I just posted this in another thread then decided it deserved a thread on it's own as it might have generated thread drift.
It's almost impossible to get an doctors appointment here anyway (Wokingham). They release some each morning at 08:00 and you have to be ahead enough in the queue (either there or on the phone) to get one.
A week ago they offered me a video appointment a week back for a non-urgent but recurring issue. It worked a treat, the doc (one from here www.pushdoctor.co.uk/ , not a local one) had access to read and update my records, prescribed me a new drug and set up a blood test (not online!! :-) ) and I was all done in less than 90 minutes from getting the link.
Not only was it much easier for me, it also meant my problem was dealt with sooner and it relieved a bit of pressure on the local surgery.
It obviously wouldn't work for all people/purposes though. Ideal for stuff like meds reviews. I suspect there are things which they might say you would need to visit your doctor with rather than trying over the video.
But I'd use it as my preferred method of "visiting" a doc for appropriate things if they offer it. What do others think?
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>>What do others think?
Don't like the idea of paying £30, we pay enough tax for these public services as it is. It would seem to me a slippery slope towards a two-tier system.
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Should have made it clear, it was no cost to me as I was referred.
I thought the £30 option could be useful if you were abroad or something.
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... and I suppose if they can't provide the service and I am in pain or discomfort I am not going to put up with it just on a point of principle, if there is an affordable alternative!!!
But I agree in theory with your point.
Last edited by: smokie on Sun 9 Feb 20 at 11:49
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The sooner we start charging a reasonable fee to see a GP the soonest we we will have more money to fund the service and reduce the number of people visiting the GP for trivial reasons. People don’t respect what they don’t have to pay for. A free service simply creates a near unlimited which demand which can never be met.
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One of the things I have discovered is that there is much more support and routes to advice and treatment than you think, and more importantly know. Even GP's sometimes are not aware of whats on offer.
This is all because the NHS has become fractured and compartmentalised, all due to funding, not lack of funding, funding is now heavily split and departmentalised for pathetic micro management reasons.
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What Zero says. Working for the NHS Courier service for a while taught me where all the the little compartments are. Emergency NHS dentist - 10 miles away, appointment more or less the same day, community dentist 4 miles away at a hospital - don't need to be registered etc. My own surgery is quite old fashioned but quite large. Phoned in for an appointment at 930am last Weds - got one that afternoon - prescription "encashed" at no charge on-site. But I do believe that appointments should be charged for (free for people on benefits). I'd happily pay thirty quid to get one when I wanted.
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>> The sooner we start charging a reasonable fee to see a GP the soonest we
>> we will have more money to fund the service and reduce the number of people
>> visiting the GP for trivial reasons.
Which sounds OK until you try and define 'reasonable' and who gets exemption.
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Simple - Passporting benefits, works in other places.
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When trying to book my appt I was told there is a walk-in at Royal Berks hospital (9 miles and expensive parking, if you can find a space) but they wouldn't have access to my records, to read or update, so pretty pointless to me on this occasion as it was a sort of follow-on appt. There is also a walk in acute I can use in Bracknell but I wasn't acute, and they have no access to records. (there is also a really good walk-in blood test service there - while you wait too!! :-) ).
So yes, there are compartments which not everyone would know about or want/be able to access.
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Not sure you are completely right about the records thing, tho you do have to explicitly give authority to share them.
4 separate NHS trusts* and my doctors surgery all have realtime online access to my records.
*with all their myriad specialities and departments.
Last edited by: Zero on Sun 9 Feb 20 at 13:05
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Just checked with SWMBO who was present at the time. Royal Berks drop-in wouldn't be able to see my records.
Next door neighbour has in the past been referred to a surgery there where I think they could see his records but they wouldn't be able to refer him on.
I obviously had to give Push Doctor explicit permission to access my records, as well as providing photo ID at the start of the call (and I think during registration)
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>> Simple - Passporting benefits, works in other places.
Simple but crude.
Actually not even simple - see free prescriptions in Universal Credit where it depends on your earnings in last Assessment Period.
Even if it were set as low as £10 that would be stretch for some families or people with chronic conditions. What happens if you cannot pay - no cash and your card is rejected? Does the doctor show you the door or see you anyway and either write off the fee or seek to recover it.
And even today they've still not actually got prescription forms that cover claiming UC. I was doing an outreach for a colleague last year and saw a lass of 19 with some pretty acute MH/Learning difficulties, on UC with Limited Capacity for Work/Work Related Activity. She'd done as she was told and ticked the ESA box only to be hit with a penalty.
Easy to put right when you're used to navigating phone menus and dealing with officialdom....
And (IIRC) the phone number was one that's only free if you've got bundled calls.
