The NHS and PPE

[winkywanky]

Perhaps that was just when you started taking notice? Because I suspect it has always been like that.

Which I don't necessarily see as a criticism of our system, providing public healthcare being about the most complicated undertaking there is.

No, I think there was a definite point where they got a load more suits in (of course they always had Hospital Adminstrators and even Time & Motion Study Officers, my mate's dad used to be one). I think it was perhaps under Thatcher? Which would be 40yrs ago of course. I'm not sure though.

[sparkus]

Apropos of nothing and possibly in bad taste but every time I hear PPE and nurses I can't stop thinking about this:

External Link/Members Only

[winkywanky]

You've just given me breathing difficulties  .

[lostandfound]

No, I think there was a definite point where they got a load more suits in (of course they always had Hospital Adminstrators and even Time & Motion Study Officers, my mate's dad used to be one). I think it was perhaps under Thatcher? Which would be 40yrs ago of course. I'm not sure though.

I suspect you are thinking of the Internal Market which was introduced in 1990. Though I disagree with your main point, as I don't believe there was ever a time when the NHS was not a political football.

Though not really interested in an argument for the sake of it or to prove a point. You seem a friendly and reasonable sort.

[winkywanky]

I suspect you are thinking of the Internal Market which was introduced in 1990. Though I disagree with your main point, as I don't believe there was ever a time when the NHS was not a political football.

Though not really interested in an argument for the sake of it or to prove a point. You seem a friendly and reasonable sort.

Ah, perhaps it was that.

I don't think my main point in this thread was that the NHS has been kicked around since then? I think my main point was that there needs to be an honest and open debate about what we want from healthcare in the future, and how we might go about doing that.

But I do think I'm a friendly and reasonable sort, but if provoked first (nastily), I will bite back   .

[sparkus]

I suspect you are thinking of the Internal Market which was introduced in 1990. Though I disagree with your main point, as I don't believe there was ever a time when the NHS was not a political football.

Though not really interested in an argument for the sake of it or to prove a point. You seem a friendly and reasonable sort.

I don't really remember that far back but as far as I've been aware, the man in the street can always be relied upon to mouth off that they are "all for more doctors and nurses, it's these pen-pushing middle managers that want got rid of" (usually accompanied by some kind of blame for the Labour Party and The Guardian).

[willie loman]

Ive always taken the view that if Tesco or amazon management or similar were parachuted into the nhs we would get a whole lot more for our buck. It is of course a complex problem, but not an impossible problem, .I would like for starters, much more paying for services, gp appointments etc, once people start getting paid for work done, they start getting pretty efficient, any one else noticed that vets  are usually open at the weekend. Once you start paying, you question whether you should be going, and more importantly where you should be going. Few people visit their local dentist, do they?

[daviemac]

Ive always taken the view that if Tesco or amazon management or similar were parachuted into the nhs we would get a whole lot more for our buck. It is of course a complex problem, but not an impossible problem, .I would like for starters, much more paying for services, gp appointments etc, once people start getting paid for work done, they start getting pretty efficient, any one else noticed that vets  are usually open at the weekend. Once you start paying, you question whether you should be going, and more importantly where you should be going. Few people visit their local dentist, do they?

My local vet only works Mon to Fri and have an emergency number for weekends, but I've had weekend appointments at my local hospital.   

[willie loman]

My local vet only works Mon to Fri and have an emergency number for weekends, but I've had weekend appointments at my local hospital.   

I can assure you that big chain vets open at the week end. Hospitals are now giving appointments at the week end and even at night, but gps are still living their cosy life. if they were paid by patients seen or similar,they would soon be opening at a time that actually suited their customers.

[winkywanky]

My GPs is open on a Saturday and does evening appointments all week too.

Depends where you live.

[daviemac]

I can assure you that big chain vets open at the week end. Hospitals are now giving appointments at the week end and even at night, but gps are still living their cosy life. if they were paid by patients seen or similar,they would soon be opening at a time that actually suited their customers.

