UKC

I rather wonder whether the Tories haven't confused running the NHS with running a shopping mall.

In reply to Rob Exile Ward:

Personnally I find I fall ill between the hours of 9 to 5 Monday to friday - preferrably with two weeks notice .... so that makes me a perfect patient.

In reply to Rob Exile Ward:
I actually prefer to get ill/need urgent dental care on weekends as then I don't have to faff about with GP surgeries; I can just phone the out-of-hours service.

(probably should register for a doctor/dentist down here...)

In reply to Rob Exile Ward:

Everybody knows that the NHS only operates 5 days a week. I feel sorry for anybody who falls ill over the weekend, such as Miss Lemming a few weeks ago.

In reply to Rob Exile Ward:

I personally expect to be seen at work any time of day or night without me having to go out of my way for free medical help

In reply to Rob Exile Ward:

Significantly higher risk of death or poor outcome if in hospital over a weekend.

GPs could help prevent some of that.

Having said that, the sums don't work - 40% more days for £100m?! Also, I hope all these extra GPs are in medical schools right now if they are to be ready for 2020.

In reply to The Lemming:

Isn't that what NHS Direct and A & E should be for?

In reply to JJL:

How does that work then? How will GPs prevent some of the poor hospital outcomes?

In reply to Rob Exile Ward:

Nope.

Primary care should be available in local community at hours that suit the patient i.e. when they are ill, when they need attention and at a time that isn't stupidly inconvenient.

GP surgeries closed outside their perception of normal working hours is a waste of a useful resource. And I don't see that longer opening needs loads more GPs necessarily - in most practices it would just mean the existing GPs working staggered shift patterns, catering to the same number of patients (roughly) over a different time period. And hopefully doing a few more patients that wouldn't come in because they couldn't, or who would have clogged up A&E for something minor.

In reply to Ferret:

GPs in their 50's are retiring as early as they can. There are vacancies all over the country
The trouble is that there are not enough, if any trained GPs wishing to become partners in GP practices.

And many of those newly qualified GPs dont want to work as salaried GPs either. They are going abroad.
Finally very few newly qualified doctors are joining GP training schemes across the country. They want to work in hospitals.

All this means that there are not enough GPs now let alone in 2020!

Of course there will be alternaives. See http://shoestoneuk.blogspot.co.uk/?view=classic

In reply to Rob Exile Ward:

A housing estate that I work on, the surgery is open one morning per week.

(Patmore Estate, Battersea)

In reply to Ferret:

I don't entirely get that. GPs are not an emergency service - there is/should be A & E for that.

If you need to see your GP take time off work.

In reply to Ferret:
in reply to JJL:

>Significantly higher risk of death or poor outcome if in hospital over a weekend.

>GPs could help prevent some of that.

How exactly? By telling them to go to A and E? GPs are not emergency services.

in reply to Ferret:


Oddly, most people don't want to go at weekends, or evenings. They tried it a few years back and few went. The majority of GP appointments are for the elderly who prefer midweek 9-5.


No it's not. The resource is the GPs, not the building they sit in. Most patients (that regularly attend GPs) want to go during the current opening times. It's will be a massive waste. Not only will the GPs need to be there out of hours but also the rest of the staff. It will cost a huge amount more and benefit a vocal few. Plus this policy will add to the current GP shortage as it is one more crap thing added to a job that is already on the verge of being so crap that no-one wants to do it.

In reply to n-stacey:

Better care of a frail elderly patient may stop them going "off their legs a bit" on Thursday and an admission on Friday...

In reply to RupertD:

You may be right. However, it is currently spectacularly inconvenient to attend a GP if you are working, what with the requirement to go to your local one, rather than the nearest to work, the need to phone at precisely 8am to get an appointment, the limited choice of times if you do happen to get in before 50 other people etc.

What is to stop people attending any practice for many things?
Why can't there be an online booking system?
Could we not have a least one or two nights a week of "late-opening" so people don't have to take time off work for minor matters?

In reply to ill_bill:
Is the GP system outdated? Should we look at what some of the European countries' insurance-based systems do and offer other options, such as online and telephone consultations for simple ailments?

I agree with the poster that says you should be able to attend any surgery. Or how about making more of the drop-in services at hospitals?

Neil

In reply to MG:

You can do all of that. It's just that everyone wants something slightly different. Resources added somewhere new either need to be taken from somewhere else (and bear in mind that the current service is stretched to bursting) or more money needs to be added. And theres no more money.

The current plan seems to be force GPs to add services for no more money. This results in GPs leaving and long term (actually it's started) will result in a GP recruitment crisis.

The end result is bound to be that nurses end up taking in the slack. They're cheaper to train and pay. And the quality will suffer. And everyone will yearn for the good old days of 2014 when at least you could see a doctor within 2 weeks.

In reply to RupertD:

I don't see how any of my suggestions requirement more resources

-Online booking reduces the need for telephone answerers
-Going to one GP rather than another is the same cost
-Evening opening could be offset by late opening on the same morning.

In reply to Rob Exile Ward:

I would be interested to see the results of the trials on this they started a year or so.

When they are developing these drop in centres with medical sevices/pharmacists ( who are always open)/ sports centres/libraries (there is one near is which does this)that you cannot have 7 day a week GP's.

In reply to MG:



Someone has to pay for the computer system. There's no money. Most practices I imagine will move to this over time, but doing it wholesale across thousands of individual small businesses that are struggling to make ends meet at the moment is not going to happen without cash.


Provided that everyone goes to a different GP at exactly the same time.


But the morning surgeries are already crammed with people, most of whom want morning surgeries.

In reply to RupertD:

TBH I think GPs being small businesses has rather had its day as a concept. With limited funds, provision would be better managed if the local NHS Trust provided and recruited directly based on demand.

Neil

In reply to MG:

Online booking isn't quite as straightforward as it sounds - after all, the NHS spent £10 billion trying to make it happen and they couldn't do so. I'm never quite sure what problem it is a solution to.

In reply to Rob Exile Ward:

Why take time off work? Any other service, tends to organise itself in a way that is convenient for its end users, why are GPs any different to that? Tax payers pay for a service here. They don't necessarily get it. Part of my point is that GPs are not an emergency service, so they should provide services in a way that doesn't push people towards the emergency service. Number of times I've taken a child to hospital for something that could be dealt with locally if the GPs were open.

I don't know the in's and outs of what's apparently so awful about doctoring that means that recruitment is a problem and that we have to be beholden to the few who deign to still provide general practice, that's another issue. But if whatever those issues are, are not in the equation, GPs can and should be offering services at times that their end users actually want them.

I can go to my Vet to get my dog seen to, pretty much 24/7 without issue.

