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A&E no walk in access from November


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Plans for patients to “call first” and book into A&E via NHS 111 will be implemented before December, NHS bosses were told yesterday.

A joint board meeting of NHS England and NHS Improvement was told that new emergency care standards designed to replace the four-hour waiting time target would also be in place before winter.

 

 

I'm going to take a wild flail in the dark here and suggest that if you're bleeding to death then ringing an ambulance will be as reliable as ever way of getting to A&E. 
 

They have missed so many opportunities over the years by building walk in centres not next to A&E... so that if you walk in you get triaged and woodworking injuries go straight through but everything else is triaged with a GP or nurse practioner first.
AND analysis of why people go there needed to be done.

1. Crap GP that doesn't even answer the phone

2. Crap GP that doesn't give out appointments if you can get through 

3. Crap GP ignoring persistent issues that the patient has underlying concerns about

4. Mental health

5. Drug abuse / Alcohol accidents and fights.

6. Drug seeking behaviour 

7. Genuine reason for seeking out of hours medical attention 

8. Elderly issues. (It's been mooted they have their own "a&e" etc)

An analysis of failing GPs could then remove those GPs from the system. Or at least put checks and measures in place and fuck them off for outperforming. De-register people from their GP if they only go to A&E and register them at the walk in centre practice. That way they're always seeing their own GP. 

The walk in centres were for the most part in stupid places - although Oldham's is next to the bus station it's not near A&E... so people don't know what hours it was... And originally 24/7. Then closing at 11, 10, 9 and now 8 - which means it's only open an hour later than most GPs.  God knows how much money was spent building white elephants when they needed to just adjust some space at the hospitals. 

I've been to the walk in centre after persistent pain in hip 5 weeks after a fall. Got sent for an X-ray and got into the x-ray room before being told I'd have to go to the A&E xray place as if it was broken when they xrayed me I'd have to lay on the table until an ambulance arrived to take me to hospital. Effectively putting the room out of use for the next 4 hours whilst they waited for an ambulance as they wouldn't be allowed to let me leave if they knew it was broken.  So could I make my own way to the A&E? 
 

A&E has got busier IMO as people have found it more difficult to see their own GP during normal working hours. 

 

 

 

 

 

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Are you susposed to know in advance when you're going to have an accidents and book an A&E appointment accordingly? The NHS is shit. Not fit for purpose. Like someone said above, this is

Another consequence of TPTB creating a total population far in excess of the available infrastructure capacity and now evidently far in excess of the capacity of the medical system to cater for like i

I had to have emergency kidney stone surgery a few years back. Walked (hobbled) to A&E after the attack. If they're asking you to phone, that's basically just a licence for them to ignor

5 minutes ago, JoeDavola said:

I had to have emergency kidney stone surgery a few years back.

Walked (hobbled) to A&E after the attack.

If they're asking you to phone, that's basically just a licence for them to ignore you and let you die.

It'll just mean people ring 999 and lie if needed. Which will waste a lot of ambulance time. Their option will be the triage these phone callers and then make the decision whether they need A&E or not. Without solving the problem of sick people (or people who think they're sick) wanting to see a doctor this won't make things better. 

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9 minutes ago, Syd Germs said:

Are you susposed to know in advance when you're going to have an accidents and book an A&E appointment accordingly?

The NHS is shit. Not fit for purpose.

Like someone said above, this is the shit that idiots went outside to clap like fucking seals for.

It is for walk-in patients.  Ie, if you can walk in, then you have to book.

If you're in an ambulance you get in.  If medics are called to the car, you're in.  If you stagger in dripping blood, you're in.  etc etc.

I think it is a good idea.  A&E was designed around 1950's (or so) Britain, where there was good GP access, no assumption of phones and far less abuse of the A&E system.   These days the system is abused but everyone has a phone or two.

A vast number of people these days think A&E is a handy 24 hour GP service.  This approach would stop (hinder) that.  Frankly, if you're thinking that you need A&E but it isn't quite an ambulance emergency (eg, child with too-high a temperature in middle of night) then it seems quite reasonable to ask that people ring 111 and have a discussion about it first.  