I can only comment on what is available to me, there's about 7 or 8 different vets within a reasonable travelling distance to me, all reasonably sized companies with between 4 and 10 branches but don't work weekends.   

My GP's opening hours are Mon 08:00 to 19:45 and Tues - Fri 08:00 to 18:30, seems quite reasonable to me, especially when you consider I got a phone call from a nurse at the surgery on bank holiday Monday to check I was coping OK with the lockdown.

[willie loman]

My GPs is open on a Saturday and does evening appointments all week too.

Depends where you live.

I live in Scotland, but my point is when gps are paid for patients seen etc we would soon see a different attitude to opening hours. A while back  I was operated on in the evening at a private hospital paid for by the nhs, although not happy to be honest to be operated on at that time by a man who had been up since 6 in the morning. He was actually my nhs consultant doing his second job. He was there cos he was making reasonable money to do it, if we introduced similar incentives,arrangements, for nhs consultants and others I suspect our waiting lists would go down. They are human after all.

[Doc Holliday]

I live in Scotland ..

You need to write to Nicola then 

In England you can (in theory) get an out of hours GP appointment, although it may not be with your own GP practice External Link/Members Only

[winkywanky]

Well you're right if medical staff are routinely doing over 12hrs a day, I wouldn't want to be operated on by someone at the end of a long day like that.

I'm not actually fully sure how GPs get paid, are you sure there isn't a small fee per patient-appt? I know they receive money dependent on how many patients they have on their list.

My prostate op. last year was an evening gig, because I was fittest I got done last  . There's been a lot of evening/weekend operations in my local NHS Trust, and waiting lists have come right down for all sorts of ops.

Of course that's all gone out the window a bit with Coronavirus.

[daviemac]

I live in Scotland, but my point is when gps are paid for patients seen etc we would soon see a different attitude to opening hours.

Do you honestly think being open for 11hrs 45mins on a Monday and 10hrs 30mins the rest of the week is not long enough. 

What hours does your doc keep.   

[willie loman]

I can only comment on what is available to me, there's about 7 or 8 different vets within a reasonable travelling distance to me, all reasonably sized companies with between 4 and 10 branches but don't work weekends.   

My GP's opening hours are Mon 08:00 to 19:45 and Tues - Fri 08:00 to 18:30, seems quite reasonable to me, especially when you consider I got a phone call from a nurse at the surgery on bank holiday Monday to check I was coping OK with the lockdown.

Fair enough, try phoning on Monday and see when you get an appointment. Every phone in , ive listened to, or article ive read moans about how difficult it is to get an appointment, one of the great grievances against immigrants, was the perception that they were overloading our gps. I can get an appointment if I turn up at 8.30 and join the line, other wise its an unacceptable wait. The truth is when appointments are based on renumeration, they quickly become available, you don't have to wait long to see a lawyer or accountant in my experience.

[willie loman]

Do you honestly think being open for 11hrs 45mins on a Monday and 10hrs 30mins the rest of the week is not long enough. 

What hours does your doc keep.   

They are open, but not necessarily for appointments, appointments are usually in the morning, the nation as a whole has been exasperated at the time you wait for any medical procedure, for many a year, I am glad your experience of the system has been so positive.

[daviemac]

you don't have to wait long to see a lawyer or accountant in my experience.

If you don't understand the difference in those professions and a doctor, I give up.   

Edit

How do you know what the appointment system is at my doctors     I've had 8 am and I've had after 6, and everything in between.

[Doc Holliday]

They are open, but not necessarily for appointments, appointments are usually in the morning, the nation as a whole has been exasperated at the time you wait for any medical procedure, for many a year, I am glad your experience of the system has been so positive.

At the risk of repeating myself, you live in Scotland which has its own health arrangements. My family always get an excellent service from my GP practice especially since they introduced a phone triage service.

[willie loman]

Well you're right if medical staff are routinely doing over 12hrs a day, I wouldn't want to be operated on by someone at the end of a long day like that.

I'm not actually fully sure how GPs get paid, are you sure there isn't a small fee per patient-appt? I know they receive money dependent on how many patients they have on their list.

