Nurses: The NHS is at breaking point
Discussion
jjlynn27 said:
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.
As a lecturer at the medical school, I frequently ask my students what they have in mind in terms of specialising. Obviously I also have F1s and F2s and I ask them too.We'll just conjure extra GPs needed, out of thin air, to cover new opening hours.
Just to confirm everyone's suspicions - not a single undergraduate medical student / undergraduate junior doctor has said "my heart's set on GP". Postgrads are more inclined to it but how many do we have in a year? CT/ST1 applications for this year's specialty training have just gone (December 2016) and in my hospital in terms of the F2s I know <10 have applied to do GPST.
This announcement from TM was made on Friday night, so I'll get back to those I know who have definitely applied to do GPST and ask what they felt about it. Don't think they'll be pleased about suddenly being made to work weekends and week nights.
Finally, let's assume this 8-8 per day involves 3 sessions in the day - 8-11am, 1-4pm, 5-8pm or something similar. That will require 21 sessions per week. I wonder how small practices with 1 or 2 GPs (or even medium ones with 3-4 GPs) will be able to cope. Simply unsustainable in the current form. This is not mentioning the overheads - receptionists, transport to/from GP, collecting samples etc.
FWIW, I think this GP thingy deserves a separate topic by itself.
Edited by 4567231 on Sunday 15th January 19:57
cymtriks said:
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?
May is helping matters along by making statements about working conditions with no reference to those affected. She got away with it with the police because there was nothing they could do. She'll find that doctors have quite an arsenal of responses. Other countries will be only too pleased to welcome our highly qualified medical staff.
Derek Smith said:
We've currently got a considerable number of doctors and nurses from the Asian area. The source is slowing, and some are returning due to the change in the economic situation of their home countries. Tick, tick, tick.
May is helping matters along by making statements about working conditions with no reference to those affected. She got away with it with the police because there was nothing they could do. She'll find that doctors have quite an arsenal of responses. Other countries will be only too pleased to welcome our highly qualified medical staff.
Unfortunately, it boils down to people having 'an opinion' which is parroting what they've read in Dail Mail / Telegraph while looking for the next story of wasteful 'public sector bad' story. This thread is another excellent example of that. May is helping matters along by making statements about working conditions with no reference to those affected. She got away with it with the police because there was nothing they could do. She'll find that doctors have quite an arsenal of responses. Other countries will be only too pleased to welcome our highly qualified medical staff.
It's quite obviously NHS fault that we have so many obese people. Quite obviously the levels of teenage pregnancies is also a fault of those damned lazy nurses and docs.
Not to worry, when it becomes obvious that system can't cope, you just remove targets and blame GPs.
http://www.bbc.co.uk/news/health-38630640
Maybe GPs should up their game and do few cancer ops to help out.
Meanwhile, on PH, idiots will type 'bottomless pit' and 'if they get 100% of taxes it would also be wasted', hoping that next equally bright poster will give them cherished +1.
jjlynn27 said:
Derek Smith said:
We've currently got a considerable number of doctors and nurses from the Asian area. The source is slowing, and some are returning due to the change in the economic situation of their home countries. Tick, tick, tick.
May is helping matters along by making statements about working conditions with no reference to those affected. She got away with it with the police because there was nothing they could do. She'll find that doctors have quite an arsenal of responses. Other countries will be only too pleased to welcome our highly qualified medical staff.
Unfortunately, it boils down to people having 'an opinion' which is parroting what they've read in Dail Mail / Telegraph while looking for the next story of wasteful 'public sector bad' story. This thread is another excellent example of that. May is helping matters along by making statements about working conditions with no reference to those affected. She got away with it with the police because there was nothing they could do. She'll find that doctors have quite an arsenal of responses. Other countries will be only too pleased to welcome our highly qualified medical staff.
It's quite obviously NHS fault that we have so many obese people. Quite obviously the levels of teenage pregnancies is also a fault of those damned lazy nurses and docs.
Not to worry, when it becomes obvious that system can't cope, you just remove targets and blame GPs.
http://www.bbc.co.uk/news/health-38630640
Maybe GPs should up their game and do few cancer ops to help out.
Meanwhile, on PH, idiots will type 'bottomless pit' and 'if they get 100% of taxes it would also be wasted', hoping that next equally bright poster will give them cherished +1.
The problem is, which a lot of politics is being played through the NHS (as too with the police), there is also evidence of sabbotage from within through mismanagement. Just over ten years ago, one of our local engineering sub-contractors got into financial difficulties. They were a key supplier and, having had several other key subcons fall by the wayside - either through their own mismanagement or by actions of their customers (the latter exposure could be argued a symptom of the former, of course) - we decided to take operations in-house. To cut a long story very short we did some due diligence and found the firm in its entirety was beyond salvage.
