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ATNotts
18th Jan 2018, 13:52
Another diary story to fill the UK airwaves and column inches; but whilst there are undoubtedly issues caused by under funding, falling numbers of nurses and so on, hardly ever is the "elephant in the room" discussed by the broadcast and print media.

The "elephant" is the number of people piling up at A&E with conditions that frankly they could get sorted by going to the local pharmacist, or waiting 24 hours and calling their GP for a same day appointment, which even at our pretty useless practice are now readily available.

When you talk to people working in the health services, especially in A&E they always mention the numbers of "frauds" turning up there because they want immediate treatment, rather than waiting 24 hours. I think it has something to do with the internet generation where everything expected to be available "now" and that waiting is somehow regarding as unacceptable "customer service".

glad rag
18th Jan 2018, 14:08
Winter crisis?
Not here..

https://cdn.images.express.co.uk/img/dynamic/1/750x445/896181.jpg

"Scottish health bosses enjoy a LUXURY junket in Florida while NHS hospitals struggle
SCOTTISH Government health bosses enjoyed a luxury junket to Florida while overstretched NHS hospitals at home were enduring their worst week in years.
By BEN BORLAND
19:03, Sat, Dec 23, 2017 | UPDATED: 19:19, Sat, Dec 23, 2017"

www.express.co.uk/news/uk/896181/NHS-scotland-health-bosses-delegation-florida-conference-luxury

Jet II
18th Jan 2018, 14:22
I'm always surprised at the numbers that now go to A&E with the Flu. When I was growing up I cant remember anyone going to hospital, they used to take to their bed with a chest full of Vicks and a glass of Scotch.

But in those days we were not vaccinated against the Flu..:uhoh:

ATNotts
18th Jan 2018, 14:41
I'm always surprised at the numbers that now go to A&E with the Flu. When I was growing up I cant remember anyone going to hospital, they used to take to their bed with a chest full of Vicks and a glass of Scotch.

But in those days we were not vaccinated against the Flu..:uhoh:

I think that's the point. The snowflake generation appears even less likely to endure "man-flu" let alone full blown influenza without cluttering up the GP's surgery, let alone A&E. And you'd think that in today's connected world there's more than enough sensible, rational advice out there online (without resorting to American health websites that will diagnose cancer within 2 clicks) to know exactly what to do, without clogging up the NHS.

highflyer40
18th Jan 2018, 14:47
While I agree there are too many people using A&E who donít need it.
Your use of flu was maybe a poor choice.

Iím not exactly sure how old you are, but from your post I think I can guess. Back then there were nowhere near the number of elderly there are today. The baby boomers are now getting to that age, and I think you will find that the vast majority of people going into A&E due to flu are the over 60ís and not the young.

meadowrun
18th Jan 2018, 14:49
And you'd think that in today's connected world there's more than enough sensible, rational advice out there online


You credit your run of the mill human with too many smarts. It just ain't so.

VP959
18th Jan 2018, 14:56
Another diary story to fill the UK airwaves and column inches; but whilst there are undoubtedly issues caused by under funding, falling numbers of nurses and so on, hardly ever is the "elephant in the room" discussed by the broadcast and print media.

The "elephant" is the number of people piling up at A&E with conditions that frankly they could get sorted by going to the local pharmacist, or waiting 24 hours and calling their GP for a same day appointment, which even at our pretty useless practice are now readily available.

When you talk to people working in the health services, especially in A&E they always mention the numbers of "frauds" turning up there because they want immediate treatment, rather than waiting 24 hours. I think it has something to do with the internet generation where everything expected to be available "now" and that waiting is somehow regarding as unacceptable "customer service".


Absolutely spot on.

Thankfully I've only ever been to A&E a couple of times, but my other half is a nurse, and has colleagues that work in A&E departments. Her view is that around 80% of the people that turn of at A&E could be treated by their GP or practice nurse at their local surgery and a wait of 24 to 48 hours would not worsen their condition, and in some cases would result in nature taking its course and the condition resolving itself.

It seems that the NHS is trying to dissuade people from using A&E unless they have a genuine need for emergency treatment, but this has little effect. Last time I had to visit there, a few years ago now, after I'd sliced my hand open when doing a bit of tiling, there was a nurse who did a quick examination of everyone coming in and sort of graded their injury/condition in terms of urgency and severity. I was given a number (may have been a letter, I can't remember) and asked to wait. The electronic noticeboard had the average waiting times for each numerical/alphabetical category, with the longest being several hours.

I would assume that, as well as prioritising urgent cases, there was also an element of trying to dissuade the time wasters from hanging around. What I can say was that I didn't wait more than around half an hour or so and that the treatment was excellent. I was stitched up, my last tetanus booster card was checked to see if I needed another one (I did) and I left with a letter to give to my local surgery explaining the treatment and with instructions to make an appointment to see the surgery practice nurse a week or so later to have the stitches out.

I believe that your "internet generation" point may well be key. People do seem to have much greater expectations, plus some seem to have a strong feeling that they have an entitlement to rapid, free, treatment for anything, no matter how minor.

Although I support the view that the NHS should provide care for all, free at the point of provision, I'm coming around to the view that perhaps there should be a charge for non-urgent treatment provided at A&E. Perhaps something like the assessment process I went through, with those who don't actually need A&E treatment being given the option of a fixed charge to use A&E at that time, plus a long wait for treatment, or be sent home with some basic medical advice and instructions to see their GP or practice nurse the next day.

I suppose the problem with that is that getting an appointment to see either your GP or practice nurse can take a lot longer than 24 hours. At my local surgery you are lucky if you get an appointment within a week, let alone the next day.

Andy_S
18th Jan 2018, 15:04
The "elephant" is the number of people piling up at A&E with conditions that frankly they could get sorted by going to the local pharmacist, or waiting 24 hours and calling their GP for a same day appointment, which even at our pretty useless practice are now readily available.
A similar discussion took place on PPRuNe a few weeks ago.

A big part of the problem isnít just the numbers of people in general piling into A&E. Itís the numbers of elderly. And given that Flu, real Flu, can be fatal to the elderly and infirm I donít altogether object.

What annoys me is that all the banner headlines seem to overlook the fact that what we are experiencing is a particularly bad spike in demand on the NHS. It isnít permanent, and things will eventually improve. So perhaps the more important questions are a) how much spare NHS capacity are we willing to fund, given that for the most part it wonít be used, and b) when the s*** really does hit the fan are there contingency plans in place?

We really do expect far too much of the NHS.

ATNotts
18th Jan 2018, 16:10
A similar discussion took place on PPRuNe a few weeks ago.

A big part of the problem isnít just the numbers of people in general piling into A&E. Itís the numbers of elderly. And given that Flu, real Flu, can be fatal to the elderly and infirm I donít altogether object.

What annoys me is that all the banner headlines seem to overlook the fact that what we are experiencing is a particularly bad spike in demand on the NHS. It isnít permanent, and things will eventually improve. So perhaps the more important questions are a) how much spare NHS capacity are we willing to fund, given that for the most part it wonít be used, and b) when the s*** really does hit the fan are there contingency plans in place?

We really do expect far too much of the NHS.

Logically, we probably need a new system for a new century, the NHS is 70 years old this year, and back then dialysis was unheard of, as was open heart surgery, and many of the "nasties" that would have killed off people, not just the elderly are treatable, but often the treatment doesn't cure, it merely delays the inevitable, clogging up the system in the process.

The problem is that no sooner does somebody (especially a politician) suggests a rethink the media comes up with the favourite mantra "we don't want an American style health system", and certainly I can't imagine many, even on PPRuNe being prepared to sanction such a system. But there are more than 180 countries in the world, and there may well be a halfway house we could lift, either in whole or in part, that could offer better ways to offer health services.

Sad thing is that nobody is prepared to sit down, think the unthinkable, and come up with proposals that could be the basis for a grown up discussion. To do so is just a sure fire vote loser. So we will continue to hobble along with a system that creaks more each year, whilst the great British public expects more, but isn't willing to pay additional tax, or change taxation priorities to improve the mid 20th century model.

Andy_S
18th Jan 2018, 16:30
Logically, we probably need a new system for a new century, the NHS is 70 years old this year, and back then dialysis was unheard of, as was open heart surgery, and many of the "nasties" that would have killed off people, not just the elderly are treatable, but often the treatment doesn't cure, it merely delays the inevitable, clogging up the system in the process.

The problem is that no sooner does somebody (especially a politician) suggests a rethink the media comes up with the favourite mantra "we don't want an American style health system", and certainly I can't imagine many, even on PPRuNe being prepared to sanction such a system. But there are more than 180 countries in the world, and there may well be a halfway house we could lift, either in whole or in part, that could offer better ways to offer health services.

Sad thing is that nobody is prepared to sit down, think the unthinkable, and come up with proposals that could be the basis for a grown up discussion. To do so is just a sure fire vote loser. So we will continue to hobble along with a system that creaks more each year, whilst the great British public expects more, but isn't willing to pay additional tax, or change taxation priorities to improve the mid 20th century model.

Very succinctly put. My views precisely.

There are high quality healthcare systems in many other European countries that work perfectly well without operating the same monolithic structure and funding model as the NHS. But itís impossible to have a grown up debate about the subject, so we will continue to stumble from crisis to crisis. Politically, we have boxed ourselves into a corner with the NHS.

Krystal n chips
18th Jan 2018, 16:45
Very succinctly put. My views precisely.

There are high quality healthcare systems in many other European countries that work perfectly well without operating the same monolithic structure and funding model as the NHS. But itís impossible to have a grown up debate about the subject, so we will continue to stumble from crisis to crisis. Politically, we have boxed ourselves into a corner with the NHS.

There was a Labour PPB on the television last night. Amongst the contributors was a GP who opined, that, by constantly giving bad news and bad information to the public regarding the NHS, the way is being paved for privatisation by stealth.

The Tories are very adept when it comes to promoting their hallowed mantra of privatisation.

ATNotts
18th Jan 2018, 16:47
How about this as a starting point to begin to resolve the "bed blocking" situation (horrible term that; nobody want to stay in a hospital ward for one hour more than necessary).

Many years ago we used to have convalescent homes, were people who'd had operations could go to recover, without necessarily requiring the level of care and technology that more seriously ill people need. I believe the Catholic Caritas organisation offers this type of post hospital care in some European countries. We prefer to discharge people back to the community, often when they're not ready to be discharged, and into the care of relatives, or the social care system, who are often unwilling / unable to cope. I have had first hand experience of this within our family. Hospital wasn't the right place, but also, neither was home.

The we need to decide what the priorities are for our health system. Should taxation be used to assist people to have children? Should it be used to pay 100% for elective surgery like stomach bands? Should more money be diverted to things such as preventative medicine? Should we all have to pay a "real" national insurance to pay for some of our healthcare, but one in which nobody can be denied cover. Dentistry is already moving in this direction.

Tankertrashnav
18th Jan 2018, 16:48
The Tories are very adept when it comes to promoting their hallowed mantra of privatisation.

As are Labour at refusing to discuss any solution to a problem other than throwing public money at it.

G-CPTN
18th Jan 2018, 16:50
Morriston hospital in Swansea had 14 patients awaiting treatment and 62 awaiting discharge.

Andy_S
18th Jan 2018, 16:50
Labour are very adept when it comes to promoting their hallowed mantra of Tory privatisation.

There. Fixed it for you.

Seriously, you just proved my point. We need an honest, open, objective debate on the future of the NHS. All you're doing is reciting the same old mantra.

