NHS whats happened?

[crankedup5]

Phoned my G.P. surgery for appointment and eventually got to speak to receptionist. Patients must advise receptionist why I wanted an appointment, saying stuff like because I’m ill is enough information. Our Surgery now have receptionist triage appointments. I was told no appointments available call tomorrow and try again by the computer. When I had to explain my symptoms to receptionist she told me a cancellation had just appeared and I was given a same day appointment.
Prioritisation is being determined by non medical staff.

Doctor went through rudimentary health checks and decided to refer me to hospital. Didn’t offer me a FIT test nor send me for urgent blood tests, nor offer me a prescription for which he recommended, if I want that I must pay, even though the product is on the prescription list and I am
eligible for a NHS prescription.

Now on two week cancer pathway examination/treatment program (again) which is running perfectly.

My G.P. surgery is worse than useless and is an obstruction and liability to my health care.

[Murph7355]

More customers and more services than the customers are prepared to pay for.

[Murph7355]

valiant said:

Paying a tenner or whatever doesn’t suddenly magic up some appointments. The same inherent problems will remain.

All that’ll happen is that we’ll have the exact same issues we have now plus it’ll now cost you a tenner for the privilege.

It’s a stupid idea,

It might put off the gonks going in for some paracetamol, a stubbed toe or a sick note. (A good friend's a GP).

That might alleviate the queues to a degree.

(I'm rural and at the moment can get appointmemts when needed as long as I call at 0800. Which is fair enough).

[Killboy]

So who wants to work for the NHS? i.e. Is this going to get better or worse?

[Rivenink]

I'm not an expert on this, but this is my understanding of some of the reasons:

1. Massive bureaucratic layer introduced by the Tories that look to me to be designed to pave the way for privatisation: https://en.wikipedia.org/wiki/Integrated_care_syst...

2. Lack of planning for Brexit. (Not a comment on whether Brexit was good or bad) NHS was staffed by a lot of EU born workers, nurses particularly. Potential new EU workers saw barriers to working in the UK, and decided to go elsewhere.

3. More demand. Population democraphic is skewing older, and older people tend to have more healtcare needs than younger people. Also, unhealthier population and pandemic after-effects.

4. Overburdening administration. Too many metrics and targets and KPIs. Requires an army of paper pushers to keep track of them, produce reports and monitor the staff doing the actual work.

5. Poorly managed and governed projects that have effectively served as vehicles for corruption.

[BikeBikeBIke]

DBSV8 said:

interested on thoughts what exactly is going on with the NHS

an example we had a friend who had an accident at work fall from height and fracture of his leg ....It was an obvious break , not a potential sprain. femur . Ambulance was called , went to Poole hospital in Dorset .

remained in the ambulance for 14 1/2hrs ............. He was told its not life threatening . subsequently he had the leg set , put in one of those leg braces and was sent on his way

Now i know casualty is busy ... but What is the reason , for such a wait

Shortage of doctors
Too many patients
not enough beds .................this didnt require a bed
poor assessment triage

or is there a darker reason , NHS going slow due to pay deals ?? political; reasons unions etc

no idea but this needs fixing

From personal experience NHS111 send you straight to casualty pretty much regardless of what you say and my GPs receptionist seems to do pretty much the same.

Surely the whole point of NHS 111 is to reassure and filter out the people who don't really need to go to casualty? Instead they seem to funnel people in.

That must put pressure on A and E.

[pquinn]

crankedup5 said:

Our Surgery now have receptionist triage appointments.

What formal recognised training do the receptionists have and what regulatory regime do they operate under?

[Riley Blue]

pquinn said:

crankedup5 said:

Our Surgery now have receptionist triage appointments.

What formal recognised training do the receptionists have and what regulatory regime do they operate under?

Probably similar to that followed by NHS 111 call handlers who also follow a 'triage pathway' to determine the appropriate outcome for the caller. In each case a clinician will advise when required.

[pavarotti1980]

crankedup5 said:

Phoned my G.P. surgery for appointment and eventually got to speak to receptionist. Patients must advise receptionist why I wanted an appointment, saying stuff like because I’m ill is enough information. Our Surgery now have receptionist triage appointments. I was told no appointments available call tomorrow and try again by the computer. When I had to explain my symptoms to receptionist she told me a cancellation had just appeared and I was given a same day appointment.
Prioritisation is being determined by non medical staff.

Doctor went through rudimentary health checks and decided to refer me to hospital. Didn’t offer me a FIT test nor send me for urgent blood tests, nor offer me a prescription for which he recommended, if I want that I must pay, even though the product is on the prescription list and I am
eligible for a NHS prescription.

Now on two week cancer pathway examination/treatment program (again) which is running perfectly.

My G.P. surgery is worse than useless and is an obstruction and liability to my health care.

What prescription item is it that you must pay for and why are they saying pay for it?

[sugerbear]

Rivenink said:

I'm not an expert on this, but this is my understanding of some of the reasons:

1. Massive bureaucratic layer introduced by the Tories that look to me to be designed to pave the way for privatisation: https://en.wikipedia.org/wiki/Integrated_care_syst...

2. Lack of planning for Brexit. (Not a comment on whether Brexit was good or bad) NHS was staffed by a lot of EU born workers, nurses particularly. Potential new EU workers saw barriers to working in the UK, and decided to go elsewhere.

3. More demand. Population democraphic is skewing older, and older people tend to have more healtcare needs than younger people. Also, unhealthier population and pandemic after-effects.

4. Overburdening administration. Too many metrics and targets and KPIs. Requires an army of paper pushers to keep track of them, produce reports and monitor the staff doing the actual work.

