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

@christinarosseti19, I get your anxieties about people who need care not getting it, but if you specifically tag low income pensioners, new mothers and carefully defined vulnerable groups, then the rest of us should be asked to contribute (not necessarily to pay the full cost) towards the healthcare we consume. I think it would be good for the population for everyone to take some responsibility. And (this is controversial) the mission of the NHS (Free to all at the point of need) has given some people license to think that should mean everything, including the most high tech expensive experimental medical innovations should be universally available, for free on the NHS because they read in the paper it was possible. No medic can reverse old age. Only very few can perform life changing surgery successfully, and then only on individuals who were in decent health before they needed interventions.

Just pay attention to your own personal health, and your family's health. Eat sensibly, exercise. Before I am berated for not mentioning MH issues, I can only say that I am still getting to grips with that one.

And those that cannot afford a modest fee?

Plus if they can operate like that with a number system why aren't they doing this now and actually seeing patients? Until we have access to that frontline gateway service we are left going to a&e.

Plus if I can pay a nominal fee or means tested in some way to bypass the middleman and get treated a lot quicker I'm going to do that leaving your gp's doing what exactly?

Even though I'm a frequent visitor I wouldn't mind paying £20 a visit. Get a quicker appointment using a system that is directly linked to those departments I need access to. I won't need to go and consult with the gp after having to take the day off and wait in a queue hoping to get seen that day. Finally convince the gp that you do need a referal after several more of those days off. And then wait for that appointment and then of course the ticket and wait to get the results explained. Just pay another £20 when your results are in.

Apologies all - I did not wish to cause upset, hurt, stress etc to anyone with my post.

For those who asked, no, I don't work for the NHS or any healthcare provider. I'm just a regular, average member of society who, by the sounds of things, has a fairly decent GP surgery. They operate a '8am call for an appointment' system which is hit and miss I admit but also an online form where you get a call back within 24/48 hours.

I've also had cause to call on behalf of a relative about something time critical and spoken to a GP within minutes and had the issue dealt with within about an hour.

I'm so sorry to hear about some of the awful experiences people are having.

XingMing the issue of high tech expensive experimental medical innovations being suggested for older people is a separate issue from presentation at A&E and needs to be thought about from medics pov.

I completely agree that aggressive medical procedures usually don't help older people with terminal illnesses (and indeed make their last few months on earth a total misery) but that's a separate issue from people presenting at A&E. If medicine could stop its bizarre denialism of mortality that would be a start. I don't think it's the patients driving this.

Paying attention to your own health is more or less possible depending on the situation that you're living in. Families in temporary accommodation with shared facilities have fewer opportunities to eat healthily than those of us with decent kitchens, but that's a social problem not an individual lifestyle one. Ditto people on low incomes.

Last year I was in A&E & was admitted to a ward. I heard the staff complaining about the amount of people in A&E because they couldn't see a GP. Last month my GP sent me to A&E for one of the dc after a telephone appt. A&E doc asked me why I had come & I showed him the letter from the GP. He was like why didn't the GP see your dc? I'm was like I can't answer that!

If gp's are off because of working conditions, underfunding and all the rest claimed as reasons. Sorry but not my problem. At the moment a lot of people are feeling the same and unlike you guys have been doing their jobs live and in person. Including those colleagues of yours working elsewhere in the NHS.. You are the ones that are adding to the current situation of patients suffering and your colleagues are feeling the strain of your direct non action.

You know what a shambles it is and you are contributing to the destruction of the NHS.

I'm sure you guys have an oath or something about a duty of care.
Seriously where is at the moment?

And when other services and businesses couldn't open because of whatever guidelines making it impossible, they were very very vocal to stand up and let us all know it wasn't them. Where are the GP's standing in front of the camera saying look we'd love to open it's just read this, look at that. Giving us actual info about the difficulties. Of course we were pissed off but we knew why.

Hospital departments we know why services aren't fully operational but at least they are still bloody there. We are getting this information.

