Alternatives to the NHS?

[BBYeah]

So there's Health insurance and Bupa but what else is there out there as an alternative to the NHS?

My g/f waiting around for hours in A&E with an eye injury and getting crap treatment has made me want to find out more about the alternatives.

Are there any private hospitals where you can just drive in and pay on a one-off basis for treatment?

[davepoth]

http://news.bbc.co.uk/1/hi/england/london/3159359....

[968]

BBYeah said:

So there's Health insurance and Bupa but what else is there out there as an alternative to the NHS?

My g/f waiting around for hours in A&E with an eye injury and getting crap treatment has made me want to find out more about the alternatives.

Are there any private hospitals where you can just drive in and pay on a one-off basis for treatment?

No. Private hospitals in general don't do emergency appointments. Casualty plus does see some injuries but I don't think they have eye docs there. I am an eye doc, and yes sometimes you can face a wait, when they are busy, however not all problems need to be seen in A&E. What is the problem?

Edited by 968 on Friday 17th December 22:48

[BBYeah]

Thanks for the replies chaps.

I thought there may be something like that in London but unfortunately live up'North.

968: The problem is now pretty sorted cheers. She came home with blurred vision in one eye and a small white dot (grit maybe) stuck to the pupil part. After a 2hr wait in A&E she saw a nurse who gave an eye test and suggested an ointment we picked up from Tesco.

The next day her vision hadn't improved and she was panicking so we went back to A&E (both trips in the late evening) and saw a general doc who gave her a cursory look over and only when I asked if it was normal her eye being so bloodshot all the time did he suggest making an appointment with the eye doc which the A&E reception begrudgingly sorted.

Those two visits were Tues / Wed and she saw the Eye doc today, with another two hour wait, despite having an appointment for a set time. Who prescribed eye drops and to come back next Tuesday for a check. She also suggested it may be an ulcer which contact lens users sometimes get.

Going into too much detail here sorry... But as you are an eye doc I would very much value any thoughts you have.

What frustrates me more is that I had an almost identical problem a few months ago and went to the same hospital. After a small wait of 30mins I saw a nurse who then put me through to the eye doc, where I had another minimal wait of about 20 mins. He was very good, explained it was nothing to worry about and prescribed the eye drops and I was sorted. Although I did seem to pick up some fleas!!

With the GF the nurse was not very confidence re-assuring and the ointment seemed to have been the wrong thing to have. It even said on the paperwork it came with that it shouldn't be used in cases of blurred vision or potentially damaged eyes.

Edited by BBYeah on Friday 17th December 23:11

[968]

BBYeah said:

Thanks for the replies chaps.

I thought there may be something like that in London but unfortunately live up'North.

968: The problem is now pretty sorted cheers. She came home with blurred vision in one eye and a small white dot (grit maybe) stuck to the pupil part. After a 2hr wait in A&E she saw a nurse who gave an eye test and suggested an ointment we picked up from Tesco.

The next day her vision hadn't improved and she was panicking so we went back to A&E (both trips in the late evening) and saw a general doc who gave her a cursory look over and only when I asked if it was normal her eye being so bloodshot all the time did he suggest making an appointment with the eye doc which the A&E reception begrudgingly sorted.

Those two appointments were Tues / Wed and she saw the Eye doc today, with another two hour wait, despite having an appointment for a set time. Who prescribed eye drops and to come back next Tuesday for a check. She also suggested it may be an ulcer which contact lens users sometimes get.

Going into too much detail here sorry... But as you are an eye doc I would very much value any thoughts you have.

What frustrates me more is that I had an almost identical problem a few months ago and went to the same hospital. After a small wait of 30mins I saw a nurse who then put me through to the eye doc, where I had another minimal wait of about 20 mins. He was very good, explained it was nothing to worry about and prescribed the eye drops and I was sorted. Although I did seem to pick up some fleas!!

With the GF the nurse was not very confidence re-assuring and the ointment seemed to have been the wrong thing to have. It even said on the paperwork it came with that it shouldn't be used in cases of blurred vision or potentially damaged eyes.

A&E departments like to pretend they can deal with eye problems and try not to refer every eye problem to the eye docs, as there arent enough of us to deal with all of them. If it is a contact lens related problem you need to be seen by an eye doc or a nurse specialist with eye training. A wait is not uncommon because such problems are fairly low in priority when compared to the dire emergencies we have to deal with. I'm not sure why there was so much difference between your 2 visits. Different hospitals have different policies. Mine directs all eye problems to the eye docs immediately.

