Idiots who should NOT be going to A&E

I belong to a health centre where you can get an appointment any day only you can’t choose which doctor. As they are all great it doesn’t much matter. The receptionists are lovely as are the nurses etc. If you want to see a particular doctor you may have to wait but the service is wonderful,

Really, I think what we need is a facility across the street from the hospital that combines urgent care with a walk-in clinic and a crisis center. (Thankfully in my area we do have walk-in clinics and urgent care facilities, although not all of them are across the street from hospitals. We also have a community paramedic program that includes a mental health division - a paramedic and a mental health therapist will go out to see someone and determine if they need to go to A&E, for example.)

Urgent care, which we have in some places, is essentially a low-level A&E. Basically, if you aren't dead, or headed that direction, you can probably be seen at urgent care. They take care of issues such as minor suturing, minor injuries, little-Johnny-has-an-ear-infection-and-Mum-wanted-him-seen-today type things, etc.

@Chestnut - Thanks for your kind words. The funding of training is complex (like everything else!) and I don't pretend to understand it, but undergraduate medical training is already subsidised although far less than it was. My fees were £3,000 a year and would now be £9,000, but the cost of training is said to be around a quarter of a million - eyewatering!

We 'pay' after graduating through providing service delivery, i.e. seeing patients, which is part of the reason why doctors still work relatively long hours (someone asked this above).

Personally I'd like to see medical training widened and made more accessible, so bright people from lots of backgrounds aren't prevented from becoming doctors. The system still favours people who can afford to do the extra-curricular things and access the private tuition that will make their applications sparkle - all credit to them as it's really competitive, but it doesn't help the NHS recruit and train doctors who represent the whole of society, not just the well-off. Cutting fees might help that. And bringing back nursing bursaries (the full amount, on top of what was announced today) is I think essential if the recruitment crisis is to be reversed.

Personally I think working for the NHS for five years would be entirely reasonable if training were subsidised further. It depends on your experience at work, though. I love my job and still feel lucky to do it, but that's inevitably been shaped by the teams I've worked with. Not everyone is that fortunate.

When my DD was 9 our Dr decided she needed to see a specialist as she suffered badly with tonsillitis every couple of months and they were permanently covered in large white spots, I received a letter 4 weeks later with an appointment.....
3 YEARS LATER I rang the hospital and asked if this was a mistake, oh no, came the reply that’s definitely right, repeating the date, I had to pay for her to go private to see the specialist, £25 a lot of money for me as a single parent. He said she definitely needed her tonsils out as they were poisoned. ‘When would you like me to book her in’ he said after telling me the operation would cost around £200! Doesn’t sound much does it? But that was in 1975!!! I do think some things have improved since then. If anyone got an appointment 3 years hence these days there’d be an uproar! She did have her tonsils out on the NHS as I couldn’t afford to pay for her operation, the specialist said he’d put her on the top of his list as he considered her tonsils to be in such a bad state.
BTW Mr Callahan was the Prime Minister at the time.

Our local hosp has changed from A&E,to walk-in centre,& now back again as a 2-in-1- you go to walk-in centre,then the staff send you to the A&E part if they think its anything more serious,or you already have other medical problems which could complicate things.I try to get in gps unless its something serious though

I understand its frustrating when you cant get gp appts- BUT,surely you dont need a 'pre-holiday once- over' just to be 'on the safe side', if you already have insurance you'l be covered if you get ill,( he maybe didnt want to fork out for insurance) and if you already have any medical problems then surely the best time to get a 'pre-holiday' medical is to book it ahead for about 2 weeks before you go?- so no need at all to block A&E,this man should be banned from A&E in future,unless its a REAL emergency! I dont think his gp is a t**t at all,he probably knows this man is a timewaster,he's probably conned him into this type of 'check up' before! I wouldnt have given him a death stare,id have had to tell him exactly what i thought!

Tenerife man illustrates how certain GP services should be means tested. If he had enough money for a jolly in Tenerife he needed to pay for his health check himself.

Dryad - thank you for your very interesting post. It's great to hear from someone in the know. I have always thought that doctors and nurses should be trained for free, with a clause that they must work in the UK for at least five years after training. Do you think that's feasible? We need so many and the answer is not to keep bringing them in from abroad or using agency staff.

Nurse practitioners are the way the NHS can continue. A large enough health centre could have two nurse practitioners on duty at the same time so each qualified NP can get their diagnosis and prescription signed off by the other, to protect the service against possible litigation.

The NPs can of course refer suitable patients to the GP as can any qualified nurse.

The NP although highly qualified does not take as long to train as a doctor, and costs less to employ.

Dryad the NHS certainly needs to ‘get better’. I’d ordered an immediate scan, followed by intravenous therapy with a multidisciplinary crash team on standby.

Personally I’m worried it might be terminal.

Bring back more minor injury units.

We know it's not working and we also know it's due to underfunding. We KNOW it isn't the doctors fault. And feel bad for you working in conditions like that, wanting to do your best, seeing people you are too busy to help as well as you'd like.

My daughter has been to A&E a few times with the children but only because the GP has not had any appointments for over a week or because they needed a fractured wrist/arm dealt with. I know she would have much preferred to have gone to a local drop in centre but ours was closed down, forcing people to go to A&E instead

Hi everyone, first-time poster here. I'm an Emergency Department (=A&E) doctor currently on sick leave after an operation, so don't normally have much time to browse the forum!

