Non-motoring > Govt. Solves NHS Doctors Retention Crisis Miscellaneous
Thread Author: zippy Replies: 30
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 Fri 30 Jun 23 23:15 
 Govt. Solves NHS Doctors Retention Crisis - zippy
Simples really.

Have 4 year medical degrees not 5.

Have apprentice doctors, who haven't studied medicine at university train fully at the hospital and allowed to qualify after 5 years.

Result..........No other country will touch them with a barge pole.
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 Fri 30 Jun 23 23:41 
 Govt. Solves NHS Doctors Retention Crisis - Kevin
And if we started accepting PPE grads as doctors it would solve the waiting list. Folks would be cancelling in droves.
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 Sat 1 Jul 23 00:12 
 Govt. Solves NHS Doctors Retention Crisis - Terry
I am assuming senior medics were involved in the development of the plan - they no doubt argued their case and inevitably all contributors compromised in some areas. It is questionable whether further delay would achieve a better plan

The real question is whether the outcome is well trained doctors capable of delivering high standards of care.

Whether other countries will recognise the qualification (I suspect) has yet to be clarified. If it reduces the loss of expensively trained doctors overseas that may be a good thing.

That existing professionals see the changes as a threat or dumbing down of their skills is no great surprise. But if they are clinging on to historical training practices largely unchanged (possibly) in decades, then a very radical review is almost certainly required.
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 Sat 1 Jul 23 00:44 
 Govt. Solves NHS Doctors Retention Crisis - smokie
Must admit I've not read the ins and outs but hasn't it already been happening to some degree for years - e.g. in our surgery we had a nurse to do some of the stuff a doctor used to do, though they've moved on from that. Some nurses are being trained as prescribers, though I believe more limited than doctors can do. And some consultations are being pushed to pharmacists.

I would suspect with "online" available for immediate reference if required that the resources at medics fingertips is greater than it's ever been. And of course much of a nursing degree (and probably a doctor one too) is on-the-job anyway, with long placements working alongside established staff.

Over the years some of my best learning was hands-on, in at the deep end etc etc, but admittedly I was trying to fix computer software not humans.

I hope it works out as I believe the situation is becoming somewhat dire.

Still, if you have a better solution Zippy maybe we can discuss it? :-)
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 Sat 1 Jul 23 01:18 
 Govt. Solves NHS Doctors Retention Crisis - zippy
>> But if they are clinging on to historical training practices largely
>> unchanged (possibly) in decades, then a very radical review is almost certainly required.
>>

It's a bit like saying the wheels on cars have been round for decades, a radical review is therefore almost certainly required.


It works. It works very well. If it ain't broke don't fix it. The same or similar process is used in most other developed nations because it works.


And there have been major changes, with many practices improved upon as new techniques and technologies become available.
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 Sat 1 Jul 23 01:41 
 Govt. Solves NHS Doctors Retention Crisis - Kevin
Called the docs last week for an ear infection that wouldn't clear up on it's own.
Seen next day by a very pleasant and professional nurse who had access to some utility which told her that I was allergic to penicillin, which other meds I'm currently taking and what the best alternative was.

They're also now employing their own team of pharmacy staff to manage repeat/followup prescriptions instead of outsourcing like they used to. I also ordered extra meds online last week to cover me while I'm on hols. Previously they would just have ignored my explanation and rejected it, requiring a call to the surgery taking up receptionist's and doc's time to sort out. This time it was approved the next day with no hassle.

Relieving the docs from the mundane day to day stuff where possible seems to be making a big improvement at our local surgery.
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 Sat 1 Jul 23 09:53 
 Govt. Solves NHS Doctors Retention Crisis - Terry
That it works does not mean it as good as it could be.

Similar arguments would have retained canal barges for transport despite the invention of the railways, horse and cart after cars came of age, analogue TV despite a digital revolution etc.

The world has changed radically in just a couple of decades. I have no idea whether the plan will deliver, but the "ain't broke so don't fix it" argument is not a recipe for sustained improvement.

