This doesn't increase demand for health services at all.
Well I don't expect that many people are languishing in A&E departments with severe cases of onychomycosis, or that many GPs are referring their patients with dodgy toenails to hospital specialists, so in that respect probably no.
But I guess the fact that Trosyl or Terbinafine require prescriptions probably does at least put some burden on the NHS.
you can buy amorolfine ernie - if you cared about the NHS you would 🙁
A toenail infection can be caused by diabetes, poor circulation, a weakened immune system, or sweaty trainers. I'd rather go to A&E just to be sure.
Well I don't expect that many people are languishing in A&E departments with severe cases of onychomycosis...
I think you'd be surprised at the pathetically minor ailments some folk do turn up at ED for. It's very difficult sometimes to stay professional and not tell people to man the $#@€ up and do one, it really is.
My 'favourite' is a regular attender who lives in the countryside and comes to hospital with 'heart pains' to get a bed for the night, when he misses the bus or doesn't have enough money to get a taxi home after drinking sessions in town. Every time he comes in we run the same tests on him, ECGs, cardiac monitoring for the night, even an angio a few times. All the time he is demanding this and that be provided, complains to anyone and everyone that he isn't being taken seriously etc. Then he sobers up in the morning, packs his few belonging and self-discharges.
There are also any number of folks who claim 'vomiting/abdominal pains' because they rather like effects of Morphine and Cyclizine.
One of them was sent packing a few years back so went to the local press to complain, hospital can't comment without said person's consent (which they obviously didn't get) so hospital gets ripped to pieces in press for sending poorly/borderline junkie* (*delete as appropriate) person away.
A toenail infection can be caused by diabetes, poor circulation, a weakened immune system, or sweaty trainers. I'd rather go to A&E just to be sure.
Are you taking the piss?
sootyandjim - Member
I see you are running B&B ... 😯
A suggestion is to bill them after they are discharged ...
Drac - Moderator
ernie_lynch - Member
A toenail infection can be caused by diabetes, poor circulation, a weakened immune system, or sweaty trainers. I'd rather go to A&E just to be sure.
Are you taking the piss?
It was not me ... 😆
Are you taking the piss?
Why - what makes you think that?
Drug companies aren't allowed to advertise prescription only medicines to the public, so they advertise the "disease" instead.
Only in this case its not really a disease is it, its just discoloured toenails generally.
Comments like
"many GPs are referring their patients with dodgy toenails to hospital specialists,"
rather miss the point. Do we only count secondary care spending now? I know GP is an infinite resource but...
rather miss the point
I was trying to figure out how much stress dodgy toenails were putting on the NHS.
Well clearly toenails on there own aren't much more than a minor annoyance.
The point I was trying to make was the general medicalisation of all of life's woes is a problem.
Kids that fall outside society's accepted behaviour patterns, adults whose shit life makes them feel sad, pensioners who don't see a living soul from one week to the next, these are all now medical issues that must be treated by doctors with drugs.
It's not exciting hi tech life and death stuff like what makes good telly, but it's much more common than the exciting stuff those clever hospital doctors deal with and it is something that we as a society now need to provide a health service for.
I've probably seen one too many today so I'll leave it there and open another beer!
It's not exciting hi tech life and death stuff like what makes good telly, but it's much more common than the exciting stuff those clever hospital doctors deal with and it is something that we as a society now need to provide a health service for.
Docrobster - I feel your pain and agree with you about the the problem with 'life issues' progressively being turned into 'medical issues' and thus a magic bullet or drug being sought out to 'fix' them.
It's not all exciting stuff in secondary care (though I guess you know this from your time doing the rounds). For every SVT or T2RF we admit there are ten 'Collapse?Cause' (usually care home residents who aren't being sufficiently cared for) or 20 'ETOH Withdrawals'.
Nothing like getting punched by a withdrawing alcoholic at two in the morning, just after you pat-slide them onto a bed, to make you really appreciate which 'drugs' are really the 'bad ones'.
Well yes it appears to be widely accepted that cuts in welfare spending have added to the NHS funding crises. As has increased longevity and also hugely increased availability of treatments and procedures in areas such as cancer and heart disease.
I just thought that spending too long looking at toenails might be missing the point when the burden it represents to the NHS is probably insignificant compared cancer, heart disease, elderly care, etc.
