NHS

[SydneyRover]

They have had nearly 10yrs Ldr the graph shows the decline, one doesn't usally decide to put the brakes on immediately before the wall it's normally a progressive act, see the obstruction, remove foot from accelerator lightly press on brake as required indicate make a u-turn.

If walk in centres are the answer then when triage takes place in A&E which should be within minutes of entry then any patients that can be sent next door to the walk-in should be and be seen in a timely manner.

If the walk-in not not near hospital escaltes a case to emergency then an abulance can be called and patient sent to A&E, this is not rocket science this admin.

[Ldr]

Think education of people has a massive part to play. National mindset seems to be pitch up to a and e with anything

[Glyn_Wigley]

Think education of people has a massive part to play. National mindset seems to be pitch up to a and e with anything

When it can be sometimes virtually impossible to get an appointment at your GP, what do you expect people to do?

[Bentley Bullet]

Ring 111.

[wing commander]

Over the years I've a lot to be thankful for to our NHS.And I'm in full agreement that more needs to be spent on it.However throwing money at it is sometimes not the only answer.Weve discussed many times about the levels of waste and how much that costs.I only know two people who work in the NHS.One is a nurse who works crazy hours,is permanently stressed and is considering leaving and going temporary as theres no relief from it all.The others a guy who works in the management side who has spent all his career working in the private sector.He thinks he's fallen on his feet,his benefit package is beyond belief and he struggles to pad his day out in doing a days work what he says he could do in 2hrs..

Also like what has been said the A&E is flooded with people who just cant get a gp appointment.There is no doubt that system is broken.A&E waiting times are somewhat irrelevant to me as until the GP problem is addressed then no targets are achievable.

[Ldr]

This, spot on WC

[BillyStubbsTears]

There are two sets of clearly established facts here.

Facts 1) We spend far less of our GDP on health care than other developed countries. Yet our clinical outcomes are not that far behind them.

Conclusion? Whatever the shortcomings in the MANAGEMENT of the NHS, it is not grossly inefficient by international standards.

Facts 2) The rate of increase of spending on the NHS by the Tories over the past 10 years has been significantly lower than a) previous eras and b) the rate of increase that most health economics experts believe is required to keep pace with a growing,ageing population. At the same time, outcomes on GP appointments and waiting times for A&E and elective surgeries have become progressively worse.

Conclusion? You don't spend enough, the system starts to fall apart.

Step away from your anecdotal stories and look at the big picture. As set out by those incontrovertible facts above.

[wing commander]

Oh for god's sake Billy stop being so patronising to anybody who doesn't totally comply with your view,with your i know more attitude,it's not impressive..

I did say that more money needed to be spent on the NHS if you had bothered to read the whole of my post,but that needs to be balanced with a proper operational review on how we get best value for money for it to,what areas need the money spending on most .That will benefit us all which is what the NHS is about..

Now i know that your solution is to just tax companies or borrow it and throw billions at it and stand back, but that will just lead to more and more waste as people and companies take advantage and we will end up no further forward..It's all about getting the best value for money..

[BillyStubbsTears]

Yes of course WingCo. Of course it is about getting value for money. The point I'm making is that, by I ternational standards (and off the scale by American standards) the NHS already IS very efficient.

One of the major problems with the NHS today is the disastrous managerial reorganisation that Andrew Lansley brought in 7-8 years ago. It costs a fortune and made the situation worse. So there is a danger, with an organisation as big and complex as the NHS, that by focussing on operational review, you actually make the situation worse. Whereas the experience of the 2000s showed that increasing the amount we spend on the NHS DID lead to huge improvements in service quality and outcomes.

[Ldr]

The major problem in this scenario BST is lack of access to GPs. GPs being private businesses that contract NHS services rather than being NHS in the main

[BillyStubbsTears]

And the problem is supply and demand?

The population has increased. The age of the population has increased. And we haven't invested sufficiently in the GP service.

