Discussion
Tuna said:
jjlynn27 said:
Tuna said:
... every extra pound in funding results in ten pence worth of improvements. Worse, the extra funding tends to have the side effect of yet more managers being employed - so efficiency drops even further (because the magic money tree keeps growing).
...
Any source for the above?...
Tuna said:
The NHS resists all attempts at quantification. 
How would you know that? Where did you look? NHS numbers are available. As are the credible studies into efficiency, both absolute and relative.
IF you actually want to educate yourself you might want to read studies by King's and Commonwealth Fund.
Or you can continue to make up stuff on pretty much any subject that you comment on.
SpeckledJim said:
PurpleMoonlight said:
Tax is personal, which is correct.
Child benefit isn't. Child benefit is stoooopid.MDMetal said:
SpeckledJim said:
PurpleMoonlight said:
Tax is personal, which is correct.
Child benefit isn't. Child benefit is stoooopid.EddieSteadyGo said:
I just wanted to make one other point to show how difficult and entangled it all is. Some time ago I was asking my sister-in-law what changes she would like to make in an ideal world which might make a dramatic improvement to her GP practice. She was explaining that she has done a lot of analysis to show in her practice a very significant portion of appointments were from the same people each month who did not need to see a doctor. So this included people who were hypochondriacs, paranoid, drug addicts to people who were just too stupid to make good decisions (yes, there are quite a few of them out there).
My guess is there are similar situations in many GP practises across the country. Now they do take action to improve things using triage etc. But really, to make a big difference you needs a national approach as some of the changes might be politically unpopular and some might require other agencies to take more responsibility. For example, you could introduce a nominal charge to discourage frivolous appointments. Just look at the effect that has had on plastic bag usage. But that would likely be hugely unpopular and could have downsides yet to be quantified.
So I'm just making the point that is a complicated minefield trying to find large savings imho.
For sure, and in that we're in agreement. My Dad was a GP, and the 80/20 rule seems to apply everywhere. Back in the days before targets though, the 80% could be shuffled through the system fairly quickly (with the occasional prescription of 'on your bike' My guess is there are similar situations in many GP practises across the country. Now they do take action to improve things using triage etc. But really, to make a big difference you needs a national approach as some of the changes might be politically unpopular and some might require other agencies to take more responsibility. For example, you could introduce a nominal charge to discourage frivolous appointments. Just look at the effect that has had on plastic bag usage. But that would likely be hugely unpopular and could have downsides yet to be quantified.
So I'm just making the point that is a complicated minefield trying to find large savings imho.
). Now that it's all been formalised, you're suddenly paying a nurse to triage people that could have been sent on their way to their own satisfaction in a couple of minutes. Two people are doing the job that used to be done by one, at the same time as leaving the patients much less happy. As far as I'm aware, the throughput of a surgery has not dramatically increased - we're still seeing doctors complaining of being overwhelmed, whilst the number of patients per GP has not dramatically changed.GPs are a particularly difficult case though, as they arguably have an important social role as much as medical. Having silo'ed the different medical processes, we're suddenly seeing calls to improve 'care in the community' and 'patient outreach' - these were previously being achieved by GPs *not* triaging patients and forcing them to book in advance. Unintended consequences and all that.
jjlynn27 said:
Tuna said:
jjlynn27 said:
Tuna said:
... every extra pound in funding results in ten pence worth of improvements. Worse, the extra funding tends to have the side effect of yet more managers being employed - so efficiency drops even further (because the magic money tree keeps growing).
...
Any source for the above?...
Tuna said:
jjlynn27 said:
Tuna said:
jjlynn27 said:
Tuna said:
... every extra pound in funding results in ten pence worth of improvements. Worse, the extra funding tends to have the side effect of yet more managers being employed - so efficiency drops even further (because the magic money tree keeps growing).
...
Any source for the above?...
You invented 'the problem' as, once again, you are completely clueless. I was kind enough to give you starting points to educate yourself.
Here. this is what people who actually know what they are talking about have to say on the subject;
https://www.commonwealthfund.org/publications/fund...
EddieSteadyGo said:
Tuna said:
The fact that the ministers for health and education are demonised the moment they begin to make any changes makes it impossible to address.
