Jeremy Hunt and A and E

District nursing has been cut back over a very long period. Over 20 years ago I used to teach DN students and the budget was starting to pinch then. There was probably some need to do this - at the time fully qualified DNs (SRN plus a year full-time in university) were doing things like bathing patients at home. But I do wonder how many of the "DNs" that my MIL sees are actually qualified at that level - or whether they are students and health care assistants in the main.

I heard on the news that the numbers of district nurses has dropped dramatically as well and I attended an exhibition yesterday where there were TWO stands trying to entice medical professional to Australia!

I remember the days when you didn't have to make an appointment to see the doctor. You turned up between certain times and waited your term and if there was an emergency, so be it.

I also heard Laurence Buckman [?] on the news this morning - GPs rep. He sounded really angry - but controlled.

gangy they are well paid but the change in contract was 10 years ago. GP representative on the radio this morning furious that Hunt is trying to pin the blame on GPs. He pointed out that demand has gone up in GP surgeries as well as in A and E. The reasons for this increased demand are complex. But we know that hospital staff budgets under pressure - and Osborne's austerity measures have not really started to kick in yet.
There was a case in the coroners court near here in which a young woman who had OD'd (long term mental health problem) was in a coma but left in the care of someone with no nursing qualification and died. Coroner wants answers from Hunt on this one - and they don't do that often. Sounds a lot like understaffing though doesn't it.

I am sure we all remember those wonderful days Galen and I can also say that I would agree that you were probably worth a lot more.
The big error was made by the last government in the arrangement of the new contract which virtually handed them a 40hour week and naturally now they are rebelling at the thought of maybe having to return to the old system. Also, I believe, that they didn't have to take much reduction, if any, in pay!! It is all too good - isn't it?

When I was a GP, we had 5doctors for 17000 patients. We did all our own night calls, rarely if ever, refused a home visit and if anyone came in and said it was urgent they would be seen in that surgery. You never had to wait more than 2 days for a non urgent appointment a d you would usually see your own GP.
For this we were paid what in comparison to today's gps was a pittance. Even allowing for inflation.

aka I agree with you that the nominal A&E charge is a good idea. It would put off those who use A&E as a drop in for minor ailments (and I am certain this does happen because I've heard people saying that's what they do).

Am I the only one who has a problem easily getting an appointment with my GP? I went in to my local practice on foot recently to make an appointment for a future date, and the receptionist wouldn't deal with me, told me to go away and phone at 08:30 the next morning if I wanted an appointment!! .

The waiting room was full and I said firmly, "I am not leaving here today without an appointment". SHe must have realised that I meant it, because she suddenly found one for 3 days hence. What if people don't have access to a phone and they simply want a routine appointment? Gr.

Maybe their lives are in danger gangy5 - I think in some city centres (Cardiff?) they have an on-site first aid facility that will assess and advise them. I guess these are the kind of initiatives that can take the pressure off A and E.

Why do the police and ambulances feel the necessity to pick up drunks and deliver them to A&E ?

Perhaps there should be a nominal charge for A&E, say £10. Possibly refundable in the case of hardship. This might just stop those who use misuse the service or are inebriated?
#justanideatoshootdown

My exhausted SIL works in A and E and would agree with you,Grannylin, and glammanana, that many there have overdone the drink,or have ailments which should have been treated elsewhere. The Elderly are not ,in general , there without a valid reason,according to him. Lack of Staff is a major factor in A and E,as in most of the NHS. Today, for instance, he was working from 8am until 8pm and from 8am to 11am he was ON HIS OWN, supervising people with potential damage from a head injury, or chest pains leading to a possible stroke or heart attack.
Jeremy Hunt needs to spend time considering the true state of the situation and stop blaming GPS and 'the elderly'. It seems that once in the '65 and over club' the Government would be only too pleased to get rid of us ---such troublemakers as we are ---not! That is the extreme ,but at times it does seem to be the case.

There were a number of medics and paramedics on You and Yours complaining that too many people just try going to A&E with conditions that they could have sorted out for themselves, with some good basic first aid and a "when to panic health" advice book.
One paramedic was complaining that with falls etc in public area shop owners etc, are so worried about being sued they just call an ambulance whatever.
Another Dr was complaining about the weekend binge drinkers bring massive amount of totally avoidable work into A&E.

