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Independents' Day

A&Es face 'unprecedented demand' as four trusts declare alerts

Four hospitals have declared black or red alerts in the last two months, with another hospital experiencing ‘almost unprecedented levels of demand’ - which GP leaders warn will put general practice under even more pressure this winter. 

The A&Es at Bath’s Royal University Hospital and Northampton General Hospital declared black alerts in September and October, while Torbay Hospital declared a red alert in September because of a high number of attendances at A&E.

This is on top of the black alerts called at Addenbrooke’s Hospital, which declared a ‘critical internal incident’ because of a lack of beds, and 13-hour waits at the A&E department at Queen Elizabeth The Queen Mother Hospital

Meanwhile, University Hospitals of North Midlands NHS Trust wrote on Twitter that demand at County Hospital and Royal Stoke University Hospital reached ‘an almost unprecedented level', and urged patients to only attend A&E in the case of an emergency.

GP leaders have warned that this is unusual this early in the season, and there is a 'big fear' than general practice will not be able to cope with the added pressure placed on practices by the problems in secondary care.

This comes as NHS England chair Professor Sir Malcolm Grant told delegates at the National Children and Adult Services Conference this month that NHS England 'is more scared than we have ever been' about the upcoming winter, due to a heavy flu season in Australia and New Zealand - a reliable indicator for the flu season in the Northern Hemisphere. 

Last year, with a mild flu season, the Red Cross said it was deployed to help in urgent care services, the Government suspended elective care and non-urgent outpatient appointments, and the BMA warned the situation in hospitals was getting to ‘dangerous levels’.

This year, more trusts are already reporting problems:

  • A combination of high demand and triaging meant some patients at Wrexham Maelor Hospital in Wales were left waiting over 12 hours to see a doctor earlier this month, with a spokesperson for the Betsi Cadwaladr University Health Board apologising to patients;
  • Patients in Shropshire have been turned away from neurology services at The Shrewsbury and Telford Hospital NHS Trust (SaTH) since March, and the service has been suspended for the whole winter;
  • Torbay and South Devon NHS Foundation Trust said the trust declared a red alert ‘on a number of occasions’ during September because the A&E had a high number of attendances and many ‘who had very acute needs’;
  • GPs were asked to review referrals and take on patients to tackle a backlog of 30,000 patients waiting for treatment at NHS North Lincolnshire and Goole Foundation Trust.
  • United Lincolnshire Hospitals Trust (ULHT) has asked GPs to refer patients out of county for non-urgent ear nose and throat (ENT), cardiology, neurology and dermatology services due to a shortage of specialist doctors and long waiting lists.

Dr Robert Morley, policy lead for the BMA’s GP Committee, said: ‘While general practice is getting used to these alerts, it is indeed unusual to get such a bed crisis so early in the autumn and it doesn’t augur at all well for the winter to come.

‘Needless to say general practice has to deal with such workload crises all year round and does not have the safety valves that hospitals can call upon.’

Dr Peter Holden, former urgent care lead of the GPC, said: ‘Most hospitals have been teetering on red and black alert all summer. This not at all surprising. The fear we've all got is how the hell are we going to manage this winter. That is the big fear because we don't think we will. The system is so chronically under funded, so stretched to the limits that we just can't do any more.'

He added: ‘The system is absolutely at its limit, it's on its knees. This is just going to mean more work for GPs, more hassle, yet more pressure in an already crazy day.’

Readers' comments (7)

  • Now when I try to refer patient to orthopaedic, medicine or paediatric ,reply is send them to a and e. it takes long time to contact dr on call. now they expect consultant to take calls.

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  • This is not a medical or general practice problem, it is a systems and managerial problem. The solution requires better organisation and appropriate resourcing. Once again, everyone seems content to dump responsibility for solving the problem into general practice - because we cost nothing extra, and because we have (through good intentions) always rolled over to help the system. We should not accept that. I think Peter is wrong. We should do what we can, within reasonable limits, but our safety valve should be to send people to A&E whenever it is clinically appropriate, and also if we are ourselves overwhelmed due to our own poor resourcing. Things will only change if there are very visible signs of the problem. That will not happen until we take a stand. At the moment we are enabling the eventual collapse of the NHS by propping it up until it is no longer sustainable. It needs to make changes before it gets to that point otherwise it will be too late.
    New contract now please, Peter, on our terms or no terms.

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  • AlanAlmond

    Like I keep on saying, we need more GPs in a&e. Close down one or two local GP surgeries and get the GPs to do a&e triage instead. They can deal with all the folk with GP problems who came to a&e because they couldn’t get an appointment with a GP. They can refer them back to the surgery they closed down to see a GP there rather than a&e where the GPs are currently working.
    It’s basc common sense. Like everyone running to the castle and pulling up the drawbridge when the massing enemy approaches.

    Get GPs out of general practice!
    Put a GPs in every a&e!

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  • The elephant in the room, yet again, the word no one will say is 'Privatisation'.

    Successive governments have prepared the NHS for privatisation and pushed it into financial crisis so it appears the only answer to the NHS's woes will be privatisation. The working conditions are rapidly deteriorating, we cannot maintain staff, moral at rock bottom, money already rapidly funnelled into the private sector, mortality rocketing, waiting times increasing, hospitals and GP practices closing. Among the lowest ration of beds/doctors/% of GDP spent on health per capita compared with other developed countries, and falling.

    What is happening to the NHS is a planned assault and the BMA, Royal Colleges have been at time complicit and at other simply turning the other cheek.

    Don't worry though Celebrity Bake Off will be back on soon......

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  • Patients in the UK now see their GP on average 7-8 times a year. In New Zealand that’s 2-3 times a year. Life expectancy in both countries is around the same. The difference. You have to pay to see your GP in New Zealand.

    As patients demand more and politicians give empty promises and no one wants to be a GP anymore, the only solution is to charge. What else can we do?

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  • Medical Professionals have no say regarding allocation of resources , so why report this in GP Pulse?

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  • The "elephant in the room" is the mis-match between demand and resource. No amount of "efficiency savings", "working at scale", "new ways of working" will solve that one.
    Nobody wants to run for election on a ticket of putting taxes up (John Smith tried it - remember?).
    So, we drift inexorably towards an uncertain end, through progressively larger crises along the way.
    The US has an expression "whistling past the graveyard", which seems strangely and ironically appropriate.

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