Id like to think its the vocal batshit minority of the tory party that think that
And moving it over takes it out of their cross hairs.
Been in an A&E today and its bursting
Alex, you've gone way off topic, the response to the pandemic was primarily directed by Govt, SAGE, PHE not the NHS, they had to responded to the dictats from the above. So conflating the issues around the pandemic with the NHS is at best disingenuous, at worst a ****ing insult to those who had to try and keep people alive whilst also living the same experience as the rest of the country under lockdown and all the bullshit that entailed.
Do better.
I posted this when the chat was active
My mrs pal has been suffering with sciatica for the past few months. Over the past few years she’s also been treated for breast cancer. All on the NHS
The sciatica has been causing huge problems for her to the point she’s on the verge of a mental breakdown. Her parents paid for a private consultation for her yesterday at a dedicated private hospital. The consultant there was absolutely horrified by the lack of care from the NHS consultant. Essentially it was “you’ve got sciatica, here are some painkillers, go away”. No MRI, no tie in with her previous cancer diagnosis, no treatment plan other than the painkillers.
Following on from this, the person has received the results of their private consultant and battery of tests which has shown that despite her breast cancer being in remission, she now has spinal cancer and not sciatica like the NHS fobbed her off with.
30 seconds on Google taught me that those who've had breast cancer are at significant risk of spinal cancer. Struggling to understand why a fully trained and qualified NHS consultant wrote this off as sciatica with absolutely no diagnostic tests.
Our friend has now been admitted to the Beatson for radiotherapy and other treatment. Had she not gone private, what would have happened?
The USA, worth a read...
I've worked in the US and their healthcare is a simple 2-tier system - rich or poor, that's it at the end of the day.
And based on the possible sheer cost of healthcare, 99% of us are actually poor.
I’ve worked in the US and their healthcare is a simple 2-tier system – rich or poor, that’s it at the end of the day.
And based on the possible sheer cost of healthcare, 99% of us are actually poor.
Is it that much different to the UK now, where the rich have access to private healthcare, so quicker and more convenient access to healthcare over those using the NHS?
The NHS is at breaking point unfortunately, i've never seen it so bad in my life, try and get a doctors appointment is basically pot luck on a phone call at 0830 and beating the hordes, A&E is a panic for most with the waiting times, operations are years in the making, etc, etc, i just don't think the NHS is able to deal with the level of demand this country puts on it, we just never thought that increasing life expectancy without increasing health with it was going to end up costing us way more in the long run.
i just don’t think the NHS is able to deal with the level of demand this country puts on it, we just never thought that increasing life expectancy without increasing health with it was going to end up costing us way more in the long run.
If we actually were serious about having a GP led service, rather than repeatedly paying lip service to it, then it’s almost certain that things would be better. As it is, funding keeps on being diverted from GPs to hospitals which keeps making things worse. Now we’re unfortunately in the position where it’ll take 10-15 years to undo the damage and neglect and make things better.
Incidentally, it’s one of the steps that the last Labour government started to take, but got absolutely pilloried for it in the right wing press, so then shied away from. “Lazy GPs” are a tenet amongst certain sections of the public unfortunately.
One last point to make, and this applies to many things outside healthcare as well, you cannot fix a demand problem purely with increased supply because of the issue of induced demand. There has to be some demand management too. Again this is something that we as GPs used to do, but rarely have the time for these days.
Yeah, my GP is great, it offers GPs, physios, nurses, etc so you can get a range of cover, but at present they are understaffed and getting an appointment is nigh on impossible, that's both due to lack of resource for the GP, and more problematic, customers who just use the service when they could use 111, the pharmacy, common sense, etc, but instead they will use up that resource.
A few years back the GP did try a triage service, so call backs to work out if an appointment was necessary, which was bookable online as well, but this disappeared unfortunately, partly because of a lot of people complaining about not getting to physically see doctors, so we end up with a poorer service because of public demand.
GP's have saved more lives then they will ever get credit for. My local GP has been a lifeline for a good friend of mine, whilst Op Courage had failed him, our GP has been fighting hard to keep him talking, signposting to other support whilst encouraging him to engage with it and then if he struggles.
I can't imagine the strain that puts in him and the service.
Worth their weight in gold, seems others don't feel the same.
I find the variability in GP services odd. Would we have more consistency / control with them being brought into the NHS?
