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At the heart of general practice since 1960

A&E won't kiss it better

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I’ve spent the last 48 hours being tailed by a TV crew trying to get me to say something outrageous on camera about frequent fliers, appointment non-attenders, heartsinks and other assorted time wasters. In particular, they wanted to know why some patients habitually turn up at casualty departments with problems that any sane person would recognise as trivial.

You’ll not be surprised to learn that my on-screen persona – as opposed to my on computer screen persona - was empathetic, sympathetic and frankly, generally bloody pathetic. I even sank low enough to mention hidden agendas, deep seated health anxieties and all the other mushy crapola I had stashed away in my Fluffy Locker to get me through revalidation. Hopefully most of that interview will end up on the cutting room floor, otherwise my status as the Hard Man of Primary Care will definitely be up for review.

In an effort to put the suffering patient’s point of view the chief inquisitor showed me an information leaflet published by an NHS Trust based somewhere south of the River Thames. The aim of the leaflet, it was clear, was to dissuade patients from showing up at the chronically overstretched A&E department at PFI Crisis University Hospital (Teaching).

‘Could you explain this?’ asked the girl with the microphone. ‘It says here that if you have diarrhoea you should consult a pharmacist. However, it also says that if you are vomiting you should see your GP. Suppose you have both? Where do you go first?’

‘Fair point, well made,’ I thought and then paused for dramatic effect while trying to think of an answer that didn’t imply that a hefty dose of loperamide from Poundshop and a side order of Man the F**k Up pills might be a more sensible option.

‘Tell me, Dr Copperfield, how is a patient in distress supposed to choose where to go based on the advice in this NHS leaflet?’

I wondered whether I could persuade her that pharmacists had particular training in the care of runny tummies and that many GPs had a special clinical interest in up-chucking. Then I remembered a similar leaflet that had been produced by my local NHS Trust. I produced a copy with a flourish: ‘You’ll see from this leaflet that patients suffering from diarrhoea and vomiting - or vice versa - are advised to attend their local 8am-8pm Seven Day NHS Walk-In Centre’.

These centres of excellence, I assured her, were staffed by specialist nurses who had post-graduate qualifications in both of the twin disciplines of poo-ology and barfiatrics.

‘So the take home message for patients is that A&E will not, as this leaflet makes clear, kiss anything better?’ she said.  Especially diarrhoea, I thought to myself. There’s only so much even the most dedicated casualty registrar will do for a patient.

It’s no wonder that people turn up at A&E after being presented with such a bewildering set of options. I’d probably do the same. Paralysed by choice we’d all plump for the most familiar. A&E has always been there, whereas walk-in centres, urgent care centres, NHS111 and minor injury units mean little or nothing to the punter in the street, especially when the world is falling out of his bottom.

Then I noticed the strapline at the foot of the leaflet: ‘A&E – we only deal with real emergencies’. That’s a lie and there’s the rub. They deal with anything and everything, always and everyone. Turn up at A&E with an insect bite or a sticky eye and they’ll sort you out within four hours or send you a bunch of flowers with a card apologising for keeping you waiting. They don’t send people away to get care from a more appropriate agency, even if that would be the most sensible option.

And maybe that’s no bad thing. What with all the GANFYD writing, GPPAQ scoring, dementia screening, QOF pointing, CQC appeasing and counter-terrorism activities I have to squeeze into a ten hour day I simply don’t have a moment to spare to deal with sick people.

 

Readers' comments (10)

  • I do like the repetition or was that just to check that we were paying attention?

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  • Perhaps he is paid by the word !

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  • If only :-)
    TC

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  • A& E will be like this sine die until triage is performed by doctors.
    Who would have the power and legal indemnity to chuck out all of the parasites in casualty.I too, was in a Sarf London cas dept. recently.About 50% of the waiting room was occupied by immigrants and teenage toms on their mobiles.But my catheter was passed expeditiously!These leaflets are bumph.

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  • Perhaps here in leafy Hampshire I practice in a parallel universe but our in house scrutiny of our patient's A&E attendances over the past year has shown that we believe only 10% of our patients went to A&E inappropriately.
    There has never been a Darzi centre within 15 miles of our practice area to take the load off us or A&E either.
    These patients, usually their ignorant, non-coping parents, are sent a letter reminding them of the error in their ways, advising them to contact GP In our Out of Hour's services in future. They would of course have been given this information on joining the practice.
    However, a 4 hour wait in A&E may be a small price to pay compared to running the gauntlet of the 111 system and their inappropriate advice.

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  • when shall we see you on TV?

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  • There is no doubt that many chargeable overseas visitors are using A and E and subsequent secondary care services without paying for the latter as they currently should. Govt plans include the suggestion of charging visitors for A and E. Who is going to check on this, and how are they going to do it? The NHS is haemorrhaging money to overseas visitors who do not pay as required - health tourism is a real and damaging problem;a radical overhaul is long overdue.

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  • It is all about money. People took money by the way they trick to fecth the NHS money. So many third parties, saying it is patient care or patient choice. Really speaking, if you really concerned about patients why the system encourags to cut the budgets and to reduce the hospital services. This is not to save lives, to muder patients. I never hard about reducing hospital factilities. The hospital services must be extended according to the population needs. Why reducing A&E services and putting the ball into GP's hands with insufficient funds. So many thrid parties are taking money and sitting on the pot to spend GP's money or patients' funds. Cann't you see this. These people who destroy the hospitals will be punished by God
    definitely believe it or not. I think all liers.

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  • Dr Mustapha Tahir

    Attending A&E first could be therapeutic. You'd be made to sit for at least four hours. During this period you may witness much more serious and urgent cases, mix with the usual culprits and benefit from a group therapy!!

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  • Hey, crazy idea, but how about taking all the gazillions ploughed into stumble in centres, 11bestgotoA&E1 call centres and instead invest in erm, A&E. Oh, and if you turn up due to your own stupidity (e.g. hoover / rectum related incidents) or alcohol, then you get charged £50

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder