Its just pandering to the Express and wail readers who believe cumbersome bureaucracy in the NHS leads to delays.

Totally.

It’s more downgrading of stuff. Rather than actual rebuilding.

Pure Tory playbook.

Also – internal bleeding? WTF.

The last thing the NHS needs is major change. major reorganizations which is what this would be takes staff time and energy out of patient care.

What the NHS needs is to remove the bureaucracy of the fake internal market in england and all the nonsense that goes with it then left alone with a bigger budget

I agree to a large extent with both those statements, but they’re contradictory.

There will be some change though, whoever wins the next election. “Leave alone but fix recruitment and retention” won’t be the line that any government takes in the coming years. Probably should be though.

internal bleeding? WTF

Probably referring to stool tests, but a nurse practitioner is likely to handle that rather than the GP anyway.

What the NHS needs is to remove the bureaucracy of the fake internal market in england and all the nonsense that goes with it then left alone with a bigger budget

Unfortunately with some of the things said, I can see a new market being created for corporate providers bidding to provide GP services.

As things stand, they can just buy up practices and take advantage of the current funding arrangements. Centene/Operose being the most obvious example of this.

I can see a new market being created for corporate providers bidding to provide GP services.

Thats clearly was Streeting is offering with his “directly employed GPs” but not changing anything else so private health companies can bid for NHS services

Also – internal bleeding? WTF.

Maybe some The Thick of It-esque clever reference / insider joke referencing the internal fractures and battles within the Labour party?

I’m still hoping that all this is one massive ruse to get the Red Wall Mortgage Man vote back onboard, then once in power he’s going to do a “GOTCHA!” and introduce some radical socialist Northern European style project.

Then again……

Probably referring to stool tests, but a nurse practitioner is likely to handle that rather than the GP anyway.

You think so?

Lol.

Give you credit your the only person I’ve seen try to extract something sensible out this ridiculous comment.

Last person I know who had internal bleeding was rushed to hospital and died in the ambulance.

Just imagine how long you’ll wait to see an NHS consultant when everyone self refers themselves to them under Starmer’s NHS plan. And if you pick the wrong one, just imagine how long getting a diagnosis might take. We have GPs for very good reasons.

— Richard Murphy (@RichardJMurphy) January 15, 2023

Probably referring to stool tests, but a nurse practitioner is likely to handle that rather than the GP anyway.

Nope. That sort of bleeding is seen by a GP as an urgent appointment. Trust me I know 😳. Even if that is what Starmer was thinking of it’s a stupid idea. I doubt a consultant gastroenterologist would be too pleased to have loads of people with haemmorhoids wasting their time.

Too much info 😬 .

I’m not onside with the over the top criticisms of changing the GP gatekeeper role though. Plenty to improve on there. Reform in this area is not a way to cope with GP shortages though. People should have access to their GP when they need it. The only answer to that is more GPs. That doesn’t mean that everything must always start with the GP though…

Plenty to improve on there.

Yup. Physio type injuries are obvious things to take away from the GP. Go to a GP with a bad back and they’ll send you away with some painkillers and instructions to rest up, when treatment/advice from a physio would be much more useful.

I actually think technology is the answer here. Seems to me a chat with an AI medical chatbot will be the standard in the not too distant future.

Go to a GP with a bad back and they’ll send you away with some painkillers and instructions to rest up,

No they will not as that is not NICE guidelines.  Mine refer to physio

While I think directly employed GPs is a laudable long term aim short term it would be ruinously expensive.  I am less confident about removing the gatekeeper role and again – short term ruinously expensive and also very disruptive.  wher are yo going to get all the extra staff needed from?  How are you going to train them?  What premises are they going to work from?

the last thing the NHS needs is more disruptive reoganisation and picking a fight with GPs now is unutterably stupid

Surely first thing to fix should be appointments that’s the thing that completely broke during the pandemic and now doesn’t seem to have bounced back.

A phone call at 8am? To be told no appointments.

Seems to me that’s the first weak link before you even get a GP. And the receptionist is already doing the misguided screening work for free.

“I’m sorry to hear that duck.”

Lack of funding and lack of resources.

What if your bad back is something way more serious than a muscle issue. (I mean as it stands my GP never got close to helping me with my chronic bad back. )

I’m sorry but is this the whole point of a GP.

While I think directly employed GPs is a laudable long term aim short term it would be ruinously expensive.

