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How can we fix the A&E crisis? Make patients wait

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Our esteemed colleagues the People In Green Pyjamas are being kept waiting for so long outside A&E departments along the Costa Geriatrica that they’re being told to offload their cargo after 45 minutes and move on to the next job.

Paramedic spokespersons have expressed anger and concern at the likely outcome. After all, they’ll now only have time for three cups of tea while chatting to Mrs Wobbly in the back of the van as she waits, handbag on lap, for a reassuring set of X-rays and unnecessary blood tests, followed by a spurious but money-making diagnosis of “presumed sub-clinical urinary tract infection” and a three-day supply of trimethoprim.

The fact is, if you arrive at A&E by ambulance and you haven’t been transferred to the nurses indoors after three-quarters of an hour, you probably didn’t need the ambulance in the first place.

All of this suggests a new and radical solution to the current A&E crisis: make the buggers wait (perhaps in a specially designated area that could be termed a “waiting room”).

Move them over from the “real” A&E to the Department of Trivial Complaints and Lame Excuses, which deals with questions such as why they didn’t self-care, talk to a pharmacist, ring their GP or, simply, man the f**k up. (Note the absence of an option to call NHS 111 from that list - not even I’m heartless enough to suggest that).

The only reason why people believe that they have to be seen within four hours is that some lame-brained political advisor once suggested that patients who “believe themselves to be ill” on whatever ludicrous grounds should have the right to be seen, treated and streeted within four hours.

Yes, back in the day when most of you were still flicking ink pellets at your teachers, there was no such thing as an A&E waiting time target. Patients were still “rushed” to Casualty, because there was, and still is, no other recognised way to arrive.

But after that they sat down in orderly rows and were told to wait their turn, which, if they had attended for trivia, might have been a long time coming.

For example, one morning my patient Mrs Demander rang me to say she’d had a sore throat all night and wanted “sumfink done abaht it”.

After a prolonged exchange of views, which to my mind proved that she didn’t have laryngitis, I agreed to see her after lunch.

Fast forward to mid-afternoon. She’d called back, but rather than passing the call onto the afternoon duty doctor, the receptionists put the call through to me on the grounds that I “might enjoy this one”.

Mrs D was ringing to tell me that she’d gone to A&E (as is her right as a tax-payer) and that, six hours later, she was still waiting to be seen. And she wanted to know what I was going to do about it.

I promised to ring the Casualty matron, and I did, telling her: ‘Keep her there until I knock off at 5.30pm, and there’s a box of Milk Tray in it for you.’

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield

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Readers' comments (9)

  • We have done our patients a dis-service, by making access more and more available - we have stoked demand. We must make access appropriately available, not universally available. And continuity is the key here.

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  • Una Coales

    In New York City, over 20 years ago, the city managed A&E demand by making non urgents wait in the waiting room for 8 hours+. They soon drifted away one by one. They were monitored by CCTV camera to catch any missed urgents who would then be called through sooner. As only one surgeon and one medic manned ER at night, an 8 hour wait was the norm as doctors decided on who needed to be seen urgently (blue lighted ambulances, trauma, gunshot wounds, machete attacks, jumpers, car vs pedestrian, etc. Didn't take a genius to work out how to prioritise) Doctors triaged and not managers with clipboards trying to tick the 4 hour target box. In fact, there were no managers back then, however did a level one trauma teaching hospital cope?

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  • Well said!

    If I had it my way, Id have them paying a fee of £10 to attend for the privilege of waiting for 8-12 hours to be seen.

    It is ludicrous what our population demands - and I fully agree - many of them should just 'man the f*** up'.

    Those of us very early in our careers are thinking long and hard about the point of remaining in this country as we are used as a political football once again for some complete and utter hunt to come and screw it all up again.

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  • Classic

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  • If you drop the thermostat by 2 degree in the waiting room I suggest the NHS may make profound savings.

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  • It is provider induced demand. Minor injury, walk in, urgent care, GP Practices, OOH, pharmacists, health visitor, maternity 24 hr self referral,A /E. How medically unwell is our public?

    The next step to control demand- have a GP in the basement of every house?

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  • It used to be the Bank Manager in the cupboard ! Can't remember which bank that was the TV advert for! But, even they are hard to find now!

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  • Having waited 8 hours in the last 7 days in Charing Cross A & E, the offensive comments of your contributors make it easy to see why there is a four hour target.

    Blaming the patient for failures in the system be it caused by reorganisation of the NHS, lack of funding or poor management or any other reason is not right or helpful...

    The A & E service until four years ago was meeting the targets, there has been no massive epidemics, no massive disasters or terrorist outrage, people have only aged by one year each year yet there are patients turning up to A & E in their tens of thousands who used not to do so!

    Fix the problem, don't blame the patient!

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  • I think the Charing Cross A&E matron is due a box of chocolates.

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From: Copperfield

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