The main problem is that the A&E abusing folk know the system; if you have to massively exaggerate your symptoms to get a slot, then that's what they'll do.  And our crazy system would refuse to take records of this abuse so that they could 'just say no' to those folk.  So we'll likely end up with a system where nice middle class folk are denied walk in access to A&E, but loads of feckless continue to do it anyway.

But that latter point isn't a reason why they shouldn't try to mend a clearly broken system.

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Just now, dgul said:

It is for walk-in patients.  Ie, if you can walk in, then you have to book.

If you're in an ambulance you get in.  If medics are called to the car, you're in.  If you stagger in dripping blood, you're in.  etc etc.

I think it is a good idea.  A&E was designed around 1950's (or so) Britain, where there was good GP access, no assumption of phones and far less abuse of the A&E system.   These days the system is abused but everyone has a phone or two.

A vast number of people these days think A&E is a handy 24 hour GP service.  This approach would stop (hinder) that.  Frankly, if you're thinking that you need A&E but it isn't quite an ambulance emergency (eg, child with too-high a temperature in middle of night) then it seems quite reasonable to ask that people ring 111 and have a discussion about it first.  

The main problem is that the A&E abusing folk know the system; if you have to massively exaggerate your symptoms to get a slot, then that's what they'll do.  And our crazy system would refuse to take records of this abuse so that they could 'just say no' to those folk.  So we'll likely end up with a system where nice middle class folk are denied walk in access to A&E, but loads of feckless continue to do it anyway.

But that latter point isn't a reason why they shouldn't try to mend a clearly broken system.

 

I agree with your comments. 

better GP access when you are ill is needed. 
The pharmacist can triage you with some stuff, but the problem is knowing where to go when.

https://www.nhs.uk/using-the-nhs/nhs-services/urgent-and-emergency-care/when-to-visit-an-urgent-care-centre/

At the moment, the NHS offers a mix of walk-in centres, urgent care centres, minor injury units and urgent treatment centres, all with different levels of service.

By Autumn 2020, these will either be called urgent treatment centres or change to offer other primary health care services.

Conditions that can be treated at an urgent treatment centre include:

  • sprains and strains
  • suspected broken limbs
  • minor head injuries
  • cuts and grazes
  • bites and stings
  • minor scalds and burns
  • ear and throat infections
  • skin infections and rashes
  • eye problems
  • coughs and colds
  • feverish illness in adults
  • feverish illness in children
  • abdominal pain
  • vomiting and diarrhoea
  • emergency contraception
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6 minutes ago, sarahbell said:

So is the answer to actually move A&E elsewhere and have the urgent treatment centres fill in at the location of A&Es.

That's what they did to our local A&E.  Well, not so much move, as close and replace with minor injuries unit.

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5 minutes ago, sarahbell said:
Quote

 

At the moment, the NHS offers a mix of walk-in centres, urgent care centres, minor injury units and urgent treatment centres, all with different levels of service.

By Autumn 2020, these will either be called urgent treatment centres or change to offer other primary health care services.

 

 

It's the same as before but they're calling them something different? 

That would be a typical big organisation's bureaucratic response to a problem.  It would help with the paperwork.

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Just now, Inigo said:

That's what they did to our local A&E.  Well, not so much move, as close and replace with minor injuries unit.

So there will be stats on how effective it is.
And I wouldn't take the signs down. I'd just channel the ambulances to someone else. but the triage is desperately needed to filter off the piss poor GPs and people not entitled to use the health service (as it's not an emergency) 

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13 minutes ago, sarahbell said:

 

I agree with your comments. 

better GP access when you are ill is needed. 
The pharmacist can triage you with some stuff, but the problem is knowing where to go when.

https://www.nhs.uk/using-the-nhs/nhs-services/urgent-and-emergency-care/when-to-visit-an-urgent-care-centre/

At the moment, the NHS offers a mix of walk-in centres, urgent care centres, minor injury units and urgent treatment centres, all with different levels of service.

By Autumn 2020, these will either be called urgent treatment centres or change to offer other primary health care services.