Official details about why gp's either aren't seeing or very limited patients. Nothing, Nada. Tumbleweed.

Seriously, we probably disagree on the route to the goal, but I think everyone with a job should be charged a modest fee with every pay check to fund the NHS. So even someone on NMW pays £1 after tax. And I still think that anyone who can afford a consultation should pay. I spent my 20s in the USA, and I only needed contraception and once, ear wax removal; I walked across the road to the suite of doctor's offices, and asked to be directed to an ENT. Room 3201. In that room, the doctor unblocked my ear, and I was at work 25 minutes later. You pay, but not stupid money, and you get on with life. The NHS is a white elephant/ sacred cow. There are better ways to organise health care IMO.

[quote XingMing]@christinarosseti19, I get your anxieties about people who need care not getting it, but if you specifically tag low income pensioners, new mothers and carefully defined vulnerable groups, then the rest of us should be asked to contribute (not necessarily to pay the full cost) towards the healthcare we consume. I think it would be good for the population for everyone to take some responsibility. And (this is controversial) the mission of the NHS (Free to all at the point of need) has given some people license to think that should mean everything, including the most high tech expensive experimental medical innovations should be universally available, for free on the NHS because they read in the paper it was possible. No medic can reverse old age. Only very few can perform life changing surgery successfully, and then only on individuals who were in decent health before they needed interventions.

Just pay attention to your own personal health, and your family's health. Eat sensibly, exercise. Before I am berated for not mentioning MH issues, I can only say that I am still getting to grips with that one.[/quote]
No, I don't agree.

You say "carefully defined vulnerable groups" but who would do the defining? You yourself mention low income pensioners but not low income younger people, so defining who is deserving of treatment at the point of delivery is by no means straightforward.

Of course it's important to eat sensibly, to not smoke, to not step into the road without looking, etc. But most of us at some stage or another will require hospital treatment. Those that don't are very, very fortunate. When you talk about "responsibility" you seem to be suggesting that people who are careful will never be ill or get any injuries.

Before the NHS, lots of people on low incomes would have symptoms and put off and put off going to the doctor because they were afraid they wouldn't be able to pay the doctor's bill. With many illnesses, early detection is key and delay can be disastrous. (And also, if you want to look at it purely economically, more expensive as well.)

"Free on the NHS" is a pernicious phrase. The NHS IS paid for, via tax.

I myself have cost the NHS a fair bit over the years, mainly due to MH issues. I suffer from depression and chronic anxiety, mainly as a consequence of a difficult childhood that involved abuse. Many folk can say the same. Maybe we just weren't "responsible" enough, or should have somehow taken better care.

I know this post is going down in flames before I write it, but America's healthcare works for 80% of the population. If you have a job you have access to a healthcare plan, which will take care of serious stuff. For low level issues, for $25 you can consult a walk in GP if you are worried, and you won't miss your shift at work. These days, $25 is not a lot of money. No insurance based plan is ever going to cover everything well. The NHS is unaffordable because it promises to cover all the costs forever. So it is doomed to underperform. Just my opinion.

Well we do paid towards the NHS but I don't think prescriptions should be free just because you are old. They should be means tested.

I just read something in a paper that said:

Anxious parents are bringing in preschool age children who have a high temperature and difficulty breathing,increasing demandon emergency departments that are already “overwhelmed”.

I'm sorry, are people supposed to feel guilty for taking their children in who are having difficulty breathing, for fuck sake. I'm sure there are some people who weirdly enjoy rocking up to A&E and waiting 9 hours to be seen, but on the whole most people go because they feel either it's appropriate, or that they have nowhere else to turn. The NHS is crumbling, as it has been for years, and it's the fault of people of course.

A friend of a friend went to A&E recently and had to wait six hours for an x ray. It was the day after the first England match and there were a bunch of drunk/hungover men in there hooked up to IVs taking up bed space and staff time. I would happily see them given a hefty bill or barred from A&E for a year.