I just wanted to make one other point to show how difficult and entangled it all is. Some time ago I was asking my sister-in-law what changes she would like to make in an ideal world which might make a dramatic improvement to her GP practice. She was explaining that she has done a lot of analysis to show in her practice a very significant portion of appointments were from the same people each month who did not need to see a doctor. So this included people who were hypochondriacs, paranoid, drug addicts to people who were just too stupid to make good decisions (yes, there are quite a few of them out there).My guess is there are similar situations in many GP practises across the country. Now they do take action to improve things using triage etc. But really, to make a big difference you needs a national approach as some of the changes might be politically unpopular and some might require other agencies to take more responsibility. For example, you could introduce a nominal charge to discourage frivolous appointments. Just look at the effect that has had on plastic bag usage. But that would likely be hugely unpopular and could have downsides yet to be quantified.
So I'm just making the point that is a complicated minefield trying to find large savings imho.
Take drugs that are so cheap they might as well be free off the prescription lists. Paracetamol. £8 to the government through a chemist, or £0.40 in the supermarket.
What about a £40 fee for a missed appointment? I can't remember the figure but a huge proportion of appointments are neither attended nor cancelled. People don't value what doesn't have a price.
What about a higher threshold of 'sorry, you haven't yet tried hard enough on your own to qualify for medical help for this self-inflicted problem. Go away for 6 months and come back when you can demonstrate that you've given it a better shot'.
What is the rate at which NHS office staff are sacked for being useless? Is it a higher rate or lower rate than in private industry? I could take a guess. If it is lower, increase it. We might get a bit more work out of people if they discover their job isn't necessarily for life, and that it relies to a great extent on actually how good they are at it.
Edited by SpeckledJim on Monday 18th June 16:24
SpeckledJim said:
Take drugs that are so cheap they might as well be free off the prescription lists. Paracetamol. £8 to the government through a chemist, or £0.40 in the supermarket.
At what point would the cutoff be? £1, £2, higher? SpeckledJim said:
What about a £40 fee for a missed appointment? I can't remember the figure but a huge proportion of appointments are neither attended nor cancelled. People don't value what doesn't have a price.
How would you go about recovering this fee. Have all patients bank account details registered with the GP so they pull it automatically? What happens if they dont pay it, is the patient removed from the surgery?SpeckledJim said:
What about a higher threshold of 'sorry, you haven't yet tried hard enough on your own to qualify for medical help for this self-inflicted problem. Go away for 6 months and come back when you can demonstrate that you've given it a better shot'.
How would this be triaged, over the phone or in person? If in person then they are already in the surgery and both options take up the same time as an appointment.What happens if the person is sent home and it gets worse/died then the family/media find out that the surgery told them to "Go away for 6 months and come back when you can demonstrate that you've given it a better shot."?
KTF said:
SpeckledJim said:
Take drugs that are so cheap they might as well be free off the prescription lists. Paracetamol. £8 to the government through a chemist, or £0.40 in the supermarket.
At what point would the cutoff be? £1, £2, higher? KTF said:
SpeckledJim said:
What about a £40 fee for a missed appointment? I can't remember the figure but a huge proportion of appointments are neither attended nor cancelled. People don't value what doesn't have a price.
How would you go about recovering this fee. Have all patients bank account details registered with the GP so they pull it automatically? What happens if they dont pay it, is the patient removed from the surgery?KTF said:
SpeckledJim said:
What about a higher threshold of 'sorry, you haven't yet tried hard enough on your own to qualify for medical help for this self-inflicted problem. Go away for 6 months and come back when you can demonstrate that you've given it a better shot'.
How would this be triaged, over the phone or in person? If in person then they are already in the surgery and both options take up the same time as an appointment.What happens if the person is sent home and it gets worse/died then the family/media find out that the surgery told them to "Go away for 6 months and come back when you can demonstrate that you've given it a better shot."?
SpeckledJim said:
I agree it is complicated. A nominal fee for an appointment might be a good start, but yes, it would be unpopular.
If it were down to me, I would trial something like a £5 charge to see a GP. Children under 16 would be free. With a promise that all savings/income would be reinvested back into front line GP services.But can you imagine the howls of protest .... "evil Tories privatising the GP surgeries via the back door". So most sensible politicians would probably conclude in advance that it was a fool's errand and not bother.
A story from my local paper always sticks with me. A hardcore group of around 100 scum were responsible for more than a million, it may have been millions of money being spent. THere in A&E every weekend, suckign resources, not just the ambulances, but the trouble, the aggro, the police presence.