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The other end of the spectrum is free prescriptions in Wales. What a daft idea. I am an irregular user of prescriptions......Last one I had was more than three years ago, but I had something that I couldn't shift without AB this time. People like me should pay.
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>> The other end of the spectrum is free prescriptions in Wales. What a daft idea.
>> I am an irregular user of prescriptions......Last one I had was more than three years
>> ago, but I had something that I couldn't shift without AB this time. People like
>> me should pay.
Given how few actually do pay and that there's no beggaring about with non payers what is the actual real world cost?
Not a challenge just genuinely interested.
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That was an argument when they decided to issue free prescriptions. They reckon that a third of the population are entitled to bus passes, a strong argument for everyone having one. In fact there is a route in north Wales where everyone can travel for nothing on buses at particular times.
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Free weekend travel on all TrawsCymru services (T1, T1C, T2, T3, T4, T5, T6 and T9 Cardiff Airport Express). Free travel will be valid all day Saturday, Sunday (but not Bank Holiday Mondays) for a trial period until further notice, subject to availability.
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>>a strong argument for everyone having one
If they even seriously thought that then the immediate high-pitched whining from a certain sector of our society of "why should 'the taxpayer' subsidise this?" would be deafening.
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Virtually all of whom would be already entitled to bus passes and free scripts by virtue of their age.
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There are some useful ideas here - not just about funding (or lack of it) but why things are as they are.
The load on A&E and their poor performance on the 4 hour target may be because there are insufficient resources in community healthcare. If I am unwell and have a choice between a week or so wait at my GP (they are actually very good) or a few hours at A&E the answer is a no brainer. Changing the way the NHS is compartmentalised could be a winner.
I am in the fortunate position where if necessary I can pay £30 to get a video doctor (many can't). But would it be better if my GP surgery did similar services to reduce number of patients visiting. They could even make a small charge (£10 ?? offsetting patient bus fares, parking charges, petrol etc) to contribute to surgery costs.
Why when I can bank online, buy online, travel online, etc can my details not ba available to all medical staff to whom I give permission. Major improvements needed!
Why should free prescriptions be available to all elderly people (of which I am one - just). For major users there is an annual charge of £104. For others all should pay - these days many pensioners have more disposable income than the young with mortgages and families. Same is true for eyetests, bus passes, TV licences etc.
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Our local Hospital has a Same Day Emergency Care (SDEC) unit. Run as a separate unit to A&E - it seems to be a good idea and appears to work.
www.wales.nhs.uk/sitesplus/861/news/51292
The big problem with A&Es are the number of people going there when clinically unnecessarily as well as the usual stop for drug and alcohol misuse problems, or simply people who can't or won't look after their own health.
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>> Given how few actually do pay and that there's no beggaring about with non payers
>> what is the actual real world cost?
>>
>> Not a challenge just genuinely interested.
I don't pay, for two reasons, cancer patients don't, and I am over 65. Having said that, there have been times when I have had prescriptions and bought meds privately.
Here is a an example of real world cost vs prescription
Loperamide Hydrochloride 30 tabs - £2.56 delivered to my door by on-line wholesaler
If I paid, Presciption cost £9.00
Branded - Imodium, Tesco, 30 tabs £12.50
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>>But I'd use it as my preferred method of "visiting" a doc for appropriate things if they offer it. What do others think?
Not a fan.
NHS GPs are not allowed to charge their own patients for appointments and other things covered by their GMS (General Medical Services) contract.
They can, however, see patients who are not on their practice list and charge them.
If a GP has time to charge someone else's patients as in this example, but then "doesn't have the time" to see their own (as is likely in the OP - there may well be a reciprocal agreement so smokie's GPs will have some time each day to make £££ from the other practice's patients) I think there is a very significant potential conflict of interests.
No-one does nothing for nothing.
In saying all of that, the starvation of funding for General Practice compared to Hospital based medicine is severe and persistent.
In saying that, the GP contract effectively rewards GPs financially by having bigger lists of patients - my practice is roughly 1500 patients per full-time equivalent partner. Some practices, especially in England, are well over 2000.
More money per partner and crappier waits for their patients.
Last edited by: Lygonos on Sun 9 Feb 20 at 15:26
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The doc I saw was working from home. I suspect she works full time for this company, rather than shoehorning it in with other work. I can see it would suit a lot of people to work like that - probably picking and choosing hours/days to fit.
She def worked from home. There is a list of doctor here www.pushdoctor.co.uk/meet-our-doctorse and mine was "Dr Sarah".
I also assumed that my surgery was paying them for my appointment. Not the commercial rate though).
(The health centre is apparently appealing against having been marked down at it's last inspection, but I guess they are prepared to shell out for this kind of service as it will improve their waiting lists and hence customer satisfaction)
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I can understand the conflict of interest point.
