Extra doctors at the weekend, more paediatric beds and integrated teams of specialists are in place to cope with what looks like being the busiest winter ever at Epsom Hospital's accident and emergency department.

On Black Friday last week - so called because of the nationwide surge in A&E admissions that day caused by pre-Christmas drinking - the Epsom Guardian visited the department to speak to its passionate and dedicated team of senior doctors and nurses.

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Head consultant Annali Lawrenson and elderly care consultant Dr Mashkur Khan

Although it was only 12.30pm at the time of the newspaper's visit, all of A&E's major treatment and resuscitation beds were already full - though not with the young adults that tend to clog up many such units with minor wounds that should be treated by a GP or drink-related injuries.

On most days, Epsom's A&E is full to capacity, with 80 per cent of those coming to the unit elderly people and the rest mainly under-18s.

Dr Annali Lawrenson, A&E consultant, said: "Unlike some A&Es we don’t get a lot of primary care stuff. We don’t get abused by the patients. We don’t get many sore throats or drunk people.

"I have friends working in the London A&Es and easily 50 per cent of their workload is just primary care, GP stuff. Epsom has a well-educated population."

But the flip side of this is that the department is working flat-out as an ever-increasing number of more acutely sick patients coming in - a situation which has seen no let-up since the summer.

During the winter months the area's elderly population are particularly susceptible to conditions such as asthma, chest infections, fluid on the lungs and bladder infections.

Jeanette Ellis, deputy general manager in medicine with a focus on A&E, said the average number of attendances at Epsom A&E were 120 a day four years ago.

This figure has now risen to 150 to 160 a day. On a particularly busy day it can be 200. Paediatric attendances have doubled in the past year.

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Dr Mashkur Khan, an elderly care consultant, said: "People come to A&E because it’s the only place with the lights on 24-7 and community care is lacking - it’s developing but it’s still in its infancy. People trust A&E and would rather wait four hours and get seen to properly."

A triage system - which sorts patients depending on the type of treatment required - is already in place at Leatherhead Hospital which filters out patients who do not need to come to A&E.

If a GP feels a patient may need some further assessment following an appointment, they will be referred to a consultant at Leatherhead, who will then send the patient to Epsom A&E if this is considered necessary.

Dr Lawrenson said the trust is also working with Surrey Downs Clinical Commissioning Group (SDCCG) to see whether patients who do come to Epsom A&E with primary care complaints can be streamed through to a GP on-site.

This commitment to integration between services, which has been encouraged by the CCG, is the approach already being used to tackle A&E pressures.

Dr Lawrenson said: "There are more patients who need more admissions and therefore more beds. We need more beds. We don’t have more beds so we have to be creative in the way we manage it.

"The CCG has been so keen to interact and integrate and that’s helped enormously."

The £1.4million of winter money the trust received last year funded extra doctors and nurses and paid for the Older Persons Assessment and Liaison Service (OPALS), which is still going strong a year later.

It has received no winter money so far this year.

The OPALS team of doctors, nurses and therapists working together in a closely integrated way to assess elderly patients on A&E and help get them home quickly and prevent re-admissions - whether this be by fitting a hand rail in the person's home to prevent another fall or sending them to a community hospital for convalescence.

A respiratory in-reach team works along the same lines and provides patients with a respiratory nurse support so they can go home.

Your Local Guardian:

Jeanette Ellis, from the Older Persons Assessment and Liaison Service, and nurse Sue Cook

Other recent measures in A&E include piloting an ambulatory care centre for three months, which started at the end of October.

The unit treats conditions such as low-risk chest pain, anaemia and acute headaches and again tries to prevent admissions to A&E where possible by allowing patients to be assessed during a longer stay, at the end of which they may well be sent home.

An extra four paediatric observation beds have been introduced in A&E, with an extra doctor to support this, and the hospital is looking at how it can improve its discharge rates.

The hospital trust has set aside £1million from its budget this year to cope with winter pressures.

Ms Ellis said: "They are paying for extra doctors to staff in A&E because it’s so busy but we don’t have the budget for it. But we have to do it for the safety of the department.

"It’s a three-pronged attack. It’s opening your back door, keeping the wheels turning in the middle and then stopping some of what’s coming through the front."

Dr Lawrenson added: "The trust have been quite proactive in saying ‘we’ve noticed that numbers have gone up in A&E and therefore the numbers being admitted has gone up so would it help if you had extra doctors over the weekend to turn patients around quicker?’.

"There are a lot of little things which are adding together and at the moment we are able to hold our heads up and hopefully it carries on."


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