I will say that the one major reorganisation I'd like to see in the NHS is doing away with GPs and moving to a polyclinic system.

The role of GPs is to act as a barrier to entry to more detailed service. They are there to weed out the coughs and sneezes that don't require detailed treatment. And one way of acting as the gatekeeper is to make it in teasingly difficult for us to get GP appointments to get INTO the system in the first place.


And of course,  by their very definition, they are not specialists. I'll go against my policy of not relying on anecdotes but this cuts hard for me personally. Twenty years ago, my dad was sent home by a GP with a bottle of Gaviscon as a treatment for his chest discomfort. He was actually in the first stages of a terminal heart attack. Had he been seen by someone better equipped to diagnose him, he may have survived.

Then 6 years ago, I got a severe bout of vertigo. Couldn't open my eyes without vomitting. Managed to get to the GP who gave me a cursory look over and told me it was a self-limiting virus that would clear up in a couple of weeks.it didn't. I was unable to drive and mostly confined to bed for 4 months.


And it wasn't a virus It turned out (and this was a self-diagnosis) to be BPPV which is caused by crystals in the inner ear affecting the balance sensors. It's treatable immediately with head manipulation. I found the videos online eventually and learned to do it myself. But that was after 4 months of hell for me and of lost economic output from me for the country. It could have been treated the first day at a polyclinic, with an expert who understood what it was. The GP saved the NHS money by acting as a barrier to me getting treatment. But in terms of the UK plc balance sheet, and my family's quality of life, the costs were far higher.

[drfchound]

BST, did the treatment you speak about above involve laying flat and turning your head sideways into certain positions because it sounds very much like the problem that my wife had a few years ago.
Luckily our GP knew what to do and was able to clear the problem for her.

[BillyStubbsTears]

BST, did the treatment you speak about above involve laying flat and turning your head sideways into certain positions because it sounds very much like the problem that my wife had a few years ago.
Luckily our GP knew what to do and was able to clear the problem for her.

Hound.

It was precisely that, with the head hanging over the side of the bed. Pretty much saved me from going mad, finding that treatment on YouTube did. I was beginning to think I was going to be permanently incapacitated. Looking back at it, the treatment from my GP was shocking. I've heard of maybe a couple of dozen friends and acquaintances who have had a similar problem, so it's not exactly rare. And everyone who has had it knows that it is pretty much totally debilitating. You can't drive, can't work, can barely set foot out of the house without support.

But the GP was utterly lacking in knowledge that I, as a layman, was able to find on-line, and dismissive of a case which effectively left me disabled for 4 months. I've come to realise that "it's a virus" is GP-speak for "I don't know what the problem is, but you look like you're not dying. I have relatively little interest in your case; the door's over there Sir, now f**k off."

I hope Mrs Hound hasn't had any recurrence. I truly wouldn't wish it on my worst enemy. For those of you who haven't had it, imagine suddenly, from nowhere, feeling like you are drunk to the point of not being able to stand, and having that feeling come back every time you open your eyes.

[drfchound]

BST, did the treatment you speak about above involve laying flat and turning your head sideways into certain positions because it sounds very much like the problem that my wife had a few years ago.
Luckily our GP knew what to do and was able to clear the problem for her.

Hound.

It was precisely that, with the head hanging over the side of the bed. Pretty much saved me from going mad, finding that treatment on YouTube did. I was beginning to think I was going to be permanently incapacitated. Looking back at it, the treatment from my GP was shocking. I've heard of maybe a couple of dozen friends and acquaintances who have had a similar problem, so it's not exactly rare. And everyone who has had it knows that it is pretty much totally debilitating. You can't drive, can't work, can barely set foot out of the house without support.

But the GP was utterly lacking in knowledge that I, as a layman, was able to find on-line, and dismissive of a case which effectively left me disabled for 4 months. I've come to realise that "it's a virus" is GP-speak for "I don't know what the problem is, but you look like you're not dying. I have relatively little interest in your case; the door's over there Sir, now f**k off."

