Sir, – GPs see about five million emergencies per year in this country (providing 24-hour emergency care to their “public” patients still forms the basis of the GMS contract); emergency departments about one million. Over 90 per cent of primary care emergencies are seen by trained, experienced doctors, ie senior decision makers. In emergency departments in general, the decision to admit is made in over 90 per cent of cases by doctors in training, whose ultimate default position, especially in areas of uncertainty, is to admit patients to the hospital. Senior decision makers, ie hospital consultants, generally see these patients for the first time on day two on the “post-take ward round”.
In departments where there are large numbers of self-referrals to the hospital (much higher in urban areas), it is logical to expect that some of the patients who end up being admitted to the hospital by doctors in training may have otherwise been managed in the community had they first seen their GP.
Solutions to overcrowding involve small margins and small wins in many different areas of the system. Without the commitment of GPs to the provision of emergency care, hospital admissions would undoubtedly increase. If the boundary between primary and secondary care was more clearly defined in the system, the impact on overcrowding may be greater than we suspect. Primary care is cheaper than hospital care. More patients being managed in the community means less overcrowding, and more money for the rest of the system. – Yours, etc,
Dr BRENDAN McCANN
Consultant
in Emergency Medicine,
University Hospital
Waterford.
Sir, – We have been analysing, writing on and discussing this problem for the past 10 years. In that time span there has been a direct correlation between the number of sick people awaiting admission to acute hospitals being held on trolleys in emergency departments and the number of medically fit for discharge older people occupying acute beds in these hospitals. The solution to this growing problem does not just lie in an increase in Fair Deal funding to facilitate admission to nursing homes but must include a more advanced and better funded home care package scheme.
I suspect politicians will only act when their sick constituents arrive in their clinics when they are not able to gain admission to an acute hospital. We are getting closer to that reality but no closer to a solution from the HSE. – Yours, etc,
Dr JONATHON ROTH,
Limerick.
Sir, – It is reckoned that a third of hospital beds are used to deal with alcohol-related diseases. The most effective health legislation was the ban on smoking in the workplace, at nil cost to the taxpayers. Similar action is required for alcohol, with a total ban on advertising, promotion and sponsorship. – Yours, etc,
JAMES MORAN,
Bunclody, Co Wexford.