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I keep hearing this, it feels like a campaign.
We know Gove wanted to privatise it, Duncan Donuts wants an insurance based system, Boris proposed charging for it.
It's almost as if the government wants to prove it's unworkable.
Here are some charts published in the FT a couple of weeks ago.
If Labour want to get elected, they could do worse than stick the NHS charts on a lot of 48 sheet posters and leave it at that.
The public spending charts do not suggest to me that Labour are feckless spenders. They do however suggest that a low tax objective must mean a government that is saying indirectly "we want to do as little for you as possible".
It's all very well leaving me with more money so that I can decide what I want to spend it on rather than government. But I can't pay for my own unpotholed roads, or hospital.
postimg.cc/gallery/T3DSCng
Last edited by: VxFan on Mon 23 Jan 23 at 10:28
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I'm not fully understanding the terminology but is it possible that the last two are the shape they are partly due to public investment shifting to private investment (which is then rented back?
Whatever, there is no doubt the NHS is in a very sorry state. I still subscribe to the theory that usage and expectation has exploded and needs to be addressed alongside the rest of the issues. I don't think they are all down to funding.
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The NHS black hole as far as spending is concerned. Medical treatement grows daily ever more expensive. THe populations is living longer and there is no financial restraint on demand.
The NHS as it presently exists will never be able to provide the service we would all like.
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>> The NHS black hole as far as spending is concerned. Medical treatement grows daily ever
>> more expensive.
Of course. You could spend as much as you liked. There has to be a limit.
>>there is no financial restraint on demand.
No deterrent to 'unnecessary' use, you mean? True.
>> The NHS as it presently exists will never be able to provide the service we
>> would all like.
Some people would call an ambulance for somebody to make them a cup of tea if they could. In fact some probably do.
But it could do a lot better than it currently does. And it doesn't mean we have to have a US style system which is even more expensive, in which there are massive inequalities in health care, and people go bankrupt paying for treatment.
The important point here is not that the NHS doesn't work, but they have not properly tried to make it work. Funding is part of that.
In perspective, in what context could Truss's and Kwarteng's overriding objective of having the lowest tax economy possibly have seemed reasonable? Only in a money worshipping cult.
Aren't the primary duties of government the defence of the realm and the welfare of the people?
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Why do ardent supporters of the NHS always cite US health care as if it is the only alternative system. There are many countries that gave better healthcare than the UK: France, Spain, Canada for example. The NHS model is over 70 years old. It needs a drastic overhaul. We are already seeing people reverting to private medicine in large numbers as the NHS is unable to provide the service they need. If we do nothing to reform the NHS we will end up with a US healthcare system by default.
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>> Why do ardent supporters of the NHS always cite US health care as if it
>> is the only alternative system. There are many countries that gave better healthcare than the
>> UK: France, Spain, Canada for example. The NHS model is over 70 years old. It
>> needs a drastic overhaul. We are already seeing people reverting to private medicine in large
>> numbers as the NHS is unable to provide the service they need. If we do
>> nothing to reform the NHS we will end up with a US healthcare system by
>> default.
I agree. It needs fixing, not destroying. I think it is fair to say it's under attack. Or maybe the government is just incompetent. Or both.
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The problems is That any proposed change to the NHS is painted as an attempt to destroy some sacred institution. Take Insurance for example. The French system which most would agree is better than ours is insurance based. Yet insurance based healthcare seems to be an anathema to the left.
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I think "insurance-based system" is used as shorthand for private insurance as in the US.
The French statutory, government run system is not very similar to the US AIUI.
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No it isn’t so why aren’t we considering it and looking at its virtues. Howevr any system which includes any element of direct payment, insured or not, is automatically rejected by those on the left. “Free at the point of use” is their mantra.
.
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>>automatically rejected
>> by those on the left. “Free at the point of use” is their mantra.
Is it? Not by me, although it's a tricky thing. People don't properly value "free" stuff and whilst some people will think "I don't need to put the NHS to time and trouble for a trivial ache when I can buy paracetamol myself", others don't care.
A doctor friend of mine (retired) who died recently started his GP career long ago with a partner who was in at the start of the NHS. He was told possibly apocryphal stories of patients who called the doctor out in the middle of the night for a complaint that had been troubling them for years. "If you've had this for years why have you called me out at night?" - "I know my rights!".
Even a small fee prompts a decision as to whether something is really necessary.
I think it would be worth trying to come up with a system that works without costing more than it raises, and without deterring the needy from seeking necessary help.
I have said before we should look hard at the French system. There's something very civilised about France, I think that whenever I go there.
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>>automatically rejected
>> by those on the left. "Free at the point of use" is their mantra.
Is it?
It certainly is
"Labour created the National Health Service – our proudest achievement, providing universal healthcare for all on the basis of need, free at the point of use.
labour.org.uk/manifesto-2017/healthcare-for-all/
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>> No it isn’t so why aren’t we considering it and looking at its virtues. Howevr
>> any system which includes any element of direct payment, insured or not, is automatically rejected
>> by those on the left. “Free at the point of use” is their mantra.
Free at the point of need/use was the principle on which the NHS was founded.
My Mother, born in 1926, remembered having to pay for the Doctor and that people struggled to do so. Literature from a similar age, Nevil Shute's 'Ruined City', refers to the Almoner chasing people for the cost of hospital care. Bevan's vision was to see that off once and for all.
Free at point of need remained the mantra of both parties throughout the era of consensus politics and beyond.
First of all we need to get the current system straight. Then we can look at whether a better funding model exists.
Trying to overlay (another) reform on the current system will only bring it further to its knees.
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"First of all we need to get the current system straight. Then we can look at whether a better funding model exists."
Can we sort out the present system without creating a sound funding model? The NHS has been inadequately funded for years.
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>>Insurances...
With a State regulated insurance service that would be fine.
However, in the UK I would imagine a free for all with people finding they suddenly weren't covered for their illness or when retired their premiums suddenly rocketed or it becomes postcode based - live in a poor area with health problems caused my pollution - pay more than a wealthy person in the 'burbs. Or they won't be covered for pre-existing conditions etc.
A flat rate per person earning above a certain amount a year may be an answer with the State subsidising the poorer members of society, but isn't that what NI is?
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No, NI is simply a tax like income tax. I haven’t paid NHS contributions for 14 years and am not a poorer member of society but am still entitled to free health care, providing the surgery ever answers the phone of course or the ambulance eventually turns up.
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>>is it possible that the last two are the shape they are partly due to public investment shifting to private investment
I would think that is hard to untangle. Labour did quite a bit of PFI of course. If you only had those last two charts, you'd want to see the first two on the same graphic so you see the sum of capital and expense spending. Those would suggest that Labour was very much mid-pack, whereas in the 90's the Conservatives weren't even in the pack.
It's weird though, I just showed these to a intelligent and educated friend whose comment was "but I still wouldn't vote Labour". Why? "I just have an aversion to all things red". She did say she wouldn't vote Conservative again, and to be fair the Lib Dem is less unlikely than Labour to change the result here in West Herts.
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The peer countries used in the graphs to prove an inadequate NHS include US (known high private health spend) + Sweden, Norway, Switzerland and Finland which together have less than half the population of UK.
Excluded are more obvious peers Italy and Spain for reasons best known to the FT. One might expect a peer group to include countries of similar, population, GDP per capita, demographics, size, public health provision policies!
The graphs are a fine example of selective statistics to prove a preconceived point. Whether a more balanced graphical demonstration using a more relevant group of peers would provoke different conclusions is uncertain.
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>The graphs are a fine example of selective statistics..
And how the use of a carefully chosen scale for each axis can give a false impression.
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I am against wholesale privatisation of the NHS but I have seen services that have been subcontracted out, set up with loans that have my recommendations on them.
There are private ambulance services that provide non-paramedic but first-aider based support where needed.
There are private ambulance services that provide a full paramedic service.