I hope Mrs Hound hasn't had any recurrence. I truly wouldn't wish it on my worst enemy. For those of you who haven't had it, imagine suddenly, from nowhere, feeling like you are drunk to the point of not being able to stand, and having that feeling come back every time you open your eyes.

Over the years Mrs Hound has had a couple of further instances of the problem but because I had seen it done, I was able to administer the treatment myself for her.
Hopefully it has gone for good now.

[BillyStubbsTears]

I had something similar Hound. When I first found that treatment, it massively reduced the symptoms, but they would then gradually come back over a few days. Then after about 2 months, I did the head movements as I'd been doing them before, but there was a sudden massive feeling of disorientation and dizziness, followed by the symptoms vanishing. The head movement exercises are all about encouraging the crystals in the ear to fall away from the sensitive hairs that are the sensors in the balance organs. I'm guessing the crystals weren't fully moving when I originally did the exercises, then on that last occasion, they properly left the building.

I've not had the problem since then. Fingers crossed.

[scawsby steve]

Having a badly perforated ear drum, I'm susceptible to labyrinthitis, which produces terrible vertigo. When it happens my GP usually prescribes Prochlorperazine, which does actually work for me.

I agree with BST though about GPs. Many years ago they did everything, including doing rounds of home visits. Most of them were brilliant at their jobs. Nowadays however, they do very little. Things like blood tests, vaccinations, blood pressure, asthma clinics and other things are done by the nurses.

[Dutch Uncle]

Hound and BST - I hope everyone concerned is well.

I can tell you from a couple of experiences that it is not always better in other countries.

For more than 30 years I had a yearly medical examination organised in our offices in The Netherlands with a very senior Dutch GP. In the yearly form prior I once mentioned in the 'any other medical issues' section that I suffer from permanent anosmia (I was born without a sense of smell and I have no idea what smell is).

The doctor then enquired............. asking if my sleeping had improved  Fortunately not a serious issue, so it was funny, but still incompetent.

On another occasion I had horrific dental pain in a couple of upper teeth. I informed my Dutch dentist that I had suffered a broken cheekbone on the same side 6 months earlier (top edged a cricket ball into my face). He treated a tooth and sent me packing. The next day was weekend, no difference in pain, and an emergency dentist treated yet another tooth, with no effect. I then had to go away for an important event I was organising and saw two more dentists while I was away. It was the fourth dentist who first thought to give me an X-ray which showed infection and broken roots where I had been hit by the cricket ball. He then fixed me in no time. Three Dutch dentists, faced with my history, either never thought of or could be bothered to give me an X-ray. Shocking.

[Bentley Bullet]

I went to my GP suffering from insomnia and he told me to try not to lose any sleep over it.

[albie]

Interesting referenced opinion piece from an NHS professional here:
https://www.theguardian.com/society/2020/jan/21/workforce-crisis-nhs-teetering-brink

I think everyone can see the need to change how the NHS works, the question is how best to reform the system once the critical funding issues are addressed.

[big fat yorkshire pudding]

I was stunned reading about the cost of litigation in the NHS, something like 5% of the annual budget spent on addressing legal costs from wrongful treatment, stunned me that.

[SydneyRover]

But it's not difficult to understand why. A mostly dedicated body of staff that have been short changed with equipment, buildings, wages staff and training over 10 years.

''‘This report is absolutely right to call for a funded and credible workforce plan for England that addresses the shortage of at least 40,000 nurse jobs. It clearly states that nursing workforce shortages are the most concerning staffing pressure in the entire health service. This should be seen in the context of a massive shortage across all health and care settings, and all sectors of provision''

 https://www.nursinginpractice.com/professional/nurse-shortages-most-concerning-nhs

And this is just the nurses

[Ldr]

Nothing here is addressing the shortage of GPs (mainly private businesses). We need to address this which has knock on benefits further down the chain

[albie]

Fair point Ldr,

Do you think GP practices should be private businesses, contracting to a public service provider.....or do you think that there is a better model for the health sector?