However, in amongst the carnage, it was clear there were jobs not worth having (mostly legacy automotive stuff) and jobs that were significantly large and profitable as to be worth having. One was our own work (which we knew - we never wanted to screw subcons into the ground, because there was no long term gain) and the other, even more lucrative was a contract to make patient lifts for the NHS. (Cranes to lift people in and out of baths and beds.)
We cherry-picked plant and machinery from the administrators and set up our own works. We never chased the NHS business, partly on moral grounds - the margins were eyewatering and also, the only reason the NHS really needed these lifts was for obese patients - partly on the complexity of dealing with the client, but mostly because we wanted to have very tight control of the demand side of the business (i.e. own sales) and focus on what was effectively a start-up business. How the pricing came about, I've no idea, whether through a very 'closed' procurement process, or grossly inefficient buyers, but the prices the NHS were being charged at that time were ridiculously high.
IMHO the idea there is no waste and inefficiency is as wrong as the idea that the issues the NHS faces are not changing rapidly enough to cause problems. Clearly, demographics are driving increased demand and there is not yet a plan to address this.
However, in amongst the carnage, it was clear there were jobs not worth having (mostly legacy automotive stuff) and jobs that were significantly large and profitable as to be worth having. One was our own work (which we knew - we never wanted to screw subcons into the ground, because there was no long term gain) and the other, even more lucrative was a contract to make patient lifts for the NHS. (Cranes to lift people in and out of baths and beds.)
We cherry-picked plant and machinery from the administrators and set up our own works. We never chased the NHS business, partly on moral grounds - the margins were eyewatering and also, the only reason the NHS really needed these lifts was for obese patients - partly on the complexity of dealing with the client, but mostly because we wanted to have very tight control of the demand side of the business (i.e. own sales) and focus on what was effectively a start-up business. How the pricing came about, I've no idea, whether through a very 'closed' procurement process, or grossly inefficient buyers, but the prices the NHS were being charged at that time were ridiculously high.
IMHO the idea there is no waste and inefficiency is as wrong as the idea that the issues the NHS faces are not changing rapidly enough to cause problems. Clearly, demographics are driving increased demand and there is not yet a plan to address this.
I doubt that anyone ever said that there is no waste or inefficiencies in NHS. If someone did, they'd be wrong. You'll have s
ty, lazy, incompetent employees like anywhere else. What grates are the incessant, moronic 'public sector scroungers' comments.
In the meantime what do you do with;
http://www.bbc.co.uk/news/uk-england-birmingham-38...
ty, lazy, incompetent employees like anywhere else. What grates are the incessant, moronic 'public sector scroungers' comments. In the meantime what do you do with;
http://www.bbc.co.uk/news/uk-england-birmingham-38...
jjlynn27 said:
I doubt that anyone ever said that there is no waste or inefficiencies in NHS. If someone did, they'd be wrong. You'll have sty, lazy, incompetent employees like anywhere else. What grates are the incessant, moronic 'public sector scroungers' comments.
In the meantime what do you do with;
http://www.bbc.co.uk/news/uk-england-birmingham-38...
Aside from people living longer and less healthily (or at least having greater access to worse food), the NHS is plagued by good, old fashioned agenda creep. Every year the list of ailments treated and procedures and drugs offered grows. You article is a perfect example:ty, lazy, incompetent employees like anywhere else. What grates are the incessant, moronic 'public sector scroungers' comments. In the meantime what do you do with;
http://www.bbc.co.uk/news/uk-england-birmingham-38...
BBC said:
BBC's Inside Out West Midlands was illegally sold Caverject, a prescription medication for erectile dysfunction, and Enbrel, used to treat arthritis.
When the NHS was born, most people couldn't afford to eat and erectile dysfunction was an alien concept, let alone treatable condition.jjlynn27 said:
I doubt that anyone ever said that there is no waste or inefficiencies in NHS. If someone did, they'd be wrong. You'll have sty, lazy, incompetent employees like anywhere else. What grates are the incessant, moronic 'public sector scroungers' comments.
In the meantime what do you do with;
http://www.bbc.co.uk/news/uk-england-birmingham-38...
Massively punitive prison sentences for anyone caught IMO.ty, lazy, incompetent employees like anywhere else. What grates are the incessant, moronic 'public sector scroungers' comments. In the meantime what do you do with;
http://www.bbc.co.uk/news/uk-england-birmingham-38...
Agree with your general comments.
What I struggle with ref the "GPs must open 0800-2000" line is how will it be staffed.
