Ah, the best laid plans of mice and men: So I set aside a bit of time on a Sunday afternoon to write this column, maybe after a nice roast dinner.

We decide (or our son decides for us) to go ice skating beforehand. Sounds great but a few hours later I am sitting in A&E, instead of writing this, with my wife and her swollen, busted knee.

Well at least it gives me a chance to consider a topic that is particularly topical among the public and the health community – the pressures on A&E.

As it happens, we had a particularly good experience. Efficient and kindly staff, and not too bad a result at the end. However, A&E is struggling across the country and is not able to deliver this consistently within the targets.

One of the reasons for this, which the stats back up, is that more and more people are going to A&E instead of using other, more appropriate NHS services. What this then means is that A&E doctors and nurses end up dealing with coughs and rashes, instead of broken bones and life threatening illnesses.

This is not just a problem that uses up time. There is another more important reason that people are seen in the right place. A&E is a good place to go if you have a broken leg, or if you are having a heart attack. It is not a good place to deal with a complicated long-term pain problem, for example, or a psychological condition.

It is not the place to go to get a diagnosis for a condition that has been developing for some time. The reasons for this are partly that the doctors are geared up to dealing with urgent problems, but it is also because a lot of medical problems need to be dealt with over a period of time (weeks rather than months) and are best dealt with by seeing the same doctor.

Another problem that is not thought about, is that being seen in a hospital means that patients end up getting more tests than are needed and can be ‘over-treated’. (Too many tests and over-treating are subjects that I will come back to in future weeks).

Lots have been said about this, about how we need to educate patients where to go, to make it harder for minor problems to be seen, even to make people wait longer to put them off.

I think fundamentally what we need is to get back to the situation that the front door to the health system, for the most part, is via your GP.

This of course means that as GPs, we need to make sure that you can get appointments when you need one. This then frees up A&E for those that can get the most benefit from it.

The problem we also face is that the rise in demand for GP appointments has been going up as well.

Consequently we need to make sure people only go the GP if they can’t manage a problem themselves etc etc etc.

So, back to my Sunday evening fun. All seems to have ended reasonably alright given the circum stances, but despite the positive experience, I will be saving A&E in the future for a time when I really need it.