On the subject of private business interests in the NHS, Sir Branson of pickle has recent form doing well:
https://www.mirror.co.uk/news/uk-news/richard-bransons-virgin-healthcare-paid-21366075

Tax free take home eh.....virgin on the ridiculous now!

[Ldr]

Maybe look at one stop shop model, I think BST menTioned it earlier. GPs have always tended to be private from the formation of the service so nothing new

[BillyStubbsTears]

Not a chance of it happening. GPs are the most powerful group of workers in the country. They would block any move to reduce that. Blair tried bringing in polyclinics when he had the biggest majority in Parliament since the War and he had to admit failure.

Doctors, including GPs nearly prevented the entire creation of the NHS. Aneurin Bevan admitted that he'd "stuffed their mouths with gold" to get them to sign up.

[wilts rover]

Don't forget Boris has promised to recruit 6000 more GP's by 2025.

Then again so did David Cameron in 2015 and achieved the grand total of 272.

https://www.bbc.co.uk/news/health-50351861

[big fat yorkshire pudding]

Don't forget Boris has promised to recruit 6000 more GP's by 2025.

Then again so did David Cameron in 2015 and achieved the grand total of 272.

https://www.bbc.co.uk/news/health-50351861

And why is this? Lack of interest, lack of funds, lack of ability?  I always wanted to be a doctor, unfortunately my intelligence and application was not of a high enough level.  Are there enough people actually capable of the job?

[BillyStubbsTears]

Don't forget Boris has promised to recruit 6000 more GP's by 2025.

Then again so did David Cameron in 2015 and achieved the grand total of 272.

https://www.bbc.co.uk/news/health-50351861

And why is this? Lack of interest, lack of funds, lack of ability?  I always wanted to be a doctor, unfortunately my intelligence and application was not of a high enough level.  Are there enough people actually capable of the job?

Occam's Razor BFYP.

When Labour came to power in 1997, the number of GPs per 100,000 of the population had been steady in the low 50s for well over a decade. That decade had been one of very low increases in NHS spending by historical standards. Labour greatly increased the level of NHS funding and the number of GPs per 100,000 went up to 67 by 2009. That's a 20% increase in about a decade.

Since then, the Tory Govts over the past decade have put the brakes on NHS funding increases. We've had the lowest percentage increase in NHS funding of any decade since the NHS was founded. And, whaddya know? The number of GPs per 100,000 has dropped back down to about 58.

So, we had more GPS ten years ago. Unless there's been a remarkable drop in educational standards or motivation over the past decade, the only thing that explains the sharp drop in GP numbers is the sharp tightening of NHS funding. As William of Occam taught us, when the bleeding obvious cause and effect is staring you in the face, you risk fooling yourself by going and looking for other explanations.

PS. This is very personal for me. The Blair Govt didn't start increasing NHS spending very much until after the 2001 Genenral Election. By 2001, the number of GPs had barely risen after the spending brake imposed by the Tories in the 80s and 90s, and followed by Blair in his first term. It was one of those overworked GPs in early 2001 who sent my dad home with a bottle of Gaviscon to have his terminal heart attack. You don't spend what you need to spend and it has consequences in real people's lives.

[albie]

Occupational stress is a factor in play here;
https://medicalxpress.com/news/2020-01-uk-doctors-burnt-stressed-poll.html

Securing improved (and sufficient) funding, and a different relationship between GP practises and the NHS, would need to address this objective of stress reduction across the sector.

[Filo]

My GP surgery is a joke, theres 3 GP’s serving 10k people they work one day a week and one Nurse Practitioner takes up the rest of the time, getting an appointment is nigh on impossible