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09-01-2017, 18:35   #1
Margarita Ma
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Jeremy Hunt Is moving the goalposts again. He has said that the four hour target for seeing patients in A&E should be limited to "Urgent Cases".
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09-01-2017, 18:47   #2
Supertramp
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Originally Posted by Margarita Ma View Post
Jeremy Hunt Is moving the goalposts again. He has said that the four hour target for seeing patients in A&E should be limited to "Urgent Cases".
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A&E should be for urgent cases only anyway. The reason why they're so clogged up is because people go to A&E with a cold or a sprained ankle.
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09-01-2017, 18:49   #3
unbeliever
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If it means that people who can and should see their GP have to wait longer that's fine. Maybe if they're kept waiting long enough they'll go away. If it's people outside that category there has to be some reasonable target.

---------- Post added 09-01-2017 at 18:49 ----------

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A&E should be for urgent cases only anyway. The reason why they're so clogged up is because people go to A&E with a cold or a sprained ankle.
Great minds...
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09-01-2017, 18:51   #4
Robin-H
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Jeremy Hunt Is moving the goalposts again. He has said that the four hour target for seeing patients in A&E should be limited to "Urgent Cases".
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It's a difficult situation.

There are many more people using A&E than when the targets were originally set (something like 9million, although I'm unsure if that is a annual figure or not). The NHS also says that about 30% of the people who go to A&E do not need to be there, which I can well believe reading some of the stories of why people go to A&E.

I believe Hunt was saying that the 4 hour target should apply to the 70% of people who do actually need go to A&E, and so they shouldn't give equal priority to people who don't need to be there.

I'm not sure how you stop people who don't need to go to A&E from going - as I imagine it won't be obvious in all cases that you don't need to go. However people have also been to A&E in order to get false nails removed or hair extensions removed. I don't mind if they have to wait more than 4 hours.

https://www.theguardian.com/society/...gency-medicine
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09-01-2017, 18:57   #5
Supertramp
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It's a difficult situation.

There are many more people using A&E than when the targets were originally set (something like 9million, although I'm unsure if that is a annual figure or not). The NHS also says that about 30% of the people who go to A&E do not need to be there, which I can well believe reading some of the stories of why people go to A&E.

I believe Hunt was saying that the 4 hour target should apply to the 70% of people who do actually need go to A&E, and so they shouldn't give equal priority to people who don't need to be there.

I'm not sure how you stop people who don't need to go to A&E from going - as I imagine it won't be obvious in all cases that you don't need to go. However people have also been to A&E in order to get false nails removed or hair extensions removed. I don't mind if they have to wait more than 4 hours.

https://www.theguardian.com/society/...gency-medicine
In my experience on the 2 times I have been to A&E in the last 3 yes (both times sent there by the GP in the walk in centre) I'd say more than 30% don't need to be there.
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09-01-2017, 19:03   #6
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Have to agree with the others.

Too many people misusing A&E and taking its free at source status for granted. People turn up at A&E for trivial issues. People turn up at A&E in substiute for not getting a same day GP appointment. People turn up at A&E with minor injuries which can be dealt with by the appropriate walk in clinic. People turn up at A&E with repeated self inflicted drink and drugs abuse.

Those who have a genuine reason to be there are pushed down the queue by those who shouldn't.

It is a very difficult situation and Jeremy Hunt (on this particular occasion) is getting a lot of unnecessary flack from certain politicians, campaigners and general rent-a-gobs pushing their anti-government agenda.

That fact its that BOTH major parties have failed in thier targets and attempts to sort out the never ending queue of people waiting for treatment and the bottomless financial hole which is the NHS. It is not something that can just be resolved with money as despite what Compo and his chronies chant. It is not "HER" failure. Its been a failure for decades including when his own party was in charge of it.

Personally, I think there should be much much more education about what exactly A&E is for. Clear boundaries about what strictly stays within the remit of A&E provision and (....bound to be contraversial) some financial penalties or other sort of sanctions against those repeat offenders who attend A&E for their own self inflicted consumption or abuse. I would increase that with the same financial or other sanctions for those who fail to turn up to GP appointments or those who use support services or patient transport when they have no justified reason for doing so.

