Hospital Accident and Emergency departments are close to breaking point. So close to breaking point that a Christmas advert was commissioned, advising people to call 111 or seek advice from their GP before going to accident and emergency – which, as the name suggests, is for more urgently required treatment.
It sounds simple enough advice to follow: if you have an illness that does not put you at immediate risk of death or serious injury then make an appointment to see your GP. In fact, this is the primary purpose of your GP: to act as a triage system and as a gatekeeper for the more specialist care in hospitals and to free up those specialists to deal with the serious cases. Unfortunately, the reality is that it is increasingly difficult to get an appointment with a GP, as often the wait is weeks rather than days. This then pushes people to A+E where patients know they will be seen if they are prepared to wait long enough.
The Health Foundation notes that the number of fully qualified full-time equivalent GPs has declined since 2015. A recent article in the Telegraph put this another way – GPs are now dealing with up to 3,000 patients each. Additionally, working practices have changed post-Covid with an increase in telephone appointments used in the first instance, which can add additional workload for a GP.
The concern is that this is pushing people with minor ailments to A-E, essentially moving the bottleneck from the GP service to the accident and emergency room.
A recent BBC analysis of Accident and Emergency waiting times between December 2022 and January 2023 identified both the best performing and worst performing NHS Trusts. It noted the best performing Trust did so as a result of having an integrated care system whereby the Trust ran both hospitals and community services.
This allowed for better communication and planning when dealing with patients’ care needs and allowed for faster discharge, freeing up space for others, as the Trust remained responsible for care beyond discharge. The best performing Trust also had a dedicated emergency care site with emergency care clinicians available 24/7 to deal with the waves of new arrivals and to treat them quickly.
Lack of integration is an issue that the government and NHS England are aware of and working towards improving. However, without a sudden influx of GPs, it seems likely that accident and emergency departments will continue to experience high volumes of patients for the foreseeable future.
Heightened pressures on Accident and Emergency departments across the country are likely to impact on the standard of care provided to patients. This might just mean longer waiting times, but the concern is that it may lead to more inadequate care being provided. There is an argument in respect of what is reasonable in the face of unprecedented circumstances. This was highlighted in a recent talk by consultant in emergency medicine, Dr Paul Kennedy, speaking as part of an AvMA series of talks.
AvMA stands for Action against Medical Accidents is a charity that promotes and campaigns for patient safety and justice. In his talk, Dr Kennedy noted that, in terms of usual wait times, the onus is on the patient in terms of decision making in the face of a long wait. Normally, if the patient were to walk out and suffer harm as a result, then that would be the fault of the patient- not the Trust.
However, as wait times increase, Dr Kennedy noted that the onus may shift if, for example, if the patient had been waiting in excess of 10 hours and walked out and subsequently suffered harm. This is somewhat unchartered territory, however, it is worth noting the potential shift from a position that the patient should just wait to be seen in A+E, to a consideration as to where the line is drawn in terms of reasonableness in wait times. This issue may become more pertinent as pressures on capacity continue amid the present climate of the NHS
If you are concerned about treatment that you, or a friend or family member has received, that could result in a clinical negligence claim, please do not hesitate to get in touch for a free consultation via our website or call on 0191 232 8345. We are happy to listen to your concerns and will provide the best advice that we can.