Nurses: The NHS is at breaking point

Nurses: The NHS is at breaking point

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Moonhawk

10,730 posts

218 months

Saturday 14th January 2017
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littlegreenfairy said:
jjlynn27 said:
Moonhawk said:
littlegreenfairy said:
10 months. She seems to be 'growing out of it' but will buy it when she's over 1 year if she needs it. The GP was very quick to diagnose it (5mins in and out) and said she doesn't need to be seen again- just handed a repeat prescription!!

It just amazes me that one pharmacy is getting through nearly 3k of milk a month. Just for that one condition. The sheer cost of prescriptions overall must be staggering.
On the subject of it only being available on prescription - just did a search and you can actually buy lactose free baby formula. Both Aptamil and SMA do lactose free variants that are available to buy without prescription.
This is intriguing. I'll ask a friend (paed) if he knows the reasoning behind it.
Now that is interesting. I asked both the GP and pharmacist and they said you couldn't so didn't look into it further. Thanks!
You can buy it in Boots by the looks of it. Says nothing about needing a prescription.

http://www.boots.com/en/Aptamil-Lactose-Free-From-...

jjlynn27

7,935 posts

108 months

Saturday 14th January 2017
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Moonhawk said:
jjlynn27 said:
Being 10th out of the 33 is not 'middle of the road. It seems that your personal circumstances are clouding your judgment. I can't see going to see doc twice a year, for someone with the chronic condition, particularly taxing. Then again I'm not GP. Are you?

I would take research done by Commonwealth fund over Bloomberg rankings. I'm sure, if you look, that there are studies that would put the UK at the bottom of the rankings.

It's always your choice if you are going to believe article in daily mail or Nature or Science.
I based by estimation on the colour in the picture provided. I'm closer in my estimate than the person who claimed we were top. The point is - there are efficiency gains that could be made.

Whether it's particularly taxing going for a 6 month review is irrelevant - it's an appointment that doesn't need to be filled by me and isn't adding any value whatsoever. I could just as easily make the request by email or phone, or even just speak to a pharmacist - freeing up the appointment for somebody who needs it more. These might only be small examples and on an individual basis seems unimportant - but multiply that up by the hundreds of thousands (or even millions) of people who have chronic conditions - and that's a lot of unnecessary GP appointments.

Can you provide links to the Commonwealth fund data you are referring to - before resorting to ad-hominem attacks.
Not sure where you see ad-homs, but if they are there they were unintentional.

Now, within an organization such as NHS you'll always have space for efficiency gains. That's not contentious. By your own admission you are there to be seen. I don't know why they want to see you, and I'm not asking since I'm not medical. It could be that it's just inefficient, or it could be that it's the standardized procedure and you are an outlier that got caught up. I don't know, and don't think it's particularly relevant. To extrapolate your experience to 'hundreds of thousands (or even millions)' is odd, to put it mildly.

What I would find more worrying is that your GP doesn't want to send you to private provider, who presumably could deal with you quicker. We have family cover through work, and on very rare ocassion that we need to see specialist, once you say that you have private cover, it's no brainer. Maybe time to try different GP?

http://www.commonwealthfund.org/


KTF

9,788 posts

149 months

Saturday 14th January 2017
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This was doing the rounds on Facebook today.


Moonhawk

10,730 posts

218 months

Saturday 14th January 2017
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jjlynn27 said:
Now, within an organization such as NHS you'll always have space for efficiency gains. That's not contentious. By your own admission you are there to be seen. I don't know why they want to see you, and I'm not asking since I'm not medical. It could be that it's just inefficient, or it could be that it's the standardized procedure and you are an outlier that got caught up. I don't know, and don't think it's particularly relevant. To extrapolate your experience to 'hundreds of thousands (or even millions)' is odd, to put it mildly.
I have been told it's "standard practice" and the following link would seem to support that given a prescription is only valid for 6 months.

http://www.nhs.uk/chq/Pages/1674.aspx?CategoryID=6...

As such it's entirely reasonable to assume that my experience is mirrored by that of others with chronic conditions requiring medication over the course of years - and there must be hundreds of thousands - even millions of such people in the country. I don't see what is 'odd' about that extrapolation at all.