If any GPs are working less than a full working week (let's say ~40hrs) then presumably they get paid less anyway (and hence the overall NHS bill is down).
If they are already working a full week, and are closing early on some days, then the only way to go 12x7 is more GPs. It's no good shouting about life unless that happens first.
Or if the 12x7 thing is just to give people more "choice", then I suspect we need to get a grip. If you're ill and need (not want) seeing for "free" then you go when the surgery's open.
Of course if you still cannot get appointments then that suggests that there aren't enough GPs, or the ones that there are not working full time. I guess this is where "austerity" may be biting...in which case we probably just need to suck it up.
A good friend of mine's a GP. She intimates that one of the biggest issues are people clogging up the system who categorically do not need to be there (as in they stubbed their toe, or have nothing more than a basic cold). She often gets the same hypochondriacs in insisting on being given antibiotics etc. If I were in her catchment there's no way I'd go in knowing how she deals with it...more GPs need to be doing the same, but I suspect if we as a society stopped over-burdening our public services with our own issues/dysfunction life might be much better all round.
The fun part would be fining a way to encourage that (I'm convinced a relatively nominal charge at point of service would be a very interesting test).
Digga said:
greed. I actually think this is a long overdue change, not least to improve acess to GPs for the majority of 9-5 workers, but it needs to be funded and staffed, not forced.
Which it can't be right now (still have a deficit, still have a massive national debt).So 9-5ers needs to take time out to fit in unless GPs can be persuaded. Ultimately funding it (or their employers funding) their appointment (TOIL, holiday, sick pay etc).
Murph7355 said:
Which it can't be right now (still have a deficit, still have a massive national debt).
So 9-5ers needs to take time out to fit in unless GPs can be persuaded. Ultimately funding it (or their employers funding) their appointment (TOIL, holiday, sick pay etc).
Just to repeat the point I made above, this is about funding which has been provided to GPs to open more flexibly, but where they are not doing so.So 9-5ers needs to take time out to fit in unless GPs can be persuaded. Ultimately funding it (or their employers funding) their appointment (TOIL, holiday, sick pay etc).
loafer123 said:
Murph7355 said:
Which it can't be right now (still have a deficit, still have a massive national debt).
So 9-5ers needs to take time out to fit in unless GPs can be persuaded. Ultimately funding it (or their employers funding) their appointment (TOIL, holiday, sick pay etc).
Just to repeat the point I made above, this is about funding which has been provided to GPs to open more flexibly, but where they are not doing so.So 9-5ers needs to take time out to fit in unless GPs can be persuaded. Ultimately funding it (or their employers funding) their appointment (TOIL, holiday, sick pay etc).
jjlynn27 said:
loafer123 said:
Murph7355 said:
Which it can't be right now (still have a deficit, still have a massive national debt).
So 9-5ers needs to take time out to fit in unless GPs can be persuaded. Ultimately funding it (or their employers funding) their appointment (TOIL, holiday, sick pay etc).
Just to repeat the point I made above, this is about funding which has been provided to GPs to open more flexibly, but where they are not doing so.So 9-5ers needs to take time out to fit in unless GPs can be persuaded. Ultimately funding it (or their employers funding) their appointment (TOIL, holiday, sick pay etc).
Sticks. said:
I'm sure addressing these two issues together in my local practice would make a lot of difference. It's very difficult to see a GP, but a nurse, often next day.
Simple steps like understanding the value of the receptionist as first point of contact to direct the customer to the appropriate service. Or some extra filters on the online service to reduce the unnecessary GP appointments would make a difference.
But I suspect the assumption that it's all down to a lack of resources leads to a failure to challenge the way the service is currently being managed. This isn't to deny a shortage of resources, but it doesn't mean improvements aren't possible.
I'm thinking of my local GP service here, so whereas this might be often the case, I'm not suggesting it always is.
There was a thread (recently?) where most posters were complaining about receptionist asking them to describe symptoms. Simple steps like understanding the value of the receptionist as first point of contact to direct the customer to the appropriate service. Or some extra filters on the online service to reduce the unnecessary GP appointments would make a difference.
But I suspect the assumption that it's all down to a lack of resources leads to a failure to challenge the way the service is currently being managed. This isn't to deny a shortage of resources, but it doesn't mean improvements aren't possible.
I'm thinking of my local GP service here, so whereas this might be often the case, I'm not suggesting it always is.
As for the solution, Murph has it right, nominal charge would get rid of a substantial number of people who shouldn't be there in the first place.
jjlynn27 said:
There was a thread (recently?) where most posters were complaining about receptionist asking them to describe symptoms.
