran out. Inevitably her hand locked. 48 hours later it’s still locked and I still can’t get any response from the GP (on the phone, email or e-consult) so I rang 111 who sent us to A&E. They took one look, gave us a box of diazepam and sent us on our way.

A visit that could have been avoided if I could have got through to the GP weeks ago. A phone consultation would have been more than fine. Didn’t need a face to face appointment, they have all DD’s medical history.

This type of post is pointless, sorry OP. Everyone that will listen already knows. In fact it's been repeated so often they take it too far at times - see the threads on here along the lines of "my leg has fallen off, should I go to A&E", dozens of replies of "no, I wouldn't unless it was both legs".

Then you've got the people that dgaf, they are the ones who show up needing a bandaid or not even that, use ambulances as taxis. There is no point telling these people, they won't listen, if anything it makes them want to go more.

The NHS will just have to cope somehow and I say that as an nhs employee. It's just too enticing to have nursing care, beds, doctors and medicine available seemingly for free 24/7, I don't see any solution.

Thanks @Bryonyshcmyony

If they are doing triage at A&E then why are they overrun? Aren't they telling people who don't need to be there to go elsewhere?

Try telling that to the receptionists at my GP surgery who refused me appointments to deal with heavy periods and instead said "if it's that heavy go to A&E as it doesn't sound normal."

For five months

And when I refused to go to A&E for a heavy period they put me down in my notes as "refusing medical treatment".

It took another GP who was a relative from another surgery to write to them to say I just needed an appointment with a gynae nurse or GP and that he was reporting the surgery to CQC for abuse of A&E services before I was finally allowed an appointment with a GP, five months later and by this point unable to walk due to terrible anaemia.

Agree re increasing capacity and funding for the NHS.
Also, what were seeing here is a result of many new parents being exposed to awful news stories and developing massive health anxiety as a result. Their baby gets its first cold or flu (all the winter viruses which are now circulating around babies and toddlers who haven't developed immunity due to lockdown) and people panic. Of course they do!

My young child, wheezing with history of asthma and frequent trips to children's ward, running a fever and coughing, was not seen by our GP because she didn't want him in the surgery. She agreed he should be seen though.

What do you think I should have done?

Her bright idea was a Covid treatment center 30 miles away which didn't have an appointment until 8 hours later (later evening). Naturally she said if he wasn't ok to take them to A and E in the meantime. So I did because they weren't ok and she knew they weren't ok.

I would have far preferred to access local primary healthcare but it wasn't available.

I am not in UK, so forgive me for butting in. Looking on from afar it would seem to me that when everything is free and scripts are cheap compared to many countries, people will not think twice about attending A+E for minor and often absurd issues.

I do understand the problem with access to a GP though. It would be unheard of in my neck of the woods to wait more than 24 hours or so for an urgent GP appointment. You have to pay though if you can afford it, same for A+E unless referred there by GP. If you qualify due to income limits your healthcare is free.

I don't think any healthcare system is perfect, but primary care is the key, not A+E masquerading as primary care when nothing else is available. Is it lack of investment/workload/etc. that has the GP system in such dire straits. And yes, what happened to walk in centres, do they still exist? I mean centres where you can present without appointment and wait your turn to see a GP.

I am in ROI and although we pay for healthcare when income exceeds certain limits, you can get seen to PDQ. Not a perfect system by any means, but there is the comfort that help is at hand at short notice even at weekends/nighttime where there is a roster of doctors on call that you can access.

I feel so sorry for those I read about who have to wait weeks to see a GP. I hope things improve for you all soon, medics and patients alike.

I agree with you BUT a couple of months ago my son broke a bone in his hand. I would normally have taken him to our local minor injuries unit but that is closed during the pandemic (why?). We rang 111 for advice and were sent to A&E. I've just checked and said minor injuries unit is still closed. This is not helping!

But with a severe lack of face to face appts etc and triage systems in place in A&Es I don't see what else can be done. If you call 111 with anything, if you have one of any high factor symptoms of pain or swelling they advise OOO or A&E anyway.

In my limited experience I have found that those not in dire need and been bottom of a triage list, they tend to leave because they can't be bothered waiting anyway.