The last time I was in A&E (maybe the only time for myself) I had ripped my chest, unfortunately for me it was in the evening, I had to sit for hours shivering (from large trauma) as police handled f
kwits, timewasters complaining about having to wait, haranguing the staff, causing further delays. I just sat quiet til it was all over. awful experience. Nurses in A&E should be paid handsomely.
The last time I was in A&E (maybe the only time for myself) I had ripped my chest, unfortunately for me it was in the evening, I had to sit for hours shivering (from large trauma) as police handled f
kwits, timewasters complaining about having to wait, haranguing the staff, causing further delays. I just sat quiet til it was all over. awful experience. Nurses in A&E should be paid handsomely.EddieSteadyGo said:
If it were down to me, I would trial something like a £5 charge to see a GP. Children under 16 would be free. With a promise that all savings/income would be reinvested back into front line GP services.
But can you imagine the howls of protest .... "evil Tories privatising the GP surgeries via the back door". So most sensible politicians would probably conclude in advance that it was a fool's errand and not bother.
Even if you have a system where everyone pays £10 when you book an appointment which is refundable when you actually show up would make a huge difference. But can you imagine the howls of protest .... "evil Tories privatising the GP surgeries via the back door". So most sensible politicians would probably conclude in advance that it was a fool's errand and not bother.
jjlynn27 said:
When caught up lying again, resorts to name calling. From the bloke who whined about people being rude to him while counting insults.
You invented 'the problem' as, once again, you are completely clueless. I was kind enough to give you starting points to educate yourself.
Here. this is what people who actually know what they are talking about have to say on the subject;
https://www.commonwealthfund.org/publications/fund...
Wow jj, your desperation to be right is getting you a little confused.You invented 'the problem' as, once again, you are completely clueless. I was kind enough to give you starting points to educate yourself.
Here. this is what people who actually know what they are talking about have to say on the subject;
https://www.commonwealthfund.org/publications/fund...
From the report you linked:
Report said:
In general, the U.K. achieves superior performance compared to other countries in all areas except Health Care Outcomes, where it ranks 10th despite experiencing the fastest reduction in deaths amenable to health care in the past decade.
So we're really efficient and cheap, so long as you don't want to be well at the end of it As it is, Eddie and I both have family members in the NHS, both actually live in this country and both appear to be in broad agreement. You can disagree if you like, but try to reign in the spittle - you come across as a little aggressive. I've recently had a family member in emergency care for just short of three months. I wouldn't hear a word against the efforts of the carers and clinicians, but no, the overall care was not well organised, and the resulting outcome meant that the service as a whole spent significantly more to achieve a worse result. Speaking with people on the ward, this was seen as the norm. Anecdotal, for sure, but it's a picture that seems to be repeated many times.
Nice of you to defend the NHS though.
mickytruelove said:
with regards to the claiming £8 paracetamol vs 40p tesco stuff, Why is the NHS paying that price in the first place. surely they should get themselves to tesco? or sack who ever is ordering the expensive stuff.
The pharmacy gets paid for dispensing the paracetamol. That’s where a large chunk of the difference goes. jjlynn27 said:
Even if you have a system where everyone pays £10 when you book an appointment which is refundable when you actually show up would make a huge difference.
So you get an appointment in 6 days time and pay your tenner, but feel much better on day 4 and are clearly making a recovery. You don't feel the need to go to the doctor's anymore - what happens to your tenner?Cobnapint said:
jjlynn27 said:
Even if you have a system where everyone pays £10 when you book an appointment which is refundable when you actually show up would make a huge difference.
So you get an appointment in 6 days time and pay your tenner, but feel much better on day 4 and are clearly making a recovery. You don't feel the need to go to the doctor's anymore - what happens to your tenner?Cobnapint said:
So you get an appointment in 6 days time and pay your tenner, but feel much better on day 4 and are clearly making a recovery. You don't feel the need to go to the doctor's anymore - what happens to your tenner?
You wouldn't even need to pay a tenner. It would be a pre-auth on a card so it only actually comes off if you don't show.That said it would need to be prob £25 to be effective. £10 is expendable to too many.
technodup said:
ou wouldn't even need to pay a tenner. It would be a pre-auth on a card so it only actually comes off if you don't show.
That said it would need to be prob £25 to be effective. £10 is expendable to too many.
Unfortunately £10 would be too much for the people who're most likely to need seeing.That said it would need to be prob £25 to be effective. £10 is expendable to too many.
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