Likewise spending too much time focusing on those who abuse the system can also be missing the point, although for obvious reasons people like Daily Telegraph/Daily Mail/Sun leader writers want to concentrate on that, as in pretty much every area of human activity there are shitesters.
Many doctors are now so tired and stressed that they are seriously asking themselves whether it is better to work under an unforgiving authoritarian regime constantly surrounded by death and despair, or to go to Syria to join Islamic State
🙂
A toenail infection can be caused by diabetes
I know this comment was partly in jest to make a point but it is actually a genuine issue. My missus runs regular diabetic foot clinics. A manky toenail can become a major issue when diabetic neuropathy means you can't feel the damage it is doing. Catching it early saves the distress (and expense) of chopping off a leg.
The first known written treatment for baldness is from 1553 BC - a thousand years later, Hippocrates was obsessed with treating it.It think its difficult to blame it on Big Pharma
Male Pattern Baldness isn't always "normal" either.
Multiple cross-sectional studies have found associations between early androgenic alopecia, insulin resistance, and metabolic syndrome, with low HDL being the component of metabolic syndrome with highest association. Linolenic and linoleic acids, two major dietary sources of HDL, are 5 alpha reductase inhibitors. Premature androgenic alopecia and insulin resistance may be a clinical constellation that represents the male homologue, or phenotype, of polycystic ovary syndrome.In support of the association, finasteride improves glucose metabolism and decreases glycosylated hemoglobin HbA1c, a surrogate marker for diabetes mellitus. The low SHBG seen with premature androgenic alopecia is also associated with, and likely contributory to, insulin resistance.[17]
Because of its association with metabolic syndrome and altered glucose metabolism, both men and women with early androgenic hair loss should be screened for impaired glucose tolerance and diabetes mellitus II.[18]
Ahh, pre diabetes and metabolic syndrome, the latest deep seam to be mined by drug companies.
Weight loss, diet, increased exercise. All sensible and effective but hard to do.
Let's patent a drug instead. One that they will be on for the rest of their lives. Kerching!
A manky toenail can become a major issue when diabetic neuropathy means you can't feel the damage it is doing. Catching it early saves the distress (and expense) of chopping off a leg.
Well luckily Scholl, as docrobster points out, produce a fungal nail treatment which is available over the counter without prescription - presumably saving the NHS a small fortune.
Scholl have also very helpfully, as docrobster points out, produced a video to inform and educate people so that they can self-diagnose, before popping down to Boots, without having to bother their GP at all. Presumably saving more money and resources for the NHS.
Seems like a double win to me 🙂
The point I was trying to make was the general medicalisation of all of life's woes is a problem.
Agreed @doc. This is a very big issue.
@kimbers the NHS has no chance of macthing IS terms and conditions as death in service benefits do not include 72 virgins (refreshed every night) 🙂
To be honest that is one of the biggest failings of those who came up with the carrot for martyrdom, who would want 72 virgins? Sounds like too much hard work.
72 'women who know what they're doing' sounds a far better a prospect.
Megalolz @ ernie's utopian view of human behaviour!
"15 quid! For a little tube of goo for my nails? Stuff that I'll go round the docs and get it for free."
...Stuff that I'll go round the docs and get it for free.
Or if the can't get an appointment for ten minutes after they phoned the GP's, or if they decide they don't like the GP's answer, they'll rock up at ED demanding they be seen by a specialist in grotty toenails.
15 quid! For a little tube of goo for my nails? Stuff that I'll go round the docs and get it for free."
Perfect example, we should all be paying for that at the point of service probably including the appointment, however discussion of that is so politicised / knee jerk we stumble on deeper into the mire.
Megalolz @ ernie's utopian view of human behaviour!
"15 quid! For a little tube of goo for my nails? Stuff that I'll go round the docs and get it for free."
Well you obviously think that Boots are wasting their time selling Scholl fungal nail treatment over the counter without prescription.
[i]Megalolz @[/i] you knowing better than Boots how to run their business and what their customers want.
I have no idea if you are actually a doctor but if so do you find that your obvious low opinion of human behaviour is a handicap?
You turn up at my surgery asking for that stuff and you will get sent off to buy it yourself. Unfortunately it is often Boots ( who are shockers) sending people in our direction.
Unless you have a nail infection which is causing a biomechanical malfunction in the way you walk, [b]and[/b] we have proven with mycology it really is fungal, you can jog on.
Ernie
I'm a GP. Been doing it 20 years. Got s bit of a feel for the job now.