My prostate op. last year was an evening gig, because I was fittest I got done last  . There's been a lot of evening/weekend operations in my local NHS Trust, and waiting lists have come right down for all sorts of ops.

Of course that's all gone out the window a bit with Coronavirus.

Renumeration of gps is complex, they do receive payments for everyone on the list, but can bump patients off their list if it suits them. All we know about human behaviour tells us, that payment for work done, usually results in more work being done. If a doctor has a contract for medical examinations for a private company, you can be fairly sure he will do way more of these if he is paid by patient, rather than a no incentive nhs salary.

[winkywanky]

We have phone triage at my GPs.

Works very well, I can always get an on-the-day appt if I wish, or deemed necessary by the Doc.

Also depends on your local area, I'm lucky where I am, surgeries in a big nearby town are snowed under with chav-crap and a very ageing population.

[winkywanky]

Renumeration of gps is complex, they do receive payments for everyone on the list, but can bump patients off their list if it suits them. All we know about human behaviour tells us, that payment for work done, usually results in more work being done. If a doctor has a contract for medical examinations for a private company, you can be fairly sure he will do way more of these if he is paid by patient, rather than a no incentive nhs salary.

Patients are 'bumped off' a list very rarely, and normally only if they repeatedly miss appts and/or abuse the doctor or surgery staff.

As for the appts, most GPs have 10min appts pretty well back-to-back all day, what do you expect them to do? 

[willie loman]

At the risk of repeating myself, you live in Scotland which has its own health arrangements. My family always get an excellent service from my GP practice especially since they introduced a phone triage service.

I live in Scotland where as you rightly observe things are different, but my observations are based on what I have read in the papers and heard in the media etc, and dissatisfaction with waiting times for any medical procedure, from a banal
gps appointment to a referral to a consultant, has become a national obsession in England, and no matter how much money gets thrown at it , the situation never improves. How often do you hear on the news, so many nhs trusts failed to meet their targets, for just about everything

[daviemac]

We have phone triage at my GPs.

Works very well, I can always get an on-the-day appt if I wish, or deemed necessary by the Doc.

Also depends on your local area, I'm lucky where I am, surgeries in a big nearby town are snowed under with chav-crap and a very ageing population.

I can get on the day appointments as well if really needed, my surgery does minor operations as well. They don't do HGV / PSV medicals now, they knocked them on the head so they could concentrate on NHS patients. They were £100 a shot as well.

[winkywanky]

Nice to know they're not just going for the money then, but serving your local community  .

[willie loman]

Patients are 'bumped off' a list very rarely, and normally only if they repeatedly miss appts and/or abuse the doctor or surgery staff.

As for the appts, most GPs have 10min appts pretty well back-to-back all day, what do you expect them to do? 

They are bumped for various reasons, and you have no idea why, or how often. My point is that they don't actually have appointments , back to back all day, they have appointments in the morning, afternoons are for home visits etc. The present system doesn't suit the patients, on the whole, and if doctors had to compete for patients like dentists, and every other professional for that matter, we would receive a completely different product.

[willie loman]

I can get on the day appointments as well if really needed, my surgery does minor operations as well. They don't do HGV / PSV medicals now, they knocked them on the head so they could concentrate on NHS patients. They were £100 a shot as well.

Well you are living in a little oasis of contentment , which is not experienced by the majority of brits, who deserve and indeed pay for better.

[winkywanky]

They are bumped for various reasons, and you have no idea why, or how often. My point is that they don't actually have appointments , back to back all day, they have appointments in the morning, afternoons are for home visits etc. The present system doesn't suit the patients, on the whole, and if doctors had to compete for patients like dentists, and every other professional for that matter, we would receive a completely different product.

And neither do you, so I don't see why you wanted to make a point of saying it?  I don't imagine they just drop patients willy-nilly, or perhaps you think they want to get rid of the ones they just don't like the look of? 

Well if they're either doing back-to-back appts in the morning or doing housecalls in the afternoon, I don't see what more they can do. Do you think they're having a 2hr lunch break?