But could the technology improve the service offered to patients - particularly if they are some distance from the surgery.
Whether the service is funded by a change to existing budgets or per video consultation income under the NHS contract or the patients themselves clearly needs to be resolved.
I am also not sure whether the video could be initially with a practice nurse - they could screen patients to ensure doctors see only patients which need their particular skills. They cost about half as much as a doctor - I know as my OH was a nurse practitioner with a prescribing certificate.
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>>Not a fan.
And I can quite see why. However, it does sound like the sort of thing that would be useful for GPs to do for themselves. Or at least the practice nurses.
Last edited by: No FM2R on Sun 9 Feb 20 at 15:57
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The reality of increasing demand and generally reducing supply (Hunt's 5000 new GPs by 2020 actually became 1000 less full time equivalents) means that when you contact your practice you are likely to be offered appointments with staff attached to the practice after your initial contact.
The new GP contract in Scotland means we (practices) are having physiotherapists, mental health nurses, pharmacists, and advanced nurse practitioners working with us.
For the vast majority of musculoskeletal problems you would be better seeing our physio than me - they consult with 20 minute appointments and can refer for XRays, and onward to specialists such as orthopaedics and rheumatology*
General practice will become more "Primary care" with GPs increasingly seeing the complex patients with multiple co-morbidities and acute issues being seen and assessed by other staff.
It doesn't save money overall, as I can see 2-3 times as many patients in a day as a physio/pharmacist/mental health nurse, but the basic fact is there are not enough GPs for the demand, and a multi-skilled frontline will probably provide a better quality of service for similar expenditure.
There is some resistance from patients who "demand" to see a GP but it is improving over time.
* for non-red flag stuff (disc prolapse, nerve involvement, symptoms of other diseases such as myeloma/cancer etc) a physio knows more than me too I expect - but they are aware of red flags and can obviously discuss concerns with myself and my colleagues.
Last edited by: Lygonos on Sun 9 Feb 20 at 16:38
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I was put on"old man's tablets" Perindropil (ACE inhibitors) many years
Absolutely fine no side effects etc etc BP steady.
SWMBO was in for the annual MoT and was told her BP was higher. Nurse Practitioner
did not speak to GP - they tried various BP tablets over 3/4 mths and BP was up/down like a yo-yo.
My wife was fed up on her NP visit and asked to speak to the GP - he changed her to Perindropil - 2 min conversation instead of 15 mins ever 2 weeks for some 3/4 months.
Perfect - no side effects &BP down & steady.
It must have cost a fortune for 4 prescriptions, 7/8 NP visits that a GP can assess & write an Rx in 2 minutes.
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>>It must have cost a fortune for 4 prescriptions, 7/8 NP visits that a GP can assess & write an Rx in 2 minutes.
As I mentioned elsewhere - having these 'noctors' is not a cost saving exercise: it's to deal with the lack of GPs.
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As I mentioned elsewhere - having these 'noctors' is not a cost saving exercise: it's to deal with the lack of GPs.
Traditional surgeries are closing across the six counties here left right and centre. The upside is that the Health Trust are replacing them with new build Health Surgeries. They are far better than a lot of the outdated buildings with proper parking and accessibility, the one in Llangollen even has a cafe !
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>>More money per partner and crappier waits for their patients.
Yep. My surgery was owned by Virgin and still probably is or some similar organisation.
Waiting time is 9+ weeks for a GP appointment. Alternatively you can try calling at 8:30AM for a same day appointment. I did that once. Waited on the phone until 9:30ish by which time they told me that all the spaces had been filled - try again tomorrow or go to the walk in centre down town.
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On the occasions that none of the GPs are on holiday (a few weeks per year) there are frequently a couple of unfilled spots in our surgeries ie. all routine requests could be seen same day.
When one or two of us are on annual leave (or maternity) then you can expect to be waiting 0-5 days for routine appointments.
From a business perspective it would make more sense for us to down-size and have 10-15 day waits and fatter pay packets.
I am pretty sure if NoFM2R studied how we ran our practice he'd have dozens of ideas about how to 'improve' it.
Many of which I have no doubt would be entirely valid!
Last edited by: Lygonos on Sun 9 Feb 20 at 17:00
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>> Waiting time is 9+ weeks for a GP appointment.
That's scandalous.
Here you ring up and speak to a receptionist. You give your name and adress/dob stuff for security and you'll be asked if you mind telling them what the problem. They will arrange for one of the Doctors, and you'll be given a name, to call you back.
Doc calls, usually within hour, and runs through a 'triage' process. Often they will prescribe without even seeing you; if my back issue has recurred I just get given codeine. If you need an appointment you'll get one that day with either a Doc or a nurse practitioner.