I like people. I get a lot of job satisfaction from helping people through their illnesses and patients seem to appreciate what I do.
This week one of the urgent appointments was used for a child with chicken pox. Mum had gone to the chemists to get calpol and calamine lotion. The CCG locally funds a minor ailments service that pays pharmacies to provide medicines that are available over the counter to people without charge if they get free prescriptions.
The pharmacist directed them to contact the GP surgery to get these simple household items on prescription.
So sometimes yes I absolutely despair.
yep... the idea that most UK pharmacists can be bothered/know how to provide decent self-help advice or primary care is one of the great myths. there are excellent examples but in my 25 yrs as a GP, I'd say the standard of advice given has gone down, and the commercial pressures on pharmacists in pharmacy chains to sell rubbish has gone up.
I am very happy to see two doctors here speaking of a few things which I think are very relevant and which I believe should be part of a wholesle review.
Firslty what is the scope of the NHS as free at the point of service ? Critical care, start of life certainly, old age care needs a serious rethink, as I posted before my neighbour (ex nurse, now professor) was awarded a CBE for her work in this area. Broader demands, not so sure at all
Who takes up the slack, better integration of state and private provision, thoughts on "offshore provision" (eg currently knee surgery is one of the few things you can have done abroad (much more cheaply) and nhs will pay). As above Pharmacies could have a significant beneficial role, I think their move into supermarkets is a questionable move vs owner run local business. Senior nursing staff could play a valuable role here too.
I know a number of GPs who think the value of their job has deteriorated with far to many trivial cases which would be better dealt with by someone else allowing them to focus on more complex medical issues.
Interesting scoop for HSJ about BMA's tactics in dispute.
[url= http://www.hsj.co.uk/topics/workforce/exclusive-huge-leak-reveals-bma-plan-to-draw-out-junior-doctors-dispute/7005113.article?blocktitle=News&contentID=15303 ]Article[/url]
Damn Tory press.
I'm more amazed the BMA are using WhatsApp for these internal discussions 😯
Despite protestations that the dispute was about “safety, not pay”, the issue of weekend pay was described late last year by a JDC executive member as “the only real red line” for junior doctors. This point was only finally conceded by the JDC on 7 May when it decided to re-enter negotiations.
Well, that is a somewhat inconvenient truth. I do hope that those who said the dispute was about "saving the nhs" are blushing today.
^^^ exactly, heard the same months ago from someone who read the contract in detail as its their job as an administrator to do so
I think it's fair to say that the causes of the dispute are multi faceted.
[url= http://thelancet.com/journals/lancet/article/PIIS0140-6736(16)30441-X/fulltext ]Lancet article blames Henry the 8th![/url]
I think it's fair to say that the causes of the dispute are multi faceted
It was about money and dosh ?
Reportedly according to one executive member, what's the full quote though?
Well, that is a somewhat inconvenient truth. I do hope that those who said the dispute was about "saving the nhs" are blushing today
and yet....
The executive also discussed concerns about safety and long working hours as well as pay. In November, Harrison Carter said: “Strongest case that we have is ensuring that all doctors are protected from working excessive hours that cause unnecessary fatigue and lead to unsafe conditions for patients. It is taking reckless risks with patient safety.”
😳
[b]the only [u]real[/u] red line”[/b]
They might have discussed the price of fish, but the only REAL red line was dosh/cash/money/moolah. That they were prepared to leave people in pain for cash was shocking. At best they seem to have misunderstood that the NHS exists for them - it doesn't patients should always come first. The times of their mouth's being stuffed with gold are over.
[i]On 15 January, after the strike, he told the group: “I don’t care about anything apart from extracting the best contract. Don’t give a shit about anything else.”
He continued: “We have told them they could offer to buy Saturday off us for £700million. But they would need to make that offer. Not expect it from us as we have no interest in the money. But if they seriously want Saturday it will cost about £500-700million.” He said this would equate to a 15 per cent pay rise.[/i]
😆 bang to rights
and the commercial pressures on pharmacists in pharmacy chains to sell rubbish has gone up.
But this is almost entirely down to the NHS not being willing to use highly qualified pharmacists as part of the overall health system - so they are doing other things to cover the fairly limited returns from prescribing - Pharmacists are highly qualified and regulated but pretty badly paid.