Tell the GPs. I haven't been but I completely understand why you might take sick child if it's the only way to get some to actually examine them. Still only telephone appointments here and you wait 3 weeks for one of those.

Also 111 because every single time I've called them (a small handful, whilst raising DC to adulthood) they've told me to go to A&E where I was then made to feel I'd wasted their time.

Are they missing the great big GP surgery sized elephant in the room?

This.

People aren’t going to A+E for shits and giggles-they can’t get a GP appointment.

I have been trying to get an appointment for my DD. My surgery says I have to ring at 8am-that is when appointments are released. I am a teacher who is not allowed their phone in the classroom-it has to go in my locker. On my one day off, I phone at bang on 8-but can’t get through and am not apparently one of the first 12 lucky people who get in their queuing system so get told to phone back later. I eventually get though and after holding in a queue for 45 minutes, get told all the appointments are gone and I have to phone the next day at 8am.

They didn’t care that I work in a job where I can’t just be on my phone waiting on hold-the woman said that ‘wasn’t her problem’, there is no online booking system and when I asked what else I could do, she told me to go to A+E.

If the GP booking systems were fit for purpose, things would be very different.

Even for things like ringing in BP readings it’s difficult. I’ve had 4 texts this week telling me to give them my blood pressure reading. I ring and get the same situation-either told to phone back later or that I am 11th in the queue and it will be about a 40 minute wait. There is no email or text number I can use to submit the results which would make sense-so they keep texting me saying I still haven’t done it!

Yes I have noticed with very young children (who A and E’s are rammed with at the minute according to the news), parents will call111 to be on the safe side, who, due to the age of the child, and not wanting to risk it, advise them to attend a and e. I work in a nursery and 4 of my class have ended up there recently.

@alloalloallo

I do agree, but my recent experience is that I simply can’t get through to a GP.

My daughter has Tourette’s and she has a tic where her hand locks into a fist, usually with her fingers entwined. It’s extremely painful, her fingertips end up blue and they can last anywhere from an hour to a week.

18 months ago our GP prescribed low dose diazepam - it relaxes the muscles so she can open up her hand. We were running low so I tried to get through to the GP for a new prescription (she’s under 16 so they won’t give us a repeat prescription. I rang for weeks and weeks and weeks. Tried to contact through email and e-consult. Tried to get the prescription through her paediatrician - but he wouldn’t as it was the GP who prescribed it in the first place.

We ran out. Inevitably her hand locked. 48 hours later it’s still locked and I still can’t get any response from the GP (on the phone, email or e-consult) so I rang 111 who sent us to A&E. They took one look, gave us a box of diazepam and sent us on our way.

A visit that could have been avoided if I could have got through to the GP weeks ago. A phone consultation would have been more than fine. Didn’t need a face to face appointment, they have all DD’s medical history.

That is disgraceful for them to leave your DD like that.

Also to add to that, if you have been told to attend A and E, people feel they have to, as they would be in huge trouble for neglect if something awful happens

Hi, I'm a GP. I've said it many times on here and I don't know how long I can keep saying it but... The reason we have no appointments is that we're overwhelmed. I'm contracted for 8.5hr day as a salaried GP and regularly work 12hrs. The partners work more. We squeeze in more and more patients until it becomes unsafe. I can't make any more decisions after seeing 50+ patients. It's drowning. Lots and lots of my friends are GPs too and I'm on a lot of the forums and it's the same country wide. I don't blame anyone for going to A&E if they're worried and I know the solution lies within a community setting but there is just not enough staff to resource it. We're a relatively small practice. We have around 150 appointments per day. Last week alone we had on average 1100 calls for those appointments. I'm not sure what else we can do...

I'd agree if 111 didn't send people there willy nilly, this was precovid too. And when children are involved they insist. I basically got called a bad parent for not wanting to take my DD to A&E for something that wasn't a massive issue and just needed advice and the clinician who I eventually spoke to hinted that she'd have to contact social services if I didn't do as I was told!

I completely agree with the sentiment you're expressing but to get an appointment at my GP you cannot call and ask for an appointment. You have to fill out an Econsult request and they will respond with a phone call within 24-48 hours. They then offer you a phone apppointment or f-2-f a few days later. A 5 day delay is simply not good enough for, say, suspected scarlet fever which is absolutely a GP job, not A&E.

