Overuse of NHS services by patients is frequently held up as the reason for the inability of GPs and A&Es to cope. It has prompted a new Friday Surgery blog. This Friday Surgery has a locum contributor who is an anaesthetics junior doctor. His name is Tar and he has serious concerns about the dangers of potential misrepresentation of this issue. This was first published as a Facebook blog and we are grateful to Tar for allowing us to reproduce it here.
"The government is in an odd situation of denying there is a crisis whilst simultaneously blaming practically everyone else for this same crisis: GPs, junior doctors, locum doctors, immigrants and the general public. Jeremy Hunt stated last week about A&E attendances: “30% of whom, NHS England estimate, do not need to be there”
. I found this an interesting figure, after all this is the same Jeremy Hunt who said that doctors don’t work on weekends, deliberately work overtime which is called “danger money” and that his door was always open to doctors – all of which were demonstrably untrue.
I’ve had a look at my own logbook from my time working on the "shop floors" of both Grantham’s and Northampton’s A&E departments and, out of the almost one and a half thousand cases I looked at 1% were inappropriate.
The current crisis stems from lack of open A&E departments, lack of beds for patients and lack of social care to safely discharge patients. Forcing GPs to work 12 hours a day, 7 days a week or face funding cuts
will do nothing for the patients queuing up on trollies in A&E who need access to specialist medical or surgical care. All it will do is further starve GP services of much needed resources, stretch GP services even thinner and drive more doctors out of the country or profession altogether.
Inappropriate attendances do not pose this sort of demand on hospitals because they can be seen quickly and sent home. 1% extra work doesn’t overload the entire system to breaking point like this. If a patient needs admission to hospital they are genuinely unwell and need specialist care in hospital, longer GP hours won’t help.
There are beds and medical specialists at Grantham 24/7. Opening the A&E 24/7 could take some of the strain off Lincoln instead of piling sick patients into corridors and tying up ambulances which are stuck in queues unable to safely offload their patients. This is apparently for want of 2 doctors.
There's also a flip side of these "inappropriate attendances" - sometimes something the patient says is mild turns out to be very serious. For example I once saw a patient whose paperwork said the presenting complaint was "sore throat" but when I saw them I brought them straight to resus. Bloods showed they were in full blown neutropenic sepsis! They had worked so hard looking after their partner, for whom they were a carer, that they ignored their own health to the point where they were seriously ill.
I've seen at least 2 patients in minors for similar thing: one complaint was "painful shoulder" but it turned out they were a motorcyclist involved in a collision and tried to "walk off" the pain and go to the pub! That's the danger with what's happening - I wonder what the patient who had a 'sore throat' would have done if they had their condition in 2017? With all the warnings, would they have come in?
The current problems stem from lack of supply rather than excessive demand. That lack of supply comes from years of underfunding, crippling PFIs, slashing social care and driving staff out of the NHS. Though the current pressures may be described as “unprecedented” they were certainly not unexpected as demand has been increasing gradually year on year and this winter was no different. The public are paying the price for government policy. If your car only has 3 wheels because Jeremy Hunt sold the other one off it doesn’t matter whether you’re popping to the shops or driving coast to coast, it's not safe and you won’t get very far."
The Friday Surgery is a sometimes satirical, sometimes serious blog on the subjects close to NHA's heart - democracy, the NHS, health and equity. If you would like to send in a contribution to be shared on the The Friday Surgery blog please write to us at firstname.lastname@example.org with your piece and a couple of lines about yourself.