ATNotts
18th Jan 2018, 16:53
There was a Labour PPB on the television last night. Amongst the contributors was a GP who opined, that, by constantly giving bad news and bad information to the public regarding the NHS, the way is being paved for privatisation by stealth.

The Tories are very adept when it comes to promoting their hallowed mantra of privatisation.

I don't agree; true privatisation (by which you are really taking about the American model) isn't the favoured option of anyone, unless they are in the selfish, fortunate position of not needing to avail themselves of any kind of national system - the "honorable member for the 18th century" may indeed by of such mind!!

Labour are arch culprits when it comes to scaremongering with the "American system" mantra, and they, probably more than any other body, stifle the grown up conversation that the UK desperately need to have.

Krystal n chips
18th Jan 2018, 17:08
I don't agree; true privatisation (by which you are really taking about the American model) isn't the favoured option of anyone, unless they are in the selfish, fortunate position of not needing to avail themselves of any kind of national system - the "honorable member for the 18th century" may indeed by of such mind!!

Labour are arch culprits when it comes to scaremongering with the "American system" mantra, and they, probably more than any other body, stifle the grown up conversation that the UK desperately need to have.

By almost a consensus on here and in the real world, wholesale privatisation would be political suicide and no political party would ever recover....do we agree ?

However, if, and here the black art of change management comes into play, you start a drip feed of bad news, more bad news and a few statistics to support your "argument " than slowly, but surely, people start to think Hmmm ? maybe a bit of privatisation isn't such a bad idea after all...I'd vote for that and...bingo ! the bait is taken.

Thereafter, it's just a nice steady incremental process to achieve the end objective....it may take time, but, they'll get there and the NHS will be gone in the form we know it.

ATNotts
18th Jan 2018, 17:12
By almost a consensus on here and in the real world, wholesale privatisation would be political suicide and no political party would ever recover....do we agree ?

I agree with you 100% there.

SARF
18th Jan 2018, 17:13
I can’t imagine a modern politician planning past next Wednesday.. never mind trying a plan that convoluted

Trossie
18th Jan 2018, 17:14
I remember the days when GPs used to treat people who were ill, doing home visits when necessary especially if children were involved.

Then there was Broon's contract with the GPs.

Now my GP surgery is Mon-Fri 9-6 (with an hour shut-down over lunch) and they have no out-of-hours contact. No wonder so many people turn to A&E.

About this 'privatisation', aren't GPs surgeries private 'businesses' contracted to the NHS? If 'privatisation' is going to mean more of those cushy deals with less of the 'treating the public' going on then I am against it. If 'privatisation' means that the NHS is going to sub-contract to organisations that actually treat people efficiently and we do not pay 'at the point of delivery' for that treatment, then I have no problems with it.

meadowrun
18th Jan 2018, 17:14
Privatisation of medical care is an anathema to me. There are good reasons so few countries use it as a system.

Jet II
18th Jan 2018, 17:22
Well its page 2 and already its back to the same old nonsense of either the NHS as it is or a US style private system - not that anyone is actually proposing a US style private system.. :rolleyes:

ATNotts
18th Jan 2018, 17:24
How do those elephants climb onto the trolleys in the hospital corridors to die while "piling up"?

Do they have help?

They don't need to get on trolley; they need turning around and sending home, but for whatever reason nobody appears to be prepared to do so - probably for fear of just once making an incorrect judgement.

meadowrun
18th Jan 2018, 17:27
They are proposing that at the very least, it is not functioning as it should.


A good next step would be to look at models that do work within somewhat similar demographics and societal structures and build a plan.
edit: (Nope, sorry. Next step would be to get together a group of people who are actually capable of building a plan.)

MG23
18th Jan 2018, 17:29
And you'd think that in today's connected world there's more than enough sensible, rational advice out there online (without resorting to American health websites that will diagnose cancer within 2 clicks) to know exactly what to do, without clogging up the NHS.

When you pay thousands of pounds of tax to the NHS every year, why wouldn't you use it?

The fundamental problem with the NHS is a simple one. There's a near-infinite demand for medical treatment, and a limited budget. By promising to treat everyone, you either ration or go bankrupt.

It'll be interesting to see what happens to the NHS as rejuvenation treatments become common. Will they be so cheap that all the diseases of old age disappear and the NHS suddenly finds itself with little to do, or so expensive that it resort to putting people on a twenty-year waiting list and hoping they die before they reach the end?

Jet II
18th Jan 2018, 17:35
It'll be interesting to see what happens to the NHS as rejuvenation treatments become common. Will they be so cheap that all the diseases of old age disappear and the NHS suddenly finds itself with little to do, or so expensive that it resort to putting people on a twenty-year waiting list and hoping they die before they reach the end?

Sounds like the NHS circa 1948 - then they based the budget on the idea that demand would reduce as the NHS cured everyone of their ills.

That worked out well..:p

The Nip
18th Jan 2018, 17:37
While I agree there are too many people using A&E who donít need it.
Your use of flu was maybe a poor choice.

Iím not exactly sure how old you are, but from your post I think I can guess. Back then there were nowhere near the number of elderly there are today. The baby boomers are now getting to that age, and I think you will find that the vast majority of people going into A&E due to flu are the over 60ís and not the young.

While what you say is undoubtedly true, don't forget that over the past 20 years our population has grown some 5 million. The UK's infrastructure has not increased to cope with that. Both political parties have ignored this as it is a difficult subject to discuss without the inevitable accusations being made.

It is not just because of growing old.

VP959
18th Jan 2018, 17:51
It'll be interesting to see what happens to the NHS as rejuvenation treatments become common. Will they be so cheap that all the diseases of old age disappear and the NHS suddenly finds itself with little to do, or so expensive that it resort to putting people on a twenty-year waiting list and hoping they die before they reach the end?

There are already lots of treatments that are not available on the NHS, and strict restrictions on how much the NHS contributes to quite a few other treatments (dentistry, eyesight correction, hearing aids etc) so why would any form of "rejuvenation therapy" be an NHS treatment?

My own view is that the NHS already does more non-essential treatment that it needs to, cosmetic surgery for reasons that are not strictly health-related reasons being an example, fertility treatment and contraception being other examples.

Dan Gerous
18th Jan 2018, 18:42
Perhaps if folk had the flu vaccine, it would cut out a lot of the flu cases at A&E. I get it every year anyway due to a health problem, but the last few places I've worked, offered it every year, and it had a good take up.

On a point of not being able to get an appointment at the docs, my sister in law works in a health centre reception, and she says there are always folk phoning up asking for a quick appointment, and when they are given one, it's suddenly, "oh I can't come in at that time, I'm doing this, that, or the other".

VP959
18th Jan 2018, 18:54
Perhaps if folk had the flu vaccine, it would cut out a lot of the flu cases at A&E. I get it every year anyway due to a health problem, but the last few places I've worked, offered it every year, and it had a good take up.

On a point of not being able to get an appointment at the docs, my sister in law works in a health centre reception, and she says there are always folk phoning up asking for a quick appointment, and when they are given one, it's suddenly, "oh I can't come in at that time, I'm doing this, that, or the other".


There was something on the radio recently that one of the flu vaccines being used this year was ineffective, as it turned out that it provided no protection against one of the most prevalent strains. I believe that the alternative vaccine, that does provide the required protection, was more expensive, and so wasn't being used much, if at all, as a consequence.

Curious Pax
18th Jan 2018, 19:13
One influential trigger to A&E attendance according to an emergency doctor interview I heard the other day is the eagerness of the NHS 111 helpline to advise people to go to A&E. Unsurprisingly it seems that despite having many medically qualified people available on that line they are very cautious in their assumptions when symptoms are described, and so often recommend hospital attendance just in case.

Ex Cargo Clown
18th Jan 2018, 19:36
Heard a horror story today of someone walking into A&E because she had "broken her spine", then refused to leave until she saw a consultant and an X-ray. All because "I've paid in, I deserve treatment".

G-CPTN
18th Jan 2018, 20:17
There was something on the radio recently that one of the flu vaccines being used this year was ineffective, as it turned out that it provided no protection against one of the most prevalent strains. I believe that the alternative vaccine, that does provide the required protection, was more expensive, and so wasn't being used much, if at all, as a consequence.

There are three variants of this year's'flu vaccine - bivalent, trivalent and quadrivalent with increasing effectiveness towards the circulating viruses.

Danny42C
18th Jan 2018, 20:51
ATNotts (#1),

There is an even bigger elephant in this room. If any good or service is "free", the demand for it is potentially infinite. The entire resources of the kingdom could be put into the NHS, and it would still be undefunded, because, on current policy, it is a bottomless pit. As we cannot ever increase the supply to match the demand, we will have to curtail the demand.

An axe will have to be taken to the fundamental Sacred Cow - the mantra: "Free at the Point of Service".(Shock, horror!) Setting aside the cold fact that "There is no such thing as a Free Lunch" - (someone will have to pay: at the moment it looks like our children and grandchildren); why am I entitled to free medical treatment, when there is no such entitlement to free anything else ?

When I were a lad ..... before the War, it cost 5/- for a visit to the Doctor (7/6 for a home visit). How could such a system possibly work without wide scale hardship ? First, what do these figures represent today? There are two Inflation "multipliers": Cost Inflation, which is 50:1 in round numbers *; and Wage Inflation (how long must you work to buy a pound of steak ?) which is 150:1 * This is a fairer comparison of the effect on the individual.

Note * you can verify these figures yourselves by reference to easily available figures.

On that basis, a visit to the doc today would cost £37.50; a home visit £56.25. Is that so impossible ? How much is 20 cigarettes? A gallon of petrol? A pint of beer? All right, let's just ask for a nominal £5 a visit, say, and £20 for a home visit. You would have to have exemptions, of course: those on benefits (but that works on prescriptions already) - and can we axe the other sacred calf: that all pensioners are by definition paupers ? It just ain't so.

There would be "collateral benefits": it would empty the GP surgeries and A&E of the time wasters who would be better off warm in bed with a cuppa and a paracetamol. [VP959 (#7), My daughter has recently retired fom a lifetime of nursing, and is in full agreement with your good lady].

So how did the old system work ? Well, count the numbers going through your GP's waiting room for a week, multiply by £37.50, deduct 10% for exemptions - and that's what a practice would be pulling in if it were in 1938 conditions. Quite enough for a doctor to "temper the wind to the shorn lamb" - give his services free to his poorer patients, while still able to run the best car in the village.

Hospitals ? Well, in Liverpool where I grew up, there was a "Penny in the Pound" scheme run by an association of the Liverpool hospitals. Employees could join this scheme, paying 1 penny per pound (1/240) of their weekly wage to a hospital fund; most larger employers would cooperate by organising deductions from wages. My father was in this scheme and it paid the hospital charges when he had an operation. Surgeon and Anaesthetist ? "Mr So-and-so", the Ward Sister told my Dad, "will do one operation for 100 guineas - and then do three more for nothing". "Sir Lancelot Spratt" could do this - and still run his Rolls-Royce !

IMHO, that is the only way out of the current mess. Could it happen - Yes. Will it happen ? - Of course not, it would be electoral suicide for any Government.

I shall be off soon, The NHS will last my time. Best of luck, all you youngsters !

MG23
18th Jan 2018, 21:19
There are already lots of treatments that are not available on the NHS, and strict restrictions on how much the NHS contributes to quite a few other treatments (dentistry, eyesight correction, hearing aids etc) so why would any form of "rejuvenation therapy" be an NHS treatment?