There’s no such thing as ruinously expensive when it comes to government spending. Of course there’s good value for money in terms of outcomes. But we are so far in the other direction it doesn’t bare analysis.

Do you think the Fed calls nearly a trillion dollars on the military ruinously expensive? No they are legally obliged to fulfill Congress’ demands. Same in the UK.

Starmer is playing a terrible and regressive game of cutting back and trimming. I’ve no interest in such a technocrat that can’t offer the country what it needs in a time of crisis. Especially when it’s leaning more left that it has in the last couple of decades.

Why do these stupid leader feel they have to echo the Daily Mail approach instead of rewriting the narrative to suit the times?

At some point in the future the young will wipe out this reactionary voting.

I actually think technology is the answer here. Seems to me a chat with an AI medical chatbot will be the standard in the not too distant future.

That would route out a lot of things and help speed it all up, as would instant blood tests via finger prick (bit further in future). A lot of people don’t actually need to see a doctor and can cover a lot of things over the phone which is the same function AI/ML could perform.

The phoning at 8am thing was bought in by a previous government to reduce waiting lists? It doesn’t actually reduce the time you wait but since you are not recorded as waiting the you don’t go on the statistics.

More GPs is the answer. One A+E near me has a good system. They have proper A+E for emergencies, GP, nurses and pharmacy. They know people turn up when they shouldn’t and adapted to be more efficient. Easier in a major hospital.

The answer is likely to be long term thinking/planning and letting people who understand the problem and have expertise sort it out. Not an MP in the job for a few weeks, only worried about the next election and siphoning money off for personal gain.

Seems to me all this stuff is just deflection to avoid spending money.

I mean AI bots – currently peak AI is to tell you that you will be waiting longer in a queue because it’s unprecedented times, and crashing Teslas.

Technology can solve a lot of problems but you can put people to work and give them an income doing these things. And you know you might be in danger of boosting the economy by following such a path.

We need better customer service not worse.

Yup. Physio type injuries are obvious things to take away from the GP.

Manchester has direct access physios. We have one in our practice and patients can self refer. Most GPs also have clinical pharmacists who now do the bulk of medicine management work. ANP and nurses team do the bulk of the diabetes checking (foot checks HR BP) etc etc. Alongside all this though you need to do a ton of patient education. Too many folks see coming to the GP as seeing a doctor, they feel shortchanged if they end up in front of something else even if they get the same (or better) information and they’re seen more quickly and get better sooner.

Self referral is fine, there was a couple of CCGs that had a direct access central triage team for ALL referrals (Milton Keynes and a couple on the Welsh Border CCGs IIRC) you create a referral request electronically and it’s sent to a central team, they triage (manned by specialists) decide on what level you should be seen and either book the appt or advise where you go. Choose and Book was a variation of this, but didn’t cut out the GP.

AI can absolutely do the same function as a GP over the phone. If it determines that you need to actually see the GP it will book an appointment for you just as the GP over the phone may do.

It will actually be better customer service as you can call at any time 24/7.

Can’t see how having more GPs doing stuff that can be faster/better/instant via AI is going to boost the economy, you will have to explain that a bit further.

We need better customer service not worse.

One of my partners has suggested in the past that any service that is free to use has intrinsically no worth, and is treated by users accordingly. GP DNA rates are partly driven by the fact that there’s no penalty for not going. Make an appt for a couple weeks*, feel better in the mean time, just don’t go. no comeback.

* GPs are NOT an urgent care service, this is how it’s meant to work.

While I think directly employed GPs is a laudable long term aim

I’m genuinely torn, although there’s some issues that need resolving. For instance; I run an inner city GP practice, I can get GP to come to work here because (partly) I can set my own sessional rate at slightly better than the GP at the leafy wealthy part of town just two miles away. If GPs are all going to be paid the same, how will I attract them to come to work for me? What’s to stop them going down the road if they’ll earn the same? Secondly the GP partnership model works reasonably well.  Decent salary, good pension; a business model that’s designed to make it hard to fail, but isn’t going to make you a millionaire either but will provide a long term secure career. The GP are invested in the practice and the wider PCN to make it a success, and in turn that’s better for patients. Agreed that the barrier to entry to new partners is too high, but if you rewrite the contract what’s the motivation? Then there’s budgets, make everyone a civil servant and the very next thing that comes along is target setting and budget cuts.

