Friday, 2 January 2015

Frequent Flyers

As it's winter, we are once again inundated with headlines about the impending NHS "disaster". There are no beds, more and more people are turning up at A&E and services simply can't cope. There is, of course, some truth in this. A particularly cold winter or an unusually aggressive strain of influenza can result on unexpected pressure on health-care services. That said, services are almost always under more pressure in winter so I'm not sure why the press jump on this like it's a new phenomenon.

As the pressure on health-care services mounts, people naturally start looking for "quick fixes" in order to relieve this. Recently, there has been a lot of talk about "frequent flyers" - an unpleasant term used to refer to patients who access health-care services more than others. There is a suggestion going around that if these greedy so-and-sos learned to self-manage better, the NHS would be in much better shape.

Although I've only been a qualified doctor for 2 and a half years, I've met a number of so-called frequent flyers. I recall a young girl with cystic fibrosis who I looked after during my respiratory rotation who had multiple admissions during the 4 months I worked there. I'm pretty sure that if she had an option, she wouldn't have been in hospital, but multiple spontaneous pneumothoraces are pretty hard to manage at home. There was a middle-aged gentleman who I met during my gastroenterology job. Despite everyone's best efforts, flares of his inflammatory bowel disease repeatedly landed him in hospital. Now I'm working in paediatrics, I can think of several patients who bounce in and out of hospital. A viral upper respiratory tract infection is generally something that can be managed at home, but if you have a rare metabolic disorder, chronic lung disease or a complex cardiac condition then it can be deadly. I can't think of a single "frequent flyer" who had multiple admissions for any reason other than that they were unlucky enough to have an unpleasant chronic disease.

Yes, keeping frequent flyers out of hospital would definitely relieve pressure on hospitals. Now, if the people who come up with these soundbites could come up with the medical advances required to cure these patients so that they don't need to keep coming in to hospital, then that would be wonderful. I'm pretty sure the patients would appreciate it too. In the meantime, let's stop blaming patients for pressure on our services and look at ways to better deal with increased demand.


  1. Just the nomenclature alone could indeed be the thin end of the wedge: your ID records may soon allow, say, five visits per annum before charging kicks in - our records show this is your sixth visit in the last year: way too frequent. People will then play fast and loose with their health (even more than they do now) and steadfastly refuse to go to hospital knowing it will, quite literally, count against them. It's shaping up to be privatisation by the back door. Which has probably been the blueprint waiting to be rolled out for quite some time.

  2. Indeed, it's a term I hate (along with "heartsink" and "fat file"). The simple truth is that years and years of budget cuts means we just don't have enough resources. And privatisation is looking more and more likely. Because that worked out so well for the railways...

  3. I work in a Paeds A&E, and frequent fliers do take up a lot of time. A lot of the time parents can't be bothered to register with their GP, or they want to be seen immediately, and thus they come to us. For example, a new mum brought her baby in four times in a month with nothing wrong with it. That cost the NHS hundreds of pounds.

    Of course there are people who need to attend regularly, but so many of our patients don't need to come to hospital at all, let alone repeatedly. We regularly have parents booking two or three of their children in at once and that's just abuse of NHS resources.

  4. @John Medd, come on, that'd never going to happen. There would be riots.Something that might make more sense is fining maybe £15/20 for those who are judged by doctors on strict criteria not to have needed to come to A&E, or those who need to come to A&E because of drinking.

  5. I guess my worry with a "fining" system is that if £15/20 is a lot of money to you, then you might avoid going to A&E when needed just in case you were fined, and if it's easily affordable you may think it a worthwhile amount to pay for the convenience of being seen quickly and not having to wait for a GP appointment. I'm not saying that there isn't some responsibility with the service user, of course, but I worry that these messages get out to those who already "don't want to bother" us and are lost on those who really don't need to attend A&E. Also, @anothernohoper, I think perhaps we're referring to different groups. To me, a frequent flier is someone who has regular admissions and therefore by definition needs to come to hospital. I agree that using A&E as a handy alternative to general practice isn't ok.


And how does that make you feel?