I've picked scarlet fever as both DC had this and in the olden days I got in to get the rash checked and anti b's dispensed the same day. If the same thing happened now it would be a 5 day delay.

I once took DS to A&E with a painful wrist. I knew it was just sore after a fall in PE and he'd be fine, but school had asked me to collect him and told me to take him.

Now, I could have made my own decision, but who wants to be known as the mother who refused to get medical attention for their child?

and before anyone says you don't need to worry about anti-b's for scarlet fever, or there's no rush, a girl in DD's class ended up with kidney failure from the scarlet fever outbreak in their class. Her mother wasn't able to get her seen by her GP in a timely fashion.

Call the GP who agrees you need to be seen in person to be properly examined to have a feel. No appointment available.

Go and see the local pharmacist who advice me to go to the gp due to contras and the meds needed are prescription only.

Go back to the GP - to get those meds you have to be seen. Or better still. cannot prescribe as they are controlled and only hospital can prescribe.

Meanwhile you're left in limbo and things are deteriorating.

You call 111 explain you have been back and forward to the gp and chemist. By now you are possibly at hospital level and ambulance mentioned.

Until I can access proper GP services I will get medical help when needed and if this means A&E then so be it. I've been there so many times I have lost count. Spent most of 2019 in a revolving door situation as I was re-admitted within days/weeks of being discharged. I know my body to know the care needed and if it can be resolved with the gp. There was times I wasn't sure, saw the gp. who sent me urgently off to A&E with a call giving them the heads up, if they hadn't already called an ambulance,

What I don't understand is why GP's practices are still on skeleton staff. We are constantly told the NHS have been fully vaccinated so what are they now hiding behind? They have PPE, can run appointments to ensure there aren't too many patients in the reception room. Mine is fully ventilated plus all the windows fully open.

How comes I can see the dentist who is inches from my face and I'm without a mask obviously. Yet cannot see a gp to have a feel of my abdomen? Give me injections needed to keep my arse out of hospital?

@Howshouldibehave I feel your pain. Our GP has stopped phlebotomy in the practice so we have to go to the hospital. You can't book an appointment on line you have to fill out an online form for an appointment for a blood test. They will then call you within 48 hours to offer you an appointment. They call once. If you miss the one phone call you have to fill out the form again and wait another 48 hours and hope you catch the one phone call.

I pointed out to the GP practice that because of the nature of my work I can't have my phone on at all times, was there any other way of getting these (supposedly urgent) blood tests done. Nope. They referred me back to the online form

DH turned yellow, his GP wouldn't see him, the receptionist 'triaged' him and told him sudden onset, painless jaundice was not a medical emergency. The British Liver Trust advised him to not mess about and go to A&E (who also turned him away). Turned out DH had bile duct cancer and his chances of survival at 5 years are 0%. I wish he had been well enough at the time to push harder because maybe, just maybe, the cancer wouldn't have spread by the time he was actually diagnosed. In his situation what else do you do but try A&E?

I spent 7 hours at A&E one night this week - i had a weird visual thing happen one evening. I was 99% sure it was an ocular migraine, having googled and also known it happen to someone else, but I am aware the same symptoms can be TIA (stroke) or retinal detachment.

Because it was late in the evening, I called 111 for advice because there is no GP service after 5.30. I thought they would take me through some basic diagnostic things to rule out the other two, but they basically just said "it might be TIA or retinal detachment, which are both time urgent for treatment, so you have to go to A&E." So I went, and it was crowded, and I waited, and I was seen 6.5 hours later at 5am and the doctor literally spent 5 mins asking me to press down and then up with my hands/legs, and to see if I could see her wiggling her fingers at the periphery of my vision, and then said she thought it wasn't either of those things, so probably just an ocular migraine.

There was nothing in her diagnosis that couldn't have been carried out by my husband with instruction from 111 seven hours earlier. It was a waste of her time, definitely my time (i got home at 5.30am and had to get up at 6.30am with my toddler), and A&E appt time. The only 'one' to benefit was the 111 system who couldn't now be accused of contributory negligence in the 0.00005% possibility that something bad happened to me as a result of not being seen. I was left with the overriding impression that I definitely hadn't been sent there for my benefit, but for the benefit of 111's insurance policy.