Everyone agrees that urgent care in the NHS is in a bit of a mess. But there are fierce disagreements when it comes to explaining the reasons why – for example, for the crisis in A&E.
Have patients lost faith in GPs out of hours services, as Health Secretary Jeremy Hunt claims, or are the closure of walk-in units and the inadequacies of the 111 telephone system responsible for the pressure on A&E?
We’ve spent two weeks in the Emergency Department at Queen Elizabeth Hospital in Birmingham trying to find out.
Most of the patients we talked to with minor injuries could have gone to their GP. But they weren’t sure whether their GP was open at weekends. Or they couldn’t easily make an appointment. Or they were confused about where they should go.
In fact, that’s the over-arching conclusion we reached. There’s 111. There’s the GP. There are walk-in centres. There’s the out-of-hours service. There are minor injuries units. And there’s A&E.
Patients are confused about where they should go and so they go to the place they trust. And that’s A&E. They know they might have to wait hours. But they also know they WILL be seen and will get good treatment, probably from a consultant if their complaint is at all serious.
But it’s a bit dispiriting for highly trained staff to be faced with two patients within two hours both of whom had no injuries at all. They just had rings stuck on their fingers and wanted them cut off.
Sir Bruce Keogh, the NHS’s most senior doctor is carrying out an investigation into urgent care. For that review the Informatics Department at Queen Elizabeth did an illuminating piece of research
The results, made available exclusively to ITV News, show that people who couldn’t easily get an appointment with a GP, came to A&E instead. It was a national survey, and the worst GP practice was in West Yorkshire. There, 50 per cent of patients couldn’t get an appointment within 24 hours. 38 per cent of the practice’s patients chose to go to A&E instead.
The best practice is in Barnsley. There all their patients got appointments in 24 hours and only two per cent of the patients went to A&E. And remember, these are NOT about out-of-hours services, these are figures about regular daytime appointment.
But all this is not only flooding A&Es – the number of patients at Queen Elizabeth has gone up by around 10 per cent in each of the three years it’s been open, It’s also put immense pressure on beds in the hospital. More of that tomorrow.