THREAD

Not expressing opinions, just curious to know what other people think

Basically does the 2020 (and beyond) public still accept diagnostic uncertainty, "watch and wait", gatekeeping and delays in access to assessment/diagnostics or are traditional models out of synch?

we know that a percentage of walk in people who pitch up in emergency departments were aware of alternative options, aware that A&E is technically for emergencies and yet chose to use ED anyway because they wanted quick access to investigation/speciality etc

talk to GPs who spend some of their time working in ambulatory ED/streaming etc and they will tell you of patients they would never have sent in in their day job and who say "oh this is much better than my own GP. He/she won't do the tests/give the prescription immediately"

we also know that (not suprising when everything else in their life is done rapidly on line by apps) there is caucus of younger urban professionals/grads who love the convenience and lack of disruption and rapid access they get from on line GP/App type services

and we know for certain conditions (like Cancer/Dementia) they are often being picked up in crisis in secondary care, partly due to nature of conditions and partly cos of access/wait issues in both primary/secondary care/mental health etc

just as GPs rightly proud of their ability to accept uncertainty as conditions resolve spontaneously or never have a clear answer....

we are proud in hospital AMU/ED/AEC of our ability to investigate fast but not overinvestigate, de-escalate, de-medicalise, discharge same or next day, avoid admission, hold managed risk

and within hospital wards we are all aware that hospitalisation has risks of its own and that home may often be safer so we are focussed on trying to move "stable enough" people on back home or to other care settings even when all concerns not yet fully resolved

but in society where people are less deferential to professionals and paternalism less acceptable and where people more likely to complain, less likely to accept things passively and stoically and there is a far more consumerist mindset with instant access web brings
what to do?

If we lost GP Gatekeeper role then hospital/MH outpatients would be unable to cope with all the self referrals. If we did not turn so many people round in A&E/AMU/AEC or focus on rapid discharge from wards, we would overwhelm the bed base and deny other patients in need

and there is no magic tree to produce health and social care professionals, for outpatient or investigation capacity, for GP appointments or for hospital beds

does this mean we are increasingly out of synch with what the public, patients, their families, the press now want and expect and if so do we need either to

1 Change the offer considerably (although with limited resource and staffing, how)?

2. Level with the public very openly

i.e. be completely honest about what a public health service for the many based on need not want and free at point can and cannot reasonably be expected to do with current staffing, capacity and resource and make it clear that is is a million miles from retail, leisure, travel?

so uncertainty, spontaneously resolving symptoms which don't necessarily need tests/treatment, just a safety netting second appointment, lack of same day/next day access, the need to leave hospital when some issues still unresolved, and a lack of choice are just facts of life?

My worry is this will be increasingly out of kilter with how people live their lives

Speak to State School Teachers or Social Workers or Police in a similarly resource constrained environment with multiple competing demands and a similar picture emerges of that mismatch

ENDS