Having Gps In A&e Units ‘Doesn’T Work'

[Bossybabe]

Finally! Someone has realised that creating the conditions for treatment creates the demand. If we build it, they will come.

It's been bleedin' obvious to me since the introduction of GP unit in A&E where I live that all the morons with acopia flock to it for reassurance. I worked in ambulance control at the start of 111. What a waste of resources - seeing people who haven't got Elastoplast in the house and would rather come to see a GP - and incidentally creating delays for people who really need to be seen.

http://www.thetimes.co.uk/article/1ea14668-0013-11e6-a930-0e570c2a63fb

STEPS OFF SOAPBOX.

[Bloo Loo]

its entitlement init

[spyguy]

Finally! Someone has realised that creating the conditions for treatment creates the demand. If we build it, they will come.

It's been bleedin' obvious to me since the introduction of GP unit in A&E where I live that all the morons with acopia flock to it for reassurance. I worked in ambulance control at the start of 111. What a waste of resources - seeing people who haven't got Elastoplast in the house and would rather come to see a GP - and incidentally creating delays for people who really need to be seen.

http://www.thetimes.co.uk/article/1ea14668-0013-11e6-a930-0e570c2a63fb

STEPS OFF SOAPBOX.

Friend works in a regional hospital.

Nose + Ear unit.

30% of their appointments do not show.

Different manifestation of the same problem - people take the p1ss when something is 'free'.

Put a charge on GP visits- £20.

A+E charge - £50.

No show at Hospital - £100

[DTMark]

Conversely, last year I had some sort of chest infection that progressed to bronchitis.

Waiting time for an appointment: one month. Went to private BUPA GP.

This year wanting to see the doctor on another matter - waiting time 3 weeks.

Have changed GP practice. This one "only" has a two week lead time.

Partner has problem involving bleeding, calls GP, diagnosed over the phone, "come back in a week if it's still bleeding".

It's still bleeding.

Lead time one month.

Has had to falsely declare it to be an emergency to get past the filtering and get an appointment.

[StainlessSteelCat]

Thanks for introducing me to a new word - acopia - bossy babe.

[Flopsy]

Friend works in a regional hospital.

Nose + Ear unit.

30% of their appointments do not show.

Different manifestation of the same problem - people take the p1ss when something is 'free'.

Put a charge on GP visits- £20.

A+E charge - £50.

No show at Hospital - £100

I hate "no shows" at hospitals. This will be adding to the waiting list for my ENT consultant.

However, as a user of the system a couple of things don't work and I think need to be dealt with before a charge is imposed

1. I can't get through on the phone to the London hospital my ENT is at to change or cancel a booking. It can be engaged all day for days. No exaggeration I have had to try for 4 days to change an appointment

2. Letters don't arrive for appointments so I don't know what I have one. 2 years ago I was referred to a London hospitals clinic to investigate cancer. My appointment letter didn't turn up. When I chased this it turned out there had been a typo on my address. When my appointment did arrive in the same envelope were 3 other appointment letters for other people at the same clinic. The line to register at the clinic was chaos. Some had been cancelled and never received a letter.

3. Renting means moving home all the time. This causes problems with regular appointments. Having something like cancer is bad enough. Try adding in a home move or two or three, having to re-register with GP's and update hospital records etc all the time. Royal mail redirection doesn't work for me.

4. Choose and book was never trialed at any of my GPs's so it's a question of waiting for a letter. See above.

5. If 30% extra people at my ENT clinic showed up we would be there all night

[Bossybabe]

Thanks for introducing me to a new word - acopia - bossy babe.

It really isn't that new. Docs have been using it for the last 40 years to my certain knowledge.

[DTMark]

1. I can't get through on the phone to the London hospital my ENT is at to change or cancel a booking. It can be engaged all day for days. No exaggeration I have had to try for 4 days to change an appointment

The GP practices here have online and (automated) telephone booking systems for appointments.

The only problem with this is that there aren't any appointments.

So you have to call.

The population hasn't increased in size by any significant degree or at all that I can see.

There remain the same number of GP practices.

When the lead time for an appointment is two weeks or more, there basically is no GP practice.

There is however a "Walk in Centre" in Woking (IIRC) staffed seemingly exclusively by a single nurse who can only deal with certain types of things before referring you to your GP.

All of this is why I cannot fathom why the country isn't full of private GP practices by now. Our nearest one, Reading (BUPA) has actually withdrawn the service.

[spyguy]

I went to a walk in centre two or three times and on each visit they told me to go to my GP after taking my blood pressure and heart rate, etc. Total waste of time.

And that, in one sentence, is wha is wrong with the NHS.

