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A&E should turn away patients with minor problems, claim MPs

The NHS should consider refusing to treat patients who turn up at accident and emergency with minor problems, a group of MPs and peers have said.

The controversial move should be looked at alongside a wider education drive to help people manage their own health issues better.

“If we have any chance of changing behaviour we must support people to become empowered and health literate”

The suggestion comes in a report from the All Party Parliamentary Group on Primary Care and Public Health, which is co-chaired by Tory MP Nick de Bois and Labour’s Kevin Barron.

The politicians call for more strategic thinking and planning across the health service to deal with the winter surge in patients seeking treatment for viruses and infections.

“Also necessary are measures to empower patients and the public, to help them understand how to look after their own health and their family’s health, especially during winter,” the report said.

“Self-care education must be part of the winter pressures solution to help reduce workload in general practice. It will also free-up capacity in A&E for those presenting with symptoms of common ailments, and long-term conditions.

“Emergency bed admissions can also be reduced if people are taught to manage their more serious health conditions.”

The group added: “We should even go as far as to consider not treating people in A&E unless they present with symptoms that are emergencies.

“If we have any chance of changing behaviour we must support people to become empowered and health literate.”

Readers' comments (17)

  • tinkerbell

    yes, the clues in the name 'Accident & Emergency' but with little chance of getting a timely GP appointment lately this is further fuelling the burden on A&E.

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  • People are left with little choice at times when you have to wait 3-4 weeks for an appointment to see their GP. The GP surgeries here in Cornwall are quite unethically run I think. GP's get huge bonuses each year and complain so much about having to see patients. The GP's here in my GP surgery all work part time as they get paid so much they don't need to work full time. People's ability to get an appointment on the day they need to see someone is slim to none existent. If GP's were held more accountable and were more conscientious, the A&E departments would probably not have so many people with non emergency problems.

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  • MPs, and non-clinical managers, have no right to override the pledge of doctors and nurses and their accordance with their professional ethical codes of conduct not to turn the sick in need away, also some complaints may be a sign of a more serious underlying condition which can only come to light on careful questioning, observation and examination. too many patients are turned away without adequate care from medical services and sometimes with tragic consequences (personal experience of a nurse and member of a ward team who lost a valued young colleague in this way).

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  • The decision for the Triage nurse to 'triage someone away' is very difficult and full of clashes of professional duty and Trust policy. Nurses would need to be assured of Vicarious Liability otherwise this type of policy won't work anyway.

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  • it is easy for these lay people and mangers simply to say turn people away but they still need somewhere to go. transport systems are appalling in the UK as is parking, and facilities are often far apart and inconveniently located. if you are sick or injured and anxious even for something minor you don't want to be turned away and pushed from pillar to post or have to hang around and ride on public transport, and a taxi may not be easily and rapidly available or an affordable option. not everybody has somebody else available to chauffeur them around at the drop of a hat or their convenience and apparently hospital transport is inefficient and for some purposes probably non-existent. Most people will even think twice about going to A&E unless they happen to be nearby or just passing by.

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  • Yes, clinical staff will never triage away. The whole system has to work so GPs must improve access, and be held to account.
    Ministers - crack on with that please instead of the triage away strategy.

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  • I have worked with Stroke for over 2 decades, and am shocked at the amount of TIAs that are turned away, only to return with full blown strokes!!

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  • it is unthinkable that care is not easily accessible 24/7 to patients in need of medical attention which cannot wait until traditional working opening hours and should be available at different levels from basic up to serious.

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  • I would also see red if I found the only choice was A&E and went there to be asked why I hadn't gone elsewhere. it undermines the intelligence and anxiety of the patient as an autonomous adult. If somebody sees the need of medical attention and turns up at A&E it is for good reason and they should be treated with respect and without question which I hope is normally the case and respect also means not hanging round in a waiting room for hours!

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  • The original comments were if I remember regarding people pitching up at A&E with minor health needs more appropriate for GP surgery. Having worked for a service that closed at 8pm we were tasked with redirecting people to appropriate services at closing time. In general red flag majors were treated or transferred to A&E, urgents to the OOH urgent care service and minors to the next day/GP/111. 111 inevitably sent people to A&E or urgent care anyway!!
    What I wonder is where this argument might go. redirecting is different from turning people away. if this narrative becomes established then it gives managers free reign to pick and choose who will be treated, thereby devastating not only the basic principle of the NHS, which govt have relinquished responsibility for via H&SCA, but basic principles of humanity not to mention the professional codes and social contract. This may look like a practical solution to service capacity however I have watched the Machiavellians put morsels of seeming sense down and then pick up the ball of strategic victory and run away with it so many times.

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  • why is the photo above of a public lavatory?

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  • tinkerbell

    bob | 28-Jun-2014 12:09 pm

    well said Bob.

    Anonymous | 28-Jun-2014 12:41 pm

    Yeah, now you mention it:)

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  • I am a full time Band 5 triage nurse for all ambulatory patients attending an ED, it is located in an adjacent Urgent Care Centre (UCC). I do not have the responsibility or the autonomy to discharge from triage, I have three basic options
    i) redirect to their own GP
    ii) seen by a practitioner in the UCC
    iii) directed to ED
    Within option iii) this could be Majors, Minors or even resus.

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  • Anonymous | 1-Jul-2014 12:51 pm

    does that work well or would you prefer to have the responsibility to discharge as well?
    would this be more effective for the service and patients alike?

    it depends on the skills and experience of a triage nurse but would seem in theory to be a reasonable safeguard and discharges by some could be highly objective with serious problems missed, but this could also happen further along the chain but by that time a patient has had more than one examination and opinion.

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  • Anonymous | 1-Jul-2014 2:34 pm: No it doesn't depend on the skills and knowledge of the triage nurse, discharge is different from triage. Responsibility to discharge would necessitate an individual at band 7 or 8, with medical training to be aware of what they need to be not missing. This would need more than a quick 5min triage (and I wonder why it is that there are no medical colleagues volunteering for this role!) This was the basis for walk-in centres, which are now working well beyond capacity as well. There comes a point where it needs to be recognised and appropriately responded to, that there is only so much that can be done with the budget we have. Anymore pressure will result in harm and unnecessary deaths of the public. Not to mention the mental and emotional distress of the staff. If that is what the public are happy to accept then that is one thing, however as staff I would not continue to put myself into such a damaging position

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  • tinkerbell

    https://www.youtube.com/watch?v=Cz5dl9fhj7o&feature=youtu.be

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  • Look, these people still need some access to health care, even if it's just to advise on self care.

    People aren't actually irrational. Given the sheer hassle of trying to get to a GP appointment and the dubious quality of some of the results, it makes perfect sense to go to A&E even if there's a long wait.

    The current model of general practice is ineffective and horribly expensive. We've been stuck with it since 1948 because the doctors' grandfathers wouldn't allow the NHS to come into being unless they got their own way on everything!

    Patients need access to 24 hour health care close to where they live and it needs to be the best 21st century quality, not governed by 19th century professional privilege and professional power structures.

    People need to have more information about self care in minor self limiting illness (preferably without abuse of antibiotics) to take up vaccination where it can help.

    We need an expanded health visiting workforce to re-start preventative health care in communities & homes, working with people directly to help them learn to cope and care for themselves in minor illness whist being aware when things are more serious and really need a hospital.

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