The only thing that is guaranteed is.......

I've just read an article in todays Guardian. I was prompted to do so by The Jobbing Doctor's latest post. Oh dear! I work in a practice very close to the front door of A+E and we have a persistent problem with people attending A+E inappropriately. 

Or we thought we did...

We decided to look at it. we reviewed our A+E attendances with the help of data from the local department (who were extremely helpful and with whom we have good relationships). And guess what...

Some people attended A+E inappropriately.

but......

lots of people had accidents........ got ill...... needed emergency treatment!

We have recently undertaken a review of our non-elective admissions in our elderly population. This review involved a comprehensive integrated medical and social assessment of potential at risk patients.  Guess what.......

A few admissions could have been avoided

but......

A lot of elderly patients with multiple pathologies needed the specialist care that could only be provided in hospitals. 

As GPs we have taken on the management of many conditions that in the past would have in been dealt with in secondary care (e.g. Diabetes, COPD, Heart failure) . In my brief career I have seen some condition that would have been managed at home moved toward secondary care (e.g. MI's, Strokes, Labour). It is likely that such flux will continue. 

I am a GP trainer and registrars frequently come to me with the question "how can I keep this patient at home?" This bothers me. Surely the first question should be " Is it appropriate to keep this patient at home?"

The reality is patients should get the best care in the most appropriate environment based on best practice at that point in time.  The vast majority of GP's seek to use both elective and non elective secondary care services as appropriately as possible. A small number of people (both patients and doctors) will misuse the service but to penalize any part of the health service for this small amount of inappropriate use is to the detriment of everyone. 

I fear that practices close to A+E departments will be unfairly penalized under this system. Most of these practices are in areas of high depravation (you can't build a large building like a hospital in affluent areas these days the land is too valuable).

There is only one certainty in life and that is death. For the majority this is proceeded by a period of ill health. The vast majority of people only use the health services when they need them. People go to hospital mainly because they are sick. I hope when my time comes that the services I need are available and I can be cared for in the right place. 

The cost of a justice system that is based on "Innocence until proved guilty beyond reasonable doubt" (something our regulating body has recently dropped!) is that some guilty people go free. The cost of a health service that is free at the point of delivery is some abuse of the system. 

I realize that the above is a little disjoined but what i am trying to say is "free" health care "costs". Its expensive but its worth it. 

Are we prepared to pay or are we going to allow the system to be squeezed out of existence?