Dear Nick
Interesting to hear your point of view re re-direction, from an A&E point of
view. As a GP, I'd like to endorse your comments. I would be more than happy
if my patients (inapropriately attending A&E) were diverted back to me.
Those that do attend (in my experience) have done so of their own accord,
often against GP advice. Patients attend A&E for many innapropriate reasons.
(No Mrs Smith, I don't need to see your bunion again today...I've already
seen it 5 times this week, and it hasn't changed over the past 10 years...
whereby she says "Right, I'm off to see a 'Specialist', I'm going to stay in
A&E and not leave until they make sure I'm seen by a podiatrist"). They
sometimes simply do it to try & blackmail their GP (Pt with D&V for 3hrs
phones in middle of emergency surgery: "If you don't come and visit me RIGHT
NOW I'm calling an ambulance")...Fine! Send them back!!! It would prevent
unrealistic patient-expectations of the NHS, strengthen our position as GPs
& free up A&E Docs to do what they do best!
Good to read a bit of common sense!
Neil
(GP & BASICS Dr)
----- Original Message -----
From: Nick Jenkins <[log in to unmask]>
To: N Meardon <[log in to unmask]>
Sent: Sunday, August 10, 2003 8:45 PM
Subject: Re: Turn them around
> Danny - we've been doing exactly that for the last 8 - 10 years. It's not
> so much a question of refusing access, it's more a question of
re-direction
> to the appropriate specialist which is normally GP but could be dentist
etc.
>
> It's actually doing the patient a favour - who treats their Primary Care
> problem best? - Primary Care Specialist or A&E SHO under the supervision
of
> A&E Consultant who's doing pretty well to keep up with developments in A&E
> without being able to tell you what the current primary care thinking on
> (for example) treatment of a rash??
> It's also good for our proper A&E patients who's waiting times to be seen
> are reduced - significantly so.
> It's also good for staff morale.
>
> If you were the patient who mistakenly thought that A&E was the correct
> place to go would you prefer to be directed to the appropriate specialist
or
> have an A&E SHO have a crack at your problem purely because they feel
> obliged to do so because you turned up? It doesn't look too good when it
> all goes wrong and the A&E guys say 'no, I wasn't the appropriate
> specialist to treat this, of course it's gone wrong' - if I was the
patient
> I'd be most miffed at not being directed appropriately!
>
> Anyway where's our pride? We're here to provide specialist A&E work - not
a
> half baked attempt at work belonging to another speciality and making do
any
> deficiencies in their system (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!). Would a
> Consultant Cardiologist treat the in-growing toenail who turned up in
> his/her clinic? - 'Cheek!' we'd say if we heard that a patient did that -
> yet old jack-of-all-trades A&E doctor thinks nothing of it!
>
> I've found it difficult to produce written protocols for my triage
nurses -
> it's one of those things where common sense is essential. They can
however
> still be triage categorised even if they're not A&E appropriate eg.
Primary
> Care appropriate Cat 3(eg. very painful period pains) - can be re-directed
> with the advice to be seen today and possibly an appointment made for them
> by the Triage Nurse - we're not turning you away - we're doing our very
best
> to help you (can increase the triage nurse workload); GP-appropriate 5
(eg.
> 10 year history of knee pain - how many A&E Depts still see those?!) -
make
> your own appointment sometime. (This means that I believe that there are
A&E
> appropriate 5s - eg. ankle injury few weeks ago - takes lower priority
than
> the pile of ankle injuries sustained today - different Depts will have
their
> own methods of dealing with these).
>
> The only formal complaints I've received have been when a patient so
> re-directed has been referred back to hospital for admission (eg. if the
> painful period above needed hospitalisation for whatever reason) - so
common
> sense must be used and, as I've said above, difficult to formalise in
> writing.
>
> It will only work if the nurses have loads of support from the A&E
> Consultant.
> It's useful to get the GPs on board but you certainly don't need their
> permission to not treat problems you're not trained to deal with.
>
> Anyway, that's far more than I normally write (or say). Just my opinion
and
> that's the way I run my place - I think it makes for better quality A&E
> care.
>
> Nick Jenkins
> A&E Consultant
> Abergavenny
> http://www.ae-nevillhall.org.uk
>
>
>
> -----Original Message-----
> From: Danny McGeehan [mailto:[log in to unmask]]
> Sent: 10 August 2003 19:30
> To: [log in to unmask]
> Subject: Turn them around
>
>
> Colleagues
> Do any departments have any robust triage or other protocols than I can
look
> at regarding Primary Care attedances to A&E. Our numbers are going up at
a
> rate of 10% and we are seeing more primary care patients attending for one
> reason or another.
>
> Our orthopods are stating that they will no longer see what they deem to
be
> inapropiate A&E referrals.
>
> With Trick and Treat it is obviously becoming easier for the patients to
> access A&E. Basically I want to know if we can turn them around and
> dispatch them back to their GP's and hence would value any comments from
the
> list.
>
> Kind regards
>
> Danny McGeehan
>
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