My GPs if you phone before 930am you will be seen that day and even if you phone after you probably will if deemed urgent. 9 doctors ( most part time, 3 still in training?) working out of a newly refurbished building with proper disabled access. Polite helpful reception. Their own MH nurse who gives counselling, 3 practise nurses ( part time) Not perfect as they don't use IT as much as could be done but for example if you have blood tests you get a text with results / asking you to make an appointment to discuss. This is in an area with both middle class housing and a lot of poverty with all the issues that brings
Very much a patient friendly service<br /><br />another local practice is in a ramshackle building, no proper disabled access, urgent appointments hard to get
Huge variability in service
Is it that much different to the UK now, where the rich have access to private healthcare, so quicker and more convenient access to healthcare over those using the NHS?
Oh yes, very different - here you've a right to the healthcare and will get it, may be on a list but you'll (eventually) get it. There...
Private healthcare, with the exception of a few hospitals, mainly in London, doesn't the systems, expertise nor volume that the NHS does - example; get run over and you'll go to an NHS A&E unit.
And those without access to healthcare in the USA still pay more than we pay (per capita) as even their Medicare/etc costs more per head than the NHS costs us.
There are probably better systems than both, but the folk with influence are pushing for a USA-style system - vote Tory in the next GE and you've helped sign the death warrant of affordable healthcare, be proud of what you've done and tell everyone!
US is around 20% of gdp on healthcare, UK around 10% and our GDP per capita is lower.
tories are deliberately creating a two tier system by stealth here and its working. folk with any access to money often go private to get appointments in a reasonable time.
I find the variability in GP services odd. Would we have more consistency / control with them being brought into the NHS?
I doubt it. Micromanaging doesn't work well for complex tasks like being a GP. Also secondary care, which is within the NHS, in general is about half as cost effective as primary care which traditionally have been independent contractors.
IMV, as a GP, the problem with quality in General Practice is down to two main things, which is an excessive workload, and repeated attempts to skimp on General Practice by getting things cheaper, and so losing quality.
In general, if you want a quality primary healthcare system you have to pay GPs very well (to make it an attractive career choice), and not overwork them. This is expensive, but generally cost effective, and has benefits for the wider healthcare system by reducing workload.
Fair enough
I just wonder how my GPs can provide such a great service - I got a text from them this morning reminding me to book a blood test for example and others provide what appears to be a substandard service
another example - my GPs have one day a week with appointments from 7 am to 7 pm for those who cannot take time off work easily
Lots of people do complain about their GPs for various reasons, not always associated with a bad service.
There is a perception that what makes the patient happy is a good service, and that is not always the case, antibiotic prescribing for example.
There's also a perception that if there's a bad outcome then the GP must have done something wrong.
GP practises are businesses in their own right, they have to make a profit, which benefits the partners. Well run ones do well, poorly run ones the opposite, hence the variability in service levels. Sounds like you have one of the well run ones tj.
Or is it that poor ones are taking more profit from providing poorer services?
Would we have more consistency / control with them being brought into the NHS?
I don't think so, there's an argument for the NHS looking after properties that are currently owned by GPs, but even that would need very careful consideration. The 08:30/09:00 'rush' is a function of over-demand and patient expectation, and needs solving with more GPs that are not killed by workload, demand management and patient education. We triage all patient enquiries, and despite some (boomer) patients complaining bitterly about it, they get seen quicker and by the appropriate clinician. The days of phoning your practice and getting an appointment with a GP are mostly over.
I have recently been in hospital and talking to some of the nurses, you get a real sense of survival and just getting on with things as best as they can.
Chatting to the nurses one of them described the current state of the hospital and the NHS service as 'third world.
Very sad to hear and see, as all the staff are working so hard on 12 hour shifts to do the best they can. I don't have a negative thing to say about any of the hospital staff that helped me during my stay, only praise.
As with everything else that's falling apart, GPs', dentists, schools etc its down to lack of funding and just too many people. The population is growing all the time, not just in the UK, but all over the world.
One thing I'd add, practice nurses, nurse practitioners, paramedics, mental health practitioners, first contact physios are all nice to have, but they do not replace GPs who are essential for primary care.
sure - but they must take some of thew workload for the stuff that does not need a doctor? Again my practice the nurses do all the asthma clinics for example.
sure – but they must take some of thew workload for the stuff that does not need a doctor?