To see my GP I have to call, and keep calling at 8am and hope I get through, and then accept an appointment at a time that's convenient to them. For people with minor but regular needs that's a lot of days off work, or a lot of going to work first thing, driving back to local surgery, being seen and going back to work. Astoundingly inefficient. Add in doing it for children as well, and add in trying to juggle all that while getting other not ill children to school and its nigh on impossible.

And all because GPS don't work flexible hours. And their receptionists are worse, the number of times they change the rules on what can and can't be done when, and then act aggressively or rudely because you don't know that childs immunisations are provided on the 3d Wednesday of every month at 2 to 2.15pm so long as its not a full moon in which case... You get my drift.

I know GPs, I like GPs, and I thoroughly appreciate each individual that provides care, but as a service I despair at the inefficiencies and the fact the service seems to think it lives in a silo beholden only to itself.

In reply to Rob Exile Ward:


Well most other businesses, such as airlines, hotels etc, seem to manage it

I'm never quite sure what problem it is a solution to.

The ridiculous game of trying to get through at 8.00:00am to get an appointment. If you could just see what was available and book (maybe for £5 to stop abuse), it would make seeing a doctor easier and reduce reception expenses. Making booking within a certain distance of your location (work, home etc) possible would be even better.

My practice has had online booking for the past few months - it's fantastic. Far easier to look directly at when appointments are available, and with which doctor, rather than explain the receptionist that I could do this Tuesday morning, or next Monday afternoon (as long as it's before 2.30), etc.

As for 7 day working - seems a distraction to me. I can see the case for maybe one weekend or evening session to see if there's demand - I'd have probably used it when the kids were small rather than try and go to an appointment for me with two preschoolers in tow - but that's about it.

In reply to Neil Williams:

Possibly true. But getting from here to there is very difficult. If you make GP practices unviable commercially they fold. Thousands of GPs will suddenly become responsible for redundancy payments for staff, disposing of buildings that are useful only for being GP surgeries etc. GP partners are personally liable for all of the business debts. How do you propose to fold thousands of small businesses whilst retaining the staff and dealing with the debts without incurring massive amounts of costs?

And bear in mind that the local NHS trust doesn't know how to run GP services. They sacked everyone that did a few years back to cut costs. The only people with the expertise in primary care are the GPs that you would make bankrupt or saddled with huge debts.

In reply to MG:

Actually I would pay a few quid for the option of online booking rather than having to phone up. Though I recognise why that is a slippery slope.

Neil

In reply to RupertD:
Therein lies the difficulty. But making it the strategic plan in the long term would be a start.

Neil

In reply to MG:

A lot of the inconvenience is essentially a rationing system. The more available GPs are the more people will use them. If you give a service away free you need to ration it somehow.

What we really need to do is to charge £10 for each visit to a GP (and perhaps £20 for each visit to A&E, £50 if drunk).

Of course there will be howls of outrage at that concept, but it's the way to have an accessible, available and high-quality service.

In reply to Neil Williams:


Ah, no. You see if you make it a long term plan to fold thousands of small businesses, no-one will want to invest in such a small business. In fact no-one wants to become a GP partner as it is, because there's zero visability as to what will happen. Would you remortgage your house to invest £50 - 100k in a GP practice with all of the proposed cuts and changes that may or may not happen?

In reply to RupertD:

No. So all new GP capacity is provided centrally. You can then "manage decline" in the others.

Neil

In reply to Rob Exile Ward:

Go back to running GP Clinics in/linked to A+E? In my experience they worked pretty well and diverted patients from the acute unit.

David Cameron cited care for the elderly as the main issue...well, we need to fund community-based services like nurses, home helps etc by re-directing the (decreasing) proportion of the NHS Budget back to Primary Care. Elderly people pitch up at A+E for very good reasons, ones that GPs wish they could alleviate but often can't.

What we also need are measures to get the worried well and minor illness out of GP surgeries. This needs education of 'the public' and once again re-allocation of funds

In reply to Coel Hellier:
While not disagreeing, I think that is a slightly separate point.

Access to the limited places is currently governed by a perverse race to get through at 8am each morning. Online booking with appointments available up to two weeks from the time of accessing the system would get rid of this, although not an overall shortage of appointments. As above, some means of preventing people booking many appointments and just using one would be needed.

In reply to Neil Williams:



I'm not sure what you mean. If you have a partnership with, say, 3 partners, and a contract with NHS England requiring 3 partners and one leaves, you need a new partner. Not only to fulfill the contactual requirements (that bit could be fixed), but to buy back into the business. If you have a policy of managed decline, no-one will replace the outgoing partner and the remaining partners will be shafted. Such a policy would lead to a fast exodus of GPs so as not to be the last man standing.

In reply to Coel Hellier:



A service to whom?...probably to those that don't need it any more than others and less than many. The problem is that illness is demographic with a higher burden (broadly speaking) falling upon people who probably started with less personal and financial resources and who once ill, became more so eg the drunk (alcoholic?) you want to charge £50 to. A good example of people who frequent A+E disproportionately but who have real health needs which if not addressed result in massive cost. Should we direct resources to making sure people can get appointments quickly or to the unit I ran until recently, which is being shorn of its capacity to manage people effectively? One example - alcohol and recreational drug user with chaotic lifestyle who attended A+E 50+ times (and was often admitted) in the 6 months prior to his admission ( add up those costs) who after a 10 week admission and outpatient rehab is now working in the unit and paying tax.

Allocation of resources within health...very complex.

In reply to MG:

Ironically - I've said this before - our local practice doesn't have an appt system at all - which I think is logical - and it works great. People with jobs - like me - get in at 8:00 and are normally out of the door by 9 (last time I went I'd had an x-ray, seen a consultant and been discharged with a prescription for painkillers by 10:30!)

I am aware though that a friend of ours who is a GP tried this in a poorer part of town and the queues were round the block, so (at the moment anyway) it doesn't work everywhere.

In reply to MG:


But the 8am-crunch is again a rationing system. If you allowed online booking for up to two weeks then those appointments would simply fill up. You'd then be back to an 8am crunch, but for an appointment in 2weeks+1day, instead of for that day.

In reply to Coel Hellier:

I was thinking more an 8am mini crunch, then an 8.10am mini crunch etc. as successive appointments became available. As everyone would logon at different times, this would avoid the pressure to get on the phone at a precise moment. Add the possibility of specifying a doctor etc. booking when you want etc. etc and it seems a better system to me.

In reply to Coel Hellier:

Then you get rid of the ridiculous targets and offer a much longer booking horizon, e.g. 6 months, for non-urgent appointments. If that fills up then you've really got a problem.

