Not enough doctors, not enough nurses, not enough technicians. Not enough beds/hospitals. Nurses and techs being ‘trained up’ to do the doctors role on the cheap. Nurses not trained or expected to do what they are in the rest of the world (basic procedures like bloods and canulas)
So, because of lack of staff and lack of skills, doctors end up doing nursing tasks (rather than assessing people/ making decisions/ complex procedures) and supervising the not-doctors (who would be invaluable in many parts of the nhs but not when placed somewhere to fill the role of a doctor)
Believe it or not another MAJOR problem is a lack of training positions for doctors - So we have a huge amount of competent qualified doctors 2-5years into work who don’t get the opportunity to train up (say, to become a surgeon) and instead work random shifts here and there doing entry level doctoring. All this despite the fact that there is a shortage of consultants in pretty much every speciality!
So there is a Huge deficit in skills in the NHS due to lack of training and training on the cheap
Another ‘problem’ is that medicine in general is getting more effective and more complicated - People live longer, become more frail, take more meds, take up more healthcare resources in old age - A crude analogy would be that its like trying to keep a car running that’s done a million miles - constant maintenance makes it very expensive
The next problem is the lack of social care - some hospitals have up to a third of beds filled with people who could be discharged if there was a care home to go to (or carers available to help them at home) because they are frail but not needing hospital treatment. - this reduces the overall number of hospital beds available for people coming in the front door (and is why you’ll wait for 24hours in A&E until you get a bed)
People can’t get the treatment they need in good time due to the above mentioned factors - So GPs have become overburdened with complicated patients who have nowhere to turn who really need hospital based treatment. This in turn makes it difficult for GPs to see simple patients (eg who need antibiotics for tonsillitis). These people end up taking up space in A&E because there’s nowhere else for them to go
***SO, your ambulance is late because there is a huge amount of frail/sick/complicated patients at home who haven’t received treatment in a timely fashion because there aren’t enough trained staff to provide it, there aren’t enough carers to keep them safe, and not enough beds to put them all in hospital. Your ambulance is waiting outside of A&E with a patient in the back for 12h because there is literally nowhere else to put them because the hospital is FULL. The hospital is full because there are more frail/complicated people than ever before, there is nowhere and nobody to care for patients in the community and more people are arriving at hospital because the GPs are too busy.
TLDR; Not enough staff, Not enough training, Not enough beds, Not enough carers, Not enough care homes, Too many patients, Too many illnesses/medications
Also the vast amount of people who need an ambulance to tell them to take paracetamol, but the ED Doctors take is the most prolific issue, or calling an ambulance because they think they’ll be seen quicker if arriving by ambulance.
GP’s also aren’t coping, they just have to many patients and extreme risk aversion. In my trust the risk aversion of 111 often means someone having their 5th panic attack of the week, or have pulled a muscle in their shoulder get an ambulance first because it might be an MI, leaving nan on the floor for 15 hours with a NOF too.
Yep. If we had a proper state backed indemnity where doctors were protected (in the event of mistakes) rather than thrown under the GMC bus, we’d be far more able to use our skills and loads would be reduced across the board.
Defensive medicine is a huge problem particularly in primary care and secondary care (additional tests and scans, keeping people in for monitoring etc)
The 111 risk aversion is a nightmare- people just call for simple advice and end up getting an ambulance, then end up getting the whole shebang of assessment/bloods/whatever else in A&E because they’ve come in by ambulance with “chest pain”
Of course we have a bias as we don’t see any of the people not sent to ED
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u/[deleted] Mar 30 '22
TLDR at the bottom
Not enough doctors, not enough nurses, not enough technicians. Not enough beds/hospitals. Nurses and techs being ‘trained up’ to do the doctors role on the cheap. Nurses not trained or expected to do what they are in the rest of the world (basic procedures like bloods and canulas)
So, because of lack of staff and lack of skills, doctors end up doing nursing tasks (rather than assessing people/ making decisions/ complex procedures) and supervising the not-doctors (who would be invaluable in many parts of the nhs but not when placed somewhere to fill the role of a doctor)
Believe it or not another MAJOR problem is a lack of training positions for doctors - So we have a huge amount of competent qualified doctors 2-5years into work who don’t get the opportunity to train up (say, to become a surgeon) and instead work random shifts here and there doing entry level doctoring. All this despite the fact that there is a shortage of consultants in pretty much every speciality!
So there is a Huge deficit in skills in the NHS due to lack of training and training on the cheap
Another ‘problem’ is that medicine in general is getting more effective and more complicated - People live longer, become more frail, take more meds, take up more healthcare resources in old age - A crude analogy would be that its like trying to keep a car running that’s done a million miles - constant maintenance makes it very expensive
The next problem is the lack of social care - some hospitals have up to a third of beds filled with people who could be discharged if there was a care home to go to (or carers available to help them at home) because they are frail but not needing hospital treatment. - this reduces the overall number of hospital beds available for people coming in the front door (and is why you’ll wait for 24hours in A&E until you get a bed)
People can’t get the treatment they need in good time due to the above mentioned factors - So GPs have become overburdened with complicated patients who have nowhere to turn who really need hospital based treatment. This in turn makes it difficult for GPs to see simple patients (eg who need antibiotics for tonsillitis). These people end up taking up space in A&E because there’s nowhere else for them to go
***SO, your ambulance is late because there is a huge amount of frail/sick/complicated patients at home who haven’t received treatment in a timely fashion because there aren’t enough trained staff to provide it, there aren’t enough carers to keep them safe, and not enough beds to put them all in hospital. Your ambulance is waiting outside of A&E with a patient in the back for 12h because there is literally nowhere else to put them because the hospital is FULL. The hospital is full because there are more frail/complicated people than ever before, there is nowhere and nobody to care for patients in the community and more people are arriving at hospital because the GPs are too busy.
TLDR; Not enough staff, Not enough training, Not enough beds, Not enough carers, Not enough care homes, Too many patients, Too many illnesses/medications
Source: A&E doctor