It's not as clear as you would think. I think they actually induce demand, much in the same way that building bypasses doesn't reduce traffic in the long term.
My experience has been that when they first start, they have lots of appointments, but they fairly rapidly become full, and then we're back where we started, but without the flexibility of having an extra doctor on the staff. They definitely (generally) increase patient satisfaction, but there's not a great deal of data to say that they're particularly cost effective.
Hmmmm. food for thought. ta
I have to say I saw the mental health nurse once and he was useless and gave me bad advice 🙂
In General Practice, most patients benefit from a holistic approach. There are very few (if any) other professions other than a GP who can offer this.
Anecdotally, I think it's a problem in hospitals too. More and more they're moving to nurse led clinics, who are great at dealing with stuff that falls within their remit and training, but not so good (IMHO) at dealing with the stuff that is outside of it.
Thats interesting. My experience is nurse are much better at the holistic approach than GPs / doctors - but I would say that wouldn't I 🙂
MY GPs are better than other doctors I have seen - very much "patient led"
very much “patient led”
I'm really not a fan of the "patient led" healthcare philosophy. I'm more into the "coaching for health" approach.
Hmmm - perhaps I am using the wrong terms?
I mean its stuff like my GPs will ask routinely " what do you want here / what outcome are you looking for" or "these are the options, which would you prefer?" They also do the thing of if its marginal if you need a med say antibiotics they will give you a script and say - fill it if needed and give yo some parameters as to what you should do - ie "if its not cleared in 2 days get the script filled" ( apparently this actually reduces antibiotic usage?) Possible that they modify their approach to me knowing I have some knowledge but as I always say - " a little knowledge is a dangerous thing" 🙂
Ta reeksy. Whatever it works for me.
Ive been patronised badly by doctors in the past and this lot do not do it
Chatting to the nurses one of them described the current state of the hospital and the NHS service as ‘third world
Whilst the description may be emotive, perhaps even helpfully so. I'd suggest that this nurse had probably never been in a hospital in the developing world.
There is a perception that what makes the patient happy is a good service, and that is not always the case, antibiotic prescribing for example.
Kramer - I almost 100% agree with you there, although if the patient is unhappy that they didn't get a prescription for something that doesn't merit a prescription the doctor is failing if they don't communicate that to the patient in terms the patient understands. Some doctors are pretty shit at adapting their communication style to different patients and I think many are even worse at understanding WHY patients go to the doctor. Our GPs have obviously been on a course that told them they should ask the patient what they were hoping would happen today - its a stupid question, which at least for a patient who is not a regular and has no relationship with the doctor is probably not going to really tell you what the patient hoped for even if the patient knows that.
But I don't really agree with this:
One thing I’d add, practice nurses, nurse practitioners, paramedics, mental health practitioners, first contact physios are all nice to have, but they do not replace GPs who are essential for primary care.
I think they are misused, perhaps even under respected, poorly deployed or undertrained but I don't buy the argument that carefully thought through and managed that they can't reduce workload on GPs and improve patient satisfaction. I actually wonder if your statement that GPs are essential for primary care is actually true. Its the model we have, but actually why do we have it? Is it still relevant in the 21st century?
I find the variability in GP services odd. Would we have more consistency / control with them being brought into the NHS?
It probably would improve consistency, but it might be consistently bad! I can't think of anything else the government has standardised which has brought everything up to the standard of the best can you?
Most of the “poorer” ones tend to be relatively underfunded.
Or could they just be mismanaged? The criteria for being a good doctor and running a good practice are rather different and medical school doesn't teach you about managing people, finances, or workloads.
The 08:30/09:00 ‘rush’ is a function of over-demand and patient expectation, and needs solving with more GPs that are not killed by workload, demand management and patient education.
I can't think of any other workplace that manages its appointments quite the way GPs do. The idea that if you are sick enough to need to see a GP at 08:30 you couldn't book that at 16:30 the day before is bizarre. The idea that if you are not actually needing to see a GP today, but later this week would be a good idea, in many practices the only way to do that is to join the 08:00 scrum. The idea that actually everyone is sitting at 0800 hitting redial and the receptionist essentially give out the calls on a first come first served basis to people who meet the basic criteria, and anyone who isn't lucky enough to get through is obviously not sick enough today and can try the lottery again tomorrow.
In General Practice, most patients benefit from a holistic approach. There are very few (if any) other professions other than a GP who can offer this.
