23 ways to relieve pressure on A&E

In the January 2015 edition of our newsletter for healthcare professionals, we asked subscribers the following question: What would you do today to relieve pressure on A&E? Here are 23 of the responses we received.

Working with the 111 service, I am aware many patients ring us because they cannot get a GP appointment within a reasonable timescale. We can often provide home management advice or send the patient to UCC (urgent care centre) or WIC (walk-in centre) if this is appropriate. However there will be others who simply go to an ED (emergency department) as a first resort. I would increase access to GPs both within or out-of-hours. Sonia Norris

I would charge a fee for all time-wasters (they know who they are!) especially drunks and the like who have self-inflicted problems and cause so much disruption and waste so much money in the NHS, which could be used in a much more effective way! Pat B

Get pharmacists trained in clinical assessment and have open door walk-ins for triage. Sam

Make it easy to see a doctor. Stop doctors having two jobs, most of them complain about the hours they work yet most consultants run a private practice (using NHS equipment) as well as working for the NHS. P. Griffin

When the social infrastructure of a country is overwhelmed by users then there is no surprise when systems fail. My first thought is 'who is using A&E and what ailments are they attending with.' I do not see the situation improving so the rules must be changed. Put simply, we start charging a nominal fee for what is not an emergency. I believe we would see numbers fall immediately. Karen Young

Perhaps the reinvention of convalescent homes would allow the discharge of the vulnerable aged patients who no longer require treatment in the acute wards while their social and community care is being put in place, prior to home discharge, so freeing up acute beds for patients to be admitted from A&E. Gwen Turner

I would ensure that people with chronic illness or cancer were taught about their condition and how to prevent exacerbations and side effects from drugs. I also think that patients with these conditions should have a named GP who knows their condition and specialist cancer GPs for symptom management and continuity. Caroline Scales

To relieve pressure on A&E, people need to be seen in appropriate areas of care; A&E for accidents and emergencies, with walk-in minor injury clinics in either health centres or hospitals. GP practices could be open 24/7 with doctors and nurses working shifts. Perhaps a cheaper alternative would be to let practices be open with nurse practitioners and one doctor. Patients could then be treated there or referred to minor injuries or A&E, with only ambulances taking patients to A&E. Isabel Bowie

I think I would try and re-educate the public to look after themselves more, to use pharmacies, call GPs or use urgent centres before rushing to A&E. I think Social Services need more financial help to be able to quickly find beds for the elderly who need to be discharged from hospital; I think bed blocking is the biggest problem and whilst some very frail elderly may need some time in hospital, many could happily be discharged home (with support which does not cost the earth) or to go to care homes. Perhaps care homes could be encouraged to have a few spare rooms to which patients could be discharged to, whilst other alternative arrangements for their care are worked out, with perhaps the cost being shared by CCGs and FT Hospitals. Sheila Miller

Start to make people responsible for themselves and their little illness such as cough and colds. People phone 111 and 999 for such trivial illnesses that they should be able to manage at home. We have given them too many choices for someone to hold their hands. Before NHS direct or out-of-hours doctors, they had to manage themselves or wait till the doctor surgeries opened. In my parents' day, the family looked after themselves but now they don't need to. Even with just a cough they want someone to tell them how to look after them. We as a nation need to cut back on this nanny state of mind. Dave Jackson

Some hospitals, I understand, have walk-in clinics as well as full casualty provision. This could be a helpful model. We also need to heighten patient awareness of other sources of assistance such as pharmacies. Perhaps we all also need to toughen up somewhat. The difficult question of how to manage the number of drunk patients must be solved. We had a dedicated bus staffed by paramedics over Christmas which eased the pressure on hospitals somewhat. We should also look at why so many people get drunk, although there is something of a decline in younger people. The four hour target and bloods queues need to be sorted. Linda Isiorho

I have been living Australia for over 30 years and came back to the UK in May 2013 to live. What I cannot get is why we have ONE hospital to cover Crewe and many surrounding areas. We have to go to Leighton Hospital for X-rays, scans, the lot; it's ridiculous, absolutely crazy. There are 23 million people live in Australia and about 69 million here, yet we don't have so many hospitals to take care of people. In Brisbane and suburbs we have at least 12 hospitals and x-ray departments and blood collection units in every suburb and you don't have to go to a hospital to get these things done. Why doesn't the government build more hospitals and put x-ray and blood collection units in more places? It would take the pressure off the few hospitals we have. They say they have no money yet they send millions to overseas aid so instead of that, look after your own people and build more hospitals and medical centres to do x-rays and all other procedures to take the pressure off the NHS. Jean Chesters

To alleviate pressures on A&E ensure that primary care advanced nurse practitioners and GPs are working at weekends, either on hospital sites or in community settings. Bring back the Urgent Care Walk-in Centres under one uniform organisation, as the few that are left have been contracted out with each centre working to different contract criteria and with inappropriately skilled staff. Privatisation of services at its worst! This is not rocket science and will save resources of emergency departments. However the way that funding works encourages A&E departments to see inappropriate presentations so good luck on this one! Ann Kelly-Smith