For patients with mild but chronic conditions - there should be an easier, less wasteful way to renew a prescription without actually having to go into a GP surgery and take up a valuable appointment. I absolutely abhor going to the the doctors for no good reason - but I am forced to by a stupid system.

jjlynn27 said:
What I would find more worrying is that your GP doesn't want to send you to private provider, who presumably could deal with you quicker. We have family cover through work, and on very rare ocassion that we need to see specialist, once you say that you have private cover, it's no brainer. Maybe time to try different GP?

http://www.commonwealthfund.org/
Perhaps it is time to find a new GP - but the fact that such GPs exist at all (and I have experienced a number of them with this attitude) surely contributes to the issues the NHS face.

That link is to the commonwealth fund website. Do you have something a little more specific (i.e. a link to an actual study/data).

Edited by Moonhawk on Saturday 14th January 21:39

jjlynn27

7,935 posts

108 months

Saturday 14th January 2017
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Moonhawk said:
jjlynn27 said:
Now, within an organization such as NHS you'll always have space for efficiency gains. That's not contentious. By your own admission you are there to be seen. I don't know why they want to see you, and I'm not asking since I'm not medical. It could be that it's just inefficient, or it could be that it's the standardized procedure and you are an outlier that got caught up. I don't know, and don't think it's particularly relevant. To extrapolate your experience to 'hundreds of thousands (or even millions)' is odd, to put it mildly.
I have been told it's "standard practice" and the following link would seem to support that.

http://www.nhs.uk/chq/Pages/1674.aspx?CategoryID=6...

As such it's entirely reasonable to assume that my experience is mirrored by that of others with similar conditions. I don't see what is 'odd' about that at all.
You didn't answer a simple question, so I'll ask again; Are you medical? I really don't see a problem with seeing GP for 5-10 mins twice a year. None whatsoever.
I would imagine that for people with chronic conditions it would be prudent to see GP twice a year, even if it's just to see if there are any changes.
How often do you think you should see a doctor to check on your condition?

Derek Smith

45,514 posts

247 months

Saturday 14th January 2017
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jjlynn27 said:
You didn't answer a simple question, so I'll ask again; Are you medical? I really don't see a problem with seeing GP for 5-10 mins twice a year. None whatsoever.
I would imagine that for people with chronic conditions it would be prudent to see GP twice a year, even if it's just to see if there are any changes.
How often do you think you should see a doctor to check on your condition?

Spot on. It wasn't so long ago that checking was not a requirement. There were numerous cases of people addicted to prescription medicine. Many were more or less cured of their ailment but kept taking the pills because when they stopped they felt terrible.

Good on the service for leaning from their mistakes.


Moonhawk

10,730 posts

218 months

Saturday 14th January 2017
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jjlynn27 said:
You didn't answer a simple question, so I'll ask again; Are you medical? I really don't see a problem with seeing GP for 5-10 mins twice a year. None whatsoever.
I would imagine that for people with chronic conditions it would be prudent to see GP twice a year, even if it's just to see if there are any changes.
How often do you think you should see a doctor to check on your condition?
No I am not medical (although I am a scientist and work in the pharma industry).

Yes it might only be 5-10 minutes, but given how difficult it can be to get to see a GP - especially within a reasonable timeframe, wouldn't the elimination (where possible) of these unnecessary appointments be beneficial to the NHS?

We are constantly told how wasteful missed appointments are - why are unnecessary ones any less so?

I would agree that it is prudent for certain conditions - but mine (hiatus hernia) isn't going anywhere. It's not life threatening, is unlikely to change to a significant degree ever and it's certainly not going to heal itself - but I do need medication to avoid uncomfortable symptoms.

If the GP took the opportunity to do other routine checks to keep an eye on things as a way of spotting other conditions early, I could see the value, but as I said earlier, more often than not, they don't. There is absolutely no reason the prescription renewal for conditions like mine couldn't be extended to 2 years or more. There should at least be an assessment regarding the type of condition and medication - rather than applying a blanket 6 months policy to everyone.

Edited by Moonhawk on Saturday 14th January 22:07

Moonhawk

10,730 posts

218 months

Saturday 14th January 2017
quotequote all
Derek Smith said:
Spot on. It wasn't so long ago that checking was not a requirement. There were numerous cases of people addicted to prescription medicine. Many were more or less cured of their ailment but kept taking the pills because when they stopped they felt terrible.