In terms of the ointment, I can only assume these were antibiotics, and sometimes these can cause blurred vision. I'd like to know what the name of it was before being able to tell you if it was the right one or not.

[sinizter]

BBYeah said:

So there's Health insurance and Bupa but what else is there out there as an alternative to the NHS?

My g/f waiting around for hours in A&E with an eye injury and getting crap treatment has made me want to find out more about the alternatives.

Are there any private hospitals where you can just drive in and pay on a one-off basis for treatment?

Damn near impossible to get an eye doc to come out to A+E at night. Some of the on-call people try and fob off the patient to every other department first, before reluctantly and very slowly making their way to A+E. Not all of them are like that, there have been a few very good ones, who turn up very quickly when requested, but generally very difficult to get them in.

[mph1977]

There is no viable emergency or primary care outside the NHS apart from at large crowd gatherings.

There is very very sparse critical care outside the NHS

Most health insurance even expensive health insurance will leave you high and dry should you have a none- profitable condition

Some health insurance even expensive health insurance fails to meet the costs of quite routine items such as discharge prescriptions or medical devices and appliances (such as dressings or a stick / crutches) on discharge

The standards of follow up care from some private providers are very poor instead they rely on the NHS to pick up the none profitable work of dealing with predictable sequalae of the treatment they provide.

[mph1977]

sinizter said:

Damn near impossible to get an eye doc to come out to A+E at night. Some of the on-call people try and fob off the patient to every other department first, before reluctantly and very slowly making their way to A+E. Not all of them are like that, there have been a few very good ones, who turn up very quickly when requested, but generally very difficult to get them in.

try finding an eye doc on call outside of a big city teaching hospital.


Most private hospitals have an SHO level generalist on site at night as a cheapest form of prescribing authority, a few may have a middle grade equivalent with some anaesthetics training ..

[968]

sinizter said:

BBYeah said:

So there's Health insurance and Bupa but what else is there out there as an alternative to the NHS?

My g/f waiting around for hours in A&E with an eye injury and getting crap treatment has made me want to find out more about the alternatives.

Are there any private hospitals where you can just drive in and pay on a one-off basis for treatment?

Damn near impossible to get an eye doc to come out to A+E at night. Some of the on-call people try and fob off the patient to every other department first, before reluctantly and very slowly making their way to A+E. Not all of them are like that, there have been a few very good ones, who turn up very quickly when requested, but generally very difficult to get them in.

As an eye doctor, we prioritise seeing referrals out of hours as we are often not resident in the hospital and more importantly, most of those referrals are not emergencies and do not need to be seen immediately and can be scheduled to be seen in a more appropriate time and setting. Also we often cover more than 1 hospital. If i dont see a referral, I will provide advise to the referring doctor.

Edited by 968 on Friday 17th December 23:25

[BBYeah]

Thanks again everyone. I really didn't expect such informative and helpfuly responses.

The ointment was: Golden Eye Antibiotic Ointment (Chloramphenicol)

It may just be the case that we should have gone in the daytime instead of at night, but work dictated that unfortunately. I have very little experience of healthcare and am just curious about the alternatives.

[sinizter]

968 said:

sinizter said:

BBYeah said:

So there's Health insurance and Bupa but what else is there out there as an alternative to the NHS?

My g/f waiting around for hours in A&E with an eye injury and getting crap treatment has made me want to find out more about the alternatives.

Are there any private hospitals where you can just drive in and pay on a one-off basis for treatment?

Damn near impossible to get an eye doc to come out to A+E at night. Some of the on-call people try and fob off the patient to every other department first, before reluctantly and very slowly making their way to A+E. Not all of them are like that, there have been a few very good ones, who turn up very quickly when requested, but generally very difficult to get them in.

As an eye doctor, we prioritise seeing referrals out of hours as we are often not resident in the hospital and more importantly, most of those referrals are not emergencies and do not need to be seen immediately and can be scheduled to be seen in a more appropriate time and setting. Also we often cover more than 1 hospital. If i dont see a referral, I will provide advise to the referring doctor.

Edited by 968 on Friday 17th December 23:25

I was a maxfax SHO being asked to examine the eye by the opthalmology SHO. So, an ophthalmology SHO is asking a dentist to look into someone's eye - when there is a problem. The A+E doctor was asked to get the maxfax to examine this person's eye because they also had a small facial laceration.