In my childhood and youth, A&E was used for exactly that; accidents and emergency. I recently broke a wrist and went to A&E I was amazed to see the place was three quarters full of people who only needed to see a doctor; that is they could be treated by a GP, but they were not registered, so had to attend A&E. I also remember from my childhood in an emergency you phoned your GP and got the doctor from the practice who was on-call. These days you are sent to the out-of-hours doctors at A&E. I sat for over an hour to get a prescription, the waiting area was full of people with coughs and colds, which is a considerable risk for someone like me with severe COPD. Perhaps a return to some of the old ways and have A&E used for what it was meant for. Lesley M. Bird

I would produce a public information short film not dissimilar to the ones the BBC/ITV put on from time to time to notify people of important issues like the switch from analogue to digital TV etc. Going back some years such announcements were used to inform us about decimalisation, the Green Cross Code and the anticipated AIDS epidemic. Who remembers the cartoon about calling the coast guard when his wife thought the drowning man was waving?

So many of our patients pitch up in A&E, as they simply haven't heard about 111 as an alternative. How about letting them know with an eye-catching, sound-byte-laden modern version of the good old fashioned information film before our good old National Health Service drowns? Denise Sharratt

Theory 1: We went to Vietnam & Cambodia recently. Developing countries, with lovely, compassionate people. Nevertheless a lady in our party had to be hospitalised...and credit cards and insurance duly produced. How many people who are non-UK residents or Europeans without the correct paperwork are treated without any consideration of reimbursement. Perhaps if our NHS care wasn't so free to everyone, the queues would be less.

Theory 2: If patients were sent home to see GP after suitable triage, perhaps our A&E wouldn't be so overwhelmed. People are going because of few GP appointments, or patients don't manage long- term illnesses well. I suppose given the level of abuse some poor staff would get if treatment wasn't forthcoming, we might not even have A&E departments. Wendy Westley

I would do the following:
a) Unless genuinely urgent, make all those suffering from alcohol abuse wait at the back of the queue. See people according to need NOT arrival!
b) Locate a GP alongside A&E, and direct people with minor problems there.
c) Educate people into using their GP and pharmacist for minor ailments.
d) Employ only trained and experienced staff on the NHS 111. They must stop sending people to A&E who have non-threatening illnesses. Dr Barry Clayton

I think it would help some people to be told what is generally considered to be an emergency and what isn't, so perhaps a list of emergency symptoms, accidents that would go to A& E and another list of illness, for which you would phone 111 and yet another list of things to wait to see your GP. I think that if very obvious non-emergencies and drunk people turn up at A&E they could sit in a separate room until all emergencies have been dealt with, with no time restraints on when they should be seen. Also, remind people that they can speak to a pharmacist at the weekend for non-emergencies. Lucy Hewitt

I honestly believe that a charge for A&E attendance/admittance into hospital should be levied to any future patient who is visiting A&E as a direct result of drink/drug and/or obese-related condition. Frankly speaking these factors are a direct choice made by the individual and could be avoided. Finally on another matter I would like to see the current and/or shadow health minister actually spend time within an A&E one weekend evening. This would give them a clear view of real life. John Williams

Make the four-hour maximum wait only apply to true accidents (within 48 hours of injury) and emergencies. All others should be informed at initial triage that they should have presented to own GP/OOH/MIU and informed that they can wait if they wish, but as the department will be dealing with true accident and emergencies first, they may have to wait over 12 hours to be seen. If this new system is advertised with information as to how to access OOH GP etc, more would take the out of hospital route. The four-hour target should only apply to those triaged as correct A&E presentations.

The non-clinical call handlers at 111 should have access to clinical back-up staff for all calls they are thinking about sending to A&E or an ambulance, as the vast majority of these I am informed about did not need to go anywhere near the major hospital and could have been dealt with close to home by GP or MIU. Only a trained clinician should send the ambulance/advise A&E. There should be greater awareness at 111 of the local options available to patients, as I don't think they even seem to know we have a MIU open 12+ hours per day, sending people to A&E instead. Jacqueline Bryant GP

Consistent triage, charging people for malady that is neither A&E. Check out the New Zealand model, where all people rich or poor pay to go to the doctor or A&E, albeit on a sliding scale, where it is not deemed an accident or emergency. A&E matters are funded separately through a portion of business and vehicle tax. Get rid of GPs and open 24hour local area clinics that have X-ray and diagnosticians and pharmacy that can handle a limited A&E service, i.e. no bed status. We can't go on letting people onto these islands without some assurance that they can contribute to the system. They bring their funds from their previous country, otherwise they must pay in some part for the services. I don't mind paying £20 for a doctor's visit, because if I used it, I would be extremely ill. Long-term illness is a different issue. John Thorogood

Why are so many people going to A&E? Could part of the reason be solved through the promotion of wellness and education about basic health needs? Arguably, there is a trend amongst some of the British public, to need to pass on their health issues on, to be dealt with by others rather than taking an informed opinion and responding to health issues in a proportionate manner. Could the inclusion of health education and First Aid form part of the national curriculum? Do we need a national information campaign? Can we promote a model of wellness? All of us have a responsibility to ourselves and to our precious NHS to start taking ownership of our own health and wellness. Cathy Szeplaki

Communicate better with the local population as to doctors' availability and their location out of hours. This being a rural area one can understand folk going to A&E if it's nearer than an available doctor, can't you? Andrew March