I wonder if anyone has collated statistics on how many a/e visits are totally avoidable, even for precautionary checks.

Perhaps much better public education on how and when to use services would help. I am sure people used to more resourceful.

There seem to be a lot of pressures - Doctors talking about the long term pressures and also blaming elderly demand...
Hunt has been talking about the evils of out of hours cover - GPs that don't know your name etc
Pause while 80% of the population fall around laughing. Most urban GP practices are so large and impersonal I would be amazed if a GP even recognised my face in a supermarket.
Suspect ministers have a warped view on the cosy relationship between GP and patients because either a/ they are the MP, so GP would remember them, wouldn't he/she
or b/ they play golf with the GP or maybe c/ they live in a time warp where family doctors know families and their histories (remember that) or maybe just d/ they are getting muddled up, it is the den-tist that knows your name jeremy, not the doc-tor.

Perhaps another factor leading to this situation would be that quite a few A&E departments have been closed in recent years. This would explain why the remaining ones have become busier and are now under pressure!! Services can't be cut without the shortfall affecting somewhere else.

Apparently A and E visits are down not up - so the minister talketh rubbish, again.
www.mirror.co.uk/news/uk-news/jeremy-hunts-claims-sunk-leaked-1897256

Ministers seldom do know anything at all about the departments that they are leading - and it shows!

Silly man!

Some years ago I worked for a Doctors' Deputising Service - it was a nationwide company. We hired doctors and young doctors from local practices to visit GP patients when their surgery was closed. We also held evening and weekend surgeries for the 'walking wounded' - people with colds, coughs etc. I worked in the Control Room passing on the calls to our drivers who ferried the doctors to their calls, this was in the 1990s. Even then I was amazed at the calls we received when I felt common sense could prevail. One Xmas morning one of our doctors had just returned to base after undertaking a few visits. These were mainly for children who'd woken up with a bad cold and instead of the parents undertaking the usual methods felt it necessary to call out a doctor on Xmas morning. The doctor said most of the children were happily sitting under the tree with faces full of sweets playing with their presents.
With various changes in GP contracts in the past 20 years companies like this closed. Now people visit A and E instead. The programme on Channel 4 highlights that - with various people in the waiting room who could visit a doctor instead. ALL practices have an emergency surgery daily - its the law - you may not see your own GP but you see someone. Routine appointments however may at times be some days ahead, but if your illness isn't urgent you should be happy to wait. Try living without the NHS as I did when I lived in NY with two young children.

Ah I thought that is what they said. 8% over 80 seems fairly lightweight to me, because most of us use most of our NHS resources in the last few weeks of life.
GP contracts have apparently been running about 10 years and don't I hear account for recent steep rise.

Apparently 8% of those going to A & E are 'elderly', doesn't sound to me as if it is all our fault!

Can anyone tell me when 'elderly' starts?

It's part of the new concerted effort to blame everything on the "ageing population".

I think it is a result of the last government's change to the GPs' contracts which enabled them to stop giving 24 hour cover. Now instead of calling a GP, people go straight to A & E. Another reason could be that nowadays no one is happy to wait and see if it gets better or just take a paracetamol.

My DD recently did a stint in A &E and was shocked at the number of Mums bringing in children with really trivial things: small cuts on fingers, spot on face etc etc.complaints that wouldn't even justify a trip to the GP . To some degree it is a reflection of the 'I want attention NOW' mentality.At the other extreme, older patients would come in when things had gone too far and they were quite ill.

Totally unfair comments by our 'in the know'!! government ministers. Many oldies are living alone and are unable to transport themselves to A&E - besides I don't think it would enter their mind to make that their first port of call.

Only a few days ago, the A&E doctors' organisation was saying that the total cock-up over the new emergency advice number combined with the fact that GPs no longer have to do out-of-hours service was leading to a crisis in A&E. Sounds more convincing than Hunt! Where else can you go?

What is wrong with these people have they been to their local A&E lately my sister works at our local hospital and she can confirm that older people do not attend unless it is urgent and the most patients are those that have over indulged on drink/drugs and sports related injuries at the week-end

I agree Hunt, and the fact that GPs no longer offer any meaningful out of hours service.