Because it potentially eliminates the diseases of ageing, which are some of the most expensive to treat.

And because not offering it will condemn the poor to death because $$$$$ (or pounds, in this case).

VP959
18th Jan 2018, 21:20
The pensioners thing (well, really over-60's) seems bonkers. I get free prescriptions, and a free eye test, but still pay full whack (NHS rates) for all dental care and check-ups, and pay full whack for glasses.

Given that we've had part of the NHS that has always charged for services at the point of use, in fact asks for pre-payment in the case of dental treatment and eyesight correction, then what's wrong with charging for other services?

The precedent for charging was set right back when the NHS was founded, so we're not slaughtering some sacred cow by introducing payments for other services at all.

Krystal n chips
19th Jan 2018, 05:04
While what you say is undoubtedly true, don't forget that over the past 20 years our population has grown some 5 million. The UK's infrastructure has not increased to cope with that. Both political parties have ignored this as it is a difficult subject to discuss without the inevitable accusations being made.

It is not just because of growing old.

Lets have a think about this

Longevity perhaps ?....nope, you ruled that one out yourself. Although advances in medicine, healthier lifestyles ( for some ) have contributed to us living longer.

Procreation ?......sex is a very basic urge after all, but, sadly, this too can be ruled thanks to advances in contraception.

Which only leaves, and apart from this being JB you have mentioned your sentiments on this topic before on here, guess what, or rather, who ?

Immigrants.......... Always a convenient scapegoat for all and any of the UK's troubles at least in the minds of those for whom societal development and progress will always be an anathema.

Eclectic
19th Jan 2018, 06:16
It is interesting that the Welsh NHS (run by Labour) and the Scottish NHS (run by the SNP) both have more spend per patient, because of the Barnett formula. Yet both perform worse than the English NHS.

The Nip
19th Jan 2018, 08:24
Lets have a think about this

Longevity perhaps ?....nope, you ruled that one out yourself. Although advances in medicine, healthier lifestyles ( for some ) have contributed to us living longer.

Procreation ?......sex is a very basic urge after all, but, sadly, this too can be ruled thanks to advances in contraception.

Which only leaves, and apart from this being JB you have mentioned your sentiments on this topic before on here, guess what, or rather, who ?

Immigrants.......... Always a convenient scapegoat for all and any of the UK's troubles at least in the minds of those for whom societal development and progress will always be an anathema.

Just point out if anything I have written in the post above is wrong? Other people are allowed to have a different opinion than yourself. It doesn't make you right.

ATNotts
19th Jan 2018, 08:37
One influential trigger to A&E attendance according to an emergency doctor interview I heard the other day is the eagerness of the NHS 111 helpline to advise people to go to A&E. Unsurprisingly it seems that despite having many medically qualified people available on that line they are very cautious in their assumptions when symptoms are described, and so often recommend hospital attendance just in case.

You make a very valid point, and one which, again, we as a family have direct experience of. "Go to A&E" is almost a default response from NHS111.

davews
19th Jan 2018, 09:05
You make a very valid point, and one which, again, we as a family have direct experience of. "Go to A&E" is almost a default response from NHS111.
And I can certainly confirm that. I had a couple of trips to A&E two years ago for urine retention. Both my GP surgery and NHS111 stressed that I needed to go to A&E immediately as the only option. Neither GPs or the Urgent Care Centre just down the road from here can do catheters (even though it seems District Nurses can). Of course by the time I arrived at A&E under my own steam mother nature had sorted the problem out anyway but still had to go through system. Most of the others waiting appeared to have nothing serious wrong with them - apart from one chap who had badly cut his hand and they gave him a box of tissues to stem the flow while he sat there...

We really do need to change the system so only those who are seriously ill go to A&E.

Krystal n chips
19th Jan 2018, 09:16
Just point out if anything I have written in the post above is wrong? Other people are allowed to have a different opinion than yourself. It doesn't make you right.

Nowhere did I say you were wrong....well, not quite. This being the reference to old age and living longer which has contributed to the population.

Here you can relax however, because, with the Tories moving the age for receiving the state pension, and people having to work longer when they get older, the only burden on the NHS will be the capacity of the morgues.

https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/mar2017

But, when you mentioned the 5million figure, you also casually alluded to immigration and a suitably pious lament about the inevitable accusations.

Which is strange really when, on one hand you say people are entitled to a different opinion, but on the other complain when that opinion is diametrically the opposite to your own.

Andy_S
19th Jan 2018, 09:21
Here you can relax however, because, with the Tories moving the age for receiving the state pension, and people having to work longer when they get older, the only burden on the NHS will be the capacity of the morgues.

So apart from blaming the Tories for everything, what do you actually propose to do about the problem?

"Go to A&E" is almost a default response from NHS111.

And what a useless service NHS111 is………

Krystal n chips
19th Jan 2018, 09:41
So apart from blaming the Tories for everything, what do you actually propose to do about the problem?

I don't blame the Tories for everything, quite, as Labour aren't entirely blameless in some respects. The only surprise is that they haven't been blamed for introducing the NHS originally.

As for a remedy, well I would suddenly become very rich if I had some magic solution now wouldn't I ?.

However, since you asked, lets start with cancelling Trident...and the overspend on that hasn't even begun yet, as far as we know, removal of several layers of "management " and cancelation of the vanity HS2 project...those should free up some financial resources....along with asking the DUP for a return of the £1bn bung.



And what a useless service NHS111 is………

On what basis please ?

Andy_S
19th Jan 2018, 09:43
So basically your solution is simply to pour more money into the NHS.

I'm glad we cleared that up.

treadigraph
19th Jan 2018, 09:51
I called 111 five times during my mum's last couple of years and I have to say I found them excellent. I wasn't sure that a 999 call was necessary and wanted advice - three times they sent out a Duty GP, the other twice an ambulance.

No doubt it varies between the different NHS Trusts though.

My local GP Practice has combined with another and now operates a walk in minor injuries unit - you see a nurse practitioner who can deal with most things and issue prescriptions; and will refer you upwards for more serious ailments and injuries.

ATNotts
19th Jan 2018, 10:04
I called 111 five times during my mum's last couple of years and I have to say I found them excellent. I wasn't sure that a 999 call was necessary and wanted advice - three times they sent out a Duty GP, the other twice an ambulance.

No doubt it varies between the different NHS Trusts though.

My local GP Practice has combined with another and now operates a walk in minor injuries unit - you see a nurse practitioner who can deal with most things and issue prescriptions; and will refer you upwards for more serious ailments and injuries.

I suppose that is another example of a "post code lottery" (another lazy journalist term I really dislike). You are very fortunate, and I only wish our local trust was quite so forward thinking.

And this brings up another issue; all these various local "trusts", which surely result in too many middle and higher management posts in the NHS, as each trust needs a chief executive and a team below them, all sucking money away from the sharp end of the health service.

The Nip
19th Jan 2018, 10:19
But, when you mentioned the 5million figure, you also casually alluded to immigration and a suitably pious lament about the inevitable accusations.

And again you are making assumptions. Population increase is a result of many variables. Of course you want find offence with something I did not say in my post. I was merely pointing out the fact that infrastructure has not kept up with the increase, and it wasn't only the fault of growing old. :ugh:

treadigraph
19th Jan 2018, 10:19
You are very fortunate, and I only wish our local trust was quite so forward thinking.

Absolutely.

VP959
19th Jan 2018, 10:32
I suppose that is another example of a "post code lottery" (another lazy journalist term I really dislike). You are very fortunate, and I only wish our local trust was quite so forward thinking.

And this brings up another issue; all these various local "trusts", which surely result in too many middle and higher management posts in the NHS, as each trust needs a chief executive and a team below them, all sucking money away from the sharp end of the health service.

I believe that the lack of consistency and the consequent disparities between what is seen as "best practice" between health care in one area and another is a significant issue.

My local practice seems to be in crisis. One senior GP retired a few months ago and has not been replaced, another GP I've seen twice since has announced to day he's resigning. I asked who would be taking over, as it's nice to see the same doctor for non-urgent care, and he said he really didn't know. Appointments to see a doctor here always have a backlog of around a week, often a lot longer. For example, I was due a medication review (an annual thing, without which my automatic repeat prescription won't be renewed) on 3rd January 2018. On the 9th December I tried to make an appointment for this review. The earliest appointment available was this morning, 19th January. This meant having to bother another GP in the practice to issue an "emergency" prescription, because my automatic repeat authorisation had run out.

All told it's a bit of a shambles, and set to get worse.

By way of contrast, a friend lives around 16 miles away and their local surgery seems to function very differently. They have "drop in" periods every day that are set aside for urgent cases, no appointment needed, they never seem to need to wait more than 24 hours for an appointment, and they get a regular newsletter in the monthly parish magazine about what's going on at the practice, any changes that are happening, or reminders for things like flu jabs etc.

How come two practices, operating within the same NHS trust area, can be so very different?

anotherthing
19th Jan 2018, 10:36
My family use BUPA but on Tuesday we did visit A&E. We were a little bit reticent about going but our son, 11 had just fainted, having had a hacking cough and temperature for a few days previous.

He was sat at the dining table when he fainted, but split his chin open, He seemed lucid and the bleeding had stopped, though I did not clean it as I knew it would bleed again. We tried to get a doctors appointment but none were available that day.

Off we popped to A&E, feeling a bit guilty for doing so, but felt he needed attending to. Upon reaching the hospital, our son fainted again, whilst we were booking him in. He was taken straight through and tests were done, and chin glued back together. We were the advised to attend another A&E straight away as it specialises in children and they wanted to investigate the fainting. We turned down the offer of an ambulance and drove ourselves.

We waited 3 hours to be seen, then had to wait for the registrar. There is only one registrar in pediatrics on duty... and they were busy. Nine hours after first getting to a hospital, I decided to discharge our son under my own steam. He seemed ok, his bloods were fine but we were still supposed to wait for the registrar. I argued, very politely, that the best place for him was in bed at home, not in a noisy observation ward where he was unable to sleep properly. I was advised that the registrar was busy intubating a baby and they did not know when she could get to us.

My impression of A&E? the first hospital was great and looked after our son as soon as he fainted. I can't comment on the others waiting to say whether they seemed genuinely in need of A&E as we were whisked away within minutes of arriving.

The second hospital waiting area was terrible and there seemed to be some people that were OK, but you can never tell.

Both hospitals were obviously under high workload. Once on the ward at the second hospital, you could tell that the children there were genuinely ill.

The nurses and doctors at both establishments could not have been better.

The NHS may be under strain, and this time of year it is maybe inevitable that they are more stretched, but the staff were stoical and very friendly.

It does seem that in this day and age, however, that people feel 'entitled' and think that if they go to A&E they will get seen quicker and get better treatment than if they waited fr a doctors appointment...

Krystal n chips
19th Jan 2018, 12:38
And again you are making assumptions. Population increase is a result of many variables. Of course you want find offence with something I did not say in my post. I was merely pointing out the fact that infrastructure has not kept up with the increase, and it wasn't only the fault of growing old. :ugh:

No assumption on my part as non is necessary. But if this 5m figure is of no relevance why include it ?

And then as I said, there was this rather definitive comment in support of your argument....remember this ?

" don't forget that over the past 20 years our population has grown some 5 million. The UK's infrastructure has not increased to cope with that. Both political parties have ignored this as it is a difficult subject to discuss without the inevitable accusations being made.

It is not just because of growing old " .


Thus if this doesn't refer to immigrants using the NHS, to whom does it apply ?