5. Poorly managed and governed projects that have effectively served as vehicles for corruption.

On point 3. We would have a NHS "tax" (and an associated drop in the income tax/NI levels to offset) So people can clearly see how much they are paying for it. All income should should be subject to it (Allowances shouldn't be allowed) and everyone contributes in some way.

[bigpriest]

Rivenink said:

I'm not an expert on this, but this is my understanding of some of the reasons:

1. Massive bureaucratic layer introduced by the Tories that look to me to be designed to pave the way for privatisation: https://en.wikipedia.org/wiki/Integrated_care_syst...

2. Lack of planning for Brexit. (Not a comment on whether Brexit was good or bad) NHS was staffed by a lot of EU born workers, nurses particularly. Potential new EU workers saw barriers to working in the UK, and decided to go elsewhere.

3. More demand. Population democraphic is skewing older, and older people tend to have more healtcare needs than younger people. Also, unhealthier population and pandemic after-effects.

4. Overburdening administration. Too many metrics and targets and KPIs. Requires an army of paper pushers to keep track of them, produce reports and monitor the staff doing the actual work.

5. Poorly managed and governed projects that have effectively served as vehicles for corruption.

Point 1 - In Greater Manchester, as an example, the ICB has replaced 10 CCGs. No redundancies yet but a few have jumped ship. In theory more efficient co-ordination of health and social care across a bigger area. Of course, councils have not been touched, still 10 of them.

[pavarotti1980]

bigpriest said:

Point 1 - In Greater Manchester, as an example, the ICB has replaced 10 CCGs. No redundancies yet but a few have jumped ship. In theory more efficient co-ordination of health and social care across a bigger area. Of course, councils have not been touched, still 10 of them.

This will be replicated nationwide as ICS/ICBs replace CCGs which was an unnecessary load of bks by Lansley.

Staff already have left as the ICBs slim down by removing duplicated roles

[devnull]

The whole 'receptionist doing some form of triage' thing isn't new, it has been happening since the mid 90s in my experience.

[devnull]

Rivenink said:

I'm not an expert on this, but this is my understanding of some of the reasons:

1. Massive bureaucratic layer introduced by the Tories that look to me to be designed to pave the way for privatisation: https://en.wikipedia.org/wiki/Integrated_care_syst...

2. Lack of planning for Brexit. (Not a comment on whether Brexit was good or bad) NHS was staffed by a lot of EU born workers, nurses particularly. Potential new EU workers saw barriers to working in the UK, and decided to go elsewhere.

3. More demand. Population democraphic is skewing older, and older people tend to have more healtcare needs than younger people. Also, unhealthier population and pandemic after-effects.

4. Overburdening administration. Too many metrics and targets and KPIs. Requires an army of paper pushers to keep track of them, produce reports and monitor the staff doing the actual work.

5. Poorly managed and governed projects that have effectively served as vehicles for corruption.

I would also argue pay - you probably aren't getting the best and brightest in the business on public sector salaries.

[Electro1980]

Murph7355 said:

valiant said:

Paying a tenner or whatever doesn’t suddenly magic up some appointments. The same inherent problems will remain.

All that’ll happen is that we’ll have the exact same issues we have now plus it’ll now cost you a tenner for the privilege.

It’s a stupid idea,

It might put off the gonks going in for some paracetamol, a stubbed toe or a sick note. (A good friend's a GP).

That might alleviate the queues to a degree.

(I'm rural and at the moment can get appointmemts when needed as long as I call at 0800. Which is fair enough).

And how many people who do need to be seen would be put off until it is too late and it costs much more to treat?

[chemistry]

valiant said:

Paying a tenner or whatever doesn’t suddenly magic up some appointments. The same inherent problems will remain.

All that’ll happen is that we’ll have the exact same issues we have now plus it’ll now cost you a tenner for the privilege.

It’s a stupid idea,

We should charge £25 for any missed NHS appointment (ie one not cancelled with at least 24hrs notice). No exceptions. Free at the point of use, not abuse.

That would eliminate a huge amount of waste.

Too costly to implement? NHS dentists manage to administer £23.80 band one charges, whilst pharmacists cope with £9.35 prescription charges.

Unfair on the poorest? Nobody has to pay, just don’t miss an appointment (or fail to phone up and cancel with reasonable notice). A small number of people will, I accept, have mental health or other issues which make them incapable of managing something this simple; that should be noted on their medical records and social services etc. informed to help manage their care through regular interactions, recognising they are vulnerable (this should weed out those who genuinely can’t even manage an appointment from those who just can’t be bothered to call and cancel).

[Teddy Lop]

devnull said:

The whole 'receptionist doing some form of triage' thing isn't new, it has been happening since the mid 90s in my experience.

Receptionists doing some form of triage would be a step change upgrade from blunt refusal.

[Killboy]

chemistry said:

Unfair on the poorest? Nobody has to pay, just don’t miss an appointment (or fail to phone up and cancel with reasonable notice).

So how do you make the appointment? Pay up front and refund if you make the appointment? Who pays the card fees? Or do you get sent a bill of you miss it?

Is this even the problem for the NHS?

[loafer123]

I am unconvinced that it will work, but it is commonly used in health systems elsewhere including Ireland and France, so can’t be easily dismissed.

[Teddy Lop]

loafer123 said:

I am unconvinced that it will work, but it is commonly used in health systems elsewhere including Ireland and France, so can’t be easily dismissed.

Pay, and be offered an appointment time to suit, I and I'm sure many would.

Don't pay, and be batched into a window, which helps offset no-shows.

Obviously the system can be flexible, if someone doesn't have means but has the need the doc can access the system and offer them a timed next appointment.

Simples, all you need is people who want to make things work.

But hoomins.

It'll never happen.