I think what's vastly more likely is that there aren't enough GPs/surgeries to service their ever-growing local community, along with the ageing demographic which makes bigger demands.

[daviemac]

Nice to know they're not just going for the money then, but serving your local community  .

Yeah, made it a bit awkward for me but I'm not complaining. Better me having to travel a bit further if it means another couple of appointment times available.

[winkywanky]

Well you are living in a little oasis of contentment , which is not experienced by the majority of brits, who deserve and indeed pay for better.

How would you know that? The 'majority'?

There will be many stories of local failures and I'm sure they're true, but to say the majority when you actually live in Scotland seems a bit much.

[willie loman]

And neither do you, so I don't see why you wanted to make a point of saying it?  I don't imagine they just drop patients willy-nilly, or perhaps you think they want to get rid of the ones they just don't like the look of? 

Well if they're either doing back-to-back appts in the morning or doing housecalls in the afternoon, I don't see what more they can do. Do you think they're having a 2hr lunch break?

I think what's vastly more likely is that there aren't enough GPs/surgeries to service their ever-growing local community, along with the ageing demographic which makes bigger demands.

They are often bumped if they have complex needs. I made the point , as you seem to think doctors are secular saints, they are not they are like the rest of  us. The point I am making is the system is not working for the consumer,  or the taxpayer, I have no problem with a system that puts more money into a gps pocket etc, I am fed up as a taxpayer waiting months for medical assistance. Its basically soviet , our health service.

[Beamer]

Patients are 'bumped off' a list very rarely, and normally only if they repeatedly miss appts and/or abuse the doctor or surgery staff.

As for the appts, most GPs have 10min appts pretty well back-to-back all day, what do you expect them to do? 

In the group practice handling my needs it is very rate for a patient to be bumped off their list.
Many doctors start seeing patients at 8am and finish at 7pm or later. The triage system works well and increases capacity because in reality, the 10 minute appointments are nearer 15-20 minutes. At least in my experience.  The big issue for GP's is that their Practice Managers ability levels vary dramatically.  A well organised PM is a great benefit. 
Again, my personal experience and that of friends and family is that when something serious occurs doctors seem to fall into two mixed bands. Some are very proactive and that was the case for me. Yet a developed cancer issue was missed for a family member.  IMO the level of competence is still needing attention with lots of younger doctors opting for specialisation.

[willie loman]

How would you know that? The 'majority'?

There will be many stories of local failures and I'm sure they're true, but to say the majority when you actually live in Scotland seems a bit much.

We have newspapers , tv , internet , up here, arguing that the majority are happy with the nhs is absurd, the scandal of waiting times in accident and emergency, and for operations has been going on for years. Not one country in the world has imitated the nhs.

[The High Sparrow]

we don't spend as much money on our health service as we should. our per capita expenditure is amongst the lowest within OECD countries. it's the same story when you look at health spending as a percentage of GPD.

But getting quality healthcare is more than about throwing money at the problem or privatising or treating it as purely as a business. The USA spends about the same amount per capita on public health care as most countries in the west and about the same amount again on private healthcare. Yet the have the worst health outcomes within the developed world. their infant mortality rate is lower than Cuba

[daviemac]

Well you are living in a little oasis of contentment , which is not experienced by the majority of brits, who deserve and indeed pay for better.

FFS there's 9 doctors at the practice I'm registered at along with 2 practice nurses, 2 healthcare assistants and 2 advanced nurse practitioners who can also issue prescriptions.

My practice is now part on a group with 3 others, all quite local and all available for appointments if needed. So yes I am living in a 'little oasis of contentment'.

I am not going off hearsay or reports by others I'm going off my own personal experiences. My doctor, NHS 111, the ambulance service and the hospital I was in, (the one I still attend for check-ups) have all been faultless.   

[willie loman]

we don't spend as much money on our health service as we should. our per capita expenditure is amongst the lowest within OECD countries. it's the same story when you look at health spending as a percentage of GPD.