That is just plain laziness and off the scale in stupidity.

There were many other occasions, including a couple where my consultant, as well as pretty much every other doctor I spoke to, thought that the patient should be seen by the ophthalmologists immediately. Instead they wanted to me to prescribe medication to the patient and for the patient to be monitored by me till the next morning.

I understand there are times when the patient does not need to be seen immediately, but the above was certainly not one of those. This was just the SHO trying to not to come in to A+E in the middle of the night. There were also times where they would not even answer the phone even though they were meant to be on-call.

My previous post was pretty much related to my experience at the hospital I worked - It can be different at others, and in hindsight was probably not fair to generalise to such as extent.

Edited by sinizter on Friday 17th December 23:41

[968]

sinizter said:

968 said:

sinizter said:

BBYeah said:

So there's Health insurance and Bupa but what else is there out there as an alternative to the NHS?

My g/f waiting around for hours in A&E with an eye injury and getting crap treatment has made me want to find out more about the alternatives.

Are there any private hospitals where you can just drive in and pay on a one-off basis for treatment?

Damn near impossible to get an eye doc to come out to A+E at night. Some of the on-call people try and fob off the patient to every other department first, before reluctantly and very slowly making their way to A+E. Not all of them are like that, there have been a few very good ones, who turn up very quickly when requested, but generally very difficult to get them in.

As an eye doctor, we prioritise seeing referrals out of hours as we are often not resident in the hospital and more importantly, most of those referrals are not emergencies and do not need to be seen immediately and can be scheduled to be seen in a more appropriate time and setting. Also we often cover more than 1 hospital. If i dont see a referral, I will provide advise to the referring doctor.

Edited by 968 on Friday 17th December 23:25

I was a maxfax SHO being asked to examine the eye by the opthalmology SHO. So, an ophthalmology SHO is asking a dentist to look into someone's eye - when there is a problem. The A+E doctor was asked to get the maxfax to examine this person's eye because they also had a small facial laceration.

That is just plain laziness and off the scale in stupidity.

There were many other occasions, including a couple where my consultant, as well as pretty much every other doctor I spoke to, thought that the patient should be seen by the ophthalmologists immediately. Instead they wanted to me to prescribe medication to the patient and for the patient to be monitored by me till the next morning.

I understand there are times when the patient does not need to be seen immediately, but the above was certainly not one of those. This was just the SHO trying to not to come in to A+E in the middle of the night. There were also times where they would not even answer the phone even though they were meant to be on-call.

My previous post was pretty much related to my experience at the hospital I worked - It can be different at others, and in hindsight was probably not fair to generalise to such as extent.

Edited by sinizter on Friday 17th December 23:41

How funny, because as the Ophth registrar I've had to see a zygomatic fracture for the max facs team, with no ocular imvolvement, because max facs refused to come. Indeed in one trust, max facs refuse to see these patients until after ophth review, whether there has been an eye injury or not!

I had to see a cheek cellulitis for Max facs a few weeks ago, with no orbital involvement and manage the patient for them because they were incapable of recognising a necrotising fasciitis. This patient ended up in ITU, with half her scalp debrided, because the max facs on call allegedly refused to see the patient despite the repeated requests of A&E. I was called as they eyelids were swollen shut, and we took over. The patient remained in ICU for weeks.

I regularly get max facs shos asking for an ophth review in out of hours for orbital fractures, to exclude extraocular muscle entrapment. For your information, there is no value in an out of hours assessment in these cases, as a full orthoptic assessment needs to be carried out, which can only be done in working hours. The only justification for a review in such cases is if there is a risk of globe rupture, manifest by reduced vision, which A&E are capable of measuring.

However to generalise the conduct of a group of drs by very limited experiences, is unwise. I've been a registrar for some years now and have found max facs to be very helpful, in nearly all the trusts where I've worked.

[968]

BBYeah said:

Thanks again everyone. I really didn't expect such informative and helpfuly responses.

The ointment was: Golden Eye Antibiotic Ointment (Chloramphenicol)

It may just be the case that we should have gone in the daytime instead of at night, but work dictated that unfortunately. I have very little experience of healthcare and am just curious about the alternatives.

Golden eye ointment is fine to use for the eye. You are probably better off being seen during the day as eye depts tend to close out of hours in most hospitals and the on call dr goes home. Hence they only come back in sight threatening emergencies, which this may not have been.