Good on the service for leaning from their mistakes.

Whilst that situation is wasteful too - surely it would be a fairly simple change to allow a doctor to date a prescription as appropriate (up to a reasonable maximum - you don't want people going 20 years without a review).

Condition that requires potentially addictive drugs and which may clear up over time = maximum 6 month prescription expiry and review.

Condition that is for life and needs fairly innocuous drugs to manage = maximum 2 year prescription expiry and review.

I do these type of 'risk based' assessments day in and day out in my job.


Edited by Moonhawk on Saturday 14th January 22:08

jjlynn27

7,935 posts

108 months

Saturday 14th January 2017
quotequote all
Moonhawk said:
jjlynn27 said:
You didn't answer a simple question, so I'll ask again; Are you medical? I really don't see a problem with seeing GP for 5-10 mins twice a year. None whatsoever.
I would imagine that for people with chronic conditions it would be prudent to see GP twice a year, even if it's just to see if there are any changes.
How often do you think you should see a doctor to check on your condition?
No I am not medical. I just find it wasteful.

Yes it might only be 5-10 minutes, but given how difficult it can be to get to see a GP - especially within a reasonable timeframe, wouldn't the elimination (where possible) of these unnecessary appointments be beneficial to the NHS?

We are constantly told how wasteful missed appointments are - why are unnecessary ones any less so?

I would agree that it is prudent for certain conditions - but mine (hiatus hernia) isn't going anywhere. It's not life threatening, is unlikely to change to a significant degree ever and it's certainly not going to heal itself - but I do need medication to avoid uncomfortable symptoms.

If the GP took the opportunity to do other routine checks to keep an eye on things as a way of spotting other conditions early, I could see the value, but as I said earlier, more often than not, they don't. There is absolutely no reason the prescription renewal for conditions like mine couldn't be extended to 2 years or more. There should at least be an assessment regarding the type of condition and medication - rather than applying a blanket 6 months policy to everyone.
I know for a fact that some people with chronic conditions are seen rather more often than six months. So it's not a blanket policy. As I'm not medical I don't know if there is any reason to see your GP six months, or if they should do more checkup when they actually see you. I'm not sure if you would like to see GP less or if they should do more checkups? But you know your condition better than me, so if you are that unhappy with the treatment, you should try different GP. All of ours never had any issues with referring us to private providers. Not once.

Moonhawk

10,730 posts

218 months

Saturday 14th January 2017
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jjlynn27 said:
I know for a fact that some people with chronic conditions are seen rather more often than six months. So it's not a blanket policy. As I'm not medical I don't know if there is any reason to see your GP six months, or if they should do more checkup when they actually see you. I'm not sure if you would like to see GP less or if they should do more checkups? But you know your condition better than me, so if you are that unhappy with the treatment, you should try different GP. All of ours never had any issues with referring us to private providers. Not once.
People may get seen more often than 6 months if it is deemed appropriate - what i'm saying is that it it should also be possible to be seen less frequently than 6 months if appropriate. It's not possible because of a blanket NHS policy (that I linked to). IMO that policy should be changed to allow longer prescriptions where appropriate.

Also - the private provider thing is a different issue - don't confuse the two. I cited both things as different examples of inefficiency (or opportunities for savings to be made) within the NHS


Edited by Moonhawk on Saturday 14th January 22:24

Derek Smith

45,514 posts

247 months

Saturday 14th January 2017
quotequote all
Moonhawk said:
Whilst that situation is wasteful too - surely it would be a fairly simple change to allow a doctor to date a prescription as appropriate (up to a reasonable maximum - you don't want people going 20 years without a review).

Condition that requires potentially addictive drugs and which may clear up over time = maximum 6 month prescription expiry and review.

Condition that is for life and needs fairly innocuous drugs to manage = maximum 2 year prescription expiry and review.

I do these type of 'risk based' assessments day in and day out in my job.


Edited by Moonhawk on Saturday 14th January 22:08
Do you have a lot of media outlets and a political party waiting to exploit every mistake?

In my last job, doing it the right way is not enough. Being right was not enough. If it left a gap for the media to insert a lever it was wrong. Mind you, we were treated lightly compared to some. I've worked with social services to a limited extent and know some of the limitations and pressures they are under. I know very little although but I know that much of the criticisms in the press is nonsensical.