Renal clinics operating out of rented / leased offices or even units on industrial estates with nurses in attendance.
MRI imaging services operating out of leased offices - I'm still trying to figure out how they got the machine in, the building was up a good 10 years before the MRI machine went in and it's a big machine and small office building.
A cataract clinic was reviewed recently but we didn't do that one because the sums didn't quite add up - wanted to borrow too much without their own equity.
if they can do it cheaper and better then why not. But cheaper and not as well and we pull funding and go to the guarantors - or tell them to get alternative funding - these are all checked by the CQC or equivalent for that sector and if there isn't one we insist on getting independent checks - then we bill the client for them.
I lobbied and succeeded in getting a loan withdrawn from a huge private hire company proving taxis to hospitals in London and the South because they were charging in full for missed trips - not just the lost profit or cost element and there is a reputational risk to the bank. This un-earnt income was £millions.
I've chatted to the staff; paramedics and nurses and they all seemed happy. Some were doing the work as overtime, some because it provided more flexibility over hours than the NHS - e.g. renal care ran well in to the night and some nurses loved those shifts because they started after their partners got home to look after their young ones. They all liked the better pay.
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>>I am against wholesale privatisation of the NHS but I have seen services that have been subcontracted out
The boss had her cataracts done at a private firm, on the NHS. I wouldn't call it a hospital, more like an office block with an operating room in it. Results seem to be good. Her friend should have gone to the same place but there were complications caused by chemotherapy so she had to have it in Stoke Mandeville hospital.
I had a heart MRI at a private hospital run by an NHS hospital trust which sounds a bit strange. Technically I wasn't allowed the free coffee and biscuits but they let me have some.
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This seems a very sensible approach.
If the quality is at least as good, and the price lower, there needs to be a very clear reason not to support the private sector - possibly strategic in that it would reduce the capability of the NHS to an unsupportable level.
Failing to source the best value, be it private or public, simply because of an ideological barrier seems daft.
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>> The peer countries used in the graphs to prove an inadequate NHS include US (known
>> high private health spend) + Sweden, Norway, Switzerland and Finland which together have less than
>> half the population of UK.
Er... you seem to have missed some out?
>> The graphs are a fine example of selective statistics to prove a preconceived point.
Quite possibly. Most reports are written that way.
>>Whether
>> a more balanced graphical demonstration using a more relevant group of peers would provoke different conclusions is uncertain.
>> One might expect a peer group to include countries of similar, population, GDP per capita,
>> demographics, size, public health provision policies!
Such as Germany and France which are in there, you mean? You challenged the inclusion of 5 countries out of 11. You aren't by any chance being selective, are you?
I wondered how you would set about casting doubt. Thanks:)
I have no idea why Italy and Spain are missing. Availability of comparable historic data perhaps? I wish they had been in there too. Some numbers here suggest they spend less, which should give us hope that the NHS can be improved rather than destroyed - particularly Italy, which AFAIK has excellent healthcare free at the point of use at lower cost.
www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29
Last edited by: Manatee on Tue 3 Jan 23 at 14:02
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The basic premise of a skewed statistical argument still stands scrutiny even if the other countries were included - I could not be bothered to list them all.
The ONS report is pre covid but reinforces the view that (a) the UK spends about the median amount per capita in the OECD (38 developed countries excl. China and India), (b) below average in the G& - noting the US accounts for ~50% of G7 GDP and will distort heath spend statistic.
Other reports I have seen similarly put the UK around mid-pack compared to EU and other developed economies. Reports also note that the UK is better at some, and worse than others in different specialities - overall outcomes are fairly average.
My own take is that it is not lack of money causing the problems - although more money and more trained staff (takes time) would actually improve things. The real issue is about management and delivery of change.
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This all comes down to means testing. A subject everyone avoids, but is the only fair system.
Is this renewed bout of unsustainability and/or crisis different from all the others that occur every winter? The tales sound very similar to me.
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>> This all comes down to means testing. A subject everyone avoids, but is the only
>> fair system.
There's no fair way of means testing and if there was it wouldn't produce enough to make a difference.
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>> There's no fair way of means testing
And there ladies and gentlemen is the blind unthinking labour party doctrine at work. Not even prepared to consider it
Last edited by: VxFan on Tue 3 Jan 23 at 20:34
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>> And there ladies and gentlemen is the blind unthinking labour party doctrine at work. Not
>> even prepared to consider it
You said it was the only fair way. Bromp simply pointed out it's not fair, which is true. But it might be pragmatic.
Only he can tell us if he would consider it.
As far as I'm concerned it's established that welfare can't work without regard to means.
Last edited by: VxFan on Tue 3 Jan 23 at 20:34
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>> You said it was the only fair way. Bromp simply pointed out it's not fair,
>> which is true. But it might be pragmatic.
In what way is "those with some/the means to pay - pay some/all" compared to "those who cannot pay - dont" - unfair?
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>> And there ladies and gentlemen is the blind unthinking labour party doctrine at work. Not
>> even prepared to consider it
I spent three and a half years of my professional life focussed on means tested Universal Credit.
Believe me I've seen all its unfairness's and that's before those that Osborne added to please the Mail reading crowds.
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Someone once suggested, anyone choosing to use the NHS, should not be allowed to sue the NHS.
Is this enforceable?
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>> Someone once suggested, anyone choosing to use the NHS, should not be allowed to sue
>> the NHS.
>> Is this enforceable?
It certainly should not be.
What about a baby strangled by its cord due to failure to follow protocols?
Woman left with severe brain damage because an alarm tone was silenced and a Cardiac Arrest went undetected.
Promising doctor dies after straightforward surgery due to an anaesthetist's failure; his colleagues had repeatedly tried to blow the whistle but frustrated.
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>> It certainly should not be.
Why not. Surgery has its risks, which are pointed out to you when you sign the consent form. No sign no surgery.
The subject of criminal negligence is a matter for the police and pursued to the full as appropriate.
Last edited by: VxFan on Tue 3 Jan 23 at 20:34
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>> Why not. Surgery has its risks, which are pointed out to you when you sign
>> the consent form. No sign no surgery.
Sure there are risks, including death, with a GA. Treatments themselves may have varying prospects of success. Having one's hip screwed back together has better prospect of success than, say, a procedure for Pancreatic Cancer.
>> The subject of criminal negligence is a matter for the police and pursued to the
>> full as appropriate.
There's a helluva gap between professional and criminal negligence. You wouldn't want to fall down it....
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>> The subject of criminal negligence is a matter for the police and pursued to the
>> full as appropriate.
>>
Surgery has risks but there is a difference between risk and negligence and not all negligence is criminal - you may have thought you counted out all of the swabs, but one was missed etc. because it was covered in blood and not seen. That's a mistake but not criminal and it's negligent so rightly a claim. We do pay for the NHS after all. There are an awful lot of cameras in surgery to help catch errors.
Miss Z spent over 16 hours in surgery on a shift that over-ran a few weeks back. Emergency after emergency and no cover capacity. Mistakes happen but there are a lot of staff to take over. She is insured and the BMA is her "union".
A couple of years ago she came home fuming. There was a very sick patient who had a kidney operation. The patient was getting very ill very quickly. She thought it was the unthinkable and turned out to be correct - that the surgery team had left the old dead kidney in and it had gone septic. Her consultant had gone off to bed and was called back in and Miss Z prepped the patient and luckily saved their life. Rather than a few days in hospital they were there for weeks. IMHO there was a valid claim against the hospital.
The same goes with the fire service - you can sue them for negligence when they fail to fight a fire appropriately: www.lgcplus.com/archive/court-rules-on-fire-brigade-civil-liability-21-03-1997
Last edited by: VxFan on Tue 3 Jan 23 at 20:34
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"It certainly should not be."
Well lets look at the example
"Woman left with severe brain damage because an alarm tone was silenced and a Cardiac Arrest went undetected. "
The court would no doubt have awarded her very large sum of money.