@TurquoiseLemur, I did state the vulnerable groups I would want to exempt in my post (elderly, poor and maternity). I guess you read it in haste and wanted to respond quickly. Mumsnet is quick to criticise healthcare in the USA, and it's not free, so the expectation is exacting. No American with medical insurance accepts 'good enough'. It is a system that drives up the average steadily, and achieves breakthoughs.

While I agree with you in principle, you have nowhere else to turn when you're ill and you can't get hold of your GP.

They need to throw funds at doctors' surgeries so they can see and treat people there, instead of hiding behind a telephone that rings and rings and rings...

@TurquoiseLemur, I sympathize but I really don't quite understand. In my world, you just take any comfort that's offered but get on with living. However, I accept that I live in a pretty rural area, which is very different to a tower block apartment in a city. Our access to healthcare is not very different, but it should be better. And I would be happy to take myself out of the NHS to pay privately, both to free resources for those in greater need and, frankly, to get an answer when I want one quickly.

[quote XingMing]@TurquoiseLemur, I did state the vulnerable groups I would want to exempt in my post (elderly, poor and maternity). I guess you read it in haste and wanted to respond quickly. Mumsnet is quick to criticise healthcare in the USA, and it's not free, so the expectation is exacting. No American with medical insurance accepts 'good enough'. It is a system that drives up the average steadily, and achieves breakthoughs.[/quote]
I didn't read it in haste, I read it carefully. And wondered why of the low-income groups, you ONLY mentioned lower income pensioners, as if other lower income people are somehow less deserving. You didn't mention "the poor" as such.

My point was also that while YOU would select those groups for non-payment, other people might choose other groups. It is by no means obvious who should be prioritised.

I'm aware enough of the healthcare situation in America to know that many people face bankrupcy after sustaining a major injury/needing treatment for a chronic condition, etc. It's not a great system. Perhaps you feel that those people should just have taken better care of themselves, I don't know.

There have been plenty of medical breakthroughs in Britain under the NHS.

Ouch! I guess because I have lived long term in both the usa and the uk I find faults with both. The UK and NHS wants to solve all the issues, regardless of what it costs we/the taxpayer. it doesn't seem to matter that quality of life is less than great. IDK how the USA manages it better or worse and woud be pleased to know more.

If we are talking about people paying a fee to access their GP, by the time we've excluded children, the elderly, those with chronic conditions and the poor ( like the current prescription charges do), we've eliminated most of the people who actually see the doctor regularly. So the poor sods who actually already pay taxes to fund the NHS have to be the few who pay yet again to see the doctor.

And these payments from the few will have to be collected, processed etc. Would probably cost as much as it saves.

@XingMing I have a disability.

I have to see the same specialist he’s the only one in my area who looks after people like me

private healthcare won’t touch my disability with a 20 foot pole.

So I’m going to have to pay hundreds of pounds every month out of my own salary just to access healthcare?

I note you didn’t exempt people like me.

It's always been a struggle to get an appointment at my practice, it's an absolute joke now. I agree that people shouldn't be going to A & E for nothing but some have no choice, what about the people who have been in pain for the last 15 months unable to have it investigated and diagnosed and it then gets to the point where you're climbing the walls because the gp wont prescribe anything strong enough to help because there's no diagnosis? What else can you do? Noone wants to sit in A & E for 8 hours but dont have any other option at the moment. (And i'm the kind of person who will just try and plough on regardless) but sometimes you need to be seen.

I should’ve had monthly appointments. For the last day 15 months.

I had one appointment last June and one this June. I’m in pain all the time.

If I reach a stage where my medication isn’t working effectively, my GP can’t manage that for me, and there’s no way to see my specialist, what the fuck am I actually supposed to do?

I’d like to see a GP (or experienced nurse?) available at A&E departments, now that walk-in centres have all but vanished (round here, anyway). I don’t rate our chances of magicking them up though.

