This site is intended for health professionals only


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



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