Now consider a similar case where the allarm was detected but the woman suffered the same brain damage. Nobody was negligent. She gets nothing.
Same injuries very different outcome for the poor women in question
Is that a fair and sensible system? would not a no fault compensation system be more equitable?
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If you are damaged you can claim damages, if there has been negligence. If nobody has been negligent, then it's an accident.
That's the legal basis AIUI.
The 'accident', the uncertainty around procedures, is the risk you are warned about beforehand and that you sign up to. But you don't sign up to negligence.
Perhaps worth looking at the numbers. The results might be surprising.
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If you are damaged you can claim damages, if there has been negligence. If nobody has been negligent, then it's an accident.
Yes but is it reasonable? Does not somebody suffering brain damage for example need financial assistance whether negligence was involve or not. Giving millions to one and nothng to another is not a very sensible system for providing for two identical outcomes.
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>> The court would no doubt have awarded her very large sum of money.
I was professionally involved in such a case. Compensation was well over a million thirty years ago.
>> Now consider a similar case where the allarm was detected but the woman suffered the
>> same brain damage. Nobody was negligent. She gets nothing.
>>
>> Same injuries very different outcome for the poor women in question
>>
>> Is that a fair and sensible system? would not a no fault compensation system be
>> more equitable?
Of course no fault compensation would produce a different outcome. There's zero political will.
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>> Someone once suggested, anyone choosing to use the NHS, should not be allowed to sue
>> the NHS.
>> Is this enforceable?
The NHS pays out between £2bn and £3bn (billion) per year in negligence claims. I imagine much of that is for future care requirements.
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>> The NHS pays out between £2bn and £3bn (billion) per year in negligence claims. I
>> imagine much of that is for future care requirements.
Yep. Even the largest of loss of earnings claims is likely to be dwarfed by future care.
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>>£2bn and £3bn .... for future care requirements...
Calculated at the official interested rate of 8% which up until recently has not been achievable since the mid '00s and therefore payments were not as high as they should have equitably been.
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Means testing for healthcare is a crock - 90% of healthcare is provided to the retired, the out-of-work, or the too-young-to-earn.
It's just another inefficient stealth tax, like prescription charges and student loans ;-)
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Yesterday and today, Miss Z is "on call" that is providing care all over the hospital and not her normal ward / specialism and is usually emergency based care, transfers from A&E, crashes etc.
She says that there are no beds on wards at the moment (this is one of the ten largest hospitals in the UK) and every patient she saw yesterday and so far today was in a corridor.
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Doesn't everything circle back to a growing sedentary elderly population in a country with weak emissions controls and poor diet, coupled with totally inadequate social care so the said fragile people are clogging up hospital beds?
The failing social care is a direct result of continuous budget cuts by local authorities coupled with lack of staff - partly due to poor pay and conditions, partly due to Brexit.
Double the pay in the social care sector; grant automatic visas for Europeans coming to work there and offer a generous golden hello and the situation might change.
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>> The failing social care is a direct result of continuous budget cuts by local authorities
>> coupled with lack of staff - partly due to poor pay and conditions, partly due
>> to Brexit.
And the cuts are not a choice; they reflect reductions in government grant.
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>> Doesn't everything circle back to a growing sedentary elderly population in a country with weak
>> emissions controls and poor diet, coupled with totally inadequate social care so the said fragile
>> people are clogging up hospital beds?
Well, I think that is at least, part of it.
However, here in leafy Surrey, you can't - for all practical purpose - see your GP. Therefore if you think your ailment is sufficciently serious to warrant to being seen by a doctor you have to go to A & E. Therefore A & E is choc a bloc, therefore ambulances can't unload their patients.
Get the GPs back to work. What are they doing all day?
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>> Get the GPs back to work. What are they doing all day?
I suspect that the GPs are overloaded by the same segment of the population as the hospitals....
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It would be interesting to know how many people who visit their GP or turn up at A & E really need to be there. My impression is that a large proportion don’t. I think we are becoming a nation of hypochondriacs who believe there is a medical cure for every minor ailment.
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>..a nation of hypochondriacs who believe there is a medical cure for every minor ailment.
Is there any treatment for that?
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>> >..a nation of hypochondriacs who believe there is a medical cure for every minor ailment.
>>
>> Is there any treatment for that?
>>
If there isn't one, there should be!
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>> Is there any treatment for that?
>>
... prescription placebos (chargeable, of course)
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Republic of Ireland, 50 euros to visit the GP, one hundred for a visit to A&E.
Of course with safeguards to protect those below a certain income. Ireland are several places above the UK in any table I've seen regarding healthcare throughout the world.
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Lygonos, was having a family discussion about free prescriptions in Scotland and how much could we put back into the NHS if we were charging. You got any thoughts on it?
I seem to remember at the time there being an argument that the prescription process was so labour intensive that it didn’t come as a huge cost to just give blanket free prescriptions? Especially based on the number of free scripts that were already in use.
And although I’m on the side of “If you can afford to pay for the prescription you should do” I also realise that healthcare is free for all regardless of income at hospitals. But I do wonder if the physical number of prescriptions had increased significantly as folk aren’t paying for them so maybe less inclined to only get what’s definitely needed?
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Yup - big bureaucratic mess to take a fee for about 10% of prescriptions - inefficient waste.
Is more efficient to use general taxation to pay for the NHS.
Or you can charge the wealthy so they pay both for their own healthcare AND those who don't pay.
Smoke and mirrors.
And a very large problem just now is that we have had 25 years of hospital bed shrinkage as a result of shorter stays and more daycase surgery.
The fools in charge completely failed to take into account the growing elderly multimorbid population and had also no recollection that pandemics tended to occur every 15yrs or so.
Bedblocking is not a new phenomenon - it was a major issue in the 90s when I qualified.
What was sown is now being reaped.
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>> Yup - big bureaucratic mess to take a fee for about 10% of prescriptions -
>> inefficient waste.
>>
>> Is more efficient to use general taxation to pay for the NHS.
My daughter's father in law a recently retired GP in Wales makes exactly the same point.
Not just taking the fee but chasing those alleged to have failed to pay. Clients presenting with a penalty notice from the NHS Business Services Authority alleging that items should have been paid for is a regular thing when doing general advice.
The manifold options on the back of the prescription form are almost set up to bamboozle those who are neither overly literate or overly worldly. I had one cam to me at a drop in pursued for saying she was on means tested ESA. In fact, following a change, she'd had to move to Universal Credit but still got the same money. Been on ESA for years and there was actually NO BOX on the form for Universal Credit.
Sorted in five minutes but she'd struggled to get past first base; press 1 for this. 2 for that etc.
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>>NHS Business Services Authority
I can't recall the newspaper source but there was an article recently about a pregnant woman who claimed a free prescription only to be fined by the NBSA. Pregnant women are allowed free prescriptions.
Unfortunately the mid-wife had not registered the correct documents so the pregnant woman wasn't recorded as being pregnant.
The NBSA refuses to budge as they cannot backdate the registration - catch 22 and the poor woman has to pay the fine. An injustice!
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"is more efficient to use general taxation to pay for the NHS."
What's not payed for isn't valued. Huge amounts of drugs are wasted by those who don't pay for them at the moment - estimated waste is £300 million per year.
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>> What's not payed for isn't valued. Huge amounts of drugs are wasted by those who
>> don't pay for them at the moment - estimated waste is £300 million per year.
There's no doubt that huge quantities of drugs go to waste from courses that are not finished. Just found some penicillin from when I had a dose of sinusitis in the spring. Free as I'm over 60.
Is there any evidence that people who pay for their prescriptions are more careful about not wasting them?
There is anecdotal (at least) evidence that people obliged to pay all but £10/item are limiting them selves to those perceived to matter most. The earnings limit at which people on Universal Credit cease to get free prescriptions is set cruelly low.