Neil

In reply to Coel Hellier:

My previous GP's system was great...appointments were full for a week ahead but you couldn't book an appointment more than 1 week in advance...only the resourceful succeeded in getting to see anyone.

In reply to Rob Exile Ward:



Perhaps not so easy in a zero hours setting?

In reply to Nigel Modern:


I agree that, if we charged to see a GP or go to A&E, you'd then have to worry about less-well-off mothers with frequently sick young children and about drug users etc. However, for the vast majority of people such a system would work and would make the overall system more functional. It is fairly common across Europe, and seems to work well enough.

The zero-charge mantra is getting to be a problem for the NHS, preventing it working much better (ditto for things like hospital food).

In reply to Timmd:

Well, fix the zero hours business; it's illegal to pay below the minimum wage, it's illegal not to give holidays at a rate of 26(?) days per year, it should be (if it isn't already) illegal to stop someone going to the Dr when they need to.

Better than re-designing an entire health service.

In reply to Coel Hellier:

I think you're wrong. The idea that rationing can and will be imposed by levying charges is so fraught - just arranging the bureaucracy to collect, administer and account for payments would pay for 100s if not 1,000s of GPs straight off.

The problem with things like hospital food is that the management are incompetent and weak and clinicians don't see it as part of their problem. There has to be a better solution than opening a Macdonalds on every ward. (Not that I'm automatically against privatisation, just need decently negotiated and monitored SLAs.)

In reply to Rob Exile Ward:


It would appear not.........

http://www.ukclimbing.com/forums/t.php?t=598809

In reply to Coel Hellier:

If a charge was introduced, I would expect it to follow NHS dentistry in terms of those who would be exempt. However I would be concerned about it being a slippery slope.

That said, dentistry is not a bad example of where additional fees are used for additional services - for example, you can be with a dentist on the NHS, but pay for a white filling privately. Could more conveniently-timed GP appointments be similar? Free 9am-5pm Mon-Fri, £10 on a Saturday, perhaps?

Neil

In reply to Oceanrower:

Is that not an apprenticeship? It also provides accommodation, which will have a value.

Neil

In reply to Neil Williams:
According to this, not really.

http://www.apprenticeships.org.uk/employers/apprenticeships-for-small-busin...

Plus, even an apprentice is supposed to be paid the minimum wage.

And, even if you take in the supposed £9,000 value to include accommodation etc. then it's still only £4.12 an hour.

In reply to Rob Exile Ward:


I'm not convinced. Any GP which runs a dispensary already collects prescription fees. Most GPs also charge fees for non-NHS items such as travel vaccinations, some certificates, etc.

In reply to Coel Hellier:

I've never seen money change hands in our local practice. And there's a heck of a difference between taking money occasionally and have practice staff routinely handling point of sale for huge numbers of patients.

But that apart, I just don't agree with this Tory line that the only way to control/ration/arrange services to put cash at the heart of it.

In reply to Rob Exile Ward:

It is true that money concentrates minds, though, even very small amounts of money.

At my Scout Troop we charge for all non-weekly-meeting activities, even if only a few quid with lunch provided to make it better value, because it means people don't book unless they intend on coming, and are less likely to randomly show up on the day.

Neil

In reply to Neil Williams:

Seems to me there's a bit of unreality about the majority of the people who actually use GP practices. Are reception staff going to turn away little old ladies because they've forgotten their purses? How many people are going to defer their next appointment - the one that would have caught their cancer in time - because they didn't have the cash that day?

Are only people with online skills going to be able to book appts? Who's going to be responsible for cashing up at the end of a day when there might be £1,000s to account for?... and go to the bank with wads of cash - or are only people with credit cards going to be allowed?

In reply to Rob Exile Ward:
You did read the bit about those currently exempt from dental charges/prescriptions should also be exempt from any GP charge, no?

Edit: One exception. I would be entirely supportive of a penalty charge being made for not attending an appointment and not telephoning in advance to state that you will not be attending. I thought it was ridiculous that dentists stopped being allowed to do this. Sure, there are many reasons you may not be able to attend. It's only polite to advise them of this.

At what point did I say that telephone booking of appointments, or booking in person, should not be allowed? The introduction of online booking for train tickets has not stopped anyone booking in person or by telephone.

Who cashes up? Well, as the practices are independent businesses that's down to them. Corner shops seem to manage it.

Neil

In reply to Rob Exile Ward:


Which dentists do routinely without much problem.


What is your method?


No they're not.


Very few I suspect.


Dunno, same method as used by dentists I guess.

In reply to Rob Exile Ward:

Just another 'policy' designed to attract their core demographic. The elderley. Never mind that G.P. recruitment is currently at an all time low. 5000 extra G.P.s they say : 5000x 5 years med school plus 6 years G.P. train ing = more than a decade, probably two if they went all out to recruit tomorrow. Maybe the plan is close more hospital beds and replace them with community services....so shifting medics from one to the other.

Don't buy the propaganda, hospitals in London are already running at twice the capacity they were planned for.

D

In reply to Neil Williams:


I wouldn't say it's true that it always concentrates it on the right thing to do though.

I'm not that keen on presenting to the doctors as it is, as I'm always convinced I can sort myself out right up until the fact that I can't slaps me hard in the face - if there was a charge I'd be even less likely to turn up and get a timely diagnosis, and I'd imagine there are a lot of problems where an early diagnosis could save the NHS quite a bit of money.

In reply to cander:

if your health is less important that your work then frankly your heads up your arse.

it'll cost a fortune. your asking the most powerful union in the UK to work weekends.

In reply to Coel Hellier:



At a time when working families are getting squeezed pretty hard, I think your suspicions are wrong.

In reply to alasdair19:

good contribution there ... however as a trainee mountain guide I'd rather hope your customer comes first - rather than your convenience - but hey ho take your chances in the customer facing world.

In reply to Rob Exile Ward:

It pains me to say it but this is a good idea.

GPs, dentists, solicitors, banks and more are service industries. It makes sense for them to be open and available outside of normal working hours.

In reply to 3leggeddog:

I don't think I agree with that. Medicine is different - it's not a service industry, it's a complex partnership (between physician, patient and taxpayer) addressing the most fundamental issues that any of us will face. To compare that with buying cosmetic dentistry, filing a tax return or applying for an overdraft seems to me a mistake.

In reply to Rob Exile Ward:
We have two walk in GP centres here, serving a population of 360,000. They are open 7.30am to 10pm daily every day of the year, including Christmas Day and New Year's Day.


Where will the GPs come from to staff these though? Will the UK continue to deprive developing countries of their doctors, by offering higher wages and better working conditions to those prepared to emigrate?