This is a really interesting thread and I'd like to address a couple of the points above. First @merlotgran, I'm sorry you had such a long wait and am glad your husband was OK.

Emergency departments (EDs), like most of the NHS, are obviously in crisis. I've done this job for nearly ten years (was a late entrant to medicine and am only now approaching a consultant post) and it's never been this busy. But there is a LOT of effort being put in up and down the country (it varies by area) to do the best with what we have, including signposting 'inappropriate attenders' to other places. For example, our ED has a GP working within the department, and we can also redirect patients to another primary care centre.

As some people commented, though, patients who 'look well' can sometimes have serious problems and most of us have learnt the hard way that timewasters too can be properly sick. If there's any remote doubt in my mind that a patient may have more going on than e.g. a paper cut or feeling a bit nauseated, I will ALWAYS see. Not before the people who have collapsed or suffered major trauma, though!

@Greeneyedgirl gave an excellent summary of the complex issues contributing to long ED waits. If anyone would like to know more, a good source is the website of the Royal College of Emergency Medicine (www.rcem.ac.uk). It's true that funding has increased year on year, but the increasing demands on the service have sadly more than made up for it.

Finally, my friends who work as GPs are absolutely up against the wall. I could not do their job (and that from somebody who regularly runs one of the country's toughest EDs overnight). I appreciate how frustrating it is not being able to get an appointment for weeks, but just wanted to say something in their defence. The whole system is overwhelmed. Now that the election is over, we can only hope that the Government rises to the challenge and helps our NHS get better.

Let's not forget who starting embracing private health services into the NHS

Thirteen years ago

Labour

www.theguardian.com/society/2006/feb/16/health.politics

Then, Saggi, if that is the case, GP appointments need to be available.

You CAN'T deny people healthcare if they are paying for it.

Anybody turfing up at A & E without a valid reason...should be seen...and charged a fee. That would stop the time wasters , every time I’ve been to A &E with either my husband or daughter (severe asthmatic) they’ve been admitted . The only time I went to A &E i could see the bone in my finger when I sliced it open with a knife....I had to attend outpatients every day for 10 days to have it dressed. I’ve never mis-used the wonderful service ...and if I did I would expect to be charged a fee!

Glad your DH is home and okay.
I do think some of is down to Health and Safety. I used to work in a Day Centre for the elderly and the carers weren't even allowed to adminster a plaster for a cut, they had to take the client to A and E. It's a prime example of Health and Safety gone mad.
I do agree though that I'd have felt the same with the guy who came in for what was basically a routine check up!
I also agree that if we're going to blame anyone for the state of the NHS it is not Labour. The Tories have already sold billions of pounds worth of contracts to private companies and it just doesn't seem to be working well.

At our dr sugery if you are asthmatic like i am you can always see the dr on the same day.This makes sense as i often need predsolione steriods and i need these quickly and this stops me going to A/E

I hope all those commenting on here watched ITV's programme The Dirty War on the NHS last night I urge anyone who missed it to watch it on catch up. It's a pity it wasn't shown a week ago. It really explains what is going on and how its come about and what will happen if people don't make their voices heard.

Yes Lilyflower someone else pointed out we had a Conservative government in the early eighties as well, true, but it’s never got better under Labour. I still think the NHS does a great job most of the time.

Thank you endlessstrife for pointing out that things in the NHS are the same whoever is in power. That is a real horse's mouth observation and to be valued as coming from experience. A little thought and knowledge would support the view as being inevitable.

We are too quick to scapegoat and vilify. It isn't helpful.

In the US more and more people are seeking treatment at emergency rooms in hospitals for a variety of reasons- Some don't have insurance- Some could afford it but choose not to buy it- Others cannot afford it yet don't qualify for social service medical coverage because their income is higher than the determined poverty line which is unrealistically low- But even people that do buy insurance as well as those covered by social service seek treatment at the emergency rooms-

There are no 24 hour pharmacies or walk in clinics- Most of the walk in clinics have no radiology equipment or labs- They don't stitch wounds- They treat colds, flu earache and so forth and frequently advise people to go to the ER when they themselves have no idea what the matter might be-

Someone with substantial health coverage can develop a condition, with severe symptoms, but is made to wait 3 months to see a specialist, during which time they seek treatment in the ER, many times over, for their severe symptoms- And then on the day of their appointment with the specialist discover they aren't being seen by the specialist but the specialists nurse practitioner who relays information to the specialist who takes another month or more to respond-

I could go on ... And on ..

Hamp75 you can get reasonably priced health checks from any of the many private walk-in health centres in most areas. We've used them and they're really not all that expensive at all. Anyone who can afford a holiday abroad can afford a once over by one of them. And its a lot more pleasant an experience than hanging about in A&E

I agree. If the guy has had heart problems and could not see his GP he was doing the correct thing in going to A and E rather than risk falling seriously I'll when abroad. Insurance would be expensive for anyone with previous or current health conditions and after Jan 31st he wouldn't be able to use an EHIC. A doctor might have advised him not to fly.We should not blame the patient for the fact the Tories have ruined our health service and there are not enough GPs.