Its an inefficient, make-work scheme, with no-one being held accountable.

[spyguy]

I hate "no shows" at hospitals. This will be adding to the waiting list for my ENT consultant.

I hate "no shows" at hospitals. This will be adding to the waiting list for my ENT consultant.

However, as a user of the system a couple of things don't work and I think need to be dealt with before a charge is imposed

1. I can't get through on the phone to the London hospital my ENT is at to change or cancel a booking. It can be engaged all day for days. No exaggeration I have had to try for 4 days to change an appointment

2. Letters don't arrive for appointments so I don't know what I have one. 2 years ago I was referred to a London hospitals clinic to investigate cancer. My appointment letter didn't turn up. When I chased this it turned out there had been a typo on my address. When my appointment did arrive in the same envelope were 3 other appointment letters for other people at the same clinic. The line to register at the clinic was chaos. Some had been cancelled and never received a letter.

3. Renting means moving home all the time. This causes problems with regular appointments. Having something like cancer is bad enough. Try adding in a home move or two or three, having to re-register with GP's and update hospital records etc all the time. Royal mail redirection doesn't work for me.

4. Choose and book was never trialed at any of my GPs's so it's a question of waiting for a letter. See above.

5. If 30% extra people at my ENT clinic showed up we would be there all night

Friend hates it.

They get fined for missing targets.

The reason why they did not hit targets is the no-shows, which prevents them operating at 90%.

I agree with your other points.

We do not need more money spent on Drs + nurses in the NHS.

We need it spent on better systems, run + operated by people who can manage them rather than the over promoted pet-orderly morons that makes up most of the NHS's management.

[Hail the Tripod]

The GP practices here have online and (automated) telephone booking systems for appointments.

The only problem with this is that there aren't any appointments.

So you have to call.

The population hasn't increased in size by any significant degree or at all that I can see.

There remain the same number of GP practices.

When the lead time for an appointment is two weeks or more, there basically is no GP practice.

There is however a "Walk in Centre" in Woking (IIRC) staffed seemingly exclusively by a single nurse who can only deal with certain types of things before referring you to your GP.

All of this is why I cannot fathom why the country isn't full of private GP practices by now. Our nearest one, Reading (BUPA) has actually withdrawn the service.

The system in Woking seems to be: you phone your GP and get told there are no appointments, but try the walk in centre, you go to the walk in centre, who tell you they cannot write prescriptions, the nurse then phones the GP practice and makes you the appointment you tried to make in the first place.

[spyguy]

The system in Woking seems to be: you phone your GP and get told there are no appointments, but try the walk in centre, you go to the walk in centre, who tell you they cannot write prescriptions, the nurse then phones the GP practice and makes you the appointment you tried to make in the first place.

The NHS world ranking is a scam.

We core high because Universal healthcare is available to everyone.

The fact that they do not take into account how long and hard it is to access that healthcare is p1sspoor.

The ranking need reworking with the metric 'Universal health care avaiable in a timely i..e 24h manner'.

Watch the NHS fall to 3td world levels.

[ccc]

Yep I am also amazed at the lack of Drop in private GP type clinics around. I would use them.

Many a time I have had a sports type injury - nothing major but causing me hassles and unfortunatley for this type of thing - the NHS is next to useless. So I end up paying for a private physio - but that of course only offers some of the services that a private 'all rounder' would.

I am thinking going in - initial quick once over - can you provide me a scan to see what the problem is rather than just telling me its fine and it will go away when it does.

I would pay for a service like that. I think I have mentioned before I did exactly that up a mountain in France a few years ago when I got a wee twinge in an achilles.

Saw a doctor, x-ray - came back in 2 hours to see bloke who did an ultrasound to look at the tendon in a bit more detail - prescription for some pain killing gel and some strapping. Job done. IIRC 80 all in.

Now maybe that was subsidised but it was a private clinic in a private ski resort and I didn't have to provide my EICC card or anything so I am not sure.

It was a great service.

[spyguy]

Yep I am also amazed at the lack of Drop in private GP type clinics around. I would use them.

Many a time I have had a sports type injury - nothing major but causing me hassles and unfortunatley for this type of thing - the NHS is next to useless. So I end up paying for a private physio - but that of course only offers some of the services that a private 'all rounder' would.

I am thinking going in - initial quick once over - can you provide me a scan to see what the problem is rather than just telling me its fine and it will go away when it does.

I would pay for a service like that. I think I have mentioned before I did exactly that up a mountain in France a few years ago when I got a wee twinge in an achilles.

Saw a doctor, x-ray - came back in 2 hours to see bloke who did an ultrasound to look at the tendon in a bit more detail - prescription for some pain killing gel and some strapping. Job done. IIRC 80 all in.