The Nip
19th Jan 2018, 13:19
No assumption on my part as non is necessary. But if this 5m figure is of no relevance why include it ?

And then as I said, there was this rather definitive comment in support of your argument....remember this ?

" don't forget that over the past 20 years our population has grown some 5 million. The UK's infrastructure has not increased to cope with that. Both political parties have ignored this as it is a difficult subject to discuss without the inevitable accusations being made.

It is not just because of growing old " .


Thus if this doesn't refer to immigrants using the NHS, to whom does it apply ?

What is your agenda here? I posted a comment about the correlation between population growth and infrastructure. You have implied that I had a hidden reason behind my statement. Are you some sort of internet stalker?
If I am wrong then make a comment to point that out and why.

Krystal n chips
19th Jan 2018, 16:05
What is your agenda here? I posted a comment about the correlation between population growth and infrastructure. You have implied that I had a hidden reason behind my statement. Are you some sort of internet stalker?
If I am wrong then make a comment to point that out and why.

Oh man, if you were a glider pilot, you'd be superb in thermals.....if you ever actually left the launch point that is.

That, and I've already commented as to your posts.

This thread is about the current NHS crisis and indeed, the NHS as an organisation, its function(s) in UK society and how essential it is for all of us, plus, in the main, it's free.

I don't have as you put it an "agenda " and as a second line of defence from yourself, neither am I a "stalker ". Because as I've said many times, here on JB there are many contributors who are unaccustomed to having their views questioned or challenged.

True, we have infrastructure problems in the UK, however, in your attempt ( failed ) to make some form of correlation, you mentioned a figure of a 5m growth in the population and also, something about being concerned about the " inevitable accusations"....what would these accusations be and why the concern ?....because let's be honest, your posts on the Brexit thread are clearly anti- EU and where have the bulk of the immigrants to the UK come from recently ?

Of course, if your concern is that the NHS should be selective as to whom it provides treatment for, if this 5m figure was plucked at random perhaps, or if you care to admit you were alluding to immigration as being a significant contributory factor to the current crisis in the NHS, please feel free to say so.

radeng
19th Jan 2018, 16:18
Seems to me that making nursing an attractive career would help. Free bursaries so training costs the trainee zero or very little - as it used. Student nurses got paid! Doctors entering the NHS and staying two years to get all student loans paid off.

How much does it cost for a nurse to get her Master's degree - which is tending to become the minimum? Plus the stresses.....my niece has just retired at age 58 from a very stressful position in senior psychiatric nursing: she had to travel a lot for meetings and Newcastle to London and back twice in a week is pretty tiring by train...My doctor has retired at age 62, and another in the practice tells me that the average retiring age for GPs is now 57, mainly because of stress......

A retired GP told me 'An alcoholic is someone who drinks more than his doctor'. Quite possibly there's some truth in that.

Trossie
19th Jan 2018, 16:39
Immigration is without a doubt a significant factor in putting pressure on the NHS. Fact. No need to try to play politics about that one.

(And don't bring in this thing about "how would the NHS survive if we didn't have all those immigrant nurses, doctors, etc.". How dare anyone think that it is OK for us as a wealthy country to deprive less-wealthy countries of their badly needed nurses, doctors, etc., just so that we can be smug and healthy. That argument is immoral.)

In far too many places the GP is no longer the 'first point of contact' for so many wanting fairly mild health treatment and that is what is overloading A&E. Also, far too many are rushing off for treatment, or being advised by the likes of 111 to rush off for treatment, too quickly rather than some common sense and self-treatment being applied. That way those who really do need the treatment are facing those horrendous waits. Maybe the fact that people don't pay makes them far to quick to go for 'treatment'? There will be a notable number of cases where that will be very true, but not having to pay is such a good thing about the NHS (having been elsewhere where things are different means that one appreciates this far more than those who have grown up with it always being there!) that I do not want to see that change. However, that thing that is so often not common in the population, common sense, could go a long way to reducing some of this problem -- just by realising what a valuable service we have and not abusing it.

Now to some politics. Quite a long time ago pensioners used to get tax-breaks for their payments into private medical insurance. That meant that one of the age groups who were likely to need medical care most were getting it elsewhere and hence reducing demand on the NHS. The loss in income to the taxman must have been very small in comparison with the reduced load on the NHS. But Labour, under Bliar and Broon, saw this as somehow elitist and abolished it. And all those people who cancelled their private medical insurance after that, and I've spoke to quite a few at the time who did, are now increasing the load on the NHS. What an absolutely stupid, narrow-minded, political decision. (But then, it was Labour!)

Andy_S
19th Jan 2018, 18:09
How much does it cost for a nurse to get her Master's degree - which is tending to become the minimum?

Another of my bugbears. Why does nursing have to be a graduate qualification? Why can't we allow direct entry for school leavers with training on the job?

G-CPTN
19th Jan 2018, 18:36
Why does nursing have to be a graduate qualification? Why can't we allow direct entry for school leavers with training on the job?

Nurses used to be recruited from girls who were 'caring' and could learn 'on the job' with a modicum of instruction (and learning).

What do other countries demand?

ATNotts
19th Jan 2018, 19:11
Immigration is without a doubt a significant factor in putting pressure on the NHS. Fact. No need to try to play politics about that one.

A factor for certain, but not that significant. Sure, immigrants will be registered with a GP, they'd be foolish not to be, but most immigrants are young, healthy and not clogging up GP waiting rooms. That accolade (clogging up GP waiting rooms) goes to those of us over 60, and year on year there are more people joining the geriatric ranks.

If the behavior of immigrants in using A&E as their destination of choice for minor ailments is any different than that of ethnic Brits I don't know, and of course the more people you have, assuming we do all behave in the same way, the more visits to A&E there will be.

Placing too much emphasis on the role of immigrants in the NHS crisis masks other failings, such as bureaucracy, and a reluctance to use modern electronic methods of communication - as I understand it consultants still "write" to GPs about a patient's condition, and post them. I hope that is an urban myth! Also, I read in the last year that the NHS is the world's largest single purchaser of fax machines; surely by now they'd be scanning an emailing documents! I hope this is another urban myth.

If anyone in the know here can dispel or verify either or both urban myths I'd be grateful.

Chronus
19th Jan 2018, 19:17
We are all too aware of our much troubled NHS. But in being told that it is underfunded, are we being told the truth.

What part do the pharmaceutical giants play in the plight of the NHS.

Here is a report by The Guardian.

Headlined :Drug firm Concordia overcharged NHS with 6,000% price rise, says watchdog

https://www.theguardian.com/business/2017/nov/21/drug-firm-concordia-overcharged-nhs-with-6000-price-rise

EGLD
19th Jan 2018, 19:19
A factor for certain, but not that significant. Sure, immigrants will be registered with a GP, they'd be foolish not to be, but most immigrants are young, healthy and not clogging up GP waiting rooms.

Got some stats to back that up?

How many of the young are women and/or young children?

Do women with young children typically visit the doctors/A&E more?

ATNotts
20th Jan 2018, 09:18
Got some stats to back that up?

How many of the young are women and/or young children?

Do women with young children typically visit the doctors/A&E more?

Only anecdotal, and I can assure you that you fairly if ever meet older immigrants, save from the Indian subcontinent, and most of the eastern European migrants you meet, and I meet a lot during the course of my job tend to be young, childless couples - they're working too hard in many cases to have time to make babies!!

It would be a real shame if this thread were hijacked by the anti, or indeed pro migration lobby. That discussion belongs on the Brexit thread, where it is alive and constantly kicking.

EGLD
20th Jan 2018, 09:57
It would be a real shame if this thread were hijacked by the anti, or indeed pro migration lobby.

If you make a claim, expect to be asked to back it up. :rolleyes:

zoomdoof
20th Jan 2018, 10:48
I was unfortuantely run over by a car on Wednesday evening and due to nature of injuries was taken down to A&E where I was assessed, had xrays done and later plaster on left leg along with CT scan on head and chest. Brilliant attention when provided but doctors are rushing from one case to the next and just not get the time to totally focus on an individual.
Ended up in AAU for evening and of the 16 beds occupied only two, myself and a teenager where under 60. Stayed over night in AAU for observation, and on Thursday morning moved up to ward once, again I was the only one under 60, everyone else was over 70 and needed constant attention, to keep them calm, clean the beds after being messed and providing the stream of medication. Thursday night was a nightmare for myself could not get to sleep as one resident, who I learnt had been in the ward for 4 weeks, constantly wanted get out of bed and had to be restrained by staff.
Asked to be moved to another ward which was granted but even here everyone of the 5 others are over 70. How do I know this well staff when attempting to dispense medication try to confirm the identity via DoB and in many case 1948 and below is contained in the reply.
Even here the staff are under pressure but constantly try to do their best.
Even as I type the codger across from me is fighting about the tight stockings they have needed to place on his legs to stop clogs but the reason why he is in hospital is because of his ingrown toenails
Underfunded I do not believe as there is the will to deliver the services needed, but from the patients I have observed it is the ageing population and their demand on services that is the issue. It is the fact that with aging comes different issues and these need addressing from a holistic view specifically in terms of social care and the types of services that the NHS should be providing.
On top of this I judge 80% of ward staff to be foreign, every single one doing the dammest to help the patients under trying conditions

Krystal n chips
20th Jan 2018, 11:22
We are all too aware of our much troubled NHS. But in being told that it is underfunded, are we being told the truth.

What part do the pharmaceutical giants play in the plight of the NHS.

Here is a report by The Guardian.

Headlined :Drug firm Concordia overcharged NHS with 6,000% price rise, says watchdog

https://www.theguardian.com/business/2017/nov/21/drug-firm-concordia-overcharged-nhs-with-6000-price-rise

Now there's a very valid point and, to add to the expenses " flowing in the wrong direction " lets include those ultimate mercenary social parasites known as.....recruitment agencies who were supplying medical staff.

Chronus
20th Jan 2018, 18:48
Now there's a very valid point and, to add to the expenses " flowing in the wrong direction " lets include those ultimate mercenary social parasites known as.....recruitment agencies who were supplying medical staff.

Yes Krystal, they are reminiscent of slave traders who held auctions in various bazaars.

Another dimension in the prescribed medicines scenario is that there is a lucrative trade in getting them free and/or cheap over here and flogging them overseas.

This emerged some years back, but nothing further since then about it. I found a report by the telegraph about it, see below:

Drug shortage as phramacists sell medication abroad - Telegraph (http://www.telegraph.co.uk/news/health/news/9106720/Drug-shortage-as-phramacists-sell-medication-abroad.html)

Then there is Health Tourism, cost estimated ?

See :

https://fullfact.org/health/health-tourists-how-much-do-they-cost-and-who-pays/

gingernut
20th Jan 2018, 20:24
I have a simple solution.........

Put my mum on the front door. :-)

galaxy flyer
20th Jan 2018, 20:34
Fairly simple problem for ECON 101 students, the service is artificially priced below its market clearing price, hence greater demand for the limited supply. Next case.

GF

radeng
21st Jan 2018, 16:05
We had a new hospital in Swindon. A growing town and a smaller hospital than the one it replaced, because I was told, there will be more community care and not the requirement to keep people in hospital for as long. The recent published results show that they aren't doing very well......

Agency nurses? In many cases, they are Agency nurses because they make more money that way....I knew of one who made as much working as an agency nurse in three days as she would working five in the NHS. She worked a lot more than three days because it meant paying off the mortgage sooner....