It's not just what you do, but how you do it. If I was stood in a queue being asked about something personal, no, I wouldn't respond well. But, in a more private environment with someone who was more than just a clerk would be different. Yes, it'd cost more, but potentially a huge saving in (expensive) GP resource.
That's just an example of thinking differently about service delivery rather than accepting receptionist/desk/queue/appointment because it's always been done that way.
jjlynn27 said:
As for the solution, Murph has it right, nominal charge would get rid of a substantial number of people who shouldn't be there in the first place.
No it wouldn't. The heaviest users of the system and the biggest drain on resources would be exempt (the elderly, the obese etc.) as they'll be a member of a group which will claim special status (and rightly so for many).And I suspect, but have no evidence other than anecdotal that doctors may have made charging for services doubly difficult for themselves by signing so many sickness benefit claims for stress, fibromyalgia and countless other imagined or made up ailments that allows the holder to stop looking for work and top up their unemployment benefit. We won't be charging the 'disabled' for their GP visits, even if that disablement is fictitious.
Could you set it up that you pay £X for your first visit and then related subsequent visits are either free are charged at a reduced amount ?
That would address some of the issues of the long term ill / disabled etc, but might deter the time wasters.
My wife went to A & E for migraine vertigo, a £10 / 20 charge wouldn't have stopped her going she was in some distress. Whilst waiting in the queue a large man without a shirt and an overly glamorous woman with soft Irish accident pushed to the front of the queue - she had broken a nail and it really hurt. Would she have gone it if it cost her £20, maybe / maybe not.
Whilst everybody complains the parking charge does not appear to have stopped anybody going.
Mark Benson said:
No it wouldn't. The heaviest users of the system and the biggest drain on resources would be exempt (the elderly, the obese etc.) as they'll be a member of a group which will claim special status (and rightly so for many).
And I suspect, but have no evidence other than anecdotal that doctors may have made charging for services doubly difficult for themselves by signing so many sickness benefit claims for stress, fibromyalgia and countless other imagined or made up ailments that allows the holder to stop looking for work and top up their unemployment benefit. We won't be charging the 'disabled' for their GP visits, even if that disablement is fictitious.
There should be no exceptions. It's the only way something like that would work.And I suspect, but have no evidence other than anecdotal that doctors may have made charging for services doubly difficult for themselves by signing so many sickness benefit claims for stress, fibromyalgia and countless other imagined or made up ailments that allows the holder to stop looking for work and top up their unemployment benefit. We won't be charging the 'disabled' for their GP visits, even if that disablement is fictitious.
The downside of course would be the Daily Mail calling politicians murderers once the family of Ethel from Clacton cite the £10 (£20/whatever) levy as the reason she didn't go to the doctors and she popped her clogs (ignoring that they could have given her the £10, taken her to the doctor, persuaded her to just not buy tinned pink salmon for the next few weeks instead etc etc etc).
If public services are to survive for the majority/everyone, we need to stop making exceptions of every man and his dog.
Murph7355 said:
Mark Benson said:
No it wouldn't. The heaviest users of the system and the biggest drain on resources would be exempt (the elderly, the obese etc.) as they'll be a member of a group which will claim special status (and rightly so for many).
And I suspect, but have no evidence other than anecdotal that doctors may have made charging for services doubly difficult for themselves by signing so many sickness benefit claims for stress, fibromyalgia and countless other imagined or made up ailments that allows the holder to stop looking for work and top up their unemployment benefit. We won't be charging the 'disabled' for their GP visits, even if that disablement is fictitious.
There should be no exceptions. It's the only way something like that would work.And I suspect, but have no evidence other than anecdotal that doctors may have made charging for services doubly difficult for themselves by signing so many sickness benefit claims for stress, fibromyalgia and countless other imagined or made up ailments that allows the holder to stop looking for work and top up their unemployment benefit. We won't be charging the 'disabled' for their GP visits, even if that disablement is fictitious.
The downside of course would be the Daily Mail calling politicians murderers once the family of Ethel from Clacton cite the £10 (£20/whatever) levy as the reason she didn't go to the doctors and she popped her clogs (ignoring that they could have given her the £10, taken her to the doctor, persuaded her to just not buy tinned pink salmon for the next few weeks instead etc etc etc).
If public services are to survive for the majority/everyone, we need to stop making exceptions of every man and his dog.
The minute you announce your universal payment policy the publicity and noise from those (or more likely their advocates in charities and NGOs) claiming they merit exemption would be deafening.
You then have 2 choices; allow exemptions which opens the door to just about every group except the working middle class, middle income income (Tory voting) demographic becoming exempt, or sticking to your guns and facing an onslaught of vitriol and negative reporting which will paint you as the 'Nasty Party' all over again such that even Corbyn would stand a chance in 2020.
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