I'm not 100% sure what a "holistic approach" means. I know what the words mean but in practice what does it mean to say that a GP provides a holistic approach? My experience (my/wife/children) is that they treat the condition sitting in front of them. Now there may well be complex patients who genuinely do get a bigger picture view, but I don't recall ever exploring anything other than the symptoms presented.
Anecdotally, I think it’s a problem in hospitals too. More and more they’re moving to nurse led clinics, who are great at dealing with stuff that falls within their remit and training, but not so good (IMHO) at dealing with the stuff that is outside of it.
My hospital medical experience is naturally quite narrow, but I don't think thats a symptom of nurse led clinics - its a symptom of specialisms. Once things start to cross over into another discipline nobody wants to (or has time to) step outside their lane. If your diabetes control is affected by your lack of exercise which is caused by physical injury nobody is tying those together and saying we really should fix the injury quicker!
Had a big bike crash in Spain so went to Spanish A & E on a Saturday with my Health Card. Got seen by a doctor, a consultant then had a scan then seen by doctor again all in about 5 hours.
I now need a follow up scan in UK after seeing local Doctor and it's a 4/6 week wait.
May not been totally broken but wheels definitely coming off.
I have had the misfortune to need a fair bit of NHS care over the last few years. My experiences
Urgent / emergency treatment - very good indeed
Urgent diagnostics - very good indeed ( cancer scare)
Mental health - poor - went private
Non urgent diagnostics ( finding out what caused the cancer scare) Poor - 18 month wait. Went private
I think this is a typical picture
Broken, no, but it's getting very close.
It's 'funny' but I read a few days ago that the UK Austerity Policy is fundamentally flawed, at least in part, because of an Excel error.
There are a few reasons for it, and yes Tory rule is usually very bad for the NHS and it's users, as was of course the pandemic, an ageing population and more and more conditions the NHS is being asked to treat and lots of new and expensive treatments for them.
I could rant away for pages on the NHS and it's problems, but I also don't really want to give away my connection to it, but fundamentally most people in the NHS the cleaners, porters, catering staff, HCAs, Nurses, Doctors, Surgeons etc etc etc do it to help others, they really do. You wouldn't do it otherwise. I do have some issues with GP surgeries (not GPs per-se) as they are businesses that the NHS sub contracts too and some I know are more commercially minded than I think they should be. Personally, I'd nationalise GP Surgeries.
The NHS though, it's under 'attack' from all sides, the Government (of all types), use it as a political pawn, users abuse it, contractors and suppliers are trying to squeeze every penny from it. It doesn't help itself either, staff hate management for being inept, but after decades of awarding the best Nurses and Doctors with management rolls, they actually started to employ non-medical managers to manage, they only hated that more.
I think 2024 will be rock bottom for the NHS. The pandemic is (mostly) over, the Tories are leaving and the economy (and therefore tax revenue) should start to recover soon. I suspect that Labour will find that magic money tree and things will start to improve.
The excel error thing is a funny story but the truth is that austerity was tory ideology since the year dot, they'd have grabbed onto any and all opportunities to justify it, and it's a huge stretch to believe that if that single bad paper hadn't existed, they would have just said "oh better change all our core beliefs then".
I actually wonder if your statement that GPs are essential for primary care is actually true. Its the model we have, but actually why do we have it? Is it still relevant in the 21st century?
My understanding is that when it's been looked at, GP centred healthcare comes out as the most cost effective system.
It’s ‘funny’ but I read a few days ago that the UK Austerity Policy is fundamentally flawed, at least in part, because of an Excel error.
Do you have a link?
My understanding is that when it’s been looked at, GP centred healthcare comes out as the most cost effective system.
I'm genuinely intrigued how you measure that, and if cost effective equates to best patient outcome? after all in pure financial terms the most cost effective solution is for us all to die young before we become expensive! in economic terms it would be to keep the workforce working as much as possible, but in healthcare terms it might be about spend not output? And is "GP centred" the same all over the world?
Here's one random link to the Reinhardt-Rogoff excel error thing. You can look for Hannah Fry on xitter for another view (no I'm not joking, sadly).
https://stanfordreview.org/clarifying-the-implications-of-the-reinhart-rogoff-excel-error/
Doesn't look broken (if you work in Barts Trust management)...in fact, looks great!
https://twitter.com/TomStocks1982/status/1769318109159022623