I have two recent examples of this:
1. I've been asthmatic for 30+ years and have always been shown the same way of using my inhalers by countless doctors over the years. Very recently a pharmacist checked how I was using my inhaler and told me I'd been getting it wrong. After checking her advice with the manufacturer's helpline it turned out she was right and all of the doctors had been wrong. Asthma is one of the most common Long Term conditions so it's quite possible that many thousands of asthma patients are also not using their medicine correctly, potentially leading to avoidable hospital admissions / more cost for the NHS.
2. I have a hiatus hernia and have been hospitalised several times due to violent / sustained acid reflux (we're talking continual wretching for 8+ hours and acute pain).
After each of these episodes I went back to my GPs to question whether another PPI would be more effective to be told no - this advice was consistent over 10+ doctors over a 4 year period. After consulting a pharmacist in desperation due to the regular pain and vomiting I was advised that PPIs all work on different receptor antagonists. After talking to me and consulting his formulary, I was advised to go back to the GP and ask for a specific / different PPI.
The GPs initially refused citing CCG prescribing guidelines but after I pushed very hard I finally managed to persuade one of them that I should be allowed to try it on a trial basis. My acid reflux is now well managed (touch wood), I don't get the regular pain and I haven't been hospitalised since.
In both of these cases the NHS has been wasting money on Long term medication and hospital admissions without anyone checking the drug was right / making sure it was used correctly. The Pharmacists in both cases have helped to improve my health and reduce NHS spend, yet in neither case was their expertise recognised or valued by local GPs who didn't really seem to have any real knowledge themselves.
Let me be clear about my views. Junior Doctors work far too many hours and are paid too little. I do believe in a full 7 day NHS including scheduled surgery. I do not however think the ideal solition is putting more money into the setup we have.
But this is almost entirely down to the NHS not being willing to use highly qualified pharmacists as part of the overall health system
@rob I agree with this, lots of vested interests at play. Also when you have one service provider in anything you'll get a single "house view" on how something (anything) should be done - throughout my life I have observed that this is generally not a good idea.
Phoned today for a GP appointment - 5 week wait. Is this normal?
Indeed @cg sadly it is, after my mum had a suspected stroke recently her GP surgery said it would be 3 weeks for the follow up appointment the hospital said was necessary, thankfully her GP saw after after "just" 2 days. The system is broken.
[quote=cinnamon_girl said]Phoned today for a GP appointment - 5 week wait. Is this normal?
Just logged on to my GP's online booking system to check. Next available appt* for me is next Weds. That's not with my regular doctor however.
* they do seem to add free slots on a daily basis however so pays to login first thing each day to check for same-day slots.
They might have discussed the price of fish, but the only REAL red line was
which was said by 1 executive member, did the chair and the rest agree that?
jambalaya - I thought perhaps it was an (overcrowded) Southern thing. Agree that the system is broken which is why I'm having to self finance my health care that includes a number of permanent conditions. Can't do this any more so GP will have to deal with an extremely assertive woman who won't take any crap.
Just logged on to my GP's online booking system to check. Next available appt* for me is next Weds. That's not with my regular doctor however.* they do seem to add free slots on a daily basis however so pays to login first thing each day to check for same-day slots.
That's pretty good. Local surgery have made it clear that patients have to consult with their named doctor. No more appointments in June now.
I can always get an appointment within a couple of days with mine, Mid Sussex.
Interesting scoop for HSJ about BMA's tactics in dispute.
All seems a bit sensationalist to me really.
They had access to over six months worth of messages, [i]"more than 1,000 pages"[/i] (odd measure), of people talking privately about tactics and negotiations during a massive prolonged bitter dispute, and that was the best they could come up with?
I'd love to see a transcript of all the private conversations and meetings that Jeremy Hunt, David Dalton, the Dept of Health and Malcolm Tucker had during that time. 😆
(But we won't obviously because, unlike the BMA, they work for us voters so what they say is kept secret).
the only real red line
Pretty easy to take a quote out of context and make it sound juicy. I'd like to see the full transcript there.
Don't forget that the plain-time Saturday payment was part of the re-definition of "unsociable hours" and bandings which undermined the protection JD had from being overworked.