AI can absolutely do the same function as a GP

Who holds it’s indemnity? what are the AI’s qualifications, and experience? is it being monitored for it’s prescribing? is it being checked by the CQC to the same standard as clinicians now? To who do I complain if i need to, and what’s the redress?

Can’t see how having more GPs doing stuff that can be faster/better/instant via AI is going to boost the economy, you will have to explain that a bit further.

You are using the power of the state to pay someone to do a job that benefits society – especially where there is demand / lack. That is one more employed person too.

That person then spends the state money into the economy through the private sector and generates further growth. Money is then returned via the taxtion system where part of it is deleted out of the economy. Leaving a net expanse of funds in the real economy.

It is exactly how an economy functions, and exactly how growth occurs given the government is the monopoly isser of the £.

Now it’s up to you to tell me how you generate growth another way?

AI can absolutely do the same function as a GP over the phone.

Lol – the NHS can’t even maintain an operable booking system – never mind AI. Maybe sometime in the future when the basics are fixed.

said he was on TV and trying to be delicate. He was referring to blood you might see when you go to the toilet.
In this case, people should be able to self-refer, he said.

So who would you self refer to?  Gastronenterologist?  Oncology?  General surgeon?  Most likely explanation for visible blood is piles and I am sure specialists will love having their time taken up with folk with piles who do not need that specialist care.  A nurse would not be able to triage that without a lot of specialist training.  Its way beyond the skillset

As Nickc says – self refferal for some conditions can be relatively straightforward.  Local to me you can self refer for chiropody for example.  I could self refer for back pain but I think that was an internal NHS only service not for the general public

The difficulty with getting GP appoints is I believe ( Nickc / any GPs please correct if wrong) 1) vacancy rates with GP.  many practices have vacancies.  2) more GP time taken up with managing very sick folk where their treatment in hospitals has been delayed and 3) a minor factor is the variable service offered by GPs

I can always get an on the day appointment with my GP.  always.  they do an open ended urgent surgery so there is no fixed number of appointments.  They see everyone.  There may well be a telephone triage stage tho to weed out those who don’t need that urgent appointment

Once again it comes down in large part to the lack of social care causing log jams throughout the system

Most likely explanation for visible blood is piles and I am sure specialists will love having their time taken up with folk with piles who do not need that specialist care.

Yup. Allow these people to self refer and you’ll get tens of thousands of people with piles self-referring themselves to specialists thinking they have bowel cancer. Not only does that waste the specialist’s time but it leads the patients themselves to suffer days/weeks of anxiety and stress while they wait for their appointment. I can’t think of a worse example for self-referral.

More GPs is the answer.

This. Anything else has to be as well as, not instead of, increasing the number of GPs.

Starmer now picking a fight with holyrood over the gender reformact

Now whether you think Scotland has got it right or not on this divisive issue ( I think they have it about right) the bill was fiercely debated, passed holyrood with a huge majority backed by (most of ) the SNP, the greens,labour, lib dems and a few tories.

But Starmer thinks his views should be imposed on the Scots parliament.  He accuses the SNP ( ignoring the big cross party support) of using it as a political  football.  Basically he is saying that the Scots parliament needs a westminster veto even on devolved powers.  profoundly undemocratic and he is picking a needless fight – and also not recognising that Scots law is different to English. In Scots law you are an adult at 16

So anti democratic and wrong in law.  He really does keep doubling down and gifting the SNP a series of open goals

If being able to change gender at 16 would cause issues in England then what has he got to say about tourists from other countries where gender change at 16 is recognised? Nowt.  They would cause these same imaginary issues

Who holds it’s indemnity? what are the AI’s qualifications, and experience?

I guess the indemnity would be held by the NHS, and the qualifications and experience would be the collective knowledge of the dataset which was used to train it. I don’t think anyone is suggested AI would replace a GP, instead it would replace the receptionists or the 111 service who ask you a few questions and direct you to the appropriate route for treatment. The limit of it’s care would probably be the ability to issue prescriptions for non-harmful conditions, and of course it would probably still have the option to ask to see a real person.

If being able to change gender at 16 would cause issues in England then what has he got to say about tourists from other countries where gender change at 16 is recognised?

I haven’t seen anything from Starmer on this, but the UK government are proposing that “tourists” from a whole load of countries will not be recognised as the gender they are in their own countries. All feels a bit Orbán.

