Dr David Turner on the surge in demand for emergency appointments and learning to say no
Where in the NHS, apart from general practice, would one doctor see 12 acutely ill patients in an hour after a morning surgery and before two hours of admin work and an evening surgery?
There is no other part of the healthcare service, not even the busiest of A&E departments, where doctors are working at this rate.
This is how we have been working in our practice for the past three weeks. An already heavy workload of ‘emergencies’ has been made immensely worse by the recent hyping up of Strep A infections in the mainstream media.
I don’t mean to underplay the potential severity of this disease and the tragic deaths that have occurred, but to be quite blunt, it is not possible for us to see every child with a cough and cold during the winter.
In my practice this week, we have had to take to locking the doors 15 minutes before the time we start booking patients in the emergency appointment slots. Patients were turning up earlier and earlier to be first in the queue, and our waiting area was beginning to resemble the outside of an Apple store the night before the release of a new iPhone.
The irony of this is that barely 12 months ago, patients were standing two metres apart and voluntarily waiting outside the surgery until the waiting area was less crowded out of fear of catching Covid. Now it seems that everyone who wants an emergency appointment – and literally all of them will likely have an infectious illness – is quite happy to cluster together near the reception desk in a superspreading rugby maul. How short memories are.
During the pandemic, I was one of those on the extremely liberal end of the anxiety spectrum and regularly preached about the overly draconian Covid spacing rules. However, I really do think that when we have people with reduced natural immunity due to several lockdowns, we should not be allowing the infectious to congregate like battery hens.
We have put a sign on our door explaining that due to circumstances beyond our control, we will no longer be able to meet all demand for emergency appointments. We have also listed alternative providers that patients may use when all our emergency appointment slots have gone. This is an unprecedented action in my working life, and I am sad to say I think it is how the future will be.
There is no cavalry coming to save us, so we need to do the best we can to look after ourselves – and this means learning to say no.
When we have no more appointments, we really mean that.
Dr Turner is a GP in Hertfordshire. Read more of his blogs here
Sad to see a medical professional repeating the misinformatiopn about lockdowns reducing natural immunity, and to keen to adhere to basic IPC measures like distancing.
It is not only covid, but all winter viruses that are reduced by distancing, avoiding indoor crowds, and using masks and hand hygeine, including Ebola, flu, rhino, adeno and norwalk viruses, none of which are pleasant experiences, and none of which are essential to catch to increase ‘natural immunity’. In fact, Catching Covid reduces natural immunity to covid and most other viral amnd bacterial infectious, even if it is an asymtptomatic covid at the time. Catching it repeatedly exponentially damages our natural immunity and makes us more prone to serious consequences and other infevctions.
It is therefore high priority that we encourage PPE and IPC measures and call out those who think it necessary to spread infection to ‘help’ others, because it is a complete untruth.
The communication about strep A has been deeply unhelpful and I wouldn’t be at all surprised if deaths result from the overwhelm of services and difficulties accessing antibiotics. Who on earth thought it was a good idea to tell every child with a sore throat they needed an urgent GP appointment? Complete and utter madness.
Unfortunately there often seems to be a problem with same day access. You cannot just say no more appointments go to ED. Well, you can but mostly it’s just poorly organised capacity rather than lack of it.
Get your ARRS staff to sit with the receptionist, listen to people’s calls and let them get triaged on the spot not bounced off a snotty receptionist.
Define ‘acutely ill patients’. Do you mean febrile children? Coughing adults? What sort of acutely ill patients do you have in mind?
12 booked in during a session? Do you have the right skill mix to see them, or are you just overbooking your own list which suggests poor planning.
Anonymous doesn’t seem to inhabit the same planet as me never mind the same country and profession. If you really think that being overwhelmed by demand beyond your capacity can be fixed by being better organised you clearly work for the DOH and are part of the problem not the solution. There are very “organised ” practices who seem to lose patients whom seek help elsewhere. I still do OOHs and it is interesting to see the effect of their organisation.
Anonymous
‘Snotty receptionist’ ???
Our receptionists are subjected to this type of low grade abuse on a daily basis, and it is unacceptable.
You ill-informed verbiage is insulting, patronising drivel
There’s a lot of varying opinions on this piece already, which perhaps highlights part of the problem.
We all organise our appointments in vastly different ways.