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 Sun 2 Jul 23 08:37 
 Govt. Solves NHS Doctors Retention Crisis - CGNorwich
“It works. It works very well. If it ain't broke don't fix it. “

It patently doesn’t work because we don’t have enough Doctors and Nurses.


The attitude of the BMA and the Consultants organisation doesn’t help. They consistently oppose significantly increasing the number of Doctors. Their restrictive practices make the Railway Unions look like amateurs.
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 Sun 2 Jul 23 10:23 
 Govt. Solves NHS Doctors Retention Crisis - Bromptonaut
>> The attitude of the BMA and the Consultants organisation doesn’t help. They consistently oppose significantly
>> increasing the number of Doctors.

I'd not seen that in coverage of the current industrial unrest.

Do we know why they're opposed?
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 Sun 2 Jul 23 12:28 
 Govt. Solves NHS Doctors Retention Crisis - CGNorwich



From the BMJ


Delegates at the annual (2008) BMA conference voted by a narrow majority to restrict the number of places at medical schools to avoid “overproduction of doctors with limited career opportunities.” They also agreed on a complete ban on opening new medical schools.

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 Sun 2 Jul 23 12:39 
 Govt. Solves NHS Doctors Retention Crisis - tyrednemotional
...yes, but that's 15 years old and against a different background.

This 2021 BMA report (as an example of more recent thinking) gives a very different view:

www.bma.org.uk/media/4316/bma-medical-staffing-report-in-england-july-2021.pdf
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 Sun 2 Jul 23 14:18 
 Govt. Solves NHS Doctors Retention Crisis - sooty123
> Delegates at the annual (2008) BMA conference voted by a narrow majority to restrict the
>> number of places at medical schools to avoid “overproduction of doctors with limited career opportunities.”
>> They also agreed on a complete ban on opening new medical schools.
>>
>>
>>

Are these just votes for 'show' or do the bma control the budgets for medical schools?
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 Sun 2 Jul 23 15:11 
 Govt. Solves NHS Doctors Retention Crisis - Manatee

>> Are these just votes for 'show' or do the bma control the budgets for medical
>> schools?

The system depends on doctors teaching new ones.
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 Sun 2 Jul 23 15:21 
 Govt. Solves NHS Doctors Retention Crisis - sooty123
>>
>> >> Are these just votes for 'show' or do the bma control the budgets for
>> medical
>> >> schools?
>>
>> The system depends on doctors teaching new ones.
>>

Well yes, but does the bma hold some form of veto over teaching places or medical schools?
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 Sat 1 Jul 23 00:55 
 Govt. Solves NHS Doctors Retention Crisis - Bromptonaut
>> Simples really.
>>
>> Have 4 year medical degrees not 5.

How intensive is current 5 year course - is there slack to be taken up so that four years can cover same ground?
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 Sat 1 Jul 23 01:09 
 Govt. Solves NHS Doctors Retention Crisis - zippy
>> >> Simples really.
>> >>
>> >> Have 4 year medical degrees not 5.
>>
>> How intensive is current 5 year course - is there slack to be taken up
>> so that four years can cover same ground?
>>

It's very intense. It's already a mix of university and placements at hospitals / doctors surgery's (and there is proof as she's on GPS: Behind Closed Doors).

Miss Z worked in numerous hospitals / surgery's over the 5 years - so there is already a similarity to apprentices, but its backed up with detailed learning at the university and exams on what she learnt academically and practically. I think it will be very difficult to learn some things just practically, e.g. if x do y because there is a need to diagnose illness based on symptoms, understanding of the biological processes and knowledge of diseases, a lot of which comes from academic learning.
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 Sat 1 Jul 23 08:00 
 Govt. Solves NHS Doctors Retention Crisis - Lygonos

I guess if medicine was made a 'paid' study then it could be done in 4 years.

Rather than 3 semesters of 10 weeks, have 4 of 10 weeks with an income of sorts paid to those studying in lieu of normal Uni holidays?