VP959
21st Jan 2018, 16:40
We had a new hospital in Swindon. A growing town and a smaller hospital than the one it replaced, because I was told, there will be more community care and not the requirement to keep people in hospital for as long. The recent published results show that they aren't doing very well......



It's a good point about the "Care in the Community" project, as it seems to have been an abject failure. NHS health care provision planning was made using the assumption that everything promised by the much-vaunted "Care in the Community" project would be delivered. In reality is seems to have delivered next to sod all, leaving the police, ambulance crews, GPs and hospitals to try and cobble together something resembling an acceptable level of care.

A neighbour over the road from me is a police officer, and one of his regular moans is that instead of policing, he often spends the best part of a shift as a social worker, trying to find ways to support and care for people who are vulnerable, elderly, have mental health problems etc, and for whom the supposed "Care in the Community" project has proved to be wholly inadequate.

I'm of the view that it was dreamt up as a way to cut NHS spending, rather than as a way to provide a reasonable level of care for people who didn't necessarily need to be in a hospital bed.

It's a sad fact that we have a growing number of elderly people who need regular care in their homes, particularly those with dementia who may well just wander off and then become a significant drain on police and ambulance services. The same applies to those with mental health problems, unless those that require it are supervised adequately there is a good chance that they will neglect to take their medication and equally cause an additional burden on the emergency services and A&E.

When we introduced the concept of "Care in the Community", the objective was to get people out of hospital accommodation, funded by the NHS, and into managed care accommodation funded by local authorities. A grand idea, except the government cut both NHS funding in this area and cut local authority funding too, so it was blindingly obvious that it was going to fail as a project.

Katamarino
22nd Jan 2018, 07:28
https://www.ukpublicspending.co.uk/include/ukgs_chart2p24.png
Healthcare spending as percentage of GDP


The NHS has, in the last few years, been getting more money than ever before. If it's still perceived as not enough then we need to either rethink how much we're asking it to do (new treatment options get more and more expensive, it's not practical to make the latest and greatest available "free" without restriction), or rethink the efficiency with which it is spending its money.

G-CPTN
22nd Jan 2018, 07:38
How does health spending in Denmark compare (http://www.oecd.org/els/health-systems/Country-Note-DENMARK-OECD-Health-Statistics-2015.pdf)?

 Growth: While average per capita health spending in OECD countries has increased slowly since 2010, spending in Denmark has contracted between 2010 and 2013 in real terms.
 Share of GDP: The share of GDP allocated to health spending (excluding capital expenditure) in Denmark was 10.4% in 2013, compared with an OECD average of 8.9%. This was unchanged from 2012 and remains below the high of 10.7% in 2009 as GDP also decreased.
 Per capita spending: Denmark spent the equivalent of USD 4553 per person on health in 2013, compared with an OECD average of USD 3453. Public sources accounted for 84.3% of overall health spending, well above the OECD average.

G0ULI
22nd Jan 2018, 23:06
For as long as I can remember every winter has been a crisis for the NHS followed by a summer crisis as the staff take long holidays paid for by their winter overtime. People are more likely to have accidents in cold weather and fall sick. You just need to be prepared to keep partially filled wards open year round and forget trying to keep staff occupied all the time running to keep up with just normal daily routine. Build some slack into the system for emergencies, that is what it is supposed to be there for.

BigEndBob
22nd Jan 2018, 23:23
Never mind flu, when i have a cold i don't want to leave the house, so who are these people clogging up A&E.
Last visit i had to A&E i pulled my back in a Cessna ( for the third time) and lay in the flying school flat out from 10:00 to 20:00 on a Sunday unable to move. I called for an ambulance. Paramedic arrived, then ambulance took me to A&E. Felt a fraud as by midnight the ward seemed full of elderly that had fallen down going to bed in night wear, or chest pain amongst the men. i was finally seen at 00:30, given cocodomol, which should have been dissolved in water, but wasn't, given dry and nearly chocked. Told i was discharged, even so, i could barely walk.

BigEndBob
22nd Jan 2018, 23:50
Only anecdotal, and I can assure you that you fairly if ever meet older immigrants, save from the Indian subcontinent, and most of the eastern European migrants you meet, and I meet a lot during the course of my job tend to be young, childless couples - they're working too hard in many cases to have time to make babies!!

It would be a real shame if this thread were hijacked by the anti, or indeed pro migration lobby. That discussion belongs on the Brexit thread, where it is alive and constantly kicking.

Husband of my business partner works in Lichfield, the factory he works at full of foreign girls, most he says are pregnant.

BigEndBob
22nd Jan 2018, 23:54
Some years ago went to my former GP by appointment. smartly dressed lady came in to reception. Thought she was doctor, turned out to be an interpreter for some Polish guy. The Asian guy next to me recognised him and asked if it was his wife, no... interpreter, he said, Asian guy jokingly said he didn't need interpreter. What scam going on here.

BigEndBob
22nd Jan 2018, 23:56
We had a new hospital in Swindon. A growing town and a smaller hospital than the one it replaced, because I was told, there will be more community care and not the requirement to keep people in hospital for as long. The recent published results show that they aren't doing very well......

Agency nurses? In many cases, they are Agency nurses because they make more money that way....I knew of one who made as much working as an agency nurse in three days as she would working five in the NHS. She worked a lot more than three days because it meant paying off the mortgage sooner....

Sister works in care homes, minimum wage, often oversees agency staff, no clue what they are doing, on £20 hour.

Wyler
23rd Jan 2018, 08:02
We live in a 24/7 world so people expect access to all services at all times.
We want people to live longer, and they are.
We want to research ways to increase longevity even further.
Government (all colours) supports the above so they have to pay for it.
That means 'we' have to pay for it. Either through increased taxes or at point of use.
Simples.

Pontius Navigator
23rd Jan 2018, 09:45
VP, I am late to this but I will address what you said on page 1. Our local A&E has established a triage in the waiting room. No longer do you enter A&E proper until triage. At times they have a GP there to intercept patients.

As for going to your GP, I was gardening and stabbed my eye with a pine needle. The GP would not accept the emergency even though it was within their competence. They could have done triage,prescribed drops and an eye patch, which is what had been done 30 years previously. They saved 10 minutes, we wasted 5 hours.

As an addition, true emergencies often occur when you are wet and tired. Sitting in A&E for hours in wet clothing is no joke. Down in Hampshire a charity organises grab bags with things like toiletries, sanitary towels, warm clothing, things like that.

Pontius Navigator
23rd Jan 2018, 09:52
Back then there were nowhere near the number of elderly there are today. The baby boomers are now getting to that age, and I think you will find that the vast majority of people going into A&E due to flu are the over 60ís and not the young.

Not all baby boomers. I think it is a societal issue. If you live in a large, warm, comfortable house then the last place you want to be is in a noisy hospital being messed around. Where your living conditions are worse, cold, damp, overcrowded, uncared for, then hospital becomes a best option. This applies to any age group.

Pontius Navigator
23rd Jan 2018, 10:08
Nurses used to be recruited from girls who were 'caring' and could learn 'on the job' with a modicum of instruction (and learning).

What do other countries demand?
No way. Mrs PN was a nurse. It was not OTJ training but lectures and practicals on a ward. There were practical and theoretical exams. Once qualified there was further professional training - no degrees.

ATNotts
23rd Jan 2018, 10:18
Over the last 24 hours the BBC has done another expose on the state on an A&E department, supposedly one of the better performing ones at that, over a weekend period and we had all the shots and vox pops of elderly people in distress on trolleys, in frankly pretty bad conditions.

But wait, it was a weekend, yet there were no scenes of drunks and others who had been dragged in off the streets after a night out; no mention of the time wasters who's medical conditions could, and perhaps should, have been dealt with through pharmacies or a trip to the GP on the following Monday morning.

I don't believe for a moment that these sorts of people weren't clogging up the department at the weekend, and wonder why, if they were doing a proper investigative report, they didn't chose to highlight that aspect. Or perhaps the conditions that were placed on the reporter and crew by the hospital management meant they weren't allowed to show that side of the story.

Pontius Navigator
23rd Jan 2018, 10:28
BigEndBob,I take an interpreter with me to see the consultant. She doesn't speak Spanish but she can understand the consultant better than I can.

I also had a flying related injury but while I was Serving but there are parallels. I collapsed from a spinal injury and any movement was excruciating. I lived off base and would normally have been expected to get to sick quarters. Exceptionally the MO came out and prescribed a cocktail of drugs. I have not idea where the drugs came from; I was out of it. I was much happier in my own bed rather than an ambulance journey, a stretcher in to A&E, and a hospital ward for 3 weeks. The MO may have made more than one visit but with the Valium . . .

Wyler
23rd Jan 2018, 10:30
ATNotts.

I agree. Thin out the time wasters and it would be a slightly different picture. That said, there is definitely a strain on the system. Mrs Wyler is in her 30th year with the NHS and says it is getting worse.
She now works in Outpatients at a small Infirmary and the number of clinics has had to be cut to allow the Consultants to work on the Wards and in A&E.
Some referrals to the clinics are seen as 'irritating' by some Consultants and they say it is easier for some GPs to refer rather than challenge some of the more 'entitled' individuals.
However, if we keep seeing adverts that suggest a cough is cancer you can hardly blame our current Society for running to the nearest A&E if the first appointment at their GP is in 2 weeks.
Tis a buggers muddle and no mistake.

Pontius Navigator
23rd Jan 2018, 10:48
I had a spell on a general ward last year. I was late getting in to the ward as the bed wasn't released until late in the day. The following day I was discharged at 11am but didn't leave the ward till gone 2pm as we had to wait for the pharmacy to make up my medications. Also on the ward was a 'very old man' 10 years younger than me also due for discharge. He was delayed as he didn't know where his house key was or when he could be collected; they would only release him when they were sure he could manage at home. Excellent care, but still two beds blocked for a few hours.

Trossie
23rd Jan 2018, 13:11
I have watched a lot on the BBC about this 'crisis' and there seems to be one very important 'missing link': the GP. Have they disappeared from the system?

VP959
23rd Jan 2018, 14:07
I have watched a lot on the BBC about this 'crisis' and there seems to be one very important 'missing link': the GP. Have they disappeared from the system?

I think it's a bit of a post code lottery. Our local GP surgery (or rather amalgamation of three different surgeries) seems to now be chaotic. At first I thought is was just them needing time to settle down following the changes, but that was many months ago now and if anything things are getting worse.

Getting an appointment takes many days or weeks now - the best they managed when I asked for the next available appointment on December 9th was an appointment on January 19th, which I think is a record, but waiting a week or ten days or more for the next available appointment is normal, and has been for the past couple of years or so.

Most patients know this, so if they have a minor injury they just bypass the GP, as they know there isn't a hope of getting even the practice nurse to have a look. The 111 service is very much the same, they know the GPs are overloaded so will just tell you to go to A&E.

A friend's GP practice is completely different. I understand that if you need something minor looked at urgently you can just drop in and the nurse will take a look and advise.

It seems that GPs have a fair bit of freedom as to how to set up their practices, and ours seems to be going through a pretty bad patch. Maybe it will improve, maybe it won't, but in the meantime the majority of it's patients that need urgent care are just going to go to A&E, as they know there's little chance of getting seen by their GP.

By way of contrast, when we lived in Scotland (different health service system to some degree) the local GP operated what amounted to a mini-A&E, with the capability to do minor surgery, do small scale X-rays, stitch up small wounds, even, in my case, remove a benign growth on my arm, all without needing to refer me to the local hospital.

rogerg
23rd Jan 2018, 14:13
By way of contrast, when we lived in Scotland (different health service system to some degree) the local GP operated what amounted to a mini-A&E, with the capability to do minor surgery, do small scale X-rays, stitch up small wounds, even, in my case, remove a benign growth on my arm, all without needing to refer me to the local hospital.
My local GP here in Northants is much the same as above, very few delays, minor surgery no prob. This is two practices working together.

