> (eg. couldn't get my doctor - I don't want to
> start a row with the GPs, I'm standing up for your expertise! - but that's
> the sort of excuse given in A&E, whether it's true or not!)
I think re-direction is very important.
As I've said earlier (although my figures were controversial!) there are far
more GPs out there than A&E doctors, so a small change in GP workload can
easily over-run a department.
Also, while a minority of GPs may be secretly fostering a 'go to A&E'
mentality to reduce their workload, the vast majority of GPs get annoyed
when their patients 'bypass the gatekeeper' in this way. I've seen several
write terse letters to patients about the appropriate use of A&E after
finding out they attended A&E for some trivia the night before.
GP access is a mixed bag, but I have never failed to make a same or next-day
appointment for a 'not able to make a GP appointment' patient when I have
phoned from A&E.
My favourite case was in Stornoway a few years ago when my GP trainer had
been covering the A&E dept overnight because of an SHO shortage. A patient
turned up in early evening and told the A&E nurse that he was attending A&E
because had not been able to get a GP appointment. He got the shock of his
life when he saw the doctor on duty was his own GP who he HAD seen earlier
that day about the same problem (I guess he just wanted a second opinion).
As you say, the only problem is when the GP then refers back for emergency
admission. Common sense and good patient triage should minimise this risk.
Having said all of that, GPs are under enormous strain just now too (2 GP
suicides I know of in the last 2 weeks) and GP services could collapse in
some areas in the next few years. But, if the government is not putting
enough money into primary care service to cope, that's not A&E's problem.
I like the idea of access to GP computer appointment systems for 'A&E only'
slots, but this runs contrary to many of the Advanced GP Access schemes that
are becoming common. Many of these Advanced Access systems have virtually
100% same-day access only except for GP booked follow up appointments (i.e.:
patients cannot book appointments in advance). If word gets about that you
can book appointments ahead via A&E, this could have the opposite effect and
turn your waiting room into a GP appointments queue.
--
Robbie Coull
email: [log in to unmask] website: http://www.coull.net
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