In reply to stroppygob:




Yes.

In reply to Rob Exile Ward:

The GP system is one where the demand is continually outstripping the supply, and the demand is continually and exponentially increasing.

Unless they (the Government) find ways to reduce/resolve this then they're living a dream to think they will get 5000 more GPs by 2020. There is already a massive recruitment problem and many practices face closure due to having no GPs.

Making GP less family friendly is only going to create more issues and many older GPs will walk if faced with having to work longer hours.

Reducing GP demand by reducing inappropriate follow ups and inappropriate signposting from secondary care, allied health professionals and local councils is one place to start.

E.g Having an appointment with a GP because the council has asked for a GP letter to state that you are medically unfit to put your bins out is inappropriate, but not an uncommon scenario.

As for falling ill outside surgery hours, there is already an OOH service in place to assist with that. Whether that is a good one is more open to debate but from my understanding this Tory policy is aimed at providing ROUTINE care 7 days a week, not URGENT or EMERGENCY care.

In reply to Thickhead:

'many older GPs will walk if faced with having to work longer hours.'

One small point - few people have much sympathy for the 'doctors will walk' argument - the same as people tend to have no sympathy for the 'if we tax bankers they will all move abroad' story. They may, but that just indicates to most that they are overpaid if they can even contemplate jacking a professional job in.

I'm not going into the reality of doctors finances, the risks of running a GP practice etc (although those risks are more a sign of a flawed system than something that can not be resolved in some way) and what a doctor may do to fill their time or earn 'once they've walked', but that sort of comment really just annoys people and sets the doctor who is looking for sympathy or support for their position apart from those they are seeking support from.

In reply to Ferret:

Sympathy for well paid people is indeed hard to find. However it doesnt mean we have an unlimited supply of very expensively trained individuals. Though it'll be interesting to see how the feminisation of the mediccal profession affects things.

The argument remains to have GPs opening 7 days we need to sacrafice another part of the Health and social care system. Any suggestions? Shoudl this be a priority?

In reply to alasdair19:
I still don't see what needs cut or added in most cases. Small practices may not have enough staff but large practices in towns and city's have plenty of staff to extend opening hours by changing working patters, not adding more resources. Work smart, work flexible. Most other consumer facing industries have and those that don't havn't survived. I can't see why doctoring is different.

The practice I use has well over 10 doctors, several nurses, 3 receptionists on at a time, admin staff, etc etc. That's plenty to extend opening hours with. Most people are not arguing for 24/7 GP cover, but they are arguing for perhaps a certain number of early mornings, late evenings and slots at weekends. You do that by having less staff on, but spread over longer periods.

I've never been paid more for 'out of hours' working, or double time for weekends and bank holidays in any job I've ever been in, I've accepted the hours as part of the job.....

And in a final irony, I know of doctors who do extra hours (at extra high pay rates, obviously) working in out of hours centres, putting in 'antisocial' hours at evening and weekend for a slug of extra cash, providing the cover required because the local surgeries don't open at those times.

In reply to Ferret:

I'm not after sympathy from you or anybody else.

I've never said GPs are underpaid. Undervalued yes, but not underpaid.

Regarding older GPs walking, I'm talking about those taking early retirement, becoming part time or in some cases moving abroad. Not necessarily "jacking work in" completely. Although I do know of a few who have become so disillusioned they have decided to do just that.

People seem to compare it to other service industries... Well in that case lets fund it the same too. Privatise GP and move to a user pays model. £30 for a 15min consultation, which could be partly reimbursed by a voucher system for the poor or unemployed or palliative care patients. Elderly and children could be subsidised, as should pregnant women. Middle class commuters, the ones kicking up the most fuss about not being able to make an appointment pay the full amount, but have an appointment when they step off the train at 6.55pm Thursday. You can register where you like. Home visits can be charged at the discretion of the GP.

In reply to Ferret:

Opening a builing that is normally closed has a cost, not massive but it's there. Most practises seem to have 8am appointments and 5:50pn allready.

Feasible to fit round a working day I'd have thought.

The GPs have been paid extra to be this flexible. To get them working saturdays and Sundays means a renegotiation this will be expensive. I;m not saying this cost if fair or reasonable but its definitly there.

Most people are ill enough to be of work or there very young or very old. I appreciate particularly for self employed being able to do their "doctoring" outside their working lives is important but i think most major cities have walk in centres and your local GP can see you before or after work.

In reply to alasdair19:


Why? Perhaps because they were unable to get a GP appointment when they were working and it was a minor problem, so they ignored it until it became serious enough to stop them working. In a case like that, an early weekend appointment might cost the NHS many times less than several weekday appointments and further treatments once the problem has festered.

In reply to Thickhead:

'becoming part time',

Yes - As I've seen, working in out of hours for an extra high pay rate. Where is the logic in that for the Tax Payer that funds it.

It seems to me that those who pay for the service (The Government/Tax Payer) get limited say in what service is provided. That's the difference between it and any other service industry. The payment system seems to allow a position of strength to the industry, rather than the other way around. If a shops not open, you shop at the one that is. The one that is, opens because it wants revenue. The one that doesn't fails.

The whole powerful BMA thing annoys me as much as the powerful unions used to.

Sympathy or not, even where Doctors or BMA are doing something they truly believe to be right for patients, they simply sound like they are spitting the dummy and I'm afraid many people doubt that the motivation behind refusing to change is patient benefit. To me, part of the issue is simply that GP practices are run as small businesses and the business owners are potentially conflicted - not surprisingly, they need what is best for them, their staff and the significant personal investment they make in the business.

In reply to Ferret:



Because they want 24/7 GP coverage. That comes at a cost.



Are you serious or trolling? The Government have an exorbitant amount of say into how GP services are run.

They introduce new contracts, tear up old ones, change PCTs to commissioning groups, close down community services like cottage hospitals, move the goalposts for QoF (performance related pay), decide how much of a global sum each GP practice should get etc. There is so much mud slinging going on that the whole structure of family practice is imploding.

Regarding the payment system a GP gets roughly £150 per patient per year on their books. For that they see that patient as many times as that patient needs.

Try insuring a dog for £150 a year with your local vet.

The alternative is as I've already stated above - privatise the service.





That's the way its been run since the NHS was founded in 1948. We could make all GPs salaried, but there isn't the money to buy up all the buildings and staff from the current business owners (the vast majority of cases being the GPs with the occasional practice manager thrown in the hat), therefore simpler to privatise the whole enterprise.

In my opinion.

In reply to Ferret:

Can we please get rid of this truly, monumentally stupid idea that medicine is a 'service industry' just like a coffee shop or accountants.

