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A faulty production line

Putting GPs in A&E wouldn't work - here's my alternative solution

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There needs to be someone in A&E to deal with inappropriate attenders: true. That someone should be a GP: false. It should, in fact, be someone mad, bad and dangerous to know, who gives patients who are neither accidents nor emergencies a well-deserved bollocking, plus advice to get to the pharmacist, get a GP appointment or get a life.

So let’s be bold

Someone, in fact, a bit like me when I was doing A&E as part of my VTS and encountered a grown man attending with earwax. At least that gave me permission to shout at him. And what I shouted was in response to his claim that his GP’s number was ‘always engaged’ and that he had no money left to try again (note to readers whose names don’t end in ‘asaurus’ – back in the day, pre-mobiles, we had to rely on payphones). After shouting, I marched him to the nearest phone, paid for the call myself, secured that GP appointment, walked him to the exit and waved him a cheery goodbye. Before shouting some more.

I like to think that this kind of approach might actually change behaviour. What won’t is parking a GP in A&E to vindicate all those inappropriate attendances by providing instant GP-ratification. As for those who bleat that much of A&E abuse results from inadequate primary care appointment provision, I say, don’t make me laugh. It’s mainly about geography and illness behaviour, with those nearest and dearest – as in habitual NHS resource-abusers – most likely to form a disorderly A&E queue.

And even if GP appointment provision is a teensy part of the problem, you won’t solve that by taking GPs out of the practice frontline to man the A&E trenches, will you?

So let’s be bold. If A&E must give feckless timewasters a warm welcome, how about using a flamethrower?

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

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Readers' comments (3)

  • Healthy Cynic

    The problem is quite simply demand isn't it.
    My practice of 5000 punters offers well over 30000 appts (GP, Nurse, HCA)annually. To my reckoning this means that every man, woman and child in the area visits us (on average) every 8 weeks. This doesn't even take account of OOH and A/E consultations. I would only expect chronically sick people to require that level of input. What's happened to that cohort of people aged 5 - 55 who generally have very little wrong with them?
    The well have become the worried well (because we keep telling them that seeing doctors and taking tablets is something everyone should do),the worried well have become the needy well, and the sick have become... well I don't know because we don't really have time to look after them any more.

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  • already given up hope NI GP

    EDs should have 2 entrances
    one for ambulances and GP referrals
    one for everything else
    the everything else area would need some sort of medical expertise to triage out a genuine emergency from the rest
    what that medical expertise is who knows but it probably would need a mixture of doctors nurses and paramedics
    then you have your next problem where do you get this expertise from there is nobody out there at present with spare capacity.

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  • I have always said that an A+E consultant needs to be sat on the front desk, just like experienced Gps need to be answering 111. Of course these jobs would be a nightmare so it should be paid very, very well, and some medicolgal protection, but everything upstream will then function just fine.

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From: Copperfield

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