But getting quality healthcare is more than about throwing money at the problem or privatising or treating it as purely as a business. The USA spends about the same amount per capita on public health care as most countries in the west and about the same amount again on private healthcare. Yet the have the worst health outcomes within the developed world. their infant mortality rate is lower than Cuba

Health is not the same as access to medical treatment. You could build the most up to date hospitals in Glasgow for example, and not make any inroads into avoidable deaths, which are mainly due to lifestyle. To be honest I am suspicious of any argument that quotes cuba, it seems that every 10th Cuban is a doctor

[willie loman]

FFS there's 9 doctors at the practice I'm registered at along with 2 practice nurses, 2 healthcare assistants and 2 advanced nurse practitioners who can also issue prescriptions.

My practice is now part on a group with 3 others, all quite local and all available for appointments if needed. So yes I am living in a 'little oasis of contentment'.

I am not going off hearsay or reports by others I'm going off my own personal experiences. My doctor, NHS 111, the ambulance service and the hospital I was in, (the one I still attend for check-ups) have all been faultless.   

I am not doubting your experience, and feel free to think that your fellow brits are happy with their access to medical care, its not my view reading papers etc

[GingerNuts]

Renumeration of gps is complex, they do receive payments for everyone on the list, but can bump patients off their list if it suits them. All we know about human behaviour tells us, that payment for work done, usually results in more work being done. If a doctor has a contract for medical examinations for a private company, you can be fairly sure he will do way more of these if he is paid by patient, rather than a no incentive nhs salary.

They are often bumped if they have complex needs. I made the point , as you seem to think doctors are secular saints, they are not they are like the rest of  us. The point I am making is the system is not working for the consumer,  or the taxpayer, I have no problem with a system that puts more money into a gps pocket etc, I am fed up as a taxpayer waiting months for medical assistance. Its basically soviet , our health service.

You're completely wrong about the reasons patients can be removed from a practice list.

External Link/Members Only

The removal of a patient from a GP practice list should be a rare event. Reasons include:

    - disagreement between the practice and patient, and an irretrievable breakdown of the relationship
    - the patient has died
    - the patient has moved outside the practice area
    - patients have a right to change their practice.

There has been public perception that patients are being removed from practice lists because their care is too costly, their clinical condition or their age.

The BMA supports actions that make it clear that any such discrimination is unacceptable. The regulations specifically require that a removal is not on the grounds of ‘race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition’.

[willie loman]

You're completely wrong about the reasons patients can be removed from a practice list.

External Link/Members Only

Nothing in that long quote either proves or disproves that patients are bumped due to having complex needs, its states that it is unacceptable, the mere fact that the warning was issued , tends to indicate to a reasonable person, that this had become a practice that was too common. It may no longer happen now, but certainly was a problem in the recent past

[daviemac]

I am not doubting your experience, and feel free to think that your fellow brits are happy with their access to medical care, its not my view reading papers etc

I'm not sure what part of "I am not going off hearsay or reports by others I'm going off my own personal experiences." you aren't understanding, unlike you I'm only referring to my own personal experiences, I have made no claim that others are equally happy.

To be quite honest it boils my piss when people start slagging the NHS off, Yes they aren't perfect but it's all we have and if it wasn't for an alert and quick thinking 111 operator, an excellent ambulance service and top quality doctors and nurses at the hospital I would't be here.

[winkywanky]

They are often bumped if they have complex needs. I made the point , as you seem to think doctors are secular saints, they are not they are like the rest of  us. The point I am making is the system is not working for the consumer,  or the taxpayer, I have no problem with a system that puts more money into a gps pocket etc, I am fed up as a taxpayer waiting months for medical assistance. Its basically soviet , our health service.

No profession is populated by entirely by saints, to suggest otherwise would be ludicrous.

I'm just interested that you base your belief that over 50% of the population south of the border is ill-served by their GP, on stuff you read in the paper, when you yourself live north of the border.

I don't think it's that bad, but I'm willing to see some credible proof.

[GingerNuts]

Nothing in that long quote either proves or disproves that patients are bumped due to having complex needs, its states that it is unacceptable, the mere fact that the warning was issued , tends to indicate to a reasonable person, that this had become a practice that was too common. It may no longer happen now, but certainly was a problem in the recent past

It acknowledges there was a public perception which is not the same as it being a common practice.