Last edited by ECCOnoob; 09-01-2017 at 19:12.
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09-01-2017, 19:08   #7
Robin-H
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Originally Posted by ECCOnoob View Post
Have to agree with the others.

Too many people misusing A&E and taking its free at source status for granted. People turn up at A&E for trivial issues. People turn up at A&E in subsitute for not getting a same day GP appointment. People turn up at A&E with minor injuries which can be dealt with by the appropriate walk in clinic. People turn up at A&E with repeated self inflicted drink and drugs abuse.

Those who have a genuine reason to be there are pushed down the queue by those who shouldn't.

It is a very difficult situation and Jeremy Hunt (on this particular occasion) is getting a lot of unnecessary flack from certain politicians, campaigners and general rent-a-gobs pushing their anti-government agenda.

That fact its that BOTH major parties have failed in thier targets and attempts to sort out the never ending queue of people waiting for treatment and the bottomless financial hole which is the NHS.

Personally, I think there should be much much more education about what exactly A&E is for. Clear boundaries about what strictly stays within the remit of A&E provision and (....bound to be contravertion) financial penalties or other sort of sanctions against those repeat offenders who attend A&E for their own self inflicted consumption or abuse.
I'm not sure why the people with trivial issues aren't just immediately turned away. I'm fortunate that I have never been to A&E, so I'm not entirely sure how it works, but I imagine there is some kind of reception/sign in desk?

If that is the case, why don't when people say 'I'm here because I have a sore throat' or 'I'm here to get my hair extensions removed' they are told to make an appointment with their GP instead (or in the hair extensions example, told to p*** off). That then wouldn't take up the time of any staff other than the receptionist.
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09-01-2017, 19:25   #8
ECCOnoob
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Originally Posted by Robin-H View Post
I'm not sure why the people with trivial issues aren't just immediately turned away. I'm fortunate that I have never been to A&E, so I'm not entirely sure how it works, but I imagine there is some kind of reception/sign in desk?

If that is the case, why don't when people say 'I'm here because I have a sore throat' or 'I'm here to get my hair extensions removed' they are told to make an appointment with their GP instead (or in the hair extensions example, told to p*** off). That then wouldn't take up the time of any staff other than the receptionist.
Again, I think its down to education and course lots of self diagnosis "what if" syndrome. For the poor staff behind the desk they can only take someone at face value and the information given is only as good as what the patient want to give.

Its a horrendously difficult position but something has got to give. Somebody has got to be making the decison. Tit for Tat finger pointing by our so called parlimentary leaders is not going to do anything to help.

I think one of the big aspects is there needs to be a far more comprehensive assessment system (i.e. NHS direct/ambulance despatch) as to what exactly the issue is. Its all well and good a call handler saying "are you having difficulty breathing" but that could mean anything from a mild wheezy cough to full on life threatening respiratory issue. All a lay person is every going to say is "YES" and a box is clicked.

Add up a few of those on a brief call and that turns into a potential full scale A&E ambulance admission for what turns out to be just a nasty but perfectly normal flu bug.

Just digging round for my own curiosity and found this interesting article from an ex Emergency Care Assistant. I think some of thier comments are absolutely spot on.
https://www.theguardian.com/healthca...lance#comments

Last edited by ECCOnoob; 09-01-2017 at 19:33.
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09-01-2017, 19:41   #9
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perhaps if people did not have to wait two weeks to see their GP then they would not have to visit A&E for non-urgent cases
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09-01-2017, 19:46   #10
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perhaps if people did not have to wait two weeks to see their GP then they would not have to visit A&E for non-urgent cases
fair point ....
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09-01-2017, 19:51   #11
ECCOnoob
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perhaps if people did not have to wait two weeks to see their GP then they would not have to visit A&E for non-urgent cases
Same problems as with A&E. Too many people who dont need to be there. Too many people going to a GP when they could simply get some self medication from a pharmacy. Too many people attending for trivial reasons "just in case." Too many people making appointments and not turning up or not cancelling them when they find out they are actually recovered from their symptoms.

Another example of free at source NHS entitlement syndrome.

