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Oh I agree, if you have all your WICs, UCCs, ECPs etc in place and properly functioning. It's just that our patch has only recently discovered these new-fangled things a few months ago. Up to then, it was "yours truly" sorting all this stuff out! AF P.S. Don't you think I was very polite there, using the word "stuff" instead of the word "c**p"! ----- Original Message ----- From: "Rowley Cottingham" <[log in to unmask]> To: <[log in to unmask]> Sent: Monday, October 31, 2005 2:03 PM Subject: Re: GPs Interface The dinosaur twitches its tail! Adrian, we have been moving away from this for 5 years with WICs, UCCs and ECPs. It has all changed. OOH emergency primary care is nearly gone, and rightly so. It harks back to some golden Dr Finlay era after the war when patients only troubled the doctor when they only had a couple of breaths and a bottle of whisky for the doctor left. People now want the health care they want and that health care when it suits them. Doctors have sussed that most of the non-urgent stuff that the punters want done pronto doesn't need their skills. So they have abandoned it - not just GPs but hospital seniors too. So it all gets sifted now by paramedics and nurses either on the road or on the phone. What needs to come to the ED will, what doesn't gets advice or treatment. I don't think its too bad an idea at all. Best wishes Rowley. -----Original Message----- From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Adrian Fogarty Sent: 31 October 2005 13:23 To: [log in to unmask] Subject: Re: GPs Interface Well depending on what you mean by "optimising". I do love that word, open to all sorts of abuse. You see, the GPs' idea of optimisation is closing their doors at 5pm and then everything primary care that's left over goes to A&E. That's kind of neat if you're on the GPs' side of the "optimisation paradigm". However if you're coming from the A&E perspective, then the "optimal" situation would be to never ever see a primary care case again. And that's not just neat, that's philosophically the more correct result, as we're not trained and equipped to deal with primary care, just as GPs are not trained and equipped to deal with accidents and emergencies. So you see, the two viewpoints are mutually exclusive, so what the talk should be entitled is "compromising..." rather than "optimising...". I suspect the latter is a GP euphemism for "how-can-we-pass-the-buck-with-nobody-really-noticing". And then there's "the interface". That makes me giggle too. You know how you started off by using the term "shifting the goalposts"? Well that's a much more accurate way of describing what's going on with "the interface" these days! You could always use my post as a way to get the debate going, John! AF (still only ever-so-slightly bitter about the deal that the GPs got on this side of the water) ----- Original Message ----- From: "John Ryan" <[log in to unmask]> To: <[log in to unmask]> Sent: Monday, October 31, 2005 9:03 AM Subject: Re: GPs Interface > Just shifting the goalposts on this thread slightly; I am due to > speak shortly at our annual GP study day on "Optimising the Interface > between General Practice and the Emergency Department" Any > suggestions on what ought to be covered ? (from the GP or the > Emergency perspective) > > John Ryan > > > ----- Original Message ----- > From: "McCormick Simon Dr, Consultant, A&E" > <[log in to unmask]> > To: <[log in to unmask]> > Sent: Sunday, October 30, 2005 9:33 AM > Subject: Re: GPs triage > > > James, > > I, together with the medical director of the local OOH primary care > facility, looked at the attendances over one weekend last year. We > decided that about 65% were pure A&E cases; 15% were primary care and > 15% were 'crossover' cases. With about 200 patients per day that's > the opportunity to 'loose' 30 patients a day. These are not just > simple coughs and colds either, which can usually be dealt with quite > quickly, they include the odd > abdo pains, deteriorated in nursing homes and COPDs that are often time > consuming to see, difficult for juniors to understand and regularly > difficult to discharge. The impact on our work would be quite > significant. > > Simon > > > -----Original Message----- > From: James McFetrich [mailto:[log in to unmask]] > Sent: 28 October 2005 16:07 > To: [log in to unmask] > Subject: Re: GPs triage > > > Is there anything showing actual numbers for people who > 'inappropriately' attend A&E? > > I appreciate that different departments will have different caseload > and > the > definition of inappropriate will vary; most people end up saying > anecdotally > that 5%, 20%, 50% (insert number as appropriate) of patients who attend > A&E > could be dealt with by priimary care. > > Has anyone even got local data on this? > > James > > James McFetrich > Clinical Research Fellow in Emergency Medicine and Education