I notice they didn't make a headline of the quote from Malwana that said:
[i]" should we trying something slightly different? Offer to talk about anything he wants as long as imposition is lifted and the end result is a contract that is not discriminatory and unsafe."[/i]
And they left this quote as a footnote: [i]"Strongest case that we have is ensuring that all doctors are protected from working excessive hours that cause unnecessary fatigue and lead to unsafe conditions for patients. It is taking reckless risks with patient safety."[/i]
^^^ exactly seizing onto a few lines in a discussion that went on for months and months smacks of desperation from the NHS haters
its not like they [url= http://www.independent.co.uk/news/uk/politics/jeremy-hunt-privatise-nhs-tories-privatising-private-insurance-market-replacement-direct-democracy-a6865306.html ]co-authored book calling for NHS to be replaced with private insurance[/url]
cranberry - MemberWell, that is a somewhat inconvenient truth. I do hope that those who said the dispute was about "saving the nhs" are blushing today.
An inconvenient truth- for you. It's only one executive member that said it; that doesn't make it the BMA's position or policy. But it's pretty obvious where you're coming from and why you'd choose to spin it like you did.
which was said by 1 executive member, did the chair and the rest agree that?
Dr Malawana asked his executive colleagues whether any deal including Saturdays at plain time might be accepted.Several members replied to say that it would not.
Former JDC chair and executive member Kitty Mohan said: “It is the only real red line. It’s the thing 99 per cent of juniors told us they were upset about in August.” Arrash Arya Yassaee told Dr Malawana: “Bluntly, no.”
Dr Malawana agreed and said: “If you play out each course of action. Then fundamentally it comes down to the issue over plane [sic] time. But no combination or scenario in my mind gives us a contract juniors would buy that gives you Saturday as plane [sic] time.”
So the article quotes the Chair, Malawana, and Yassaee as agreeing Saturday plain time was not negotiable.
mefty: you realise none of those quotes actually mention money?
Saturday as plain time (or even "plane" time) is a direct change to the banding system, which is a system that was put in place to try to limit the number of ridiculously long and anti-social hours that junior doctors were being asked to work in the bad old days, which everyone agreed were dangerous.
The proposed contract said they were changing the definitions so that working till 10pm during the week and working 7am till 10pm on a Saturday was no longer considered to be "anti-social" hours.
So yes a 50% increase in the number of hours that were consider normal, sociable hours, did "upset" a great deal of juniors.
Especially as that change was sold to them on the back of lies, spin and misinformation.
That's not the argument though. Cranberry is maintaining that the comment proves that the entire dispute was only about money, which of course it doesn't remotely.
But of course with this [s]spin[/s] story that's the way it will be remembered.
It's almost as if the government, bitter at losing the dispute, has made a last minute effort to poison the public sympathy for doctors by releasing the [s]GCHQ surveillance transcripts[/s] [i]extensive message log kept by a concerned citizen[/i] to a suitably sympathetic publication so they can scrape some small "victory" from the whole sorry mess.
Funny that.
This is for you ernie. And for cg it might explain the long wait for appointments.
Graham, you had a JHJ moment there 🙂
docrobster - thank you. May I ask some questions and fully appreciate if you'd rather not answer them? In your experience, and since the start of austerity, has there been an increase in consultations due to patients not willing to buy their own medicines? Has there been an increase in the number of patients entitled to free prescriptions? Are patients more informed or less informed these days, or simply disinterested in their own health?
Thanks. 🙂
The proposed contract said they were changing the definitions so that working till 10pm during the week and working 7am till 10pm on a Saturday was no longer considered to be "anti-social" hours.
And the fact that anti social hours are paid more is of course an irrelevance.
Especially as that change was sold to them on the back of lies, spin and misinformation.
Well it would appears from the article that lies, spin and misinformation weren't restricted to the DofH. I personally don't have a major problem with that though, it is sanctimony as if doctors should be treated better than any other profession that I find grating.
It's almost as if the government, bitter at losing the dispute, has made a last minute effort to poison the public sympathy for doctors by releasing the GCHQ surveillance transcripts extensive message log kept by a concerned citizen to a suitably sympathetic publication so they can scrape some small "victory" from the whole sorry mess.
Oh look who has drunk the Kool Aid, you don't think that there may be some disagreement within the group itself.
And the fact that anti social hours are paid more is of course an irrelevance.
No it was/is pretty relevant as it is the entire basis of the banding system, which was originally devised to make it more expensive to have one doctor working ridiculous or illegal hours than two doctors working reasonable hours.
Well it would appears from the article that lies, spin and misinformation weren't restricted to the DofH.
