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

If you call your GP, who then tell you to call 111, who then tell you to go to A&E what do you suggest people do?

I don’t doubt that the whole of the NHS (including GPs) are under pressure. However, don’t blame the people trying to access medical care. Blame the people who should be in charge of ensuring the NHS is efficient and running properly.

To be fair to GPs, I rang them a couple of weeks ago at 8am and was telephone triaged, seen by a gp and then admitted to hospital by 10:00am so I can’t fault their care at all.

@justchecking1
Because here in my local surgery they are not seeing people.
This is what we are being told by the surgery on their FB page

Occasionally someone from the surgery posts to try and reassure us they are doing everything they can and hope to resume seeing patients soon. They understand our frustrations. Their lines are always open between x and y to discuss referrals, meds etc.

They are letting 0 through. Even 4 would be a start.

Why?
You have ppe, ventilated rooms, vaccinated etc.

Why only 4 per day? When the dentists are seeing more? My last visit they saw 4 of us in one hour. Gp? Tumbleweed.

The people who live opposite and above the surgery aren't even seeing people come in or out. The lights are off.

Surgeries haven't suddenly had an extra couple of thousands register. Ours haven't been taking new patients for around 3 years. There are 8 full time gp's, 2 part time ones, a pharmacist and several nurses.

I'm sorry but if school staff can be in a room with 20+ other people gps should be seeing patients.
If dr's and nurses are seeing people in hospitals, doing rounds and coming into contact with several people an hour then what is the gp's excuse?

My friends who work in hospitals cannot understand it either and face the same frustrations trying to access their own gp's.

Econsults, Video, phone calls cannot diagnose appendicitis, feel the hernia, do a smear, stick their finger up your arse and countless other things we need to be seen for,.

My husband is a GP, a partner. He's never worked as hard as he has this past year. He's been in the surgery since the first lockdown started, the only time he's worked from home is when we were isolating. He and his colleagues have seen patients face to face when required since then too. The majority of patients are dealt with over the phone but those that need to be seen in person, are.

He's supposed to have 1.5 days a week for admin etc. This doesn't happen because they cannot recruit any more salaried GPS at the moment because there's a massive shortage. Those 1.5 days are now spent seeing patients. Consequently, he leaves for work at 8am and arrives back home after 19:30 each day and spends most of Saturday catching up on admin. He's absolutely on his knees - his annual leave was cancelled last week due to another doctor going off sick.

The system is desperately underfunded.

@Orf1abc

My local NHS team are racking their brains to put systems and procedures in place to ensure our A&E departments don't crash

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

This

GPs need to fully reopen, it’s not public misuse of a and e causing this issue it’s the fact virtually nobody can access the appropriate level service

@canigooutyet they must be seeing people, surely? Or at least be telephone triaging and managing people virtually?

They have a contract to keep.

The only reason I can think of for why they might not be seeing people face to face is if they are clinically vulnerable and were shielding. Our health board still won't let any shielders go back to direct patient contact.

I understand the sentiment, but things are not always clear cut.

Example. I though I was having panic attacks which almost made me pass out. Couldn't get a gp appointment and because I didn't want to be one of Those people I paid for a private gp appointment, but ended up in resus in a&e for a heart issue I never knew I had.

So yes I agree, but equally people shouldn't be shamed when seeking help. It's because I worried what people would think that I didn't go to A&E.

Econsults, Video, phone calls cannot diagnose appendicitis, feel the hernia, do a smear, stick their finger up your arse and countless other things we need to be seen for,.

True, but you'd be amazed how many diagnoses you can complete without even laying eyes on a patient, let alone hands. About 90-95% of the diagnosis is in the history, more if you're very experienced in your field. The last few percent is just belt and braces for most conditions

Gps have been incredibly lucky until now to have their weekends free and to be given time during their working day to allow them to do admin work. To have the same pattern day in day out unless something unusual happens.

Nurses and other nhs departments have been trying to bring it to our attention for years that they are overworked and underpaid. That they often have to work through breaks. That they are there until well after hours doing admin work.

Same with a lot of public service sectors.

Reading stories of people being told by receptionists that they dont need to see a doctor, go to pharmacy, get given some lotion or potion without any diagnosis then ending up seriously ill in hospital. I will decide for myself if I need to go to hospital if it's the only way I get to see a doctor in person and the tests I need.

On the other hand, many people feel like they shouldn't bother A&E, are not able to get a GP appointment, think "I am probably OK" then die. (This happens).

Many people have mental health issues but can't get seen by mental health services.

Worrying mothers desperately need advice but their health visiting team has been disbanded.

This is the fault of underfunding not people.

@justchecking1
They are seeing in person 0. I wish I was making this up. Local mp and more are involved in this because of the ridiculousness of it all.

