19th October 2026

Newsletter Monday

Hello Reader,

On a recent home visit, I went to see a man in his late 90s. The complaint was painful legs.

He lived alone, with carers visiting twice a day.

When I arrived, I found him dozing in his chair, surrounded by the essentials of his daily life. Everything he needed was within reach. His phone, TV remote, snacks, drinks and urine bottle.

The only reasons he needed to get up were to go to bed or use the toilet for a poo.

In between visits from the carers, if he needed help, he’d been calling his neighbour. Except his neighbour was also disabled and had reached the point where they could no longer keep coming to his rescue.

His legs were pretty swollen, but there was nothing particularly alarming about them. The swelling was longstanding and largely a consequence of his immobility.

I could have prescribed a diuretic, a water tablet, but I suspected it would do very little for his legs and might well cause more problems. At his age, lowering his blood pressure and increasing his need to get up to pass urine could easily result in a fall.

What he needed wasn’t another medication.

He needed more help.

I helped him to the bathroom, which took quite a while, and explained to his daughter that there was very little I could offer medically. His legs were heavy because he was weak and frail. He could no longer lift them onto the stool.

The obvious thing to me was that his care package was no longer adequate.

As he was already known to social services, I offered to give them a call.

They took the details, and while I was still writing my notes, they called his daughter back. She put the phone on speaker.

The social worker explained that he was already receiving the maximum amount of publicly funded care available under his current arrangements. If he needed more, he would have to pay for it himself.

His daughter replied that he had money, but she didn’t have lasting power of attorney to access it, and he was now too frail and exhausted to sort things out easily.

And that was that.

I left knowing this man needed more support than he was receiving, but with no immediate solution.

I don’t know what happened to him afterwards. I hope his daughter managed to arrange something.

But I wouldn’t be at all surprised if he ended up in A&E.

Not necessarily because he needed hospital treatment, but because he could no longer manage safely at home.

And what else do people do in such a crisis?

This is just one of the reasons our hospitals are struggling.

The problem doesn’t begin at the hospital doors.

Corridor care has been in the news again this week, accompanied by the familiar promises to tackle overcrowded emergency departments.

I’ve been a GP for 19 years. I cannot remember a time when we weren’t talking about A&E departments being overwhelmed.

Every winter, another crisis. Another set of targets. Another urgent plan.

Except now we’re seeing corridor care throughout the year. Perhaps we should stop calling it a winter crisis unless we’re planning to extend winter to include July.

Yet, at the same time, the NHS is doing more than ever.

We hear about record numbers of appointments, more diagnostic tests, more treatments and more healthcare professionals.

Primary care has changed enormously during my career. Patients can now access pharmacists, physiotherapists, specialist nurses and a whole range of professionals who weren’t routinely working in GP practices when I started.

Much of this is a good thing.

But there’s a trade-off that I don’t think gets nearly enough attention.

Continuity of care.

The relationship between a patient and a clinician who knows them, understands their history and can recognise when something isn’t quite right.

We have evidence that better continuity of care is associated with fewer emergency hospital admissions, greater satisfaction, lower mortality and, in some studies, reduced healthcare costs.

Yet we’ve increasingly built a system that prioritises access to an appointment, often with whoever happens to be available, over seeing someone who knows you.

For patients with straightforward problems, that may work perfectly well.

For more complex cases or older, frail patients with multiple conditions, it can make an enormous difference.

More appointments don’t necessarily mean better care.

And more professionals don’t automatically mean better coordination.

There’s another person in my patient’s story who deserves a mention.

His neighbour.

Someone who had been quietly filling the gaps in his care despite having their own disabilities.

We rely enormously on people like this. Family members, friends and neighbours providing support that never appears in NHS activity statistics.

Until they can’t.

And when that happens, the need doesn’t disappear. It simply lands somewhere else.

Often, that somewhere is A&E.

Of course, this isn’t the only reason emergency departments are overwhelmed.

Hospitals also struggle because patients who need admission cannot move into beds, often because other patients are medically ready to leave but don’t have the support they need to go home.

It’s a problem at both ends.

People arriving at hospital because they cannot be adequately supported in the community, and people unable to leave hospital for exactly the same reason.

Meanwhile, we keep asking emergency departments to absorb the consequences.

And they can’t.

We can announce new standards for corridor care, but telling hospitals not to treat people in corridors doesn’t magically create somewhere else for those patients to go.

I don’t pretend there’s a simple answer.

More funding is part of the conversation, but so is how that money is spent, how services communicate and whether we’re investing enough in the less glamorous parts of healthcare.

New cancer centres and cardiac units make for excellent press photographs. Community nursing, rehabilitation and social care are considerably less glamorous, but no less essential.

Nobody writes a glowing newspaper article about the elderly man who didn’t end up in hospital because he received the right support at home.

But perhaps we should pay rather more attention to those outcomes.

Because while we celebrate increasing the number of appointments and procedures, we ought to be asking whether we’re actually making the system work better for the people who need it.

I keep thinking about that man, sitting in his chair with everything he needed arranged around him.

He didn’t need a new drug, another investigation or a referral to a specialist.

He needed someone to help him live safely in his own home.

And despite recognising that, I couldn’t make it happen.

The NHS doesn’t have a corridor problem. It has a problem that ends up in corridors.