Please provide some examples of patients being removed from lists due to the cost/complexity of their care.

[willie loman]

I'm not sure what part of "I am not going off hearsay or reports by others I'm going off my own personal experiences." you aren't understanding, unlike you I'm only referring to my own personal experiences, I have made no claim that others are equally happy.

To be quite honest it boils my piss when people start slagging the NHS off, Yes they aren't perfect but it's all we have and if it wasn't for an alert and quick thinking 111 operator, an excellent ambulance service and top quality doctors and nurses at the hospital I would't be here.

I misread your post I assumed that you thought other people were equally happy with the nhs. No one is slagging off the nhs, it is just no longer fit for purpose, it was founded in 1945, and its been time for a major rethink for years.

[winkywanky]

In the group practice handling my needs it is very rate for a patient to be bumped off their list.
Many doctors start seeing patients at 8am and finish at 7pm or later. The triage system works well and increases capacity because in reality, the 10 minute appointments are nearer 15-20 minutes. At least in my experience.  The big issue for GP's is that their Practice Managers ability levels vary dramatically.  A well organised PM is a great benefit. 
Again, my personal experience and that of friends and family is that when something serious occurs doctors seem to fall into two mixed bands. Some are very proactive and that was the case for me. Yet a developed cancer issue was missed for a family member.  IMO the level of competence is still needing attention with lots of younger doctors opting for specialisation.

Indeed, most appts are more than 10mins, that's what they aim for but many will go over.

From what I read and hear I think I'm pretty lucky where I am.

As for competence, again I think I'm quite lucky with my local practice, although I am myself very proactive, I read up a lot and will engage with the Doc if I see him/her. When practices are busy I think that can help. Of course we should be able to rely totally on doctors having the time to tend to our needs properly, as well as being good enough in the first place.

I do think many practices are overstretched though, and as we know we are very short of GPs as well as many other health professionals.

[willie loman]

It acknowledges there was a public perception which is not the same as it being a common practice.

Please provide some examples of patients being removed from lists due to the cost/complexity of their care.

You are right they are not the same, but its kind of curious that they felt they had to make the point? Why was there  a public perception of it being a common practice ?

[winkywanky]

We have newspapers , tv , internet , up here, arguing that the majority are happy with the nhs is absurd, the scandal of waiting times in accident and emergency, and for operations has been going on for years. Not one country in the world has imitated the nhs.

I didn't say the majority are happy, I said how do you know the majority are unhappy? And we were talking specifically about GP surgeries, were we not? 

[willie loman]

No profession is populated by entirely by saints, to suggest otherwise would be ludicrous.

I'm just interested that you base your belief that over 50% of the population south of the border is ill-served by their GP, on stuff you read in the paper, when you yourself live north of the border.

I don't think it's that bad, but I'm willing to see some credible proof.

I cant recall saying 50%. You will actually find that most scots  get most of their information from English media, either newspapers or telly, circulation for Scottish newspapers is extremely low, and this is a country where people read the papers. If you want to believe that your fellow citizens are happy with the nhs, feel free, its not my perception.

[willie loman]

I didn't say the majority are happy, I said how do you know the majority are unhappy? And we were talking specifically about GP surgeries, were we not? 

I don't know, I am only giving you my perception, which is actually how most people operate in the real world, I personally was talking about health care in general, which in my view, has not been fit for purpose for years

[GingerNuts]

You are right they are not the same, but its kind of curious that they felt they had to make the point? Why was there  a public perception of it being a common practice ?

"Common practice" you've added yourself. The BMA only say there had been public perception that it happened.

I don't know why there was such a perception, it's certinly not something I perceived.

[willie loman]

"Common practice" you've added yourself. The BMA only say there had been public perception that it happened.

I don't know why there was such a perception, it's certinly not something I perceived.

You hadn't perceived it? fair enough, but there had been a public perception, which would indicate to a reasonable person that it was something that had happened or seemed likely, to have happened