Last edited by ECCOnoob; 09-01-2017 at 19:54.
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09-01-2017, 19:58   #12
Robin-H
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Originally Posted by ECCOnoob View Post
Same problems as with A&E. Too many people who dont need to be there. Too many people going to a GP when they could simply get some self medication from a pharmacy. Too many people attending for trivial reasons "just in case." Too many people making appointments and not turning up or not cancelling them when they find out they are actually recovered from their symptoms.

Another example of free at source NHS entitlement syndrome.
Other countries with publicly funded national healthcare systems charge people for GP appointments (such as France, Sweden, Ireland to name a few). I know there would be opposition to such a move here, which might be valid, but it could stop people from making appointments when they don't need to. Equally it might stop poor people from making appointments when they do need to, so that would have to be addressed somehow (such as not being applicable to people on benefits).
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09-01-2017, 20:06   #13
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09-01-2017, 20:29   #14
Margarita Ma
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perhaps if people did not have to wait two weeks to see their GP then they would not have to visit A&E for non-urgent cases
Two weeks? you are a lucky patient if you only have to wait two weeks to see a doc on a non urgent appt.

Receptionist " do you need an urgent appointment?" Patient " Well I don't think so otherwise I would go to A&E" Receptionist the first non urgent appointment I have is February 15th. Patient "I could be dead by then" Receptionist " I will put you on Triage then the doctor will call you later and decide if you need to be seen urgently."
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09-01-2017, 20:48   #15
the_bloke
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perhaps if people did not have to wait two weeks to see their GP then they would not have to visit A&E for non-urgent cases
Probably shouldn't have introduced that ridiculous new contract for GPs in 2004 then?

http://www.telegraph.co.uk/news/poli...-on-AandE.html

My old GP surgery used to have late night Wednesdays, was open Saturday morning and would have a GP available every weekday morning for 'turn up and wait' cases. Then the contract changes came in 2004 and that all went.
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09-01-2017, 20:58   #16
Robin-H
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Probably shouldn't have introduced that ridiculous new contract for GPs in 2004 then?

http://www.telegraph.co.uk/news/poli...-on-AandE.html

My old GP surgery used to have late night Wednesdays, was open Saturday morning and would have a GP available every weekday morning for 'turn up and wait' cases. Then the contract changes came in 2004 and that all went.
Yes I agree. That was a disastrous contract that benefited nobody except GPs.
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09-01-2017, 21:09   #17
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I don't respect Hunt for the way he went after the Junior Doctors, but in general he is on the right track. The NHS can only function as a legit emergency service.

It is about time that GP services got branched off and covered by a social security insurance that will also cover dentistry and non-emergency mental and occupational health services. It won't be long before that comes. The NHS leads to people thinking healthcare is cheap, so they get a cheap service, I can't wait for the day it becomes a proper health service.
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09-01-2017, 21:11   #18
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The latest study (March 2014) into the 'appropriateness' of self referrals to A&E said that 85% were appropriate.

http://www.bbc.co.uk/news/health-27512613

To be honest, I expected that figure to be higher. But it does beg the question what is & what isn't appropriate, not everyone has a medical qualification, and if you're genuinely poorly logic is the first thing to go out the window.
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09-01-2017, 22:56   #19
nightrider
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Originally Posted by Robin-H View Post
I'm not sure why the people with trivial issues aren't just immediately turned away. I'm fortunate that I have never been to A&E, so I'm not entirely sure how it works, but I imagine there is some kind of reception/sign in desk?

If that is the case, why don't when people say 'I'm here because I have a sore throat' or 'I'm here to get my hair extensions removed' they are told to make an appointment with their GP instead (or in the hair extensions example, told to p*** off). That then wouldn't take up the time of any staff other than the receptionist.
I find it very hard to believe such a filter algorithm is not already in usage. Does anyone know?
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09-01-2017, 23:50   #20
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The latest study (March 2014) into the 'appropriateness' of self referrals to A&E said that 85% were appropriate.



To be honest, I expected that figure to be higher. But it does beg the question what is & what isn't appropriate, not everyone has a medical qualification, and if you're genuinely poorly logic is the first thing to go out the window.
I would say someone visiting A&E to get their false nails removed could be classed as trivial.
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