And much more time working in GP practices - the level of ignorance shown by consultants towards general practice and what we do is often impressive.

All GPs have spent years in hospital, many consultants have spent a handful of weeks in GP (as students) - it's where 90% of patient contacts happen.
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 Sat 1 Jul 23 08:07 
 Govt. Solves NHS Doctors Retention Crisis - Lygonos
Heh forgot how long terms were at Glasgow - instead of 30wks teaching plus exams, increase to 40 weeks was the point.
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 Sat 1 Jul 23 09:07 
 Govt. Solves NHS Doctors Retention Crisis - smokie
My recollection of daughter's nursing course (@ Birmingham) was that compared to her sister she didn't have very long holidays at all, mostly taken up with placements. 4 weeks in the summer rings a bell.

She's just doing the prescribing course I mentioned and as part of it has spent some time in a GP surgery (days not weeks, as she is doing this alongside her day job), and really enjoyed it.

Mind you, it'd open peoples eyes a bit to work alongside her in the community mental health bit, where she had two members of staff injured by a service user with a sword the other day!! And during her training she enjoyed Broadmoor...
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 Sat 1 Jul 23 09:41 
 Govt. Solves NHS Doctors Retention Crisis - Manatee
13 years in, they've practically wrecked the NHS, looking very likely to be thrown out in 2024, and now they come up with a long term plan? It's literally incredible.

It's not to do with Covid, or Brexit. The common factor is Conservatives. Remember John Burn-Murdoch's charts in the FT about 6 months ago?

www.ft.com/content/b2154c20-c9d0-4209-9a47-95d114d31f2b

A chart I'd like to see, the one that's missing, is the one showing how much revenue has been extracted from the NHS by firms linked to Conservative MP's and donors.
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 Sat 1 Jul 23 10:00 
 Govt. Solves NHS Doctors Retention Crisis - sooty123
archive.ph/pGEhw

Non paywall FT article.
Last edited by: sooty123 on Sat 1 Jul 23 at 10:03
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 Sat 1 Jul 23 10:12 
 Govt. Solves NHS Doctors Retention Crisis - Manatee
Thanks Sooty. The first link worked for me when I tried it, didn't just now!
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 Sat 1 Jul 23 11:03 
 Govt. Solves NHS Doctors Retention Crisis - smokie
From stuff I've read a lot of the NHS problems are caused by the numbers of users exploding. And that does to some extent seem to be since Covid, which happened under a Tory government - typical eh? :-) Whether the increase is directly due to Covid I don't know, but Covid affected the priority of the resources (this creating a backlog for other patients) and also the way the services operate - some of which in my limited personal experience hasn't returned to it's pre-Covid state. E.g. hard-to-get GP appointments, and drop-in blood tests have gone.

Oh, and the staff issue which is also causing havoc in the NHS is surely to some extent due to having to let go people that BREXIT deemed "we" no longer wanted here.

Governments often get accused of short termism, or not doing anything about the really big problems. Then when one goes and does something it also doesn't suit.

I don't doubt there are likely flaws with the current approach so I can't wait to see how the next government approaches it.
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 Sat 1 Jul 23 11:23 
 Govt. Solves NHS Doctors Retention Crisis - Duncan
>>
>> Oh, and the staff issue which is also causing havoc in the NHS is surely
>> to some extent due to having to let go people that BREXIT deemed "we" no
>> longer wanted here.

After Brexit Some foreign nationals decided - of their own volition - to return to their country of origin.

This was as a result of BREXIT which YOU voted for.