The less doctors have to do for us, the better they are doing their job. If they can persuade us to lose weight, stop smoking, cut down drinking and get a better work life balance then the less work there will be for them. And that is a good thing.

The problem with all this 'service industry' cr*p is that it reinforces the idea that every visit to a GP must result in cure, an intervention, a result which will be entirely independent of our own actions. So antibiotics are issued, anti-depressants dished out, tests initiated which may not be necessary - may even be counter productive - but it keeps the consumer/patient off the doctor's back. Who ever got chased for medical negligence for prescribing unnecessary antibiotics?

Medicine isn't like that - at best it's a subtle interaction between patient and physician, on the whole 'it's what doctors do to amuse the patient while nature takes its course.'

The key to a sustainable NHS - and I think it's a viable goal - isn't so much increasing supply as it is in managing demand; making us - the patients, and taxpayers - responsible for own health outcomes. And this constant banging on about 'meeting patient demand', as though the NHS were a branch of Tescos, trying to grab market share, is plain wrong, counter productive and feeds directly into the privatisation agenda, another catastrophically stupid idea.

In reply to alasdair19:


It really isn't that simple. A minor health complaint is perhaps less important than losing your job.

Neil

In reply to alasdair19:

Or, as I said, you charge for the extra service on the principle that people are either cash rich/time poor, or time rich/cash poor in most cases.

Neil

In reply to Rob Exile Ward:


In what way does that differ from, say, motor vehicle maintenance?


One thing the NHS does very, very badly is proactive care. It's break-fix.

Neil

In reply to Neil Williams:

Yes you're right, motor vehicle maintenance is exactly like medicine - my car certainly responds better to a grease monkey who takes the time to listen than someone who just changes the oil

And yes the NHS does do the pro-active thing poorly, mostly because it is chasing it's tail trying to provide headline good news stories for politicians who think that homeopathy is a valid form of medicine.

In reply to Neil Williams:




Are you comparing medicine to being a mechanic?

Although some loose similarities in terms of diagnostics they are completely different. You scrap an old banger for a start.

And the NHS isn't too bad in terms of proactive care. Maybe behind other western countries but ahead of many. I don't think its break-fix.

For example, childhood immunisations are amongst the highest take up rate of any health system. Cervical smears similarly high. Breast cancer screening is competitive with most western countries. (Which might just say we're the best of a bad bunch but you can only compare yourself with your peers).

There has been a monumental shift in the past 10years from acute to chronic/preventive care but that is what Labour and GPs are being castigated for - not providing the break fix model that they were previously.

In reply to Thickhead:

No - I'm not trolling - I'm describing it as it is seen by me, a user of the service who is not 100% up on every nuance as presented (differently)_ by each side in the argument (i.e. the Government and the GPs/BMA).

The way its run since 1948 isn't an answer - its clearly part of the problem.

I'm in no way anti Doctors, and I believe they have patients at heart much of the time, and try to protect care from political interference... but I also see a massively dysfunctional, disjointed, inefficient and badly run system which both sides are to blame for in some shape or form. The mud slinging as you describe it helps nobody and as I say, damages peoples (mine clearly!) perceptions of GPs.

As for £150 per year, that doesn't cover all healthcare, only parts of it so its an invalid direct comparison.

In reply to Rob Exile Ward:






Great post.

The problem is, of course, that people are (deeply?) conditioned to expect treatment as a 'consumer' as well as longterm prepaid 'investor', having worked hard their whole lives, etc; this exchange/entitlement situation causes a lot of confusion, I think, and tends to fuk up the doctor patient relationship for some deeply conditioned people. Service ethic is not as deeply understood, it seems, all round.

Personal responsibility is out of fashion, money-power is all that seems to matter when it comes to leveraging our own life-changes. Of course, the scarcity of the latter then dictates the sense of exclusion that accompanies the expanding class of 'failed consumers', who must either reinvent themselves or go elsewhere to perish unseen. We cannot pay an expert, and thus blame the experts should we fail to change our market-based lives, if we cannot first exist in the market-based society as 'members'. But ultimately, we, as we are now, cannot afford a system where a person's healthcare is susceptible to the situation of 'consumer-failure'; this would be a failure of society, as it is in the USA. Unless, of course, "there's no such thing as society"?

From above, leaders see so much 'exciting' thinking based on market-driven solutions, cash seems to be ready and waiting if they shape policy correctly, state-based provision and the technological thinking that sustained it is being thrown in the skip as fast as possible to make things even more irreversible...

The economy is already disposed to 'service-industry' solutions, if not locked-in to them, so the great assumption is that once we get this giant ball rolling again, there will be loads of spending to tax, and so on. (Austerity was supposed to clear the field for our business leaders/saviours by promising no tax-restrictions on freedom in the near future but they all seem to know something the public doesn't, as they sit on beds of cash) Transnational capital is running out of solid places to place its money in the UK and the NHS has been in the sights for decades. The average person doesn't seem to understand that the goal of privatisation is never the same as the goal of institutions such as the NHS - it's just that capital uses the language and structure of healthcare to get a return on investment, just as it uses the brains of intellectuals who run thinktanks. The value sets are different, incompatible: Life and Profit. The incompatibility problem can only be dealt with by Newspeak thinking. Some people seem to volunteer to learn it though, higher and lower and tv educated examples are everywhere amongst us.

People forget that if our GPs are all salaried, working hard for MegaCare Corporation, they aren't going to be interested in working all those extra hours for 'the customers' and 'the employers'. Which is why it is going to be more costly, less efficient, more soulless, for everyone, and for those who cannot meet the necessary costs, the 'failed consumers' of healthcare, there will only be 'dumpster-diving', that fabulous tradition that started in the land of the free. Perhaps there will be a place for out of date medicines to go to the needy, like soup kitchens, because we care in a way?

Motivation is an interesting subject and an ancient one. I think we know which way to go on this regarding health and that the NHS is moving as fast as it reasonably can. I am beginning to think that there needs to be tax on fat and sugar as soon as possible, to pay for healthcare and demotivate self-destructive eating. Jacky Davis has suggested taxing international capital to pay to keep the NHS public [actually, existing in its present, Life-directed form] but that has ALWAYS been a possibility and was not taken up, because of 'motivation'.

I was looking at a packet of apples in the supermarket the other day and found myself thinking, "Two quid for four apples, that's a rip-off". I cannot remember when I thought a multipack of sugar bars was expensive.

Jon

In reply to Ferret:



So, how are you going to change it...

1) Make every GP salaried which there isn't enough money to do. This is a relatively good option for GPs as all of a sudden they will get paid hourly rather than a payment system. It takes away the burden of running a business and owning property. In an ideal world, this should have happened in 1948 but it didn't.