It's a public negotiation. Both sides are going to have a certain amount of tactics, bluff and PR. That's to be expected really.
But the whole "7 day NHS", "work shy junior doctors kill thousands of patients by not working weekends" thing was an out right lie from the start. As was the whole "it's actually a pay rise, that is also completely cost neutral, and saves us a lot of money" thing.
All these things did was anger the doctors and rally them against the government.
it is sanctimony as if doctors should be treated better than any other profession that I find grating.
Any other profession is allowed to strike if management decide to force through a drastic change to terms in their contract that their union opposes. Most other professions are not government run monopolies.
I suspect any sanctimony or superiority is more perceived than real.
mefty - MemberAnd the fact that anti social hours are paid more is of course an irrelevance.
Of course it's not irrelevant; I don't recall many doctors saying "we don't care what we're paid. Pay is irrelevant! Pay us nothing, we don't care". The question is whether it was central, or critical, or as some outright liars would have you believe, what it was all about.
But don't forget Northwind:
That they were prepared to leave people in pain for cash was shocking. At best they seem to have misunderstood that the NHS exists for them - it doesn't patients should always come first.
Doctors should work for free if they have to, because asking for money is immoral when people are in pain.
You know, just like any other profession.
docrobster - MemberThis is for you ernie.
Thank you docrobster, however I have absolutely no idea why you think it would be of interest to me.
Yes I think it's probably a good idea that you can buy nail fungal treatment in Boots without a prescription, and no I don't think it's a good idea that someone should make an appointment with their GP so that they can weigh their holiday luggage on the practice scales.
But once again, thanks anyway. 🙂
Cinnamon girl im happy to try to answer your questions although clearly this is just my experience.
Bear in mind that where I work is in the 20% most deprived in the country according to the index of multiple deprivation.
I can't say that there has been an increase in number of appointments due to people not being able to afford to buy medication, simply because most prescriptions I write are free anyway, over 60s, kids, diabetics on medication, and of course those on low incomes all get them free anyway. There has always been an element of going to the doctors to get it for free which is why the CCG, like most, has a minor ailments scheme to provide over the counter medication to those in receipt of free prescriptions for no cost from the chemist. What worries me more is that people will stop getting their medication because they have to pay for prescriptions but can't afford them. In that case they usually just stop coming to see us as well. This definitely happens and probably more in recent years. I have no idea what gets sold in chemists shops because very few of my patients would have money for that anyway. It is a lower priority than phone credit. As above though, it's frustrating that any old crap is punted across chemists counters at times. Cough medicine for children being a case in point. Complete waste of time yet still sold in large quantities.
Regarding the second question I've no idea but I expect there are national stats somewhere. As above the majority of prescriptions are not charged for in the first place. What I have seen is a huge amount of consultations for people who have been thrown off the sick and wish to appeal so of course expect a letter from the gp. Two thirds of cases are overturned on appeal so the dwp gets the assessments wrong more than they get it right. I hear horror stories on a daily basis of people being badly assessed.
Last question is actually something I was discussing with my wife this morning. We feel there is more variation, so you get people obsessed with their health, clean eating etc all that stuff. They come with sports injuries and expect first class treatment so they can keep doing their triathlons or whatever, and are often disappointed by they 6 week wait for physio etc. Then you also get the hard drinking and smoking people with a completely fatalistic attitude of "we all die eventually of something, no point trying to be healthy". I think there are more of the second group in more deprived areas. Where I work alcohol is a huge problem. Yet the government bows to pressure from industry and won't bring in minimum pricing. 3 litre bottles of white lightening sell very well.
In your earlier post you asked about whether poor access to gps was a London thing due to overcrowding, in fact the opposite is true. The inverse care law is still very much in effect. There are more doctors per head of population in less deprived areas. The hardest to recruit areas are generally the most deprived. London deanery has the least trouble filling it's go training places. I was informed this week that the minimum standards required for workplaces based assessment by the trainees are less onerous there than in other areas ( number of learning log entries required per month to be signed off as competent) but I expect it's more to do with the pull of London.
The effect of cuts to council funding cannot be over emphasised. Apart from obvious things like longer waits for assessments for social services, councils commission public health services like sexual health smoking cessation, health visitors and school nurses etc. All these budgets are being actively reduced so "ring fenced" healthcare spending is having to be spent to fill the gaps. Not good for the health of the nation and incredibly short sighted stupid policy.
