Encouraging Patients Not to Use A & E

I have always thought that to steer patients away from going to A & E to another NHS service was an uphill almost impossible task. GP Practices have religously warned their reception staff not to make clincial comments.

Many solutions have been and are still being tried to encourage less use of A & E ranging from Minor Injury Units and Walk-In Centres to the ‘111’ telephone line and you could ask your local pharmacist in a consulting room the size of a shoe box. One group of CCGs in West Yorkshire has published a leaflet which attempts to direct patients to the ‘right’ location.

The leaflet suggests (my comments in brackets) that

URGENT CARE – CALL ‘111’ This is to be used for worsening health conditions, when you need advice, when you need to see a doctor out of hours, and if you have severe dental pain.

SELF-CARE – Look after yourself if you have a hangover, a sore throat and and runny nose. (This means self-medication and a well stocked medicine cabinet)

PHARMACIST – Go to see a pharmacist at your local pharmacy if you have diarrhoea, a running nose, a painful cough or a headache. (I have never known a pharmacy have access to a toilet. What’s the difference  between a runny nose and a running nose?)

GP SURGERY – Go to see your GP for cuts, a stomach ache, and a back ache. (Oh if that was all that could be on the list)

NHS WALKIN CENTRE or MINOR INJURY UNIT – Use this service for Cuts (but you said I should go to my GP), sprains, rashes, and a cough.

A & E – Go to A & E if you are choking, have chest pain, severe bleeding and are blacking out.

I have to say that broadly speaking I found the list or the idea of a list useful, but there is a risk of such lists causing confusion and directing people to the wrong place. It is like the instructions given to GP reception staff not to give clinical advice. To start listing ailments and symptoms and saying do this or do that without a proper history or clinical assessment is never wise.

A couple of points to bear in mind. Minor Injury Units tend to have access to a radiography unit if not then A & E it is. The Minor Injury Unit I attended yesterday after a car shunt did not have triage. Therefore there was an hour plus wait before beeing seen. At leastt in A & E I would have been triaged or would I.

My second point is there is an assumption that practice nurses will be on hand to deal with minor injuries. This is not what they are paid for.

As I have said a leaflet is a good idea but they are extremely difficult to write.

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