I had a coughing, non-covidy 3yo recently, got worse on the weekend. I wasn’t too concerned, DH was, we rang 111 who sent us to A&E. This seems to be how the system is set up. She, like every other preschooler in England, just had a random viral infection.

Everyone is a bit to blame. GP practices because indeed, getting appointments has become very difficult if not impossible in some areas. Sadly, being a GO is not a very attractive prospect any longer. The admin side of the job has almost taken over the clinical side. GPs are now accountable for absolutely everything they do. It's a vicious circle. There are under much pressure so don't do their job as well, patients are pissed off and all they get is to see annoyed, unappreciative patients. The older ones have retired early, the younger generation are not interested. Primary care is in crisis.

111 isn't helping much either. They are run by private companies and their goal is to ensure they minimise errors in diagnosis or advice. It's not in their interest to minimise A&E attendance, so I less it is obvious there is nothing urgent, they will advise to go, even though in the vast majority of cases, it's not necessary at all.

Then you have patients who really on Google, who believe that any pain beyond dull one, any fever above 38, any rash is an emergency. People who also think they will access a consultant quicker that way.

This is why a resolution is not straight forward.

Then you have patients who really on Google, who believe that any pain beyond dull one, any fever above 38, any rash is an emergency. People who also think they will access a consultant quicker that way.

Did you read my post describing how my GP sent my young child, who is asthmatic and was not coping with a respiratory infection, to a Covid treatment center 30 miles away with an appointment for 8 hours time because she didn't want him in the surgery? With instructions to go to A and E if I was concerned he wasn't managing, knowing full well he wasn't managing and I was concerned.

Where do you think the hundred odd children she has probably done that to this week ended up and how on earth is this even remotely the parents' fault?

I worry about the ones ordering illegally online, which people are doing. There was a local boy to me who was ordering "diazepam" online and died because they weren't diazepam at all, looking on my Facebook this morning I have dodgy adverts for medication for asthma appearing. Not sign that they're a genuine pharmacy, people have commented saying get from your dr and overwhelmingly people are replying saying that they can't. If ordering to collect from GP its at least four working days to get a prescription from the surgery (which is nearly impossible) the pharmacy require extra two days at least to make meds up.

When I had tonsilitis I had no choice but to order what I knew had treated it before online by pretending I had another condition (the medication was genuine as I took it to pharmacy to get it checked and they confirmed) - the "specialist trained receptionist" having told me to phone back when I couldn't breathe or speak as before then I didn't need a prescription. From experience I know when at that point what's needed is A&E and IV antibiotics.

Primary care in rural areas is dreadful. There's little if any secondary provision now with it all being "centralised". Which the GPs supported at the time, why did they support it? Because they had zero concept of what would happen, they were dazzled by centres of excellence and fancy new hospitals, new services for all. BUT Services being hours away mean patients unable to attend appointments, more people ill being seen in primary care. Moving simply isn't always an option. It's all well and good to say to someone "simply use hospital transport" but that's no longer free where I am and costs a fortune (80% of fare must be paid by patient), majority of specialisms are gone from the local "hospital" so yes there is an a&e (of sorts) but most of the time you're put into a taxi to go to South Wales - costing hundreds of pounds and whilst it's ok for a Dr or even nurse to say to a patient (and they do) just pop it on your credit card or ask family and friends this simply isn't always possible and people end up going home instead.

An example. My GP was 100% behind orthopaedics only being open one morning a week (since covid zero provision) because simply not enough people had broken bones that couldn't just be sorted by a nurse - right up until they broke their leg and were told to pay to go to South Wales because they didn't break it on the right day, how they complained!! Went to the local rag and everywhere with their pathetic sad face. What did they expect? they were perfectly happy for everyone else to do the same trip and pay for it (on much less salary) and push them into debt as its hundreds of pounds to go. Yes I told them this when they complained to me about it; they had the sense to drop it quickly as I told them what I've said here.