Conditions that can be treated at an urgent treatment centre include:

  • sprains and strains
  • suspected broken limbs
  • minor head injuries
  • cuts and grazes
  • bites and stings
  • minor scalds and burns
  • ear and throat infections
  • skin infections and rashes
  • eye problems
  • coughs and colds
  • feverish illness in adults
  • feverish illness in children
  • abdominal pain
  • vomiting and diarrhoea
  • emergency contraception

The answer is stopping people who have no right to from accessing the nhs. Can’t register with a doctor, so you rock up at A&E.  last time i was in one, the waiting room was massive and filled to the brim with people who really didn’t look to be having a medical emergency. 
 

i was in with a suspected infection from surgery. Funnily enough, i jumped the queue and was seen almost immediately. The others can’t really have been that poorly. There must have been over 200 of them and not an English name amongst them. 

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27 minutes ago, sarahbell said:

 

I agree with your comments. 

better GP access when you are ill is needed. 
The pharmacist can triage you with some stuff, but the problem is knowing where to go when.

https://www.nhs.uk/using-the-nhs/nhs-services/urgent-and-emergency-care/when-to-visit-an-urgent-care-centre/

 

One of the main problems is the monopoly GPs have on dishing out certain medicines. Until recently you could not get Magrocol a common effective treatment for constipation without a GP prescription. I am sure there are other examples. It is this sort of madness which is why the NHS is buckling. Presumably the original idea of these restrictions was to ensure serious conditions were not missed because people did not go to the GP but as the latter are almost impossible to see now it is pointless. Pharmacists are probably better at diagnosing appropriate treatments for minor complaints and allergies than GPs anyway as they often understand the drugs better.

Edited by Virgil Caine
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6 minutes ago, Virgil Caine said:

One of the main problems is the monopoly GPs have on dishing out certain medicines. Until recently you could not get Magrocol a common effective treatment for constipation without a GP prescription. I am sure there are other examples. It is this sort of madness which is why the NHS is buckling.

That's also evident just by looking at what's available anecdotally OTC compared to other nations including the US.

Edited by twocents
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When I had my asthma attack and ended up - eventually - in A&E a few weeks ago it was very clear to me that there is basically no A&E service now. They clearly intend to protect the medical staff first and foremost - if people die then, IMPO, there are people whom they are willing to sacrifice in order to protect the staff.

Someone, somewhere has made this decision and presumably there is a list of what is now considered a real emergency. I believe an asthma attack no longer counts as one. Which makes me wonder what does.

That they are announcing this now also suggests they are either planning for or fearing - they probably have no idea - a huge upturn in admittances for the China virus this Autumn and Winter. Make of that what you.

One last point, I recently overheard some GP's and nurses talking about some of their patients who were awaiting operations. Someone ventured whether the surgeries would be rescheduled soon. It was a question asked genuinely but it got a half-laughed response. Someone said that the surgeons were doing private surgery in the morning and playing golf in the afternoon.

 

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8 minutes ago, Virgil Caine said:

One of the main problems is the monopoly GPs have on dishing out certain medicines. Until recently you could not get Magrocol a common effective treatment for constipation without a GP prescription. I am sure there are other examples. It is this sort of madness which is why the NHS is buckling. Presumably the original idea of these restrictions was to ensure serious conditions were not missed because people did not go to the GP but as the latter are almost impossible to see now it is pointless. Pharmacists are probably better at diagnosing appropriate treatments for minor complaints and allergies than GPs anyway as they often understand the drugs better.

 

My local pharmacist is one of the unsung heroes in all of this. He has a small team. They have been remarkable during this time. They look a bit better now but a month ago they all looked exhausted.

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9 minutes ago, Long time lurking said:

They have to keep the excess-over all deaths numbers up they are going to look a bit silly if we get to next March and the numbers are there or there about on par with other years

What they are doing is fucking evil and when people wake up should lead to the entire UK establishment being replaced, of course it will not

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"Soon you'll have to book an appointment at A&E before you have an accident" was a punchine to a joke I heard decades ago. Sad how reality changes.

At the start of year I was using a chainsaw to cut up some dead / dying trees for firewood at the place I was landscaping. All dangerous tools got put away in March and I let the owners know I wouldn't be doing anything likely to need a trip to A&E @ CV19 HQ. 
Needing to book an appointment while holding bits of your body together after a disaster is crazy !

Easy solution: just announce all hospitals are CV hotzones and watch the numbers of bored hypochondriacs drop to near nil as they decide going to hospital for imagined problems is too risky. Its worked so far this year ¬¬

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