Wyler
23rd Jan 2018, 14:57
Our 2 have joined together. When making an appointment you are called back by a Doctor same day. He/she conducts a phone triage and decides if you need to be seen urgently, if you can wait, if you can see a nurse or don't need any of the above.
Irritates some (the 'entitled') but generally well received because those who need to be seen are seen very quickly and by the right individual.

ATNotts
24th Jan 2018, 08:07
Our 2 have joined together. When making an appointment you are called back by a Doctor same day. He/she conducts a phone triage and decides if you need to be seen urgently, if you can wait, if you can see a nurse or don't need any of the above.
Irritates some (the 'entitled') but generally well received because those who need to be seen are seen very quickly and by the right individual.

Reading a few of these posts on the ways in which GP practices work, it seems to me that, rather than allowing each practice to determine how they want to work, all these various different examples of what at least sound like good practice, along with probably a myriad other across the country, be analysed and all GP surgeries be compelled to operate the consistent systems across all aspects of their service - appointments, phone triageing or whatever else.

It is (allegedly) a NATIONAL health service and all that the individual trusts and self governing GP surgeries seem to achieve is too much disparity in service standards across England; and why the Welsh, Scottish and N.I systems aren't reintegrated into the national service I simply don't understand.

VP959
24th Jan 2018, 09:05
Reading a few of these posts on the ways in which GP practices work, it seems to me that, rather than allowing each practice to determine how they want to work, all these various different examples of what at least sound like good practice, along with probably a myriad other across the country, be analysed and all GP surgeries be compelled to operate the consistent systems across all aspects of their service - appointments, phone triageing or whatever else.

It is (allegedly) a NATIONAL health service and all that the individual trusts and self governing GP surgeries seem to achieve is too much disparity in service standards across England; and why the Welsh, Scottish and N.I systems aren't reintegrated into the national service I simply don't understand.

It's a very good idea, but my understanding was that GPs were very deliberately encouraged to become independent "businesses", in order to give them the "freedom of choice" to offer services as they wished.

I think the idea of taking all the examples of best and worst practice and coming up with the "best of the best", in terms of providing effective and efficient primary health care is an outstandingly good one, and one that would probably take a fair bit of the load away from A&E in some areas, but it's never going to happen, simply because GPs operate semi-autonomously, and would fight like hell to retain their independence, I'm sure.

ATNotts
24th Jan 2018, 09:24
It's a very good idea, but my understanding was that GPs were very deliberately encouraged to become independent "businesses", in order to give them the "freedom of choice" to offer services as they wished.

I think the idea of taking all the examples of best and worst practice and coming up with the "best of the best", in terms of providing effective and efficient primary health care is an outstandingly good one, and one that would probably take a fair bit of the load away from A&E in some areas, but it's never going to happen, simply because GPs operate semi-autonomously, and would fight like hell to retain their independence, I'm sure.

If the NHS is going to show radical improvement, while continuing to be funded as it is now, with service free at the point of use, then vested interests are going to have to be challenged head on, be they GPs, Consultants or Nurses, not to mention the top heavy management.

Mrs. Thatcher had to do it with the NUM, and perhaps a government (not sure which one, or when) will really have to upset the vested interests in the health service to get things back on track.

After all, Tesco doesn't allow it's local managers to run the business the way they like, opening and closing when they want, and deciding what products to sell, and which ones not to; which is tantamount to what GP practises are getting away with.

Trossie
24th Jan 2018, 10:22
Local GP hours:

Mon to Fri, 08:00am to 1:00pm and 2:00pm to 6:00pm
Sat, Closed apart from 1 extended hours clinic per month from 7.30 am to 12.15 pm.

People get sick, have minor mishaps, etc., etc. 24 hrs a day, 7 days a week. People who want routine check-ups/visits often work those hours or similar themselves so no wonder that the 08:00am to 08:30am and the 5:30pm to 6:00pm appointments are likely to be booked up way ahead. Those GP hours are as useful to all those people as a chocolate teapot.

No wonder A&E is overloaded as it is effectively the primary contact for most people for NHS medical care.

Curious Pax
24th Jan 2018, 10:36
Mrs. Thatcher had to do it with the NUM, and perhaps a government (not sure which one, or when) will really have to upset the vested interests in the health service to get things back on track.


Somewhat ironic that the proliferation of NHS managers was started on her watch by the NHS and Community Care Act 1990 which introduced the internal market and NHS trusts!

charliegolf
24th Jan 2018, 11:07
... but my understanding was that GPs were very deliberately encouraged to become independent "businesses", in order to give them the "freedom of choice" to offer services as they wished.



Indeed. My understanding is that GPs contract to the NHS, and are not NHS employees. Am I mistaken?

CG

Trossie
24th Jan 2018, 11:13
My understanding is that GPs contract to the NHS, and are not NHS employees.I'm sure that some would call this 'privatisation' if it happened in any other sphere of the NHS!

charliegolf
24th Jan 2018, 11:29
From BMA...


GP partners (contractors):
Self-employed independent contractors. The partners are essentially shareholders or owners of the practice and take an active role in the strategic development of the practice as an independent business.

Approximately 75% of GPs are partners (this figure does not include locums).

Salaried GPs:
Salaried by the practice (not by the NHS). This arrangement benefits both the practice and the employed doctor by allowing flexible working patterns where appropriate.

This can be especially useful for managing extended opening hours and supporting other activities within the practice.

CG

Mr Optimistic
24th Jan 2018, 19:41
It all relates back to how the NHS was set up and the compromises to get doctors on board. Why not reorganise around hospital led services and pharmacies?

Pontius Navigator
24th Jan 2018, 20:23
Bevan got GPs on board by stuffing their mouths gold.

ATNotts, you are right. National is a fig leaf applying to patients. Staff moving lose seniority.

Biggest money waste is logistics. Certainly shopping in a 'medical supermarket' for supplies gives competition in a grocers sense, but only where individual trusts actively search for best price. Surely our military system of a unified stores catalogue with stores stocked through competitive contract should save money. Gloves, catheters, stethoscopes should be common source item s.

Wyler
25th Jan 2018, 09:44
I had some blood sugar issues a few years back and was sent on a one day 'course' to look at a better diet.
4 staff including 2 X Ward Sisters and a load of plastic food (cheese etc, the sort you get in a kids toy kitchen).
Whole day being told an apple is better than a pie (I may beg to differ..).
Complete waste of time.
I suggested that Toys'R'Us must have been happy selling all that toy food to the NHS.
No, was the reply. We have to use a specialist American supplier and this little lot cost over £4,000.00.
So, 4 Grand plus 4 staff for an entire day delivering nothing. There is a lot of this in the NHS and I think that this kind of stuff needs to be eradicated to save money.

abgd
25th Jan 2018, 22:51
The "elephant" is the number of people piling up at A&E with conditions that frankly they could get sorted by going to the local pharmacist, or waiting 24 hours and calling their GP for a same day appointment, which even at our pretty useless practice are now readily available.

I disagree. There's some of that, for sure, but GP services cost something like 7% of the total budget for the NHS. I don't know what proportion of the budget A&E counts for*, but when combined they'll be a relatively small proportion - perhaps 15% for the sake of argument.

Now, a GP or A&E doctor worth their salt will not be admitting patients with rubbish complaints into hospital. Occasionally somebody with a bit of Munchausen's will get through but by and large people who are in hospital are there because they are sick, or have been sick.

If you work in A&E or GP-land you will see a lot of people with self-limiting illnesses and so your impression will be that the NHS is being brought to its knees by timewasters. But if we take that figure of 15% and accept that few timewasters get past the gatekeepers, then it seems unlikely that the NHS as a whole is being brought to its knees by them.

The wards are full of very frail very elderly people who often have dementia and who cannot be discharged because of insufficient spending on social care. The average hospital is, at present, a stupendously expensive public nursing home. A lot of what we do for very frail people is cruel and futile too. We have elderly people on literally dozens of tablets to reduce their blood pressure, strengthen their bones and reduce their cholesterol - even though they're likely to die within a few months. People fall over and bump their heads and are sent in from nursing homes and get brain scans even though it's years since they last recognised their children and we know before looking that they have no brain worthy of the name. Then they seem a bit chesty so before you know it they're on IV antibiotics and so can't be sent home. Next, they don't like their cannulas and try to pull them out and try to jump out of bed even though it's got railings like a prison, so we need to have someone assigned to them 24/7 to stop them harming themselves. Then we need daily blood tests to correct their Potassium levels that might just cause them a cardiac arrest. And so it goes. We all know it's wrong, but guidelines are guidelines, and whilst many people are sensible, unreasonable relatives in possession of guidelines are not uncommon.

A few years back a Chinese student turned up at A&E locally having arrived 5 days ago from Beijing. 'Doctor, please help me. Every day I go to sleep in the afternoon, and wake up at 3.00 in the morning'. We've laughed about it at least once a month ever since. I think he took up about 5 minutes of our time. Compare and contrast with the poor gentleman who waited >200 days for a nursing home place to be found.

*I'd be very interested to know. I suspect there are good reasons why it's harder to quantify than spending on GPs.

WE Branch Fanatic
27th Jan 2018, 15:31
Perhaps we need to put more money and effort in preventative medicine? However, like deterrence - it is hard to sell. If you say smoking kills 50% of smokers, can you prove which ones? If you spend £x on smoking cessation, can you prove which individuals will not die of cancer, heart disease, etc or need expensive treatment?

Also putting more money and effort into rehabilitative medicine would greatly reduce the need for social care, restore quality of life, and allow many ill and injured (and their carers) to return to the workforce?

abgd
27th Jan 2018, 23:20
No, and no.

Public health medicine is great, but it's arguably what got us to this position in the first place. When the NHS was set up, life expectancy was 66 for men and 71 for women. Now it's 78 for men and 82 for women. Retirement lasts a lot longer, and people live with chronic medical problems for a lot longer. This is great, but puts huge stresses on healthcare systems.

From an economic perspective you want people to work to retirement, then drop down dead with a massive smoking-induced heart attack. Then they won't need a pension and if they can arrange to be found dead in the morning they won't even need an emergency ambulance.

Obviously for humanitarian reasons we want ourselves and our loved ones to enjoy a long and active retirement. Preventative medicine should perhaps be called 'postponative medicine' as it doesn't stop you getting ill. It just makes you start to get ill at an older age. If you have the same illnesses then this will cost the same to the NHS as if you had them at a younger age. The bill is delayed, but it comes along sooner or later anyway.

In practice you'll probably alter the diseases you get e.g. more likely to get cancer or need a cataract operation if you don't have a heart attack at 50. But you are likely to get non-fatal diseases too, and live with these for longer, requiring more input from the NHS.

As for rehab medicine... I fear you may overestimate what medicine can do. For certain, there will be people who would benefit from more rehab, but I don't think there is a large cohort of people who will suddenly be magicked back to work. Most people who come into a hospital are past retirement, and so are their carers - often their spouses. If you go to my local A&E it's not unusual for all 6 beds to be occupied by somebody over 90.

You do see a number of younger people - e.g. people with early onset severe hip arthritis - who are on waiting lists for procedures that will help them get back to work. I think you could make a good case for them jumping the queue above people who are past retirement, particularly when they are self-employed. Politically I think this is unlikely to happen.