Now maybe that was subsidised but it was a private clinic in a private ski resort and I didn't have to provide my EICC card or anything so I am not sure.

It was a great service.

Why amazed?

Due to hard bargaining during Labour's years, GP pay went from 50K -> 100K and, not resting on their laurels, Labour managed to negotiate hat the GP does not have on-call services.

Poof! Went private GPs as they went back to the NHS - as private contractor, which most GPs are anyway.

Open up more Mecial schools.

Pump more money into training and use the number hammer out useless GPs + DRs.

Dont let the BMA (DRs union) dictate how many are trained each year.

[SarahBell]

2. Letters don't arrive for appointments so I don't know what I have one. 2 years ago I was referred to a London hospitals clinic to investigate cancer. My appointment letter didn't turn up. When I chased this it turned out there had been a typo on my address. When my appointment did arrive in the same envelope were 3 other appointment letters for other people at the same clinic. The line to register at the clinic was chaos. Some had been cancelled and never received a letter.

4. Choose and book was never trialed at any of my GPs's so it's a question of waiting for a letter. See above.

Choose and book failed. Numerous times. Appointments cancelled as I was checking in. They claimed they'd sent a letter but it never arrived, and being handed a letter printed out in front of you hurts.

I did then miss an appointment but I've no idea how - I assume that was an appointment they made and didn't tell me. \

Adult medicine had about 6 nurses stood about doing nothing. They measured my height but whilst I was wearing my heels and wouldn't take that into account. Still it helped my BMI I spose!

[sPinwheel]

Privitise the NHS. Apparently that's fixes all these problems.

[spyguy]

Privitise the NHS. Apparently that's fixes all these problems.

No.

Make it work better.

NHS is lousy compared to other, Western European healthcare systems.

[Bloo Loo]

Privitise the NHS. Apparently that's fixes all these problems.

Privacy and dignity is very important in the NHS.

Not sure about Privit hedges though

[Bloo Loo]

Choose and book failed. Numerous times. Appointments cancelled as I was checking in. They claimed they'd sent a letter but it never arrived, and being handed a letter printed out in front of you hurts.

I did then miss an appointment but I've no idea how - I assume that was an appointment they made and didn't tell me. \

Adult medicine had about 6 nurses stood about doing nothing. They measured my height but whilst I was wearing my heels and wouldn't take that into account. Still it helped my BMI I spose!

Friend of mine (used to be NHS affiliated osteopath) was TOLD she would have to have Choose and Book at her clinic.

She needed...ADSL line £500, router and computer, £1000, then a monthly fee.

she did it all herself for a fraction, then the system, using outlook as the client, didnt work at all.

useless.

[Bossybabe]

The NHS world ranking is a scam.

We core high because Universal healthcare is available to everyone.

The fact that they do not take into account how long and hard it is to access that healthcare is p1sspoor.

The ranking need reworking with the metric 'Universal health care avaiable in a timely i..e 24h manner'.

Watch the NHS fall to 3td world levels.

It's at third world levels already here. A friend of mine had a second mastectomy last Friday.

Her consultant had broken his ankle, so it was done by a locum. To quote my friend: "He asked what side I was having done (he was looking at my naked top half) and so I told him right so he drew an arrow on me so that he would be certain which boob to take. In the ward, was not fed properly, as the nurse doing the food was called away to help someone in the toilet. She came afterwards and said the food was not hot but not cold. There was a choice of a slice of pizza or beef stew. I had a cheese sandwich which I did not eat but fortunately the lady in the opposite bed phoned her husband and he made us both a sandwich and came up with that, a packet of crisps and a pear. If I had stayed in today I would have had a sandwich for lunch and evening meal. No rest all night and suspect drug info."

Reinforces my decision to have carpal tunnel surgery at the teaching hospital on the mainland, where I had my knee transplant.

[SarahBell]

I can't read the article about why GPs in A&E doesn't work.

Do people want to see GPs about stupid minor things?
Well put the GPs behind a pharacy counter and let the pharmacy triage them.
When someone gets it wrong and someone dies it'll be all over the papers.

People expect to be able to see a GP about anything no matter how minor. Chemists are not private places even with consulting rooms.

What is the answer? Charge people? Allow so many free visits a year? Refund if you're sick enough to pass go?

[spyguy]

I can't read the article about why GPs in A&E doesn't work.

Do people want to see GPs about stupid minor things?

Well put the GPs behind a pharacy counter and let the pharmacy triage them.

When someone gets it wrong and someone dies it'll be all over the papers.

People expect to be able to see a GP about anything no matter how minor. Chemists are not private places even with consulting rooms.

