I do think the majority of GP’s would disagree with you about living the easy life. They work really hard during the day, and have the same government targets regarding access as we have in secondary care. The majority may opt out of OOH care but at least theoretically new ways of working should improve access for patients during the daytime. However the publics expectations for a 24/7 instant access service is insatiable, so it will be a fact of life that we will continue to see lots of primary care type problems. Perhaps this should become a component of our SPR training?

Andy Webster

SPR in Emergency Medicine

Northern General Hospital

+447989587971

From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
Sent: 20 December 2004 00:45
To: [log in to unmask]
Subject: Re: Four hour waits and on-call

Not glib at all, John, on the contrary, it almost amuses me that you're working in a department that sees only 38,000 patients. There are not many of those left in the UK, and those that are left are either being merged into bigger units or else being converted into minor injury units, not least because such departments usually have only one consultant and a few middle grades left running them.

Allow me to elaborate. My department serves a catchment area of around 450,000 population, and my department sees around 70,000 patients per annum. A colleague of mine is taking up a position in an Auckland ED early next year. The population served for his new unit is around 450,000. But guess how many patients his new ED sees? Around 35,000 per annum. Why? Because they've got decent primary care for that population, which means that his department sees only those patients with serious illness or injury. Of course, that's a heavy dependency workload, with admission rates of 36-38%, while our admission rates are around half that figure. Basically, we're seeing a huge amount of primary care in British EDs these days; we always have, but that percentage has increased dramatically over the last 12 months, as GPs have relinquished their out-of-hours commitment.

So, I don't think Marco is being glib, and whether you blame the patients themselves, the GPs or the system, matters little to the individual emergency physician. At the end of the day, you can perhaps understand how emergency physicians in this country are getting a little pissed off being placed under huge pressure to see effectively their GP colleagues' patients out of hours, and to see them within a four-hour target, while, in the meantime, their GP colleagues are living the easy life, with a fast-track career to a good-salaried daytime-only job, with their respective target being to see their patients within 48 hours.

Merry Christmas!

Adrian Fogarty

John Chambers <[log in to unmask]> wrote:

I think the vast majority of ED patients attend very appropriately and these sort of glib comments seriously undermine our specialty and our patients

These statements are usually made by people who do not actually work in the ED - perhaps the e-mail was facetious

I and my specialists colleagues here are today having a meeting (accompanied by a mediator from our specialist Union) to discuss a similar statement made to the media regarding our patients here by the Chairman of our Health Board

The intention here is to try and get 12000 of our 38,500 patients to go "elsewhere" and there is a propaganda campaign to get across the message that they should not be in the ED with which neither I nor any of our specialists agree

Access to public hospital Emergency Departments almost has to be written into the constitution of civilised countries to stop it being tampered with !!!

...and no I do not think that if people just had to pay a small fee it would keep away the rif raf

JohnC

Dunedin NZ

-----Original Message-----
From: Accident and Emergency Academic List [mailto:[log in to unmask]]On Behalf Of Marco Bennett
Sent: Saturday, December 18, 2004 12:04 AM
To: [log in to unmask]
Subject: Re: Four hour waits and on-call

I totally agree with Danny's comments - I'm afraid in A&E we seem more concerned about how long people have to wait rather than concentrating on clinical need! If we're to be perfectly honest how many people who attend A&E really need to be there anyway? The majority of them should have attended their own GP - particularly with their 2 month old injury for which they've never bothered to try and self treat or seek previous medical advice! Whether they get to see their own GP within a reasonable time is a different matter entirely - they need to get past the battle-axe GP receptionist first!

If someone needs urgent treatment based on clinical need I think we endeavour to the best of our ability to make sure their needs are met - unfortunately it is this as well as other things like delays in obtaining investigations that cause people to breach waiting times not because we're sitting on our backsides drinking coffee!

Marco Bennett