Just because I can see the necessity of the doctors' actions does not, of course, mean I think it is efficient.


jjlynn27

7,935 posts

108 months

Saturday 14th January 2017
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Moonhawk said:
jjlynn27 said:
I know for a fact that some people with chronic conditions are seen rather more often than six months. So it's not a blanket policy. As I'm not medical I don't know if there is any reason to see your GP six months, or if they should do more checkup when they actually see you. I'm not sure if you would like to see GP less or if they should do more checkups? But you know your condition better than me, so if you are that unhappy with the treatment, you should try different GP. All of ours never had any issues with referring us to private providers. Not once.
People may get seen more often than 6 months if it is deemed appropriate - what i'm saying is that it it should also be possible to be seen less frequently than 6 months if appropriate. It's not possible because of a blanket NHS policy (that I linked to). IMO that policy should be changed to allow longer prescriptions where appropriate.

Also - the private provider thing is a different issue - don't confuse the two. I cited both things as different examples of inefficiency (or opportunities for savings to be made) within the NHS


Edited by Moonhawk on Saturday 14th January 22:24
I don't see the situation where seeing someone with a chronic condition less than 2 times a year is appropriate. I seems that people who knows significantly more than either of us on the subject see the things the same way. If you allow for more than two years, who decides how often? GP or another body? What happens when two GPs have different opinions, one of them decides it should be a year. Someone develops condition which could have been caught by more frequent visit. Someone sues NHS for stloads of money and GP loses his license to practice medicine depraving more people from their sevices. It's not like we have suprplus of them as it is, is it?

I do think that there are inneficiencies in the system that should be erradicated. Your example is anything but. 10-15 mins once a year or once every two years, in the great scheme of things makes no difference at all. Nada, zilch, zero.

I'm not conflating two issues at all. Not sure why would you think that I do. I told you already that I never had GP who didn't want to send me to private provider. Not once. If you do change the GP. After all, just like in any other walk of life, you have good ones and bad ones. From my experience and from the figures available, I'd say that huge majority are good ones.

Moonhawk

10,730 posts

218 months

Sunday 15th January 2017
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jjlynn27 said:
I don't see the situation where seeing someone with a chronic condition less than 2 times a year is appropriate.
Depends on the condition surely. Chronic simply means it's long term or persisting. There are plenty of fairly innocuous illnesses/injuries that can be chronic and need of medication - but which pose little to no danger to the patient.

My condition is a prime example.

jjlynn27 said:
I do think that there are inneficiencies in the system that should be erradicated. Your example is anything but. 10-15 mins once a year or once every two years, in the great scheme of things makes no difference at all. Nada, zilch, zero.
Not for one person I would agree - but like I said, scale that up across hundreds of thousands or even millions of patients, and it could well do.

If I miss an appointment every so often - what's the problem, it's only 10 or 15 minutes once a year or once every two years - right?

Yet missed appointments cost £162 million per year and are a big enough problem for GP surgeries to have to highlight the issue.

We are clearly going to have to agree to disagree on this one. I did say in my original post that these are small examples, but at the same time, they are potentially easy to fix for low risk patients too.....every little helps.

Edited by Moonhawk on Sunday 15th January 00:48

Gandahar

9,600 posts

127 months

Sunday 15th January 2017
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It's alright for some

http://www.bbc.co.uk/sport/formula1/38624865

"His wife Lady Moss said the Singapore hospital was "second to none" and she could not wish for better care.

"Once he is discharged from the hospital, it is Sir Stirling and Lady Moss' hope to stay in Singapore to enjoy a few days recuperating at a lovely hotel, being thoroughly spoilt, whilst lying in the sun by a gorgeous swimming pool," the statement added."

Ok, ok, no need to make Doris with the chest infection in Barnoldswick get green eyed !!


