Tim: exactly. It is the point I have been making here for some time. The
complexity of the elderly patients attending is now quite remarkable, and
sorting the problem accurately and swiftly can be a significant issue.
Patients no longer attend with one problem, but a problem overlaid on
previous issues and conditions. 

The division of health and social care responsibility into different funding
pots has exacerbated the problem.

I'm not sure whether the politicians have not grasped the problem or there
is an element of dissembling in their public pronouncements to suit a
slightly tangential political agenda with general practice.

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Adrian Boyle
Sent: 10 June 2013 10:37
To: [log in to unmask]
Subject: Re: Attendances and GPs

I agree with Matt and Tim, the issue is not the primary care attenders, for
us it is a combination of complex elderly and reduced in hospital bed
capacity.  I really think we ought to stick with the GPs on this one and
push for system wide reform.
  
The only areas where primary care might be contributing are at OOH and
emergency paediatrics.

Adrian

On Mon, 10 Jun 2013 08:41:30 +0000
  Matthew Dunn <[log in to unmask]> wrote:
> I've got a simiilar experience:
> The main problem is exit block: if there are beds in the hospital, the 
>ED runs smoothly (more or less, most of the
>time)
> Our total attendances are up
> However the issue isn't in the minors, it's in the majors  In the 
>majors we are seeing more complex patients and we are seeing sicker 
>patients. (Some of this may be patients who wouldn't have come to 
>hospital in previous years)
> 
> The Kings Fund report notes something fairly similar 
>http://www.kingsfund.org.uk/audio-video/john-appleby-pressures-accident
>-and-emergency-services
>:
> Total attendances in major EDs fairly static (not what I've observed 
>in my own department, but what the figures show). The increase in 
>attendances is attendances at minor injuries units, walk in centres 
>etc.
> Admissions not up (our admissions actually are up, particularly in the 
>older age groups)  Main problem is increased length of stay in hospital 
>leading to an exit block.
> 
> The patients who can't access GPs tend to be fairly simple ones to 
>sort out (from our point of view) in any case.
> 
> 
> Matt Dunn
> Warwick
> 
>From: Accident and Emergency Academic List 
>[mailto:[log in to unmask]] On Behalf Of Coats Tim - Professor 
>of Emergency Medicine
> Sent: 10 June 2013 09:16
> To: [log in to unmask]
> Subject: Attendances and GPs
> 
> Can I use the list to cross-check what I am seeing.
> 
> The current government emphasis on 'inappropriate attenders' due to 
>'lazy GPs' doesn't really fit with what I am seeing in my own ED - 
>where we seem to be overcrowded with sick elderly patients who need a 
>level of care that cannot be provided in the community, but they remain 
>in the ED as there are no beds for them to go to. Patients with minor 
>conditions who could have gone to their GP are certainly still 
>attending the ED - but if they were removed I don't think that it would 
>really create much improvement in the current pressure (as most are 
>either diverted or seen rapidly by nurse practitioners).
> 
> If I am experiencing something different from the national picture 
>then we may be right to emphasise failings in primary care. If the 
>underlying cause of the current crisis is (as it seems from my 
>perspective) the initial explosion of the demographic time bomb of a 
>rapidly aging population - then we are talking about the wrong issue. 
>If we are talking about the wrong issue we are playing into the hands 
>of the politicians who would like an easy target ('lazy GPs') rather 
>than tackle the politically very difficult, and potentially expensive, 
>issues that surround how we look after old people, relative's 
>expectation of level of treatment, management of dying, end of life 
>planning, resourcing the hospital care for the current rapid increase 
>in our elderly population, and resourcing the social care required.
> 
> I would be very interested in the list's experience - is it really 
>patients who cannot access GPs that are causing a crisis in your ED?
> 
> Tim.
> 
> ------------------------------------
> 
> Prof. Timothy Coats
> 
> Professor of Emergency Medicine,
> 
> University of Leicester, UK
> 
> 0116 252 3263
> 
> ________________________________
>From: Accident and Emergency Academic List 
>[mailto:[log in to unmask]] On Behalf Of Jel Coward
> Sent: 06 June 2013 17:43
> To: 
>[log in to unmask]<mailto:[log in to unmask]>
> Subject:
> 
> On 6 June 2013 09:22, PHILLIP OCONNOR 
><[log in to unmask]<mailto:[log in to unmask]>>
>wrote:
> Am I the only dissenter?
> 
> Positively I agree with GPs doing a year of ED after their core 
>training and immediately before GP land.
> 
> 
> That would be good.  Similarly forcing ED career track trainees to do 
>a year of GP.  Do you agree?
> 
> or bill the GPs for their non-urgent patients.
> 
> Get lost.   So wonderful for us to characterise 
>colleagues as the bad guys - helps our egos, but not much else.
> There is a stack of stuff that GPs see that could appropriately be 
>seen in A+E - should they bill you?
> There is a stack of stuff that GPs deal with that are bounces back 
>from inadequate hospital care -  should they bill you?
> Picking on each other goes nowhere.
> 
> 
> To your second point.......I agree that _forcing_ folks to work in 
>places they don't want to be is counter-productive.
> Cheers :)
> Jel
> 
> 
> 
> If I need a plumber at 1.00 am, he will charge me £120 call out fee, 
> therefore that blocked sink can wait...
> 
> Phil
> 
> .
> 
> 
> 
> --
> Jel Coward
> 
> Some Open-Source and Creative Commons interests.....
> The CARE Course http://www.theCAREcourse.ca  Wilderness Medicine 
>Twitter account<http://twitter.com/#%21/wemsiint>
> WEMSI-International http://WEMSI-International.org  OSCAR open-source 
>EMR http://OSCARcanada.org
> 
> ________________________________
> This e-mail, including any attached files, may contain confidential 
>and / or privileged information and is intended for the exclusive use 
>of the addressee(s) printed above. If you are not the addressee(s), any 
>unauthorised review, disclosure, reproduction, other dissemination or 
>use of this e-mail, or taking of any action in reliance upon the 
>information contained herein, is strictly prohibited. If this e-mail 
>has been sent to you in error, please return to the sender. No 
>guarantee can be given that the contents of this email are virus free - 
>The University Hospitals of Leicester NHS Trust cannot be held 
>responsible for any failure by the
>recipient(s) to test for viruses before opening any attachments. The 
>information contained in this e-mail may be the subject of public 
>disclosure under the Freedom of Information Act 2000 - unless legally 
>exempt from disclosure, the confidentiality of this e-mail and your 
>reply cannot be guaranteed. Copyright in this email and any attachments 
>created by us remains vested in the University Hospitals of Leicester 
>NHS Trust.
> 
> This email has been scanned for viruses; however we are unable to 
>accept responsibility for any damage caused by the contents. The 
>opinions expressed in this email represent the views of the sender, not 
>South Warwickshire NHS Foundation Trust nor NHS Warwickshire unless 
>explicitly stated. If you have received this email in error please 
>notify the sender. The information contained in this email may be 
>subject to public disclosure under the NHS Code of Openness or the 
>Freedom of Information Act 2000. Unless the information is legally 
>exempt from disclosure, the confidentiality of this e-mail and your 
>reply cannot be guaranteed.
>