Knowledge and promotion of the prepayment 'season ticket' is appallingly low. I had one before 60 as, with a regular monthly prescription, I only needed the odd couple of extras for antibiotics or a recurrence of back pain and I was winning.
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"And although I'm on the side of "If you can afford to pay for the prescription you should do" I also realise that healthcare is free for all regardless of income at hospitals. But I do wonder if the physical number of prescriptions had increased significantly as folk aren't paying for them so maybe less inclined to only get what's definitely needed?"
Same in Wales. I mentioned this to someone I know in the business and her response was that it would cost more to administer that it would gain.
I listened to one of BBC's one minute podcast this morning. It covered "s*** lives" (BBC's words not mine) and how they impact on health. We had a client in at the Foodbank this morning who fitted exactly into this catagory. Declining physical and mental health brought on by loss of self worth following loss of work and dependent on benefits for the first time ever. It is really s***
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"The Rest is Politics" podcast dropped this morning and most of the first half is discussion on the NHS between Campbell A. & Stewart R. More conversation than analysis but interesting.
Not just about money. Reform also needed, which is where political difficulties arise. Add in that policy should ideally be cross-party so that a subsequent government doesn't undo everything, and it becomes very difficult indeed.
shows.acast.com/the-rest-is-politics
"The News Agents" have also had a go at it.
podcasts.google.com/search/the%20news%20agents
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"Campbell A. & Stewart R. More conversation than analysis but interesting."
There was a consensus between the two of them that we should at least be looking at some sort of Insurance based system like the French have.
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The NHS issues ~1bn prescriptions each year, of which 10% are paid for and 90% free.
The price of a prescription is currently ~£9. The income from prescription charges could be as much as £900m - although i suspect that the real number is somewhat lower due to "season tickets" which discount the cost for medium and higher regular users.
How much it costs to administer is anybody's guess - we need a consensual rational debate of cost vs complexity vs distraction vs moral/ethical etc. Sadly it is yet another part of healthcare where dogma and politics trump rules.
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>>How much does it cost to administer....
I'm sorry that I bring up examples from work but that's the way my mind works...
We lend to Pharmacies, I am not a specialist in this area though I understand that it works like this:
The Pharmacies buy medicines from wholesalers / suppliers at the normal cost. Some will be expensive, some will be cheap.
They invoice the NHS for the cost of medicines dispensed and take off the money collected from prescription charges.
They then send the prescriptions with the self - certification on the rear to the NHS for processing.
Some small pharmacies don't have the cashflow to purchase some very expensive medicines and that where our funding packages help.
There was a very big fraud against the NHS by a wholesaler who made emollients for pharmacies and charged the pharmacies £thousands. The pharmacies passed the £thousands bill to the NHS. The wholesaler then gave the pharmacy a credit note for £hundreds back: Something like this: Medicine: £1,000, credit note £900, charge to NHS £1,000, cost to pharmacy £100. Cost to make ointment £20.
The bank actually withdrew lending & recalled loans almost immediately effectively shutting down the £100m business overnight. A multinational buyer subsequently purchased the business. I suspect the similar goes on with other companies.
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My wife who is older than me and over sixty can't believe that she gets free prescriptions while still working, as do many of her working friends.
Why not just increase the age limit... run it along the same lines as your national pension age.
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>> My wife who is older than me and over sixty can't believe that she gets
>> free prescriptions while still working, as do many of her working friends.
>>
>> Why not just increase the age limit... run it along the same lines as your
>> national pension age.
>>
>>
>>
Because they are a group more likely to vote.
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>> Why not just increase the age limit... run it along the same lines as your
>> national pension age.
There was a consultation on doing just that in 2021.
tinyurl.com/5n78yzj3 (gov website with long url)
Don't know what happened next but, as already observed, the over sixties vote.....
Last edited by: Bromptonaut on Thu 5 Jan 23 at 09:09
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A bit cynical, but it sort of demonstrates the point I've previously made- everyone wants a better service but people aren't prepared to pay for it.
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While we are on the subject of health, please have a care for your own…
en.m.wikipedia.org/wiki/Doomscrolling
;-)
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>> I wonder if convalescent homes will come back?
Wales did that sort of thing during the pandemic. What England called Nightingale hospitals they called Rainbow Hospitals and used them for patients notionally fit for discharge but awaiting a proper Social Care Assessment.
One of them was a leisure centre or similar in Connah's Quay near my daughter's place. Her father in law, a retired GP, was doing some work in the wards there.
Last edited by: Bromptonaut on Thu 5 Jan 23 at 17:38
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Regardless of affiliation, I wouldn't call that stumped. It takes two sides to agree. What was he supposed to say?
The government isn't negotiating.
Personally I'd be looking at linking mediation (not arbitration) to the right to strike for critical public services. Until I saw a good mediator in action I wouldn't have believed what could have been, and was, achieved.
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Well, he can't afford to upset the nurses, can he?
He's going to need their help to get those splinters out of his 'arris when he eventually gets off that fence.
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. What
>> was he supposed to say?
An answer, rather than waffle, might have been nice.
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A few news sources are carrying this in different levels of depth...
www.thesun.co.uk/health/20989169/brits-charged-modest-sum-gp-nhs/
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Too obvious and sensible to be discussed or even considered and will be autumatically rejected out of hand by both Labour and Conervatives.
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Will be a pointless stealth tax - the vast majority of my patients will be exempt from any charges due to age, disability, or being on benefits.
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The French seem to manage to make such a partly insurance based system work and they have a pretty good healthcare system, some say the best in the world. Surely worth investigating instead of automatically being rejected out of hand. The illusion that our model is the only one possible and must never be changed guarantees existing funding problems will continue forever.
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>> Will be a pointless stealth tax - the vast majority of my patients will be
>> exempt from any charges due to age, disability, or being on benefits.
Well thats the fix init. Make a charge for services, those that cant afford it, dont get it, maybe die, and save the NHS a fortune.
To be serious, Every other country in the world makes it work BY CHARGING PATIENTS.
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Trouble is they'll either just sub it out to private capital who will design it to make money, or invent something that turns out to cost twice as much and or takes decades to sort out.
What they need to do is look at something's Ng that works for patients and copy it.
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> What they need to do is look at something's Ng that works for patients and
>> copy it.
>>
Ng?
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>> > What they need to do is look at something's Ng that works for patients
>> and
>> >> copy it.
>> >>
>>
>> Ng?
>>
I think that typed itself. I meant look at France, Spain, Italy etc, pick the best, copy with minimal mods and then it should at least work
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>> To be serious, Every other country in the world makes it work BY CHARGING PATIENTS.
Is that an actual fact?
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Most countries with a successful healthcare systems are mainly funded out of taxation with a contribution from the individual, usually covered by some form of insurance. Not aware of any other that has our “free at the point of use” system.
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If you think the NHS delivering healthcare in the way Dentists provide dentistry will save you money, I can recommend a good psychiatrist.
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Not so much about dentists charging, but is it impossible to learn from other countries and have a better system, or is the NHS model the best and only system we can have?
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It is the refusal to even look at how other healthcare systems are funded and administered that I find odd. There are other systems that are arguably superior to our own that surely should be examined. That a system designed in 1947 in a very different world should be the the only way forward in the twenty first century seems unlikely to say the least
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>> If you think the NHS delivering healthcare in the way Dentists provide dentistry will save
>> you money, I can recommend a good psychiatrist.
No one said it would save money, clearly it wont, but sooner or later its going to have to be accepted that you pay to get it.
How you pay is the bit thats up for debate.
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Pretty sure Denmark has a version of free healthcare to all of their citizens that comes out of general taxation only.
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>> Pretty sure Denmark has a version of free healthcare to all of their citizens that
>> comes out of general taxation only.
Its backed up by personal medical insurance for some services
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General Practice "costs" each person in the UK ~£12/mth
(A practice of ~7000 patients will receive funding of ~£1m)
This is something like 7% of the NHS budget.