SBDJ

1,320 posts

203 months

Sunday 15th January 2017
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Moonhawk said:
Until recently, both me and my wife have to submit repeat prescriptions every month. This is despite the fact that surgery has the capability to issue 3 months worth of medication in one go, but have refused to do so. This makes the repeat prescription process 3 times more burdensome on both the surgery and on us. They finally succumbed after we argued the point multiple times. For people on long term, unchanging medication - this should be the norm.
Experienced similar a while back. My son takes Omeprazole solution which is a special order for the pharmacy at a cost of around £100 which is mostly the charge for the order rather than the medication. For some bonkers reason it was decided by the GP that this long term medication would be best given in a weeks quantity at a time. 3 days to process the prescription, 2-3 days for the order - I was basically handing the repeat back in when I picked it up.

I eventually got them to up the amount to a months supply - at pretty much the same cost. Absolutely nuts that this wasn't the default. Consultant has just doubled the dose now, so will have to try and get them to double the quantity now...

Sticks.

8,708 posts

250 months

Sunday 15th January 2017
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A couple of anecdotal points on appointments and chronic conditions.

I've had a chronic condition for 17 years, I see 2 consultants, 1 annually, 1 not for a few years before this year. I've never had 6 monthly GP reviews.

Getting a GP app't is very difficult - I got up at 5.30am to book one last time. Med centre covers a large village of 7k pop. At the next village, no problem, apparently.

Getting a repeat prescription has, at some points, taken 7 days. 14 days is the most between ordering it and getting it filled.

Resources or management? Who knows, other than the variation implies there's no one answer for all.

FWIW, re the 'responsibility' post, I currently spend @ £230 pcm on gym/pool membership, physio and prescriptions.

Just my 2p.



jjlynn27

7,935 posts

108 months

Sunday 15th January 2017
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Moonhawk said:
Not for one person I would agree - but like I said, scale that up across hundreds of thousands or even millions of patients, and it could well do.

If I miss an appointment every so often - what's the problem, it's only 10 or 15 minutes once a year or once every two years - right?

Yet missed appointments cost £162 million per year and are a big enough problem for GP surgeries to have to highlight the issue.

We are clearly going to have to agree to disagree on this one. I did say in my original post that these are small examples, but at the same time, they are potentially easy to fix for low risk patients too.....every little helps.

Edited by Moonhawk on Sunday 15th January 00:48
I don't know why you persist with 'scaling up'. You have an opinion that you are seeing doc too often, someone else might feel it differently. Leaving it up to a doctor is impractical, I've already explained why.

Missing appointments is completely different, and I for one would love to see the system where people who don't show up get fined.

You are right, we are going to agree to disagree. This is a complete non-issue, not seeing a patient with a chronic condition that requires medication at least once six months would be negligent, IMO.

anonymous-user

53 months

Sunday 15th January 2017
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One way to reduce GPs workload would be a nominal charge for an appointment, say £10, to anybody of working age. Whether they work or not.

Also no prescriptions for medicines that cost less over the counter. You wouldn't believe how many on benefits get a prescription (a load of paperwork and overheads) for e.g. paracetamol, to avoid paying 25p at the supermarket. Mental .

cymtriks

4,560 posts

244 months

Sunday 15th January 2017
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Lozw86 said:
There are thousands of European doctors and nurses working in the NHS
We really shouldn't depend on this. It is actually an incredibly bad state of affairs.

Don't we have an excellent education system? The one we all pay for? The one that churns out ever higher A level results because it's so good? The one in which standards have never ever gone down, the one in which pupils work harder than ever and are cleverer than ever and that explains, completely , the higher grades? Surely such a system cannot possibly fail to educate the doctors we need?

We'd never stoop to poaching doctors from poorer countries would we? We give them aid to help train... erm... doctors that will cure the sick who are also poorer than us?

So we don't need them do we?

Oh, did I get something wrong?

jjlynn27

7,935 posts

108 months

Sunday 15th January 2017
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Jimboka said:
One way to reduce GPs workload would be a nominal charge for an appointment, say £10, to anybody of working age. Whether they work or not.

Also no prescriptions for medicines that cost less over the counter. You wouldn't believe how many on benefits get a prescription (a load of paperwork and overheads) for e.g. paracetamol, to avoid paying 25p at the supermarket. Mental .
Do you actually think that anyone would propose that? It would be an election suicide. But genius that our current PM is, she is making profession, that already can't fill vacancies and where a significant number of GP will retire over next five years, even more unappealing.
We'll just conjure extra GPs needed, out of thin air, to cover new opening hours.