ATNotts
28th Jan 2018, 09:27
You do see a number of younger people - e.g. people with early onset severe hip arthritis - who are on waiting lists for procedures that will help them get back to work. I think you could make a good case for them jumping the queue above people who are past retirement, particularly when they are self-employed. Politically I think this is unlikely to happen.

That's what intelligent, radical thinking is all about.

I fear there's not a politician in the land who would dare utter such thoughts, even though there is some merit to them.

Mac the Knife
28th Jan 2018, 12:13
Good posts abgd

Mac

:cool:

Trossie
28th Jan 2018, 16:01
Without a doubt the elderly are using up a lot of NHS time, along with children and pregnant women.

Until it was cancelled by the Bliar/Broon government, pensioners had tax deductions for payments towards private medical insurance. (The concept was too 'elitist' for those inverse snobs.) The number of pensioners keeping private medical insurance going after that fell.

If those pensioners still has private medical insurance they would be in beds in private hospitals rather than in NHS hospitals. If only 1% of pensioners were using private hospital beds rather than NHS hospital beds this would surely make a notable difference to the present situation. But don't let common sense get in the way of politics!

KelvinD
28th Jan 2018, 16:24
You can put the private patients in whatever bed you like. The bottom line will be the doctors. Many (most) are on NHS staff somewhere and moonlight with private work.
They should be told they are either contracted to the NHS or elsewhere and if they can't devote their time exclusively to the NHS, then show them the door.
And the same goes for NHS hospital beds; in more than a few NHS hospitals, a number of beds are "let" to private patients and that should be stopped.
I notice a trend in the above posts re pensioners. Is anybody suggesting they should be done away with to free up space for younger patients? Incidentally, the ONS predicts children will outnumber pensioners by 0.5 million by 2019.

Pontius Navigator
28th Jan 2018, 16:33
In our local hospital is a private wing. If it was not private it would not be there at all. When we asked about going private we were told it did not have the facilities for our needs.

When my wife wanted to go private to shorten a waitung time she was told her consultant did not offer private nor was he keen on her switching.

paulc
28th Jan 2018, 17:26
Does the health service claim back from other nations the costs of treating those tourists who fall ill whilst visiting the UK. The EH111 card is meant to guarantee reciprical treatment but in reality does not always work in that way.

Pontius Navigator
28th Jan 2018, 17:47
Paulc, I believe some do but I read it is only a small percentage. Just looking at our hospital with a very high local immigrant population I didn't see any obvious organization for doing such claim backs. The three primary reception desks close at 5. The operating areas has a receptionist and the rest appear to be operating staff.

abgd
28th Jan 2018, 20:10
Immigrants shouldn't need to pay extra for their care, as they've immigrated and pay tax/national insurance etc... Or will have before retiring/losing their jobs. Same as someone born here.

The EHIC card doesn't entitle tourists to get free medical care everywhere. It entitles them to get medical care on the same terms as the residents of the country they're visiting - which may or may not be free. I have heard rumors about hospitals in the Alps stopping accepting it as we're so bad at paying up.

My partner is Australian but has British parents and a British passport. On the basis of this, she got healthcare in Holland and Germany for 20 years, but when I dragged her back to Britain she found that she couldn't access healthcare for about 6 months because she was not a resident here. Had she been a Dutch or German person moving to the UK they'd have known what to do, but they didn't know what to make of a British citizen without an NHS number or a Social Security number. She spent a whole day on the telephone trying to sort it out. So obviously somebody's taking these things seriously.

VP959
19th Mar 2018, 20:11
Just raising this again in the light of an interesting conversation I had this afternoon with the receptionist at my local GP practice, that relates to this post I made earlier in this thread: https://www.pprune.org/jet-blast/604368-nhs-winter-crisis-5.html#post10029076

I've been taking medication for high blood pressure for around 27 years now, and generally don't bother my GP very often, as he's always been happy for me to monitor my BP at home and for me see him once a year for the mandatory medication review, where he writes me up for another year's worth of repeat prescriptions.

Towards the end of last year my GP retired, so my annual medication review was undertaken by his successor, someone I'd never met before (I'd been with my previous GP for around 19 years, so knew him fairly well). The new GP took my BP, expressed concern that it was dangerously high, and wasn't overly reassured by me telling him that it had always been OK when I checked it at home. He duly handed me a couple of leaflets, advised that I get my machine checked and then take regular measurements and see him again in a month's time. I went and bought a fairly expensive Omron machine to replace my ageing Boots own brand one, as it had all the required approvals and seemed recommended by the NHS etc, and started a regular regime of monitoring my BP every few days, as suggested.

I went back to see this same GP on January 19th and he looked at my home readings (which were OK) and suggested that he needed a baseline set of measurements, so stopped my medication prescription and asked me to continue the home measurements, plus do two 24 hour ambulatory blood pressure monitoring sessions (which are a PITA, BTW). He asked me to make an appointment to see another GP in around 4 to 8 weeks time, as he was resigning and would be leaving in mid-February.

I duly did as instructed, collected a lot of home measurement data, plus two days of data from the 24 hour thing, and rang the surgery this afternoon to see a doctor.

I was told, categorically, that there were no appointments. I explained that it probably wasn't very urgent and that an appointment in the next couple of weeks or so would be OK. Th receptionist repeated that there were no appointments available to see any GP for the foreseeable future. I asked when she thought I might be able to make an appointment and she said she didn't know, but probably not this year.

At this point I was a bit stunned. I know that my local practice has amalgamated with two other practices recently, and there has been a fair bit of chaos as a consequence, but to be told that I couldn't make an appointment to see any doctor for the foreseeable future, came as a bit of a shock. I asked if I could make a triage telephone appointment, so that I could at least talk to a doctor, but was told there were no triage appointments available for the foreseeable future, either.

I then asked if this meant that I would need to change to another GP practice, and was told that all the practices in the town were in much the same position, and I would be unlikely to get an appointment to see a GP even if I did change to another practice, but was given the contact details for two other practices.

I should add that there was no animosity with the receptionist at all, in fact she said how nice I was not to shout at her, as she'd had weeks of people shouting at her on the phone because they couldn't get an appointment.

Frankly I'm at a bit of a loss as to what to do next. Changing to another practice seems unlikely to enable me to see a GP, apparently.

I have phoned 111, gave them details of what's happened, that I currently have no medication, just the blood pressure data I was asked to collect, and they advised me to see my GP ASAP. I explained that my practice can't give me an appointment in the foreseeable future, and although not urgent, I would like to be seen within the next few weeks. Unfortunately the 111 service then falls over, as they said I should not go to A&E (which is pretty obvious) and should not call an ambulance (also pretty obvious). They couldn't offer any further advice at all.

Clearly the primary health care service here isn't just broken, but has now collapsed and is non-functional. Anyone any ideas as to who to talk to next, please?

rifruffian
19th Mar 2018, 21:38
WOW!
Wonder what happens if you sit in waiting room in surgery and refuse to move until you see a GP ? (Take water and food for the sit in)....alert local media ?

Referring to #111 and what are the benefits of EHIC card......I had the misfortune to be injured recently, in Spain. I walked in to hospital, was seen literally instantly, underwent surgery same day, three days in hospital.......all on the strength of being the bearer of an EHIC. I heard a rumour that this very good treatment was the result of UK settling its EHIC bills promptly..........but who knows ?

VP959
19th Mar 2018, 22:24
WOW!
Wonder what happens if you sit in waiting room in surgery and refuse to move until you see a GP ? (Take water and food for the sit in)....alert local media ?

Referring to #111 and what are the benefits of EHIC card......I had the misfortune to be injured recently, in Spain. I walked in to hospital, was seen literally instantly, underwent surgery same day, three days in hospital.......all on the strength of being the bearer of an EHIC. I heard a rumour that this very good treatment was the result of UK settling its EHIC bills promptly..........but who knows ?

I've decided to make two official complaints, one to NHS England, using their complaints procedure, one to the practice manager at the surgery, using their complaints procedure.

Thankfully, I got to see an army MO on the QT later this evening (my other half's a nurse, and works for the army), who is unofficially arranging to sort out the same medication and dose I was on as an interim measure, whilst I try and sort out what's going to happen next.

Pontius Navigator
19th Mar 2018, 22:29
And that is where a private health care provider can step in. In my case they act as a secondary health care provider when the NHS waiting list is too long.

Contact your MP?

rifruffian
19th Mar 2018, 22:38
I think you can buy your own supply of some BP medications........by applying for an online prescription which is issued on the strength of a recent prescription through offline channels....something like that.......and then it is simply meds in exchange for cash.

k3k3
20th Mar 2018, 00:32
Where are you VP?

Here in Torbay my wife called the surgery ten days ago about a mole which had changed, got an appointment with the GP the next afternoon, and has an appointment with a dermatologist in the local Hospital this Thursday.

abgd
20th Mar 2018, 07:23
Clearly the primary health care service here isn't just broken, but has now collapsed and is non-functional. Anyone any ideas as to who to talk to next, please?

Estate agents in a civilised country.

I'm semi-serious, the NHS is about to implode spectacularly. It takes 10 years to train a GP. In 2015 we needed 5000 more by 2020 but in fact numbers have been falling by a few percent a year ever since. In my region, most of our EU GPs have left to go home and few EU doctors seem to be arriving. I wonder why?

There's a view that nurses, pharmacists and paramedics will be able to take on some of the workload, but we also have a shortage of nurses and paramedics so that's robbing Peter to pay Paul. They're also not particularly good at being GPs, or particularly cheap at being GPs (on an hourly basis they often take home more than doctors). There's also a view that artificial intelligence will take on a lot of GP work. I have some sympathy for this view - more than do most people in the sector - but I think it's 10-20 years out before it might make a significant impact and the collapse will come before that.

Forty percent of GPs are planning to quit in the next 5 years. Perhaps only 10% or 20% will, but workload is also increasing steadily - a 2-3 percent a year by some estimates. When you're already working 60-70 hours a week how much of an increase can an individual GP absorb? Did I mention it takes 10 years to train one?

I don't see a ready solution. Some areas of the country are harder to recruit to than others which is why they are seeing the collapse first, but VP959's experiences are likely to become the norm.

VP959
20th Mar 2018, 08:14
I agree, the NHS is in a bad way. There were signs that my local practice was suffering problems towards the end of last year, when my GP decided to take early retirement. He and I knew each other pretty well, and it seemed pretty clear from a few comments he made that he was getting out because the situation in the NHS was no longer tenable. Pity, as he was one of those "teaching GPs" (not sure what they are called) and often had medical students sitting in on consultations, so his loss was a bit of a double whammy to the NHS.

The other GP I saw had been with the same practice for many years, and was quite open with me that his resignation a few weeks ago was because of the situation locally. He even went so far as to hand each of his patients a letter (including me) asking them not to try and find where he was going, as he would not be accepting any patients from his old practice, which seemed a bit odd.

I'm near Salisbury, but the practice I am with is now an amalgamation of three of the largest practices in town, plus the receptionist I spoke with thought the other two were in a similar position. She did tell me they were having problems as several GPs had left recently. I strongly suspect that their problem isn't wholly down to the NHS, but may well be some sort of internal conflict caused by the merger of the three practices. GPs here are effectively self-managed businesses, that are semi-independent from the NHS, and have quite a lot of freedom to provide services in the way they wish.