The GP contract, however, doesn't work well for patients: that practice of 7000 patients gets the same total funding if it has 3 GPs or 5 GPs.
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>> General Practice "costs" each person in the UK ~£12/mth
I'll use that the next time I try and get past the obstructive gatekeeper harridan AKA surgery receptionist.
"I DEMAND MY 12 QUIDS WORTH THIS MONTH"
Last edited by: Zero on Tue 10 Jan 23 at 11:48
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>>"I DEMAND MY 12 QUIDS WORTH THIS MONTH"
You'll get 1 minute with Dr Smith, or about 40 seconds with Dr Copp.....
www.gpplus.com/fees/
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>>
>> >>"I DEMAND MY 12 QUIDS WORTH THIS MONTH"
>>
>> You'll get 1 minute with Dr Smith, or about 40 seconds with Dr Copp.....
Which is about what I get now on the phone.
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...but Mr Z, you've already used up your allowance to 2029...
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I have a second cousin who is a GP in France (great lad).
I think he mentioned that consultations are €25 and an amazing number of old biddies come in just for a chat.
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I wonder what the true cost of health insurance is?
I am covered by work and it costs them £35 a month with Bupa (according to my P11D) for elective surgery and lots of things are covered. The Mrs I have to pay a further £35 a month for.
I have a horrible feeling that if it was compulsory the costs would be higher than this - companies like to profit from individuals whereas big banks have bargaining power.
Re a compulsory insurance scheme...
Would any insurance cover previous injuries or illnesses? Would it be possible for some people to be refused insurance?
I also dread to think what the cost of cover would be when I get old(er).
If it's anything like the cost of pet insurance then it would be about £80 a month for "lifetime" cover but I think you have to stay with the same insurer and are hostage to their price rises.
Here's a talking point (that I don't subscribe to, just a thought):
Every one has to have insurance to get treatment - no insurance no treatment - no exception.
Insurance is fixed at £50 a month. Those on benefits get the £50 added to their benefit.
You can chose to pay it or not. Those not get a tax reduction to cover the cost.
It would be interesting to see the take up and the potential increased death rate - perhaps generating a real saving?
Last edited by: zippy on Mon 9 Jan 23 at 23:30
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NHS England budget for 2023 is just over £160bn. On that basis the cost per head is way above £50 a month, maybe £200 a month more? If it were entirely to be covered by insurance, with a profit element, it’s even more. I am not saying it can’t be done but if it was a flat rate, the young healthy would be overpaying. If it were age related then many elderly people would be unable to meet the cost. It’s Poll Tax Mk 2?
Your Bupa cover cost reflects the lower risk of white collar workers on good salaries and with an average age of, say 45 years, will be the healthiest group on average. I know my work scheme (for a FTSE 100 company) was based on actual costs for the previous year so was not very expensive.
I think an element of insurance can work but it will not be easy. It seems to work on dental work, if you can afford it. We pay nearly £40 each a month. This is a lot but much less than full health cover.
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>> It would be interesting to see the take up and the potential increased death rate
>> - perhaps generating a real saving?
Compulsory health insurance is fairly common i believe in several countries in Europe. Very difficult to bring in here though.
Last edited by: VxFan on Tue 10 Jan 23 at 11:12
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Personal schemes are heavily age dependant. Until the age of 50 average NHS health care costs are ~£2k pa. They rise to about £4k by age 60, growing to around £10k by age 85.
The major costs of healthcare occur unsurprisingly in the few years before death.
Company schemes will often average out the cost of the cover across employees covered. This may typically cover those aged 25-65, and in larger schemes reflect an average illness risk.
So if you are a 40 year old with no health problems premiums may be low and it may be affordable and sensible if (say) self employed to get treatment quickly.
If you are 65 with a few past issue it will be unaffordable for most with any kind of negative history - and you need a lawyer to read the small print to dig out all the exclusions.
Best option is to simply accept as one ages that you pay for treatment as and when required - if you can afford it.
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Just off the phone to Miss Z.
Her on-call shift was supposed to finish at 18:30. She has just left.
The reason she stayed late was because there were people seriously ill and not enough doctors. She did 4 operations "alone" today. Normally there is support from other surgeons. They were all tied up, so her, the anaesthetist and theatre nurses only.
She is a real advocate for the NHS and her comment tonight was that it's not failing, it's failed.
Whilst she was in theatre, in one of the corridors, a patient crashed and was not seen by a doctor for over half an hour and there was only one trained nurse to try and resuscitate them. They didn't survive.
Very sick patients have not been seen. She has been on call over the weekend, so this is day 4, with all days being over-hours and she's exhausted. She has officially noted the lack of resources and that she is to tired to see any more patients safely today. She has officially handed them over and done what she needs to do to cover herself legally, but the reality is that for some, they won't be seen until it's too late to do anything for them. The Trust won't / can't provide any more staff.
A colleague told her that he has applied for a position in Australia. He says he has been promised significantly better terms and less hours. (I don't know what the reality is.)
Last edited by: zippy on Tue 10 Jan 23 at 22:32
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>>A colleague told her that he has applied for a position in Australia. He says he has been promised significantly better terms and less hours. (I don't know what the reality is.)
That is the reality.
Have a colleague who moved to Perth, Oz about 10 years ago - earns about 50% more than me, sees marginally less patients, and does zero house calls.
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>>.. and does zero house calls.
>>
>>
What are these "h o u s e c a l l s" you speak of, kind sir from a strange land? :-)
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>> Have a colleague who moved to Perth, Oz about 10 years ago - earns about
>> 50% more than me, sees marginally less patients, and does zero house calls.
Pray, what is this strange "see patients" of which you speak?
I am in my late 80s. Not surprisingly, I have a number of health problems, with new conditions popping up from time to time.
A couple of weeks ago, I had a problem with my feet. They got me to photo the feet, but because I didn't know how to upload (or summat) the image, I took my phone into the surgery. The staff in reception showed me what to do, while presumably the doctor was sitting ten feet away the other side of the wall reading the BMJ.
I haven't seen my GP for over three years. I have seen other medical professionals, but not my GP.
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>> I haven't seen my GP for over three years. I have seen other medical professionals,
>> but not my GP.
>>
The trick is to agree to see the trainee GP. I had a great visit about 18 months ago with one and because they are worried about missing something, you get a thorough prodding.
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>> Have a colleague who moved to Perth, Oz about 10 years ago - earns about
>> 50% more than me,
He'll need it. My cousin from Perth came over for Christmas, Her tales of price inflation and her shock at how low the food prices were (In Waitrose of all places) surprised me.
She came over because she said she couldn't face another another 42c+ Christmas. (and she is a born and bred West Australian)
So think carefully about joining your cousin. Not that the loss of a another GP would matter, what we dont get to see we wont miss.
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He'll need it. My cousin from Perth came over for Christmas, Her tales of price
>> inflation and her shock at how low the food prices were (In Waitrose of all
>> places) surprised me.
Indeed I remember those home or away shows, they used to compare food prices 50-100% more on fresh and dried food was pretty normal.
I know a couple that have been posted to the US, eating out 'tourist' style is cheap, fresh food expensive. They got 3 figures extra a month to help cover maintain/cover the extra costs of living there.
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> A colleague told her that he has applied for a position in Australia. He says
>> he has been promised significantly better terms and less hours. (I don't know what the
>> reality is.)
>>
Many in Australia have private health insurance, this helps lift wages. But then few in this country would want that and even fewer working in the nhs.
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The grass is always greener. Google "australia health waiting list". Limit search to last year.
They have precisely the same problems the UK and most of the developed world has - without delving into statistical detail it may be a case of "we've got it worse".
I have been the unexpected beneficiary of the skill and commitment of NHS staff over the last 5 days.
111 call got doctor call back in 1hr. Told to go to A&E (no ambulance queues). Triaged A&E within 30 mins. Bed, blood test, CT scan, doctor in A&E. Moved to bed on surgical assessment unit in 4 hours later. Hopefully home this morning.
Perhaps I just very lucky but leaping on a media bandwagon is a little like helping the school bully kick his victim.
I believe the military have a way of expressing things - "failing to plan is planning to fail".
Most (not all) deficiencies have their roots in staff planning, capacity planning, onerous contract commitments, medical training, strategy implementation etc.
The 3000 + staff at the DHSC should face far more public scrutiny in their management of public health services. They are the "professionals" and "experts" upon which all governments rely in formulating effective strategies and they have failed.
Last edited by: Terry on Wed 11 Jan 23 at 08:09
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We recently had two of our experienced theatre staff (plus family) emigrate to New Zealand.... all expenses paid, hotel until they found a house then subsidised rental on a long-term property, no on-calls plus major change of life-style as both are young and outdoor types.
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I have no interest in going to the Antipodes - at 51 I have already started drawing my pension while continuing to work 6 sessions/week.
The GP contract is not fit for purpose: it encourages as few GPs as possible to have as big a list size as possible.
The ultimate iteration becomes a few partners in charge of loads of salaried doctors and noctors.
This is well underway in England and is creeping into Scotland.
As long as all the money 'follows' the patient you'll have a service that looks to cut doctor numbers as much as they can.
When a 9 partner practice gets the same income as a 4 partner practice of the same size, where is the incentive to take on another partner?
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How could the contract be written better?
Last edited by: sooty123 on Wed 11 Jan 23 at 09:49
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>>How could the contract be written better?
Some money needs to follow the GP.
Not a salaried service as that will be less efficient.
Eg. Practice income = (List size x £xx.xx) + (GP partner sessions provided x £yy.yy)
Other fudge factors are already part of the sum - a patient is 'worth' more if they are very young/old or from a deprived postcode.
In Scotland the number of whole time GPs over the past 15 years has dropped very slightly. This is despite a small amount of population growth, a greater proportion of elderly patients, and a much higher level of multimorbidity.
I suspect in England the situation is similar or worse.
Consultant numbers on the other hand are something like 50-70% higher than 15 years ago. I want to know WTF they're doing :-)
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>> Consultant numbers on the other hand are something like 50-70% higher than 15 years ago.
>> I want to know WTF they're doing :-)
Mixing their NHS "wage" with private practise for a start.
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Thanks for the explanation.
>>
>> Not a salaried service as that will be less efficient.
How so?
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>>emigrate to New Zealand
When Miss Z was doing a stint for her degree Auckland she was given the hard sell re going there after she qualified and still gets emails and letters from them encouraging interest.
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It’s a flipping long way from anywhere else. Apart from penguin land. Friends have emigrated to both Oz and NZ. Both returned within 10 years…missed the variety of holidays available in Europe.
would apply to me…I’ve been fortunate enough to visit both.. great holidays. Couldn’t live there.
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>> It’s a flipping long way from anywhere else. Apart from penguin land.
So true!
Miss Z was very lucky to get an AirBNB room in a professional family’s home. A kids room as the kids had grown up and moved on.
Owners treated her like a daughter, including day trips. They still chat on social media.
The AirBNB was in the same ball park cost wise as a budget hostel so I was well happy and seeing photos of the house, it was luxurious.
I did get the odd call at silly o’clock from Miss Z, including on one occasion where she forgot the combination for the front door and didn’t want to wake the hosts up! Only for the host to answer the door saying they were up to make sure she got home OK from a night out!
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The only friend of mine who emigrated beyond European shores went to Canada...Quebec. Loved it there, winter sports, summer back packing.
Far easier to visit family in the UK than being in the Antipodes
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Going well in France too.
www.bbc.com/news/world-europe-64216269
Appears a similar tale across the continent.
Last edited by: Lygonos on Wed 11 Jan 23 at 20:00
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I meant to say my only friend who emigrated beyond Europe, and continued to live and work there ....my Oz and NZ immigrant friends eventually fell out of love with their new countries of residence. To be fair, it took several years.
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People that leave then return can often find themselves a bit being in both camps. You end up feeling a bit anchorless, depends how important a sense of 'belonging' is.
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I knew a couple who took their Railway pensions early, sold up from somewhere in the Midlands area and moved out to France, near Le Mans, as both were (amongst other things) motor racing fans. They had a modest sized but lovely place with a bit of land.
I was told it was a one way move as they couldn't afford the prices back home.
Very sadly, a few years after moving out there she was involved in a quite serious road accident and eventually passed on. I believe he had to stay out there but it certainly didn't go to plan.
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You need to know and love the culture, people and lifestyle of the region you want to emigrate to, let alone the country.
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Spent last 20minutes on phone to a 'Quality Support Disability Assessor' chasing a DS1500 medical report. That's the one used where there is a terminal diagnosis giving access to fast tracked benefits under so called Special Rules. Looks as though they'd not retained a copy.
Email sig says they're working for Crapita.
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Is there any reason not to expect Capita to "do a Carillion"?
Do they have partners of ministers on the Board or summat?
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>>Capita...
Known as Crapita at work.
I really don't like them.
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Apparently there are a couple of military doctors at the hospital today. In normal scrubs but you can tell by their shoes!
One F2 level and one SHO level.
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Usual rubbish. Voters are not demanding more without paying for it. We all know it's taxpayer funded.
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I don't think the article mentioned that, it was about extra taxes to pay for more.
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>> Apparently there are a couple of military doctors at the hospital today. In normal scrubs
>> but you can tell by their shoes!
>>
>> One F2 level and one SHO level.
My colon surgery was done by a lieutenant colonel in the RAMC, had just done a tour in Afghanistan, fixing/stabilising shrapnel injuries.
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>> Frimley Park?
Thats where he was based.
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Military surgeons?
en.wikipedia.org/wiki/Rick_Jolly
If you were mince & chunks this was the guy you wanted to see you in the Operating Theatre.
"Before visiting Argentina in 1998, Jolly had sent ahead a list of Argentine casualties and asked the authorities there what had become of them. As a result, the Argentine Foreign Ministry discovered the truth about the battlefield medical care of their wounded by the British during the conflict and invited over 50 of them to a ceremony in Buenos Aires, where Jolly was appointed as an Oficial (Officer) in the Order of May in recognition of his outstanding work in saving the lives of many wounded Argentine soldiers and airmen.
As it was a foreign decoration, Jolly had to write to the Queen for permission to wear his Order of May award with his other medals, to which she personally responded by authorising him to wear the award "on all occasions" on behalf of the 300 British Naval, Royal Marines and Army medics involved in the war. The Argentinian award made Jolly the only serviceman to have been decorated by both sides after the conflict."
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news.sky.com/story/if-you-dont-reform-the-nhs-i-fear-it-will-die-sir-keir-starmer-pledges-overhaul-of-gp-services-12787219
Looks like starmer, if he wins the next election, will be butting heads with GPs.
Last edited by: sooty123 on Sun 15 Jan 23 at 15:27
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>> news.sky.com/story/if-you-dont-reform-the-nhs-i-fear-it-will-die-sir-keir-starmer-pledges-overhaul-of-gp-services-12787219
>>
>> Looks like starmer, if he wins the next election, will be butting heads with GPs.
It will be interesting to see how that, ie moving away from the post war model of GPs as self employed contractors, plays out.
There are some reports that younger doctors are less wedded to the idea of partnership with the associated cost of buying in. Instead the practice employs them on a salary. Our local practice now has only three partners; used to be more like five.
If the reform limits itself to buying out retiring GPs rather than some sort of Nationalisation and the buyout offers are worth good money and are less hassle than getting in new equity he might have less of a battle than some suggest.
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he said he would phase in a new system as existing GPs retire, replacing their contracts with direct NHS employment for new practitioners,
The report doesn't say what, if anything, he'd do about those GPs working in partner practice already. Just what they'd do with newly qualified.
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It's a shame - I thought Starmer was quite bright but his lackey Streeting is just a Tory scumbag in a red jersey :-)
Salaried GP service will mean huge areas devoid of any GPs (worse than now).
And the fantasy of patients self-referring to specialists - aye let's see the hospitals cope with that.
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>> Salaried GP service will mean huge areas devoid of any GPs (worse than now).
>>
>>
Wages too low?
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Not necessarily, but given the choice does someone work in "a nice town" or "a poo hole" for the same money?
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Well it would be nice to get access to a doctor in my "nice" town.
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>>Well it would be nice to get access to a doctor in my "nice" town.
I don't doubt it Zero - General Practice has been all but ignored while HMG fanny about trying to make hospitals work.
The contract effectively incentivises poor provision of less doctors and more noctors, for even bigger populations.
Lots of evidence showing that people with regular GPs over a number of years have better health outcomes than those who have "whoever is available".
Last edited by: Lygonos on Sun 15 Jan 23 at 18:36
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>> Well it would be nice to get access to a doctor in my "nice" town.
>>
My feeling is that the quicker the doctor fits you in, the more worried you need to be. It's when the GP calls you back and says "can you make it in this afternoon?" that you need to be worried. :-(
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Even worse when he says you may not make it to this afternoon!! :-)
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>> Not necessarily, but given the choice does someone work in "a nice town" or "a
>> poo hole" for the same money?
>>
They could give an add on to wages if dealing in a deprived area. Perhaps they'll be sent wherever and new GPs won't know any different.
Many salaried employees have the same issues of no extra money for working in a poo hole such as teachers and salaried members of the NHS etc. But seem to function, perhaps the case with GPs will turn out to be different or not. If labour win i suppose we'll find out.
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There aren't enough GPs.
Salaried doctors do less work than partners and have less responsibility. They are off sick more often.
Trying to manage 50-100 practices from a Board level rather than locally is going to need an ass-ton of new managers.
Our Health Board has about 3 staff in charge of administering 55 odd practices: each practice has its own management team already.
Who is going to be the line manager for all of these salaried doctors? Who is going to make decisions about the level of service provision for each town?
I will tell you now it will be an Orwellian disaster.
Much like Hospital management is right now.
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There aren't enough GPs
Shortage of training places or people coming forward to do it?
> Salaried doctors do less work than partners and have less responsibility.
I assume the pay reflects this.
: each> practice has its own management team already.
I'd guess they wouldn't be needed and they'd be some of duplication removed due to centralisation. I bit like councils running schools before they went to academies. They now have more management at lower levels, similar to GPs now i guess.
Who is going to make decisions about the level of service provision for each town?
If i had to guess whatever CCG/CB are called now.
I don't know if I'm mistaken, but wasn't there a role out of NHS salaried GPs in walk in centres? Maybe 10+ years ago, they seemed to disappear a few years after. I can't remember the ins and outs of it.
Last edited by: sooty123 on Sun 15 Jan 23 at 19:25
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>>Shortage of training places or people coming forward to do it?
-Early retirement.
-Established GPs reducing the sessions they work (especially those who had worked full-time when younger, typically men). Pension limits aggravate this.
-New GPs are much more likely to be part-time from the start (75% are women, many of whom have young families).
-Many Unis/Medical Schools are still either actively or passively discouraging students to aim for General Practice.
None of this is new information to HMG/SG, yet they have failed to act and we all suffer from crappy GP provision in many areas.
www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis
English data above:
Sept 2015: 1923 patients per FTE qualified GP (total 7623 practices)
Sept 2022: 2272 patients per FTE qualified GP (total 6429 practices)
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I wonder how much the government could do on retention, it's a tricky business. You don't want to pay unaffordable amounts but not too little and then you have to pay for it.
I wonder what the bottle neck in recruitment is. If there is one, training places i would think.
Probably another area we could perhaps learn more from other countries.
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All of the nearest surgeries to yours truly have now been taken over by an outfit called Operose Health and the GPs have gone salaried.
BBC Panorama investigated and found that they'd managed to reduce the number of FTE GPs from 25 to 11. Must have been through efficiency improvements I guess?
www.basingstokegazette.co.uk/news/20207288.operose-run-basingstoke-surgery-features-bbc-panorama/
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>> BBC Panorama investigated and found that they'd managed to reduce the number of FTE GPs
>> from 25 to 11. Must have been through efficiency improvements I guess?
Do you, as a patient, notice how those efficiency improvements have been achieved?
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Yes. It's much quicker to not get an appointment. Plus they've appointed a fulltime Complaints Manager who fobs you off within 48hrs.
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>> Yes. It's much quicker to not get an appointment. Plus they've appointed a fulltime Complaints
>> Manager who fobs you off within 48hrs.
QED
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Sorry Bromp, I read that "how" as 'what'.
Efficiency improvement was poor sarcasm. Panorama found that they've basically replaced qualified GPs with what the surgery call "Medical Professionals". I have no idea what's required to earn that lofty status.
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>> Panorama found that they've basically replaced qualified GPs with what
>> the surgery call "Medical Professionals". I have no idea what's required to earn that lofty
>> status.
The GP practice here has done that too. Last time my regular back disc/muscle spasm manifested itself I saw an Advanced Nurse Practitioner. It felt like a GP consultation and she was happy to prescribe Codeine and Robaxin, which is the best treatment we've found.
The DWP use 'Healthcare Professionals' to do assessments for both Personal Independence Payment and the so called Work Capability Assessments for ill health benefits. Unsurprisingly, Physiotherapists are rubbish when assessing Mental Health - and the whole structure of PIP is totally unfit for purpose with Mental Health anyway.
Last edited by: VxFan on Mon 16 Jan 23 at 10:14
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"Yes. It's much quicker to not get an appointment. Plus they've appointed a fulltime Complaints Manager who fobs you off within 48hrs."
Miss FC who does suffer from a number of conditions including Crohn's around 3 months ago had a really bad flare up of an awful facial rash (not confirmed yet but it could be Lupus).
The process to actually get physically examined by her GP was obstructed at every level resulting in her mother (daughter is 26) trying to get somewhere and failing. Mother was involved as Miss FC struggled to make inquiries due to work time commitments.
At one stage the surgery, due to a 'training day' suggested she visit the walk in minor injuries unit.
She left with a letter (copy to surgery) suggesting she be seen ASAP by a Dr.
Again this was frustrated and daughter eventually submitted a complaint. This was not undertaken lightly.
The matter was not responded to with within the designated time and was riddled with untruths, even alleging that Mrs FC had been 'forceful' with the receptionist. I was privy to the conversation and it had been very civil even with some humour. She did ask when would things get back to normal when a patient could see a Dr.?
The final reply was riddled with excuses and untruths as to why there had been no other responses to telephone calls or emails and deadlines were not met because she had been on holiday. Never was that fact ever mentioned earlier. Her interpretation of ASAP was as soon as an appointment could be made.
Its now 3 months down the line and still awaiting the results of a skin biopsy. Whilst the rash has subsided there is permanent scaring. Her concern, and as a woman, would an early intervention with the right treatment have prevented some of the scaring?
That's not a question to the panel just an observation of the way things seem to by heading.
Last edited by: Fullchat on Mon 16 Jan 23 at 10:43
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>> "Yes. It's much quicker to not get an appointment. Plus they've appointed a fulltime Complaints
managing the expectations and service delivered by the local GP surgery is becoming an increasingly valuable life skill. Its a two stage process, getting past the gatekeeper by learning and using their trigger words, phrases and symptoms, and then informing the doctor what you expect to happen or need from them. You need to learn much about your symptoms and options before you engage them, then steer them.
Finally got mine to warm to the idea of getting a consultant microbiologist involved with curing a persistent and increasingly resistant E-coli UTI.
Last edited by: Zero on Mon 16 Jan 23 at 14:19
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It definitely helps if you know what's wrong with you before you go. Just don't actually tell them, unless it's been previously diagnosed, they hate that.
Thankfully I've got rid of the Dr. I had for years whose favourite answer was "if it's still the same in a fortnight, make another appointment".
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>> Thankfully I've got rid of the Dr. I had for years whose favourite answer was
>> "if it's still the same in a fortnight, make another appointment".
>>
Actually for most problems for which people visit their GP that is actually the right action. The trick for the Doctor is, I guess, identifying those people who actually have something wrong with them which won’t simply clear up over time.
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>>
>> >> Thankfully I've got rid of the Dr. I had for years whose favourite answer
>> was
>> >> "if it's still the same in a fortnight, make another appointment".
>> >>
>> Actually for most problems for which people visit their GP that is actually the right
>> action. The trick for the Doctor is, I guess, identifying those people who actually have
>> something wrong with them which won’t simply clear up over time.
You're right I think, but it's frustrating for those who think can can filter out self-resolving stuff themselves.
I had one GP who told me that most patients had something that would get better on its own, most of the rest had something chronic or terminal, and there was about 1% that he could do something for. Then he asked me the reason for my appointment!
That particular GP and I later fell out. He insisted my mother had incurable dementia which I knew she hadn't.
For balance I should say I had the most fantastic GP in 2018 when I went with what turned out to be heart problems. Sadly she has now moved on. The cardiologists said most GPs would have missed the diagnosis.
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>>they'd managed to reduce the number of FTE GPs from 25 to 11
Back-of-a-napkin figures:
A 50,000 patient "super practice" (or group of practices) will attract about £8m per annum.
In a traditional practice about 30% typically is spent on admin/premises/practice nurses, leaving say £5m to pay for medical staff.
11FTE salaried GPs will cost max £1.5m including pension/NI.
20 noctors (to try to cover the 14 GPs they aren't employing) will cost max £1.2m including pension/NI.
Hmmm, where does that remaining £2m+ go?
Patient care?
Lolz.
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>> I wonder how much the government could do on retention, it's a tricky business. You
>> don't want to pay unaffordable amounts but not too little and then you have to
>> pay for it.
The mantra of governments, of all stripes, since the eighties has been that pay should be (no more) than was needed to recruit, motivate and retain.
We're now at the point where recruitment and retention are massive issues in the Health Service and nothing's happening to improve pay....
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The mantra of governments, of all stripes, since the eighties has been that pay should
>> be (no more) than was needed to recruit, motivate and retain.
>>
What should governments aim for?
>> We're now at the point where recruitment and retention are massive issues in the Health
>> Service and nothing's happening to improve pay....
>>
I think the nurses are likely to be offered a one off bonus shortly. Beyond that not much, I've seen anyone in or outside of government suggest a plan to deal with it.
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>> What should governments aim for?
>> I think the nurses are likely to be offered a one off bonus shortly. Beyond
>> that not much, I've seen anyone in or outside of government suggest a plan to
>> deal with it.
Let's assume we're back in the seventies.. :-P
One off bonus as you suggest and some sort of enhanced remit for the review body looking at the 2023/4 settlement.
Or maybe that plus a longer term structural review of pay and conditions.
Didn't we solve a miners strike in 71/2 by paying them for the time it took to prepare to go underground and shower afterwards?
Last edited by: Bromptonaut on Sun 15 Jan 23 at 21:39
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I owe an Army Surgeon, serving in Cyprus in ‘57, for the state of my face. He did warn my parents I would need plastic surgery later. He did such a good job I was left with a small scar on my forehead, which faded in adulthood. No plastic surgery.
My parents said army surgeons were great at putting pieces of humans back together and this one took special care as I was a very small child.
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I have 1 nephew & 2 nieces.
All medically qualified
The nieces have worked part-time for lots of the last 30 years
My nephew works full-time - he is a VET and needs to see his patients.
From small sample no conclusion can be made BUT most younger GPs are female and some have kids and work part-time.
As partners they get paid pro-rata if they see patients or do not see patients.
The vet depends 100% everyday on seeing dogs & cats to make a living! He works 5.5 days and does OOH visits on top.
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So I'd be better off registering with a vet?
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Depends what you want doing really... they are specialists in castration or euthanasia :-)
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My family know if I am in a "bad way" a single ticket to the Swiss Clinic is the answer for me.
Something like £12-£15K but better than languishing in misery for what could be years!
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PS - I have already had the vasectomy - June 1977 - it was a snip at £80.
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>> The vet depends 100% everyday on seeing dogs & cats to make a living! He
>> works 5.5 days and does OOH visits on top.
For which we pay for on each visit. and take out private medical insurance
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>> From small sample no conclusion can be made BUT most younger GPs are female and
>> some have kids and work part-time.
>> As partners they get paid pro-rata if they see patients or do not see patients.
>>
>> The vet depends 100% everyday on seeing dogs & cats to make a living! He
>> works 5.5 days and does OOH visits on top.
As you say, it's a small sample but I suspect the comparison is in apples/pears territory.
The work they do, and the way in which they're remunerated for it, is different. Doctors neither euthanise not neuter their patients. I suspect too that a lot of advice is given over the phone and at least some treatments delivered by the equivalent of what Lygonos calls 'Noctors'.
Whatever latitude part time GPs have to be paid whether or not seeing patients applies to the full time cohort too. Presumably partnership agreements, peer observation and action by senior and/or managing partners ensure that folks pull their weight.
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>>>Doctors neither euthanise not neuter their patients.<<
Not sure that patients at Donneybrook Medical Centre in Hyde, Greater Manchester, would agree with your statement.
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That the current system of primary care is not working satisfactorily for all seems beyond doubt. I suspect there is no simplistic simple solution, but a range of issues and possible conflicts:
1. Funding - increase in primary care will allow more patient needs to be met reducing pressure on the rest of the NHS - but only if not absorbed by pay increases.
2. Training - a shortage of qualified staff due to a failure to train in the past - more funding will make little difference in the short term - GP training (I understand) can take a decade
3. Pay increases - to what extent would this encourage part time staff to increase their hours, and attract leavers from the profession to re-join.
4. GP contracts - rewarding practices on the basis of patient numbers encourages some (not all) doctor/partners to prioritise profit over service levels. No clear answer to this.
5. Demographics - aging and increasing population mean that resources inevitably need to increase to maintain service levels. By how much.
6. Nurses - should practices make far more use of suitably qualified and experienced nurses. An analogy - you don't need an F1 mechanic to service a Ford Fiesta
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There is another option: private health care, to which an increasingly large number of people are now being driven.
To be honest if I though I really needed to see a doctor at the moment I would go down that route. Waiting on the 'phone forty minutes listening to Holst's "The Planets" to obtain an appointment in 14 days time doesn't really appeal.
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news.sky.com/story/patients-should-be-charged-for-gp-appointments-and-a-e-visits-to-ease-waits-sajid-javid-says-12791533
Reading the article, there looks to be a tiny bit of consensus between javid and shadow health secretary. It may well be a matter of when not if.
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It is, in my opinion, a foolish idea.
1. It’ll probably cost more to implement than it’ll ever recover.
2. If the intention is to reduce pressure on GP surgeries, there are better ways.
3. It’ll discourage people with minor symptoms from visiting their GP, meaning serious conditions are no longer caught early.
4. It won’t solve the problem of people missing appointments at short notice. In fact, it’ll probably make it worse because if I’ve got to pay for it anyway, who cares if I forget?
Personally I’d look at implementing a fine system for people who miss appointments without good reason.
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Other countries seem to manage such a system and have for a while. We might not have such a system now or in the future but I don't think it's pointless, unworkable etc.
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>> Other countries seem to manage such a system and have for a while. We might
>> not have such a system now or in the future but I don't think it's
>> pointless, unworkable etc.
I worry about the workability of the inevitable means test.
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NHS Unsustainable? - smokie
