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At the heart of general practice since 1960

Bring back the queue

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The NHS in England missed its A&E four hour waiting time target in Winter 2013. Just like it did in Winter 2012, 2011, 2010 etc etc. So what? The target was 95% and NHS England scored….. 94.3%. I reiterate. So what?

Many years ago, in the days before waiting time targets were thought of and patients were seen in A&E in order of urgency rather than order of arrival, I wrote a piece in a now defunct newspaper along the lines of: Mum rings GP surgery to inform us that her kid has vomited once and she wants him seen stat. Quite reasonably, Mum is told to obtain what we medics refer to as ‘A life’, take some ‘Man Up’ pills and let us know how things go with Junior over the next few hours.

She wasn’t happy. Eventually, under a good deal of duress we gave the boy an appointment for four hours hence. Which he did not attend. Instead, Mother called us from A&E to tell us that he’d been waiting three hours and hadn’t been seen yet and why can’t we ring the A&E people and tell them to get their expletive deleted fingers out?

She actually moaned to us that she’d have been better off waiting for the appointment we’d offered. Many of us eavesdropping on the speaker phone cried real tears of laughter.

Now the pendulum has swung as far as it can the other way. Patients rock up to A&E with paper cuts and acne and are guaranteed (as near as dammit) some quality time with a doctor within four hours. And we’ve all seen the results. And they’re still not happy.

It’s time to scrap the target, or at least replace it with something sane and workable. ‘If you need to be here, we’ll see you as soon as we possibly can. If you don’t need to be here, you’re in for a bloody long wait. Maybe six to eight hours if we’re busy with stuff that your Mum, your pharmacist, a walk-in centre, a minor injury unit or your GP isn’t better placed to deal with.’

And feel free to clear off and seek advice from any of the above if you don’t fancy a few hours sitting watching sicker people than you are get wheeled past you on gurneys.

There’s only one way we’ll get A&E services to work for the people that really need them. Bring back the queue.

 Dr Tony Copperfield is a GP in Essex. You can email him at tonycopperfield@hotmail.com and follow him on Twitter @DocCopperfield.

Readers' comments (9)

  • The 4 hour waiting target for A&E is just a measure of how efficient the department deals with patients. Whilst GPs tend to compare the 4 hour wait with a call to a practice it is actually more important for those being admitted - especially the frail elderly. If these cannot be admitted from A&E within 4 hours the hospital clogs up and starts to go into meltdown.

    I would personally make every person inappropriately attending A&E wait 3 hours 55 minutes for an appointment and tell them that when the pitch up

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  • Dear Tony
    I'm not sure you'll get the job commissioning urgent care for your CCG.
    But you are absolutely bloody right as usual.

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  • The problem here is that GP's are not proper doctors. Anyone who reads the daily mail knows that. They like to see a real doctor at the hospital who won't fob you off with " it's a virus" .You can get fancy investigations with lovely radiation and blood test- because you can't be too careful. If Gp's are denigrated any further we won't have any patients to see at all .

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  • Just finished a night shift in a and e as a gp trainee couldn't agree more

    Worst thing is we over investigate even the most ridiculous of complaints due to defensive a and e medicine

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  • Bob Hodges

    Amen

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  • Spot on!
    Trouble is if we dare challenge the unreasonable and service-abusing patient who is our master then we risk all hell breaking loose. Personally and just like the sketch, " I know my place".

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  • The Daily Mail have almost killed General Practice. I am prepared to throw the towel in, and I am in my 40s. Nothing is worth all this stress and endless media abuse. Let us leave this pike of steaming mess to Hunt and his businessmen friends and good luck to the public.....

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  • Although this article is written tongue in cheek, it should be taken very seriously. We all have first hand experiences of this phenomenon. I once triaged a child at midday to a 4pm appointment, for likely viral conjunctivitis. Dad was not happy and went to the local eye hospital. The discharge summary shows he pitched up at 13.00 and was seen at 14.20. I don't need a degree in behavioural psychology to see the positive reinforcement of attendance that has just happened.

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  • The PCT's/CCG's used to run a 'choose well' traffic light campaign which has now unfortunately been discontinued. I would like to see it reinstated and called the 'is your visit really necessary ?'
    The stupidity of the general public in misusing A&A is the main cause of the current crisis.

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From: Copperfield

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