Our health board allowed shielders to go back in line with the government guidelines. A lifetime of hospital stays you get friendly with staff.

At one point MH thought I must be confused as I was told by the GP I needed to be seen urgently but they aren't seeing people. Mentioned it at my next appointment, this was confirmed and MH stepped up. It should not have been down to MH.

And yes I did need to be urgently seen and had the GP seen me when I first called, I could have been treated at home. Instead 3 weeks in hospital during which time my children could not see me. which was hard on us all as I am their only parent.

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.

Today I've been in agony with what feels like a UTI (dark red urine, the usual pain, constant urge to wee etc) . I phoned the GP surgery and was told to bring in a urine sample and leave it in a bucket outside the surgery and a nurse would test it at some point. When I phoned a few hours later I was told that the the sample had been sent off for testing and the results should be back by Tuesday so ring back then. The dip test was 'borderline' and in the past that has meant antibiotics (which have actually always worked) but not now.

So I'll be drinking loads of water and knocking back ibuprofen all weekend I guess. Maybe the new NHS motto is survival of the fittest?

GPs are paid by the number of patients on their books - whether they are seen or not. So the fact they are not personally seeing patients makes no differance to their income. But what is the answer? It is in their very generous contract.

The only thing my GP seems to do is authorise my repeat meds which I can request online and collect from the pharmacy. I have various tests and health checks (including an endoscopy ) which have been on hold since March 2020.

I applaud the NHS staff working on emergencies and accidents and hope their onerous work load can be mitigated in the future when the GPs get back to full work.

I agree but sadly one you can’t get an appointment at my doctors for weeks and 2 my medical conditions are too jumbled up for the doctors so I’d get sent to a&e then admitted. I also don’t trust my GP practice as they nearly killed me twice so I will always go to 111 or A&E now .

@DelbertGrady

My husband is a GP, a partner. He's never worked as hard as he has this past year. He's been in the surgery since the first lockdown started, the only time he's worked from home is when we were isolating. He and his colleagues have seen patients face to face when required since then too. The majority of patients are dealt with over the phone but those that need to be seen in person, are.

He's supposed to have 1.5 days a week for admin etc. This doesn't happen because they cannot recruit any more salaried GPS at the moment because there's a massive shortage. Those 1.5 days are now spent seeing patients. Consequently, he leaves for work at 8am and arrives back home after 19:30 each day and spends most of Saturday catching up on admin. He's absolutely on his knees - his annual leave was cancelled last week due to another doctor going off sick.

The system is desperately underfunded.

But why? GPs were busy before covid but not this busy surely? So what is the difference? I would assume with the fairly low levels of covid right now and the fact that we are mixing less there should be no higher level of illness in the population?

The real problem is that after about 1800 hrs there are few options. You rarely can speak to a doctor certainly not your GP 111 is useful if slow and if you do not know what to do where is the option?

@Sweetpeasaremadeforbees
Go easy on the ibuprofen. Over use can cause stomach lining damage and pain relief then becomes problematic as there isn't much else that you can buy over the counter that deals with the inflammation side.

Cranberry juice can also help to flush out UTI's.

@justchecking1

Econsults, Video, phone calls cannot diagnose appendicitis, feel the hernia, do a smear, stick their finger up your arse and countless other things we need to be seen for,.

True, but you'd be amazed how many diagnoses you can complete without even laying eyes on a patient, let alone hands. About 90-95% of the diagnosis is in the history, more if you're very experienced in your field. The last few percent is just belt and braces for most conditions

Your argument assumes that the patient is articulate and forthcoming over the phone. This is often not the case.

Some people are anxious over the phone in a way they are not face to face.

Some are inarticulate over the phone in a way they aren't if put at their ease face to face.

Elderly people (esp if they have dementia, diagnosed or not) often struggle with phonecalls.

It is difficult to discuss mental health issues over the phone by their nature.

Also, a fair number of people phoning nowadays will not have the necessary privacy at home. (Partner or other working from home in the background, etc.)

Some conditions and problems will be missed of GPs are only relying on phone consultations. The relationship between a doctor and a patient is not just one of asking for and providing facts; it is about connecting. And most connecting cannot be done by phone alone.

My friend died at Christmas from a UTI that turned to sepis after the practice refused her more than three days of antibiotics, after making her wait days to speak to someone, after they told her to just drink more water. No sample was taken in the first place, not examined at all, just sent a prescription for three days. Now her 18 year old who was told to look after her siblings has had a breakdown and her siblings taken into care.

All because of "just a UTI".

They can be very very serious.

I've a family member dying from terminal womb cancer that was fobbed off as "just a UTI" for months last year. Again not seen just sent antibiotics to take from pharmacy. Not seen by anyone, just phone appointment with a nurse and sent antibiotics for MONTHS!!

My practice yesterday put up yet another video on social media saying everyone loves the new way of working and it's far too dangerous to attend (video now deleted). Except those for whom the online system doesn't work (most people as due to geographics signals here are too poor for any kind of online consultation in real time as no broadband and even wifi doesn't work properly) the phone system is fine as long as you can a) accept calls from a witheld number (not every one can) and b) can be rung at any point between you call and 7pm - and you need to bear in mind it maybe the following day as they don't give appointment times.

Under no circumstances will they see anyone without a facemask, even if exempt, or who attends in a taxi.

Disabled people are finding they can no longer manage their conditions having been so long without any help, some have lost their benefits due to treatment being stopped.

Even a&e here now require triage which is leaving people suffering as well.

They have one GP still on furlough (they've been online saying they're not needed - now deleted as they got shredded for it) along with two admin staff - information is publically available on every business claiming furlough. Staff are frequently seen in shops (rarely had time before). I've seen the GP in the "it's too dangerous to see you" video in a shop without a facemask brushing past people (to be fair she got thrown out after jumping the queue, refusing to wear a mask claiming exemption which she clearly isn't as the surgery is zero tolerance for face masks even if exempt and even wears one in her videos), the practice manager has also been seen shopping without a facemask as have admin staff.

Then there's last Friday when they all went to the pub for lunch.. Easily seen by anyone walking past.

I'm not saying NHS staff don't need to have a life and should be tied to their desks BUT if you're going to block people from accessing your surgery because "it's too dangerous" then you need to stop doing such stupid things. I'm rural VERY rural and it's beyond stupid to be posting such videos and then ignoring the rules where the very people who need help are getting their food.

@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

I agree OP. it never ceases to amaze me how during the school holidays urgent care is quiet as soon as Monday morning comes round all of a sudden they need medical care!! I feel sad to say that we may have to charge people. But I think that would immediately half the number of people attending

So. how comes those A&E. staff can see me? They don't know my history or anything when I show up on their doorstep.
How comes they can be in the same room as the various ward staff and they can be a lot closer than the gp would? Never mind the patients and the few visitors allowed.
I can be taken (at various points by hospital doctors as it was so manic) by porters to have whatever test done?

But I cannot see a gp or even drop off a piss sample? Someone who knows my history and has an idea about why I want to actually see them f2f. I don't mind getting triage over the phone, I. actually prefer it and have been talking to my gp this way for years. Just when they mention f2f they would normally make an appointment and often on the same day,

Imagine if hospital staff operated in the same way these surgeries are? Don't bother showing up we will triage you over the phone/digitally?As the calls to 111 have shown for years and its predecessor has shown, you cannot accurately do this over the phone. The mistakes have also. been mentioned on this very thread, never mind media.

It's not like they aren't over worked, underpaid, underappreciated, underfunded, not enough staff etc. Sadly it's nothing new with our hospitals and iirc the reason for the first lockdown because hospitals were beyond stretched even before the first CV. patient entered a building.

And now gps have all been vaccinated apparently, and can see the medical records of their patients, why only see 4 patients a day? Isn't that the point in the vaccine that it protects you and others? Why not do as school do and those quick tests?

And if you're only seeing 4 patients a day for example how can you have a load more paperwork to do? It's not like gps are ordering supplies unless of course it's only them working there full stop.

And I know in a few different trusts near me, the CEV were working from home doing admin. Was able to remotely log into the surgery so they could do various parts of their jobs like ordering whatever. Not everyone in the NHS was furloughed for that exact reason to keep on top of the admin. But of course, thats just a few out of hundreds of trusts and nhs can be a postcode lottery,

I can't help thinking that the NHS has to bite the bullet and start charging a very modest consultation fee to working adults and pensioners with pensions above the flat state pension, and also to borrow some ideas from other countries which have co-payment systems. For example, in France nurses are allowed to form professional firms and offer walk-in services for routine/follow up care... like re-bandaging or replacing dressings or taking blood samples, so the patient can drop them into the local independent lab for analysis. GPs practice as sole practitioners with patients walking in, taking a ticket number, and in small offices, often with only a receptionist, if that. It takes the stress-y day to day routine out of the GP's workload, and as my best friend was a GP (who retired because of the endless paperwork trail) it does need to be considered from both sides of the wall. GPs need to be able to have a life, and patients need treatment.

Tbf, as far as I know, it's GPs trying to fulfil NHS England's requirements rather than individual surgeries deciding that they don't want to see patients face to face.

I am really opposed to any suggestion of charging people at point of contact tbh. It will only stop the poorly poor presenting at A&E, not the poorly wealthy.

The NHS is meant to serve the public, not the other way round. If GPs still aren't seeing patients and people need assistance then yes, A&E will take the hit.