I've now filled in the complaints form for the local practice and will drop it in today, and also sent off a compliant to the NHS England complaints people. I should have some medication this morning, thanks to the private prescription I obtained last night on the QT, but I feel that having to call in a favour from one of my other half's colleagues is not how health care is supposed to work here.

I've never seen things this bad, in all the time I've been using the NHS. I don't often need to see a GP (thankfully) but until the end of last year I can't say I had had anything other than exemplary health care from the NHS for my whole life. Something seems to have changed locally in the last six months or so. I'm not sure if it's just my practice, or whether it's more widespread - the receptionist led me to believe that the other two practices in town were much the same.

I hope that your predictions, @abgd, are out, but I fear you may well be spot-on. Our practice seems to have lost around 30% of it's GPs in the space of around 6 months, with no replacements, and one of those GPs was a "training GP", so that also reduces the number of new GPs being trained locally I'd guess.

I'm going to look into private health insurance today, even though it really goes against the grain, as I've always fought shy of the whole idea two-tier health care, as a matter of principle. I doubt it will be affordable for me now, anyway, being 65 and with high blood pressure, but I need to look at all the options, as moving house to another area just to find a different GP practice isn't practical.

If I get nowhere with the complaints procedure my next stop will be my MP, although frankly I suspect he'll be as much help as a chocolate fireguard.

It was interesting chatting to my other half's colleague last night. She was planning to go into general practice when she leaves the army, but has changed her mind and is staying in the army, as she's had a look at general practice and decided it's more stressful than being an army doctor, which says something about the state ot things, as she's done two tours in Afghanistan.

Andy_S
20th Mar 2018, 08:24
I'm going to look into private health insurance today, even though it really goes against the grain, as I've always fought shy of the whole idea two-tier health care, as a matter of principle. I doubt it will be affordable for me now, anyway, being 65 and with high blood pressure.......

I would assume that if you went down that route, they wouldn't cover pre-existing conditions anyway.

VP959
20th Mar 2018, 08:33
I would assume that if you went down that route, they wouldn't cover pre-existing conditions anyway.

That's my main concern, as I would guess that they could easily link a lot of other conditions to my long history of hypertension, so making the policy fairly worthless in a lot of respects.

When I've found out more I'll post back on here, just in case it's of use to anyone else.

Smeagol
20th Mar 2018, 17:43
I can assure VP that any existing conditions will DEFINITELY be excluded from any medical insurance. Had private insurance from my last employer for many years, cover for the wife as well but could never use it for her as EVERYTHING that she suffered from was excluded. So not much use.

On a similar vein she has recently decided that she has to have knee surgery privately at a cost of over £2500 as she can stand the pain no longer, She has been on the NHS waiting list for almost 30 weeks and when we managed to find out how much longer she was likely to wait (and it took some several phone calls and vague threats of formally requesting the info as a 'public information request') the answer was at least another 30 weeks (but no guarantees that will not extend when that time has elapsed).

VP959
20th Mar 2018, 19:29
I can assure VP that any existing conditions will DEFINITELY be excluded from any medical insurance. Had private insurance from my last employer for many years, cover for the wife as well but could never use it for her as EVERYTHING that she suffered from was excluded. So not much use.

On a similar vein she has recently decided that she has to have knee surgery privately at a cost of over £2500 as she can stand the pain no longer, She has been on the NHS waiting list for almost 30 weeks and when we managed to find out how much longer she was likely to wait (and it took some several phone calls and vague threats of formally requesting the info as a 'public information request') the answer was at least another 30 weeks (but no guarantees that will not extend when that time has elapsed).

I suspected this would be the case. Sorry to hear that you're wife's had to suffer because of failings in the system.

In my case I've had an interesting day. Last night I sent a detailed complaint to NHS England, but have yet to hear back from them. This morning I filled in the complaint form for my GP practice and hand delivered it around 09:00 (they don't accept emails, no idea why).

Just after lunchtime I had a call from the receptionist at the surgery saying that there was an appointment free for this Friday afternoon. When I came off the phone with her yesterday all I said was that I would look around to see if I could move to a different practice - she made no mention at all of trying to find an appointment and call me.

What I want to know is how they went from having no appointments available for the foreseeable future yesterday, to finding me an appointment at the end of this week, immediately after I'd raised an official complaint.

It's not so much the waiting for an appointment I mind, it was the fact that I was told, categorically, that they had no appointments available at all, and couldn't tell me whether there would be likely to be an appointment available for the rest of this year. I shall ask on Friday where this magic appointment has come from.

Pontius Navigator
21st Mar 2018, 11:31
VP, appointments, easy. Our last practice had over 100 missed appointments per month- 4 a day.

Like airlines, they may overbook so you have an appointment.

VP959
21st Mar 2018, 11:47
VP, appointments, easy. Our last practice had over 100 missed appointments per month- 4 a day.

Like airlines, they may overbook so you have an appointment.

I think you're absolutely right, but what I want to know is why the receptionist was so adamant there were no appointments, and no time in the future when I could call to find out if there were any.

In the past I know that my wife (who uses the same practice) has been told that they might have a cancelled appointment, and if so would she be able to take it if they rang her.

This may well be what's happened here, that I now have an appointment that someone else made for this Friday but who has had to cancel. If that is the case, then why on earth couldn't the receptionist have just told me there might be cancelled appointments and I might like to try calling them the next day/week/month or whatever?

It's almost as if the receptionist was trying to tell me, without coming straight out about it, that the practice is in crisis, they've had several GPs leave, are unable to cope, and they don't know how to handle patients who call for an appointment.

I was talking this through with my wife last night, and asked how they dealt with situations like this where she works. She said they keep a waiting list of patients for cancelled appointments, with their contact numbers, and call to give them the next cancelled appointment on a priority of treatment basis. Taking account of the fact that I'd expect a military medical centre to have pretty robust ways of working, I can't see why a GPs surgery can't adopt the same basic principle.

KelvinD
21st Mar 2018, 22:01
This is indeed a sad situation. Recently, while having a general chat with my GP (I always enquire after his health when he greets me with the customary "How are you"). We ended up in a very interesting conversation, during which he told me something of the stress he was under with a very high work load and he had in fact thought seriously about committing suicide twice. Some years ago, colleagues at work recommended me to HR for participation in a work/life balance competition (for want of a better word) and I ended up coming in the top 10 nationwide. So, I tried to apply a little of what I had learned when researching into and writing up my submission for the competition. That seemed to work and each time I see him, we go into it again. It does seem odd, the patient counselling the doctor! It is a bit of a symbiotic relationship; I counsel him on the work/life balance and he lectures me on why I should be concerned about my high blood pressure and why I should continue to take pills daily, for the rest of my life. (I must go back to see him as I ran out of the bloody pills a couple of months ago!). When I had the temerity to propose we all must die of something, what alternative did he propose to high blood pressure? That was the only time I ever saw him get somewhat "agitated" while he tore me off a strip!
Incidentally VP, which Omron machine do you have? I too have one of theirs and was taking readings twice daily. It is similar to the one the GP uses, so I faithfully logged the readings on a daily basis. I was surprised and disappointed when I saw 5 minutes of one of those interminable health programmes on TV recently and the GP carried out a comparison of various machines, including an Omron similar to mine. And he found it was consistently providing high readings. So I suppose I ought to get that checked now.

abgd
22nd Mar 2018, 05:41
I was talking this through with my wife last night, and asked how they dealt with situations like this where she works. She said they keep a waiting list of patients for cancelled appointments, with their contact numbers, and call to give them the next cancelled appointment on a priority of treatment basis. Taking account of the fact that I'd expect a military medical centre to have pretty robust ways of working, I can't see why a GPs surgery can't adopt the same basic principle.

I believe many of them do, though there are several models of how to allocate appointments. My guess would be that if they've recently lost a lot of staff they may be 'caught in the headlights', but should hopefully still be managing to prioritise emergency appointments (which elevated blood pressure normally wouldn't be).

sitigeltfel
22nd Mar 2018, 06:05
VP, appointments, easy. Our last practice had over 100 missed appointments per month- 4 a day.

Like airlines, they may overbook so you have an appointment.

A friend in Scotland, who had heart surgery three years ago, contacted the hospital when he hadn't received his annual checkup appointment letter. They insisted they had sent one and it was his fault for not attending, they said it would be three months before they could fit in a new appointment. Being a tenacious bugger, and mindful of the screw ups before his operation, he requested proof the letter had been sent, on headed notepaper from his own law practice. They then admitted that although an appointment had been made, the letter did not go out! Why not send emails and only firm up the appointment when a response was received, he asked? Their systems were not set up for that, was the reply.

VP959
22nd Mar 2018, 07:44
Incidentally VP, which Omron machine do you have? I too have one of theirs and was taking readings twice daily. It is similar to the one the GP uses, so I faithfully logged the readings on a daily basis. I was surprised and disappointed when I saw 5 minutes of one of those interminable health programmes on TV recently and the GP carried out a comparison of various machines, including an Omron similar to mine. And he found it was consistently providing high readings. So I suppose I ought to get that checked now.

I bought an Omron M7, mainly because it was validated by the British Hypertension Society, independently of any manufacturer validation. I was a bit disappointed to find that it gives the same readings as the much cheaper Boots machine I bought several years ago.

My old GP used the same machine, I think, it was certainly an Omron with the same shaped housing.

I believe many of them do, though there are several models of how to allocate appointments. My guess would be that if they've recently lost a lot of staff they may be 'caught in the headlights', but should hopefully still be managing to prioritise emergency appointments (which elevated blood pressure normally wouldn't be).

I think you may be right, in that they haven't had time to sort out how to deal with their inability to allocate appointments, but I also suspect that one of their problems may be that there are internal tensions within the new practice. It was notable that as soon as the three practices merged our local surgery lost all it's reception staff plus the pharmacy staff and the practice nurse, then two GPs left over the next few months.

This sort of sudden change seems to indicate that there may well have been some sort of major shift in the way things are being managed, as they haven't closed any of the practices that make up the new group - people have just left, it seems, with some (the receptionists and pharmacy staff) being replaced. There is a new practice manager, and it may well be that there have been significant changes in the management policy, that some just don't like.

VP959
22nd Mar 2018, 16:26
Another update. Just had a call from NHS England. The lady was very polite and sympathetic, asked me to confirm some details and asked me a few questions, like was I informed that there was a local walk in centre? No, I wasn't, but now I know there is and when it's open, thanks to her. She took some more details, was pleased to hear that I'd got an appointment for tomorrow, and confirmed that, based on their data for this practice that was extraordinarily quick - mean times between calling for an appointment and getting one for this practice were, according to her, over two weeks,

I explained I'd also complained directly to the practice manager, using their complaints procedure and she agreed that in her view this would have been the only reason they'd have called to offer me a cancelled appointment.

She's handed it off to the contracting team to investigate, as it was clearly a breach of the contract the practice has with the NHS, and I probably wouldn't hear any more but could rely on the contracting team investigating this thoroughly as they already had many other recent patient complaints about the same practice that were similar to mine.

Her advice was to change practice, as despite what I had been told, the ratings for the other local practices were currently quite a lot better, especially with regard to appointment waiting times.

I find it interesting that NHS England, which has a three day target for an initial response to a patient complaint, contacted me within two days, yet my practice, which has a 24 hours initial target for an initial response to a patient complaint has yet to respond to the complaint form at all. The local practice response target for resolution of complaints is 3 days, so I doubt they will meet that, either.

I've decided to change to another practice, and will set the wheels in motion to do this as soon as I've completed whatever treatment or further investigation results from tomorrow's appointment.