Can take a while to get past the engaged tone early on, particularly on a Monday, but I've never not got through.
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My experience, for myself and the children, has always been the same as Bromp's, I don't think I've ever waited a week.
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Our surgery used to do that Bromps but moved onto the appointment system. It is ridiculous, especially for those who work. Days to get an appointment weeks in the future.
They can usually fit acute cases in same day though.
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I live on the edge of a London Borough, my wait to see a GP for a non-urgent appointment is between 4-6 weeks, and that's just to see the 'next' GP and not the one you might prefer, in my opinion and experiences practices are still not geared-up for people who work full-time.
I have to be on shift at 07.30 and don't get home until after 6pm, I have zero chance of being on the phone at 8am to be in a queue to try and get an urgent appointment.
When I do get an appointment I always ask for a time after 5.30pm and then beg to get off work, surgery throws their hand up in horror and reminds me that they close at 5.45, when I do go there the place is like the Mary Celeste!
Last time I was at my GPs (to prove I still needs my BP meds) I was asked to go and have a blood-test.... guess what they only do them at the GPs between 9-10 twice a week, or I could go to the hospital but they are only open 8-4.30pm! what makes it worse is that I have a blood-test department only in the next block of my work but I live in a different catchment area so the results can't be transferred!
Weirdly my wife went to have her shoulder u/s done on a Sunday but they same hospital won't run a blood test clinic for people who work full-time.
The NHS can be a very unforgiving employer... I would need to take a days AL to go for my 10 min blood test!
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I'm surprised about that, I thought the nhs would be fine about taking time out for stuff like that.
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Rather ironic that the NHS won't let its staff off to attend a medical appointment.
It seems to me that the NHS is similar to the Post Office in that it needs a damn good kick up the a*** to bring it kicking and screaming into position where it actually is responsive to those who pay for it to exist in the first place...
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>> Rather ironic that the NHS won't let its staff off to attend a medical appointment.
Assume you mean authorised time off for appointments without using annual leave or impinging on sick leave considerations.
I'm surprised by that as it's pretty much universal in rest of public sector.
Is this general or down to considerations in just one business unit?
My daughter works for NHS and she's never complained or sought my advice about hospital etc appointments.
Last edited by: Bromptonaut on Sun 9 Feb 20 at 21:38
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>> It seems to me that the NHS is similar to the Post Office in that
>> it needs a damn good kick up the a*** to bring it kicking and screaming
>> into position where it actually is responsive to those who pay for it to exist
>> in the first place..
No-one now needs the post office, it is a dying and disappearing service. Not so the NHS.
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>> No-one now needs the post office, it is a dying and disappearing service.
Really????
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>> >> No-one now needs the post office, it is a dying and disappearing service.
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>> Really????
Yes Really,
Last edited by: Zero on Sun 9 Feb 20 at 21:45
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>> Yes Really,
The one here closed after the sub-postie had a run in with his bosses, possibly related to Horizon accounting system, but it involved Royal Mail and local sorting too.
After some delay service was moved to be co-located with village Pharmacy.
Was last there on Friday with an item too large for local posting box
Scope of service is changing but not even dying never mind dead.
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>> but not even dying never mind dead.
Well that's not what the PO business managers are long term planning. Its in terminal decline.
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>> Well that's not what the PO business managers are long term planning.
I rest my case :-)
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>> >> Well that's not what the PO business managers are long term planning.
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>> I rest my case :-)
How can managing for a terminal decline prove your case that its not dying?
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Oh and I have a golden coloured dog.
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>> How can managing for a terminal decline prove your case that its not dying?
Were business managers at 'Big Blue' always spot in in their analysis?
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>> Rather ironic that the NHS won't let its staff off to attend a medical appointment.
I think Mr R dog does not know how to play the internal system, Mrs Z and her nursing mates got fast appointments, consultations all timed to fit in between shifts.
Example, nursing friend came back from holiday with broken ankle last Sunday in plaster, Appointment with fracture clinic consultant Monday 13:00 after a 08:30 phone call "to the right people".
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Oh how things have changed believe me...
I'm in theatres and have plenty of contact with consultant surgeons who are very helpful BUT they now can do nothing to help staff unless they have been through your own GP* and got a referral letter from them... no preferred treatment anymore!
I can't even do that as I live in a different borough to where I work and my own GP will still only offer me appointments at the local hospital.
We don't even get seen quicker in our ED unless it's a needle stick injury... join the queue like everybody else!
*see my post about getting a GP appointment.
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>> Oh how things have changed believe me...
well they cant have changed much since last monday!
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Video doctor ("Push doctor") - The Melting Snowman
