Perhaps we're looking at two sides of Ray's original argument. Yes, he did
say that admissions are going up generally (your focus) but my
interpretation of his post was that regardless of the general increase
(which we've seen anyway year on year and so is no surprise) it's the manner
in which they're arriving that has changed radically: i.e. they're not
coming via the GP service so much any more. Whether this matters much for
the overall planning of service was my understanding of Ray's original post
and Mark's follow up.
----- Original Message -----
From: "Maurice Clayton" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, January 16, 2006 2:30 PM
Subject: Re: New Patients 2005
> Maybe I was being a little tongue in cheek, and I'm not tying to deny
> anything that you have written, except that I missed the point. As part of
> the 999 delivery system that is seeing circa 3% call volume growth per
> (some 3500 to 4000 calls per day pan London) the current major outlet is
> going to be A&E until suitable alternatives become available pan London.
> increased admission rates are suggestive that there is a sicker population
> (or exponential population growth) and is also suggestive of the fact they
> need to be somewhere rather than the community to be treated. One wonders
> how many could be discharged home early if the support network required
> fully established.
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
> Sent: 16 January 2006 13:49
> To: [log in to unmask]
> Subject: Re: New Patients 2005
> I think you're slightly missing the point Maurice. What Ray is
> suggesting -
> and we're all seeing this to a greater or lesser extent - is that patients
> no longer bother their GPs with serious medical complaints (or minor
> complaints for that matter) but rather call 999 for an ambulance. This
> partly relates to difficulty accessing GP services but also partly relates
> to cultural shifts in patient behaviour (although the latter is heavily
> influenced by the former) and includes the fact that many patients either
> not have GPs or do not know their GPs any more, but also includes, for
> example, the simple fact that chest pain cases are now encouraged to call
> 999 rather than their GP. No doubt this trend also partly relates to GPs
> avoiding such cases (i.e. potential admissions) and advising them to call
> 999 rather than come to the surgery or wait for a home visit.
> Adrian Fogarty
> ----- Original Message -----
> From: "Maurice Clayton" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Monday, January 16, 2006 11:48 AM
> Subject: Re: New Patients 2005
>> Some interesting conundrums. Afraid no answers, just things to consider.
>> Are the patients attending via Ambulance assessed to see if they tried to
>> get a GP visit / appointment?
>> If a patient self refers by whatever means then there will be no GP
>> Where GPs failing to refer patients that clinically needed to be
>> Are there other care pathways that patients and Ambulance can access
>> needing admission?
>> Does the admission rate change by hour of day / day of week which may
>> indicate patients are continuing to work until it is convenient for them
>> Is there any significant demographic changes that have occurred,
>> housing, older population, major road networks that make it easier to
>> to one location rather than another etc?
>> -----Original Message-----
>> From: Accident and Emergency Academic List
>> [mailto:[log in to unmask]] On Behalf Of Prescott Mark (RLZ)
>> Sent: 16 January 2006 10:26
>> To: [log in to unmask]
>> Subject: Re: New Patients 2005
>> Yes - we have in Shropshire - in the past approx 4/10 of emergency
>> admissions came through the Emergency Departments and the rest were
>> GP referrals to the in-patient teams.
>> Over the past few years (4-5) this ratio has reversed and the majority of
>> emergency admissions arrive into the Emergency Departments as 999 calls,
>> having been either seen or referred - 2005 my own hospital site had 8177
>> patients admitted from GPs and 10220 admitted from the Emergency
>> with no GP intervention
>> Mark Prescott
>>> -----Original Message-----
>>> From: Ray [SMTP:[log in to unmask]]
>>> Sent: 14 January 2006 10:45
>>> To: [log in to unmask]
>>> Subject: New Patients 2005
>>> Last year the numbers attending Lancaster went up, but to my surprise
>>> increase was all with admissions. Another 1,500. When I looked at GP
>>> direct admissions to the Medical Admissions Unit they had reduced
>>> over the same period.
>>> I'm presuming the patients and GPs are changing the way that they use
>>> Has anyone found a similar trend?
>>> Ray McGlone