If you're interested in actual stats as opposed to my jaundiced view there is research being done on this issue in Glasgow and Leeds/Sheffield search for deep end general practice.
[url= http://www.gla.ac.uk/media/media_296141_en.pdf ]This paper probably covers quite a lot of it though[/url]
Sorry ernie I thought you questioned human behaviour and how it might impact on health services. I must have misunderstood.
Once again, for the hard of thinking, the proposed settlement was cost neutral, the actual settlement is cost neutral. Doctors overall are not getting paid any more. They are just making sure that money isn't getting taken away from the people who work in the actute specialities who deliver the 7 day NHS... And making sure whistle blowers are protected, women aren't disadvantaged, all those really bad things. AT NO ADDED COST. Yet it's all about the money?!
Interesting to see who won't last this lie...
Sorry ernie I thought you questioned human behaviour and how it might impact on health services. I must have misunderstood.
Misunderstood? I thought it was [i]you[/i] who questioned human behaviour and how it might impact on health services !!
Well there's certainly been some misunderstanding, that's for sure! Still never mind.
ny other profession is allowed to strike if management decide to force through a drastic change to terms in their contract that their union opposes
I can't think of another "classical" profession that is unionized.
Teachers?
Classically I don't think teaching was regarded as a profession but a vocation, hence I used a qualifier, that is not to demean it, just a recognition that the use of the words "profession" or "professional" have changed. After all in the context of sport, it means you are simply paid.
At best they seem to have misunderstood that the NHS exists for them - it doesn't patients should always come first.
But without them the NHS folds and then the patients will definately come last.
In my experience of working with my junior doctor colleagues "da money" is far from the first thing they worry about with Herr Hunt's meddling, but it shouldn't be the last either.
I believe we all work for the NHS because we truly believe in the ideal of a 'free at the point of use' healthcare system. That shouldn't mean we do it for peanuts though.
ENgineers- they certainly have [ a number of] unions as well
I can't think of another "classical" profession that is unionized.
Hmm.. not sure what you mean by "classical" profession there?
[url= http://www.oxforddictionaries.com/definition/english/profession ]OED says[/url] a profession is [i]"A paid occupation, especially one that involves prolonged training and a formal qualification"[/i] and gives teaching as an example.
Wiki says [i]"Medieval and early modern tradition recognised only four professions: divinity, medicine, law and Engineering – the so-called "learned professions"[/i]
Is that what you were going for? If so then pulling medicine out as one of four special disciplines seems an odd way to convince us that it isn't special 😕
But since you asked, [url= https://en.wikipedia.org/wiki/Prospect_%28trade_union%29 ]Prospect[/url] is the independent union for Engineers (of all kinds).
Lawyers have [url= http://www.lawsociety.org.uk/ ]The Law Society[/url], which is a "professional body" rather than a union but does do some fairly uniony things like making press statements on behalf of members, petitioning government etc.
No idea what divinity have, other than a really good after death package.
Lawyers have the Law Society, which isn't a union but does represent lawyers
Actually lawyers working for the Crown Prosecution Service, for example, have a TUC affiliated trade union - the FDA
I was referring to professions that have been organised in Institutes, or Royal Colleges in the case of doctors, since the 19th century or before. That said, on reflection, I think that unionisation is more a function of the nature of the employer, lawyers who work for government will be often be members of FDA so the fact that hospital doctors are unionised is a function of who employs them rather than anything else.
EDIT: Sorry Ernie, I didn't refresh so didn't see your post.
so the fact that hospital doctors are unionised is a function of who employs them rather than anything else.
Doesn't the BMA represent self-employed GPs as well as hospital doctors ?
😆No idea what divinity have, other than a really good after death package
Brilliant
Doesn't the BMA represent self-employed GPs as well as hospital doctors ?
I wasn't sure - hence I restricted my response - but if the answer is yes - substitute who pays them rather than who employs them - still doesn't cover every situation.
That said, on reflection, I think that unionisation is more a function of the nature of the employer
I guess being employed by big government might encourage people to join a union to defend themselves - but there are tons of unions for all kinds of jobs/professions/vocations and all kinds of employers:
Unite the union represents Church of England clergy, which I'm sure mefty in his role in the established church is aware of.
[quote=Junkyard ]ENgineers- they certainly have [ a number of] unions as well
TBH I dont even know what point you're trying to make here mefty
What is it - genuine question not sarcasm.