I spent last evening in the A&E (A.K.A. Casualty or ED, Emergency Department) watching how things were being done there.
Possibly the biggest change to affect A&E came about 10 years ago when GPs gave up night and weekend cover. There is now based in our department a GP and a nurse practitioner, together with a car and driver.
With the vast increase in attendances since the introduction of the 111 service, in normal working hours the GP can filter off many of the patients who are not emergency cases, and at night, between them and the paramedic service, they can provide an excellent service, which they consider to be considerably superior to the old GP out hours cover, which couldn’t be re-implemented anyway because of the national shortage of GPs.
The patient mix that came through the doors last night was fairly typical. The broken wrist due to a fall, the collapse in the street, the severe headache causing vomiting, etc. But we were spared any drunks (apparently the problem in Salisbury is not as bad as it was a few years ago), or any accidents. Severe accidents are of course in any case taken direct by helicopter to the trauma centre in Southampton. The security man came by to check that all was well, and confirmed that we are remarkably fortunate to have very little call on his services.
When I was there, all the A&E beds were occupied by medical patients overflowing from the medical wards – a national problem caused by inadequate provision in the community for our aging population. This inevitably meant delays in getting patients out of A&E, with knock on effects on patients waiting to be seen; we’d all like to be in and out of A&E in hour, but unfortunately blood tests, x-rays etc. take much longer than that to be processed even when one has been seen.
Then of course there are the occasions when two or three patients requiring urgent attention arrive simultaneously. That’s when waits really turn into hours, as every member of staff is totally occupied with the emergencies.
My impressions were of wonderfully friendly and competent staff all doing their absolute best to help their patients. The department is scrupulously clean, well equipped, and all the patients I spoke to were most grateful for the care and attention they were receiving. I went home at midnight mightily impressed.