What is the answer? Charge people? Allow so many free visits a year? Refund if you're sick enough to pass go?

Charge.

Fees are there to act as hurdle/deterrent for timewasters and not as revenue.

A friends a GP in my home town. A good 40% of his surgery time is spent with the same time wasters.

£20/visit will see those disappear.

A lot of OAPs just use a GP like they'd use chrich bingo nights - something to do/occupy their time.

[workingpoor]

I hadn't really had much dealings with the NHS system (beyond long GP waiting times) until i suffered a broken leg recently.

I discovered an outdated, oversubscribed, failing system with alot of poor attitudes from non medical admin staff.

My A&E visit at 1am on a wednesday was pretty much standard stuff 2hr wait then a prod & xray.

Cast fitted and crutches provided etc.

Only real problem were the malingerers and drunk students in groups clogging the waiting room.

Should have bouncer type security to weed out this type.

The problems came with the follow on consultations & CT scans etc

They send you a letter out inviting you in for a consultation and from there it all goes pearshaped.

Was told i needed a CT scan and it would be within 7 days as emergency, i waited 10days then phoned them up, no record of request being recieved.

Phoned the helpline and the consultants office all gone home by 4pm on a friday

nothing can be done until 9am monday morning!

This is the problem and one i hope Jeremy Hunt absolutley crushes because it needs addressing.

I eventually had to organise the CT scan myself by contacting the CT dept and a nice lady decided to help me and contact the consultant and sort the request out.

I got a scan within 2 days.

Now Consultant led clinics? who is familiar with these?

it seems you have a consultant who leads the clinic, but you see one of the junior doctors under the consultants command. It is unlikely that you will ever get to see the Consultant in fact your appointment letter will tell you so in a disclaimer printed on the bottom.

It was one of these junior doctors that messed up my CT scan request and left me waiting weeks for something that hadn't even been organised.

I did in fact get to see my particular Consultant on the last occasion as my appointment was on the day of the first junior doctors strike! So the Consultants had to run the Fracture Clinic!

They had Nurses doing all the organising and menial tasks.

I believe the whole junior Doctors thing is about them not going to get the same lucrative pay & conditions of these consultants that they currently work under.

Edit: IMO walk in centres are only any good if they are attached to a hospital and have full X-ray facilities etc

The one's out in community centres are a waste of time and usually have to refer you back to your GP or A&E

[SarahBell]

http://www.careuk.com/news/research-links-walk-in-centres-reduction-in-ae-visits
This seems to say GPs at walk in centres cut A&E visits.

So put the walk in centres next to A&E and then send people from one to the other.

[spyguy]

I hadn't really had much dealings with the NHS system (beyond long GP waiting times) until i suffered a broken leg recently.

I discovered an outdated, oversubscribed, failing system with alot of poor attitudes from non medical admin staff.

My A&E visit at 1am on a wednesday was pretty much standard stuff 2hr wait then a prod & xray.

Cast fitted and crutches provided etc.

Only real problem were the malingerers and drunk students in groups clogging the waiting room.

Should have bouncer type security to weed out this type.

The problems came with the follow on consultations & CT scans etc

They send you a letter out inviting you in for a consultation and from there it all goes pearshaped.

Was told i needed a CT scan and it would be within 7 days as emergency, i waited 10days then phoned them up, no record of request being recieved.

Phoned the helpline and the consultants office all gone home by 4pm on a friday

nothing can be done until 9am monday morning!

This is the problem and one i hope Jeremy Hunt absolutley crushes because it needs addressing.

I eventually had to organise the CT scan myself by contacting the CT dept and a nice lady decided to help me and contact the consultant and sort the request out.

I got a scan within 2 days.

Now Consultant led clinics? who is familiar with these?

it seems you have a consultant who leads the clinic, but you see one of the junior doctors under the consultants command. It is unlikely that you will ever get to see the Consultant in fact your appointment letter will tell you so in a disclaimer printed on the bottom.

It was one of these junior doctors that messed up my CT scan request and left me waiting weeks for something that hadn't even been organised.

I did in fact get to see my particular Consultant on the last occasion as my appointment was on the day of the first junior doctors strike! So the Consultants had to run the Fracture Clinic!

They had Nurses doing all the organising and menial tasks.

I believe the whole junior Doctors thing is about them not going to get the same lucrative pay & conditions of these consultants that they currently work under.

Edit: IMO walk in centres are only any good if they are attached to a hospital and have full X-ray facilities etc

The one's out in community centres are a waste of time and usually have to refer you back to your GP or A&E

Thats standard.

There's too many people and they are not having their ar5ses kicked.