– For some it’s “all pre-bookable”, others all “on the day”, many a hybrid.
– Some do “total triage”, others do none at all. Increasingly ARRS staff are deployed to manage these cases, but many patients “only want to see a GP”.
– Some GPs are happy to dole out antibiotics based on a few symptoms detailed to a receptionist, others retain a very high bar of only prescribing to patients properly assessed.
– Some practices have many clinicians , others barely surviving on skeleton staffing.
– Some practices have lots of overspill and OOH services to send patients to, others have none
– Some practices have small list sizes, many are already dangerously overstuffed with patients due to local practice closures.
– Some have an “emergency duty” doctor, others don’t have enough GPs for this “luxury”
– Some have virtually unlimited “emergency slots “, others will do this case by case, many will simply declare themselves “full” for fear of being overwhelmed, stressed out, and therefore liable to make poor rushed decisions that could result in litigation.
(Etc, Etc….)
This massive variation can be a strength as local practices organise themselves according to their local needs, but a Health Scare exposes these differences to the light.
Lot of banter here. Because there is no solution. Just tailor made sticky plasters to your local community.
Feels like you are always thinking on your toes to stay afloat of the “agenda” and medicalisation “narrative”. Activity for nothing. Monitoring for everything. You can have 100 slots every day – you will not be paid one ounce more. You can start at 8am, instead of 9am or run into 2pm or extra evening slots at 7pm. No one cares. You can be a good-doer and go for 200 slots a day – and be heroic with 5 minute consultations. Still – not paid anymore and no one could give two hoots up there. You can do 20% same day, or 80% same day – still – no one cares. You can see children same day to improve “access” and save A+E. No one cares. You can see elderly walk-in face to face. No one cares. You can even see chest pains just to be an angel – no one cares, not even the GMC. You can run a free yoga class on weekends for wellbeing and a class on how to buy fruit and veg and be an LGBT champion with medals on your website. No one is bothered. And you can do all the Consultant’s work and block referrals, whilst he is in his private clinic creaming the overflow of backlog and protect an extra 50 A+E slots a week. And still – no one cares. You just get burnt into a hole. You can even be redirected lots from 111, schools, care homes, pharmacists and allied health professionals and still – no one cares one inch. It is a model which had its worth one time ago. In 2023 – you will have to think like a dentist whether you like it or not, because they are coming for you. You’ve already huddled in a PCN for slaughter. Dentists were your sharper friends at university, who bargained their worth early to the public, and got respect for less access, more payment and no media villification for it. They are akin to the bankers, solicitors and accountants. Look around you, and ask yourself – what exactly are you doing – and who are you doing it for? The puppeteer is watching you.
I know one thing, anonymous hasn’t made any friends here today!🤣 Perhaps they should be talking to their snotty receptionists themselves rather than asking their ARRS staff to do it. Anonymous, if you are actually a GP and think your life is hard, try walking a mile in their shoes you jumped up little twit.
“reduced natural immunity due to several lockdowns” – there is no such thing, as David Church rightly says. Important not to repeat and spread unfounded misinformation. ‘Immunity debt’ is a libertarian invention and has no immunological basis.
A 2-year lockdown will not weaken adult immune systems per se though the stress of social isolation may: https://medical.mit.edu/covid-19-updates/2020/05/all-social-distancing-weakening-our-immune-systems
As others rightly state, “anonymous” is wrong to think that by being better organised, we can match supply to demand. When self care is replaced by healthcare no system in the world can cope. Media frenzy on iGAS failed to focus on the rarity and the fact that by the time it’s iGAS it is sepsis rather than a mere strep A infection. Fear, disinformation and reduced self care coupled with a decreasing workforce mean demand levels that no amount of planning will ever resolve.
“avoiding indoor crowds” at Christmas might be difficult
I am not sure we should be encouraging our children to lead pious lives of studious germ-avoidance – there is a soul as well as a body !
@Patrini: absolutely on the money. No-one cares. That’s it. I think it has to break and then be missed and then be valued. It’s all about re-defining society’s priorities in this “comfort democracy” . Primary Care sees 1 million people a day in the UK: that’s the truth of our value. If we are willing to take a risk with our (withering) pension we should just sit this one out. My accountant straightened me out on the pension question: a good pension from an under-earning job is not as good as a bad pension from a high-earning job. Mmmm.