A and E the only way to get seen by a consultant??? Spinal stenosis and severe nerve impingement.

[andnowwhatdowedo]

I have been given a diagnosis of cervical stenosis with severe nerve impingement, been referred to neurosurgery, and had the referral expedited when the symptoms got worse (expediting seems to mean nothing as I was put back to 'routine'). I have just been told by my osteopath that two of my newer symptoms are red flags and I must press to be seen by a neurosurgeon. Originally I was given to understand that there is an 8 week waiting list, but when I checked with the IMSK team who referred me just now, they say it is currently 12 months.
IMSK say that I need to go to A and E. But I am not experiencing my symptoms as either accidents or emergencies, and sitting uncomfortably or standing around for hours sets off my dizziness and nerve pain.
Does this really sound like a good idea? Should I consider going private? Could anyone chip in with their experience or expertise please?

Contact pals, ask to be put through to the directorate manager for spinal, explain your symptoms have worsened and ask that your referral and notes of your worsening symptoms are put in front of a consultant for triage. They might review and upgrade you to urgent or offer more advice.

waiting times for surgery often are around 1 year minimum but 85% of people should be seen for their first out patient appt by 18 weeks, most places are achieving this or near this. I’d be surprised if wait to be seen from date of referral was indeed 52 weeks, but clarify that with the manager. Ask to be put on the short notice cancellation list, ask to go on whoever has the shortest wait, advise you’re happy to be seen by a registrar, ask for the average wait to first appt.

that’s what I’d do before waiting in A&E for hours when you’ll be referred to orthopaedics, who may or may not refer you to a different hospital for spinal. And you’ll be seen in ED by a registrar in the first instance anyway.

UNLESS your symptoms worsen, you lose control of your bladder or bowels, or use of any limbs, in which case go STRAIGHT to a&e!

@Catsonskis Thanks so much for your response. Unfortunately I don't think it would work to ask PALS to contact Neurosurgery on my behalf, because Neurosurgery only have the original referral from IMSK to go on, plus a single-line 'expediting' message 'the patients symptoms have worsened, please expedite'. IMSK did not record what I said to them about my worsening symptoms, just agreed to write that email, and now they say they have no means of making Neurosurgery do anything at all.
I guess I will either have to wait a year or go to A and E, which feels ridiculous when there is no emergency and they are already so overstretched.

I’m not sure A&E will help, as they will assess you and look to see if any red flag, but I don’t know if going will expedite things. Do you have any of the red flags for urgent assessment? If so, definitely go and get seen but if not going to A&E will not help. If I was you, i’d pay for the first appointment privately, then ask to be referred to NHS for further treatment. I’ve done that several times and it at least skips the initial wait.

I was speaking to a doctor friend recently and unfortunately, due to cuts and staff levels, this is a regular occurrence. The pathway for care is a&e and that’s the only way. He said it’s incredibly frustrating as he knows that 1.they may not go 2. A&e may turn them away and they need to go again until they are seen which increases likelihood of option 1. It’s a mess.

go to a&e. A medical professional has told you this is the pathway.

If you have current red flag symptoms, then A&E is appropriate. If you have had them but now don't have them, waiting is appropriate.

Thanks everyone.
I have some red flag symptoms but on the mild side, eg since being seen by IMSK I have started having numb feet as well as numb hands but only at night; no loss of bladder control but a constant tingling feeling like the beginning of cystitis. Problem is I will be dizzy and in pain after sitting uncomfortably in A and E for a few hours, there's no such thing as a comfortable chair these days.
Guess I should start looking into private...

I’ve got the same worsening symptoms as you. My gp referred me for another MRI (last one was 3 years ago), I waited two weeks for an appointment and then a four week wait for the scan. I’m now waiting for the results.
im not sleeping as the pins and needles/numbness in my hands and feet keeps waking me. I’ve also got a lot of referred pain in my shoulder. I find exercising and keeping mobile helps with the pain. I do feel worried though. I hope you get seen soon.

One of the most common complaints I deal with is that patients don’t agree with the grading of their referral or consultants won’t re-grade/expedite.

There is a few issues to deal with here:

• The consultant really is the expert , they review and triage hundreds of referrals monthly. They have to make a clinical decision based on the information they’ve been given by the referrer. Increasingly this is utterly shoddy, inappropriate information missing key aspects sent in by anyone other than a GP.
• Patients are often disappointed the consultant doesn’t agree with what they have been told and will push for a re-grading. We always put these in front of the consultants, sometimes they agree in the case of new symptoms sometimes they don’t.
• Ive had my arse handed to me booking a routine referral patient into an urgent slot as the patient put multiple complaints in regarding her grading and red flag symptoms. The admin team were so fed up with it I approved just booking her in. I paid for that one
• It’s a complete fallacy you will see a consultant because you’ve presented to ED. You’ll be seen by a junior member of their team (if ED refers you in the first place) who will then decide if it’s an emergency. I’m not saying don’t go, you absolutely should if you have true red flag symptoms, but it doesn’t track that you will then see a consultant

Have you had an MRI at any stage?

Unlikely as A and E only treat acute symptoms and then make referrals to relevant team.

Thanks for your input; it's good to hear from a professional.

A member of the IMSKT I spoke to on the phone was very clear that I had some red flags and need to be seen quickly; so is my osteopath who has a lot of experience with stenosis. Not an emergency yet but could easily become an emergency. I am shocked that the details of my new symptoms haven't been passed to the consultant, just an email 'Please expedite as the patient's symptoms have worsened'.

If the consultant had been given full information and made an informed decision about how urgent my case is, I would accept it with relief even if it meant waiting a year to be seen. I'm not wanting to make a big fuss.

I'm sure you are right that there is no point going to A and E at the moment, though I will go if I suddenly get much worse. But it would be nice not to have to take the risk of having a crisis which may not be reversible.

I guess I will have to go private. Thank God I have some savings.

Yes, an MRI and a diagnosis with amongst other things stenosis and 'severe nerve impingement' at C6/C7'.