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 Sat 1 Jul 23 11:29 
 Govt. Solves NHS Doctors Retention Crisis - smokie
Me? Nah... :-)
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 Sat 1 Jul 23 12:17 
 Govt. Solves NHS Doctors Retention Crisis - Manatee
>> From stuff I've read a lot of the NHS problems are caused by the numbers
>> of users exploding. And that does to some extent seem to be since Covid, which
>> happened under a Tory government - typical eh? :-)

The charts suggest the current situation has been accumulating since 2010, not 2020. Granted there was a financial crisis just before that. But after 13 years, and any number of people prepared to say it's a very complicated problem, to produce a 'solution' like a rabbit from a hat is simply not credible - especially when the retention plan does not include pay increases. I think it will be about as successful as the plans to halve inflation, grow the economy, reduce debt, and stop the boats.


>>
>> I don't doubt there are likely flaws with the current approach so I can't wait
>> to see how the next government approaches it.


I think it will be very difficult, far more so than 1997, and if the NHS can be fixed at all in my lifetime I don't think one parliament will do it, starting from here. Apart from the measurable financial strain and lack of resources including people, there is a massive hidden deficit in capital and maintenance spend that was cut and needs to be made up, not just in the NHS but roads, schools, you name it. There is nothing that can be cut. Almost everything is broken, now including, it seems, the water industry.

Quite an achievement from the 'fiscally responsible' party. The old "Labour would be worse" refrain is now just risible. What do the Conservatives have to do to convince 26% of the electorate they are incompetent or simply not acting in the interests of the many (i.e. crooks)?

I want everyone to have the chance of a decent life, and under the Conservatives that just will not happen.

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 Sat 1 Jul 23 14:14 
 Govt. Solves NHS Doctors Retention Crisis - Kevin
>A chart I'd like to see, the one that's missing..

The charts I'd like to see would all have the same X and Y scales.
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 Sat 1 Jul 23 15:38 
 Govt. Solves NHS Doctors Retention Crisis - Terry
Health spending as a percentage of GDP rose from 7% to 10% in the period 2000-2010.

Until covid it remained fairly static - rising to 12% during the pandemic.

With increasing demands on health care it is little surprise the service is under stress.

It also demonstrates why the finances were broke at the end of the Labour administration in 2010, and austerity followed.

We now have a debt to GDP ratio of ~100% compared to ~35% in 2000 and ~75% in 2010.

I make no particular judgement of higher tax vs poorer services - that is a democratic choice. Any party in denial of economic reality is not worthy of election.

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 Sat 1 Jul 23 16:45 
 Govt. Solves NHS Doctors Retention Crisis - Manatee
>>Any party in denial of economic reality is not worthy of election.

That's a ludicrous statement. Almost no politicians accept economic reality. Only the Green party even contemplates zero or negative growth as even possibly necessary to achieve sustainability. And without much fairer distribution there is no possibility of achieving that.
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 Sat 1 Jul 23 19:26 
 Govt. Solves NHS Doctors Retention Crisis - Terry
>> That's a ludicrous statement. Almost no politicians accept economic reality. Only the Green party even
>> contemplates zero or negative growth as even possibly necessary to achieve sustainability. And without much
>> fairer distribution there is no possibility of achieving that.

Denial of economic reality leads to a Liz Truss initiated financial crisis. At the other end of the spectrum is a print (spend or borrow) culture which delivers politically attractive quick wins - ultimately followed by economic collapse of a failed state at the end of the game.

No party, whatever their political bias can ignore economic reality - there is a price to be paid for consistently spending more than affordable.

The increasingly fragile state of the UK economy is due (in significant part) to the failure of politicians to own the consequences of their actions, preferring the superficial vote winning policies to responsible financial management.
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 Sat 1 Jul 23 20:59 
 Govt. Solves NHS Doctors Retention Crisis - smokie
wrt your last para, it is also problematic that everyone wants everything to be better and yet cost them less.

Few would welcome a tax rise to provide funding to support the necessary improvements in public services.

From reading some of the HYS on Beeb articles and forums elsewhere, many people don't seem to comprehend that ultimately they are paying (well, taxpayers at least) for whatever govt or local councils do.



Also I feel many people are just generally uninterested and/or stupid, and aren't ashamed to prove it. For instance forums round here are still blaming the Tories for current local issues when the Lib Dems have had control of the council since last year..
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