They would cause these same imaginary issues

I’m with you on this. Creating fear for political advantage. Do you have a link showing Starmer supporting the UK government as regards blocking the move in Scotland?

Found something @ the Guardian Live feed…

“I am worried about the fact that I think this is being used by the SNP as a sort of devolution political football. And I think it’s being used by the government – or might be used – as a divisive football in relation to the particular issue.

On this whole issue of trans rights, I think the government is looking to divide people rather than bring people together.”

…they’ve got it from LBC. Didn’t hear it myself.

In Scots law you are an adult at 16

So why don’t they allow a 16 year old adult to buy a pint of beer in a pub?

It doesn’t sound very absolute.

Alcohol is a westminster decision.  there are some differences in alcohol law in Scotland.  You can have beer with a meal at 14

anything that is under Scots law you are an adult at 16.  Under wrestminster law it varies hence yo can get married without parental assent at 16 in Scotland.  You go from youth courts to adult courts at 16  You can vote at 16 in Scotland in Scots elections

Is the formatting mucked up for everyone onthis thred?  Its allover the place for me since my cut and past post above. I’ve reported i to tech

Is the formatting mucked up for everyone onthis thred? Its allover the place for me since my cut and past post above. I’ve reported i to tech

Yeah you broke the thread TJ.

It had to happen eventually – it was just a matter of time.

Toynbee can truly jump through hoops to justify Starmer’s Tory posturing but this piece elevates ‘Starmerhope’ to new levels of Emperor’s New Clothes.

https://www.theguardian.com/commentisfree/2023/jan/16/keir-starmer-nhs-reform-tory-labour

Toynbee is another that has traveled a long way from the left to the right

You are using the power of the state to pay someone to do a job that benefits society – especially where there is demand / lack. That is one more employed person too.

That person then spends the state money into the economy through the private sector and generates further growth. Money is then returned via the taxtion system where part of it is deleted out of the economy. Leaving a net expanse of funds in the real economy.

It is exactly how an economy functions, and exactly how growth occurs given the government is the monopoly isser of the £.

Now it’s up to you to tell me how you generate growth another way?

Yes, I know that thanks. The question was specifically more about why a GP benefits the economy more than anyone else. The person who becomes a GP could go into Science based R&D, engineering and 100 other things that would use their dedication/intellect and also benefit the economy while the automation deals with stuff a GP doesn’t need to do.

Guess you will be with the mobs trying to burn down the AI/ML…

Interesting to see some supposed lefty types oppose Starmer/Streeting’s idea of making GPs salaried staff. I don’t really know enough about it TBH but on the surface it looks like a classic left wing thing to do. Essentially nationalising general practice. If you ask most people of a left persuasion they would advocate the wholesale nationalisation of the NHS and care sectors so I don’t know why GPs are an exception? I suppose the devil is in the detail. I see no reason why GPs couldn’t have the same autonomy as an NHS employee as they do now.

he question was specifically more about why a GP benefits the economy more than anyone else.

Anyone else? Did we even go there. Apologies I might have missed the reference to that.

Can’t see how having more GPs doing stuff that can be faster/better/instant via AI is going to boost the economy, you will have to explain that a bit further.

There’s your question …

Guess you will be with the mobs trying to burn down the AI/ML…

No idea what you mean there. What mob are you in?

Interesting to see some supposed lefty types oppose Starmer/Streeting’s idea of making GPs salaried staff. I don’t really know enough about it TBH

I think it’s based on one Streeting comment about ripping up contracts.

GPs don’t like the sound of it though.

How they structure their tax affairs – either employed or self-employed but still paid for by the state – not sure how it has bearing either way. Barely any detail out there from what I’ve seen.

I’m probably out of the loop on all of this.

What mob are you in?

Everything has to be a polar debate these days.

In this case… are you “pro-Skynet” or a “modern day luddite“… nonsense of course.

The nuance of this one is… both Machine Learning and Expert Systems have a role to play in triage, diagnosis and giving patient advice…. but that doesn’t change the fact we need more not fewer GPs with our aging population.

In this case… are you “pro-SkyNet” or a “modern day luddite”… nonsense of course.

Anything that benefits society is good by me. Providing there is a back-stop for employment in the case of AI.

Bring on Fully Automated Communism. 😉