2) Privatise the whole enterprise. Then you pay on demand. Not good for patients unless they have oodles of cash.



And that is exactly what the Government wants. Damage perception of the most trusted profession and this gives them the power to do what they want "in the patient's best interests" which is clearly more for their own political interests.



Its a comparison that's often used. I know its pretty loose but it gives a general idea.

£150 for unlimited access - try seeing a vet 5 times in 12months for that. Last time I went I paid £88 for a single blood test for my dog.

In reply to Carolyn:

My local practice refuses to deal with any communication on line, even the most simple question. I got a very snooty response when I tried to check something. Everything has to be in writing addressed to the head gp. This is the same surgery that gave me antibiotics for a chest ache - until realising a week later I had a blocked artery.As to payment, I suggest we all have our own fund in a sort of debit card which we spend where we think we will get the best service. That will keep the gps on their toes and get rid of that 8 30 morning sit on the phone to beg for an appointment.

In reply to Rob Exile Ward:

This whole thread just adds to my desire to sack being a GP off and do something else.

GPs are by far the most efficient part of the NHS and they are being treated (and portrayed) abominably.

If general practice fails, the whole NHS fails and privatisation is the only option.

7 day working can not happen in the current structure. Fact.

In reply to bentley's biceps:

How far are you into training?

There is no way I would return to being a GP in the NHS system.

That was 5years of my life lost, robbed.

I'm enjoying the job again now though, in a different system. So its not all bad.

In reply to bentley's biceps:

Why is this thread bothering you?what is the problem with asking if more convenient opening hours are possible?

Also gps are in credibly highly paid and can choose when and where to work. How is this abominable?

In reply to Rob Exile Ward:

If I want to book an appointment my closest option would be...

http://www.southyarramedical.com.au/page/7/appointments

Crazy options are offered, on-line booking, evenings, weekends!!

Is this just a resistance to change or is there something deeper in the UK psyche about the NHS?

Cheers
LD

In reply to Rob Exile Ward:

If I want to book an appointment my closest option would be...

http://www.southyarramedical.com.au/page/7/appointments

Crazy options are offered, on-line booking, evenings, weekends!!

Is this just a resistance to change or is there something deeper in the UK psyche about the NHS?

Cheers
LD

In reply to MG:


Its the MORE opening hours rather than the MORE CONVENIENT opening hours, I suspect.


Some GPs are highly paid.

Choosing when and where to work is somewhat contentious.

E.g I couldn't have said "Right, I'm going to close my surgery on a Tuesday and open Saturday instead" as the core hours have to be covered i.e Monday - Friday 8am-6.30pm currently and weekend work would have to be additional to this.


What's abominable is the way the Tories and the Tory press (aka Mail) are attacking what has been, and still is, the most trusted profession and threatening the whole existence of family medicine in the UK.
The current structure is failing to meet the demand so God knows how having to work longer hours is going to change that.

In reply to Thickhead:

See Lurking Dave's post above. The impression I get from this thread and elsewhere is that GPs will object to and frustrate even the most minor changes and suggestions for improvements out of hand. Online booking and evening opening ate pretty basic ideas and fundamental to customer service. They do not imply longer hours.

By choosing where and where, I meant that GPs have the option of part time work, or locum work, in all parts of the country (or abroad) at rates and terms most professions would only dream of.

In reply to Lurking Dave:

Not only that Dave but;

To arrange a doctor to come to your home, please call 9429 5677.

In reply to MG:


See my post above, evening opening has to be additional to core hours. Therefore longer hours.

I would have loved to be more flexible with my working life and offered evenings instead of mornings, Saturday instead of a weekday but I had to provide core hours. Therefore its the system preventing me from change, not me being a GP. Be careful who you blame and don't believe all the smears.


Compared to vets, solicitors, lawyers, airline pilots, bankers, accountants, estate agents, I don't think they earn exceptionally more.

Its not easy to move abroad with the qualifications, unless you speak another language you are pretty much restricted to Australia and New Zealand for comparable pay. If prepared to sit more exams that opens up USA and Canada.

In reply to stroppygob:

How much would you pay for a home visit?

We currently charge $20 extra if within a 5km radius of the practice.

Thats about 10GBP.

Seems to make much more people book a taxi!

In reply to Thickhead:

Well I don't hear doctors, certainly here, saying, " yes, we want to open at other times but can't because of xyz restrictions, let's look at this", I hear "no, not possible", and the same for other suggestions.

In reply to MG:



Well I'm one on this thread who is saying exactly that!

This from the Royal College of GPs doesn't seem to be too obstructive to extended opening, or flexible opening hours...

http://www.rcgp.org.uk/news/2014/september/gp-workforce-too-overstretched-t...

I'm currently working in a practice that is open 8am until 10pm 365 days a year and am much more fulfilled than I ever could have been working core hours in Blighty.

In reply to Thickhead:
$20 sounds reasonable.


Where abouts are you? I'm in Canberra.

In reply to stroppygob:

Dunedin, New Zealand.

In reply to Rob Exile Ward:

last ditched attempt to get on the country's good side (to little to late) pack your bags Cameron..

In reply to MG:

'Online booking and evening opening ate pretty basic ideas and fundamental to customer service.'

That simply isn't true, how ever often you say it. It's easy booking airline seats online, after all a seat is free or it's not, and if you don't turn up then that's no one's problem but yours. But how does a patient know what sort of appointment they need to book? How will you make them turn up? How will the elderly - who often can't use a hole in the wall to get cash, but constitute the majority of patients - navigate such a system?

The GPs I know - particularly in the poor areas - do seem pretty much overwhelmed by demand, whether justified or not, and they don't appear to either be making silly money or have a great deal of scope for manoeuvre.

In reply to Thickhead:

Nice place!

In reply to Rob Exile Ward:


About the most sensible post yet.

I know UKC opinion is going to be skewed by the demographic of largely young, largely middle class workers so its not representative of the population at large. However we are forgetting here that the people who need to access GP services the most are the elderly, the disabled and the young. Its not going to matter to them whether you are open evenings because they aren't going to attend at those times (except for acute illness in kids maybe).

And your last point about GPs in poor areas sums up my former practice in North Wales. Very low earning (relatively), very high demand, services constantly being cut by Government and when suggestions made for improvements e.g closing under utilised branch surgery, told that is not possible.

In reply to stroppygob:

Certainly is... I have had to pinch myself a few times this week when I've been driving about in beautiful sunshine with beautiful coastal and mountain scenery.

We've been lucky - we made the escape at the right time.

In reply to Thickhead:

Sounds like any other part-privatised situation (anyone mention the railways?) - worst of both worlds.

Neil

In reply to Rob Exile Ward:

Well LD clearly showed that it works in Australia and there were examples upthread of it being implemented here too, so it is possible and not too hard. The vet has more convenient access than my GP. You seem to be just throwing up objections for the sake of it to small changes that would make things much smoother for anyone who works or owns a computer, or doesn't want to make 10 phone calls between 8.00:00 and 8.00:30 to be told all the slots are taken. There is no reason why it couldn't be done in tandem with a telephone system, if needed.

In reply to MG:

' You seem to be just throwing up objections for the sake of it to small changes that would make things much smoother for anyone who works or owns a computer'

Well just to put it in perspective I personally have been responsible for implementing about 3 - 400 computerised appointment systems, in a profession allied to medicine, and it isn't a small change. Throw in the complications of integrating an online booking system exposed to t'internet with the system used internally and you are opening up a world of pain which, rightly or wrongly, issues regarding px confidentiality and such like make virtually impossible. I don't know how Australia manages, maybe px confidentiality isn't such a big thing and/or they let their old and their poor people die.

And it really isn't constructive to keep comparing medicine with vets, car mechanics and coffee shops, none of these are dealing with just about the most fundamental issues that any of us will ever face in our lives. But that's what GPs do. Go down to your local surgery, look at the majority of faces in the waiting room, - the fear, the pain, the distress - and then say it's just like running a whelk stall, or something.

In reply to Rob Exile Ward:

Sorry I just don't buy it. I really can't see that GPs are somehow unique it not being able to modernise in small ways unlike ever other service. Banks used to be the same - claiming that opening 9.30-12 and 1.00-4.30 was the only possible way to operate. Nowadays we hardly need branches at all. The fact that some surgeries are changing, and in the UK, shows it is possible.

You go on about poor old dears who can't do anything. In reality the number who find phoning repeatedly easier than a quick click online must be small, and these can easily be catered for by keeping a phone line if needed.

In reply to Neil Williams:



What are you referring to?

I've genuinely no idea what your on about with that comment.

In reply to MG:

Well to be fair I'm not a fan of appointments at all - our local practice doesn't have them, you turn up when you need to see a GP and the earlier you turn up the earlier you are seen. That makes perfect sense to me, what proportion of appts can be meaningfully scheduled? - if I book an appointment in a week's time because of discomfort I'm feeling today, it may well have gone away by then so what then is the right thing to do? Cancel at the last mnute? Not turn up? Turn up anyway? All 3 involve wasting resource.

I'm aware that another practice in a poor part of town tried the same thing and claimed to be overwhelmed by the demand, and had to abandon it; which is a shame.

In reply to MG:

'In reality the number who find phoning repeatedly easier than a quick click online must be small,'

I really, really don't think that is the case. I'm working, so I can't look it up myself, but I'm sure Google will tell you the 'typical' demographic of GP appointments.

In reply to MG:

. Nowadays we hardly need branches at all.


Exactly, this is what will happen.

http://www.bbc.com/news/health-29440139

http://www.pulsetoday.co.uk/home/stop-practice-closures/health-secretary-ba...

http://www.dailypost.co.uk/news/north-wales-news/last-gps-blaenau-ffestinio...

In reply to Rob Exile Ward:

That does seem a reasonable approach. Would switching from paying for prescriptions to paying for appointments work for controlling demand (with, as for prescriptions, a "season ticket" if needed)?

In reply to Thickhead:

I don't see how GPs getting old and retiring will be altered by small changes in how surgeries operate?

In reply to MG:


In my experience, yes it clearly would.

There would be less abuse of the system by attention seekers and less laziness. Patients would have more empowerment to "get what they have paid for" and there would be less wrongly placed signposting to GP which is often used as a "dumping ground" by various agencies, health and social.

However, I think prescription charges should exist also as this encourages less waste of valuable medicines.

In reply to Rob Exile Ward:


How is waiting in a queue for three hours an improvement on getting an appointment and turning up ten mins before you're seen? That is the sort of system that treats the patient's time as of no account.


I'm not at all medically qualified so may be talking utter bollox, but I'd have thought that for the vast majority of "discomfort I'm feeling today" items one should not go to a GP, since the vast majority of them will clear themselves up on a 10-day timescale. If the problem persists for those ten days, then one should go to a GP.

But, as I say, the basic question here is demand management. You have to manage demand somehow, otherwise the service will inevitably be over-loaded. Hard-to-get appointments are one way of doing that, but a more sensible way is charging £10. Plenty of other countries with good health-care systems do that, but we in the UK have got so hooked on a particular ideology of zero charging that it is preventing necessary modernisation.

In reply to MG:
Have you read the articles?

Clearly not.

Banging. Head. Against. Brick. Wall.

(Good job its thick).

In reply to MG:


A "season ticket" would be fair for some with genuine health issues that the GP can help with, but many of the "regular customers" of a typical GP are really after a social worker or tea-and-sympathy rather than a medical professional, and allowing them a season ticket might be counter-productive.

In reply to Coel Hellier: 'How is waiting in a queue for three hours an improvement on getting an appointment and turning up ten mins before you're seen? That is the sort of system that treats the patient's time as of no account. '

Turn up 10 mins before? What fantasy world do you live in! Mum plans to go 10 mins before - then baby's nappy needs changing. A little old dear is kept waiting for her carer who's late - she misses her appt. A hot shot exec gets caught in a traffic jam on the M6...

If you're paying for a service, e.g. seeing a lawyer or dentist, who will charge you anyway, then most people allow a lot longer than 10 mins.

In reply to Rob Exile Ward:


I routinely turn up at the dentist about 10 mins before the appointment time, and routinely get seen with about 10 mins waiting, and this seems to work fine, as does the charge for each visit.

You're right that if someone needs to travel on the M6 to get there or depends on a carer transporting them, then they may need to allow extra time, but for me a system of "turn up and wait for 3 hours in a queue until seen" is a much worse system than "pay £10 and be seen at the appointed time".

In reply to Coel Hellier:

I'm not sure where you get 3hrs from. I did once have a surgery that operated this way and it worked fine. Maybe 15-20 minutes wait if you were unlucky. Given the propensity for missed appointments and appointments over and under running, it may well be better.

In reply to MG:

If the demand is such that with a no-appointments system you can just turn up and be seen within 15-20 mins then fine, I'm ok with that. I'd presumed, though, from comments about GPs being over-loaded, that the queues would expand to the point where they became a deterrent.

In reply to Coel Hellier:

It would be interesting to know how many potential appointments at a typical GP are unfilled.

In reply to Rob Exile Ward:

I work with premature babies and it never fails to amaze me that many of the parents start off thinking using the service like they're going shopping. The younger/ poorly educated they are the more this is the case. When the penny finally drops it's a steep learning curve for them.

As for getting GP practices to open longer, good luck with that..........

In reply to Coel Hellier:

I just don't get this at all. Sometime during a GP surgery, a GP is going to have to break it to a patient that they're going to die soon; or lose their sight; or their child has leukaemia. What are they supposed to do: say 'awfully sorry, not good news, but you've only booked a 10 minute appointment so out you go, NEXT!'

Anyone who turns up for a GP appt and expects it to run smoothly - like a dentist, for instance - is being utterly unreasonable. (It's bad enough when my wife - who is an optician - has to take time out to explain to some weeping parent that their child needs glasses.)

In reply to Removed UserDeleted bagger:

'many of the parents start off thinking using the service like they're going shopping. The younger/ poorly educated they are the more this is the case. '

Well, this is exactly the attitude that politicians encourage - it's like going shopping, it's a service that you've paid for, it should be 'customer friendly' etc etc - and it's free! No wonder people get the wrong idea.

Education, education, education as a great man once said (ahem.)

In reply to MG:
As I'm rarely seen on time, I've always assumed that missed appointments allow time to balance the books a bit for all the other appointments that run over. I'm also very understanding of why I'm not seen on time as I know many appointments do run over for good reason. I'm less happy, when I'm seen 45 minutes late on the first or second appointment of the day as it seems unlikely that patient related issues have caused that particular problem.

Still to be avoided as a run of people all failing to arrive in a row is clearly a waste, but as I've seen lots of complaints online from doctors about doing umpteen 10 minute appointments, on the trot, with no time between to catch up, make up lost time, write notes, answer emails etc etc, that the odd gap may actually help.

In reply to Rob Exile Ward:


No, of course not. You do seem to come up with the most bizarre excuses for not moving to a more sensible system, as used in many other countries. Of course it is the case that some appointments will take longer than others. Why is that an argument for not having appointments?

In reply to Thickhead:

That to me part-privatisation works badly, because the private company can't use private initiative, whereas there is not the level of control you get from running directly as a nationalised industry.

Neil

In reply to Thickhead:

I have wondered if moving to super-practices would make more sense. Could it be cheaper and more effective to do that and pay for transport for those who cannot afford it than to have a GP in every village and housing estate?

Neil

In reply to Coel Hellier:

One way of handling it would be for one fee to cover a course of treatment for one issue, just as the dental fees do.

Neil

In reply to Rob Exile Ward:
One of the reason I have switched to a private dentist (fortunately I can afford this) is precisely *because* of the systemic short-appointment way the NHS works on it - this suits me badly for dentistry because I seem to need a lot of anaesthetic and a fairly long wait[1] for it to take effect, which doesn't work with 10 minute appointments. I find that works badly for GPs as well, if the health issue is even vaguely complicated.

[1] In the latter days of me using NHS dental services, I used to ask to wait in the waiting room for them to treat the next patient while the anaesthetic kicked in. But that always seemed to be hassle, and I had to ask for it specifically. I expect many people have had to put up with unnecessary pain as it didn't occur to them to ask for that.

Neil

In reply to Coel Hellier:

Because neither the px or the GP know how long the appointment is going to take. If the px and/or GP knew what was wrong with them, and what was the best course of action, then there wouldn't be any need for an appt in the first place!

'More sensible system, as used in many other countries' - hmm, I don't believe you can squeeze a quart in a pint pot. If a GP surgery is running smoothly and efficiently, it's because they have surplus resource and a whole load of people are excluded, probably the poor people have to turn up at Medicaid-type hospitals and queue for hours, leaving just those on employer-funded medical insurance to enjoy the service.

In reply to Ferret:

There are two different problems here. One is time pressure on GPs. Clearly to do the job well they need time for notes, catching up emails etc as well as seeing people. This is question of resources and funding.

The second is simply being customer friendly with things like appointments, opening and so on. While there are links between the two, it's not the case that nothing can change without more funds. In fact some changes would save money.

In reply to Neil Williams:

My dentist seems to do OK, he shuffles people in and out of his clinic like billyo - I've turned up for an emergency extraction, he's found literally 1 minute to inject me, he's kicked me out and then found another five minute slot a bit later to do the extraction. I'm not sure the GP is the same, though, or amenable to that model.

In reply to Rob Exile Ward:


Well obviously, and equally obviously if you average over a bunch of appointments you can make reasonable predictions of average appointment times, and GPs have experience of this so can plan accordingly, and also build in some slack (which can be used for other tasks if it is not needed) -- and obviously there will be times when things over-run and extra waiting will be incurred.

Now, having stated the obvious, do you have any sensible criticisms of a system that is used in other countries and which works well?

In reply to JJL:

Also, I hope all these extra GPs are in medical schools right now if they are to be ready for 2020.

The students could be at Med School during the week, and filling in at GP surgeries at the weekends , they can then get some 'early work experience' and help meet the government targets.

(as long as they don't include outcomes in the targets

In reply to Coel Hellier:

I've lost the plot here - what 'system that is used in other countries that works well' are you referring to?

In reply to Rob Exile Ward:


A system where, in order to see a GP, you (1) book an appointment, and (2) pay a charge for it.

In reply to Coel Hellier:

And if you haven't got the money, or you're slightly confused, or anxious about your finances, or you're in pain or distress right now, that works how exactly?

I'm not saying the service is currently the best of all possible worlds, and that there isn't scope for improvement; but you seem to be modelling a system that will work very well for well heeled, mostly healthy, well organised people. Which is what works in the US. Our NHS has slightly different priorities.

In reply to Rob Exile Ward:


Very straightforwardly, as it does in lots of other countries.


I'm saying it works fine in lots of other Western countries, it is only us with our mantra about "free at the point of delivery" that is out of line. In several countries in Europe it works fine.


*Yawn*. Whenever anyone suggests anything sensible about the NHS the comparison is *always* with the US, as a means of closing down debate. There are two non-sane ideologies about health care in the Western world -- those of the US and the UK (for opposite reasons). How about being sensible and comparing with elsewhere in the Western world?

In reply to Rob Exile Ward:
How about somewhere like Singapore, with the lowest infant mortality in the world, very high life expectancy and widely acknowledged excellent health care all round. Nothing is free at point of use but everyone has access to health care. The principal is that if people get something for "free" they don't value it, while if they make an obvious contribution they do and use it wisely.

In reply to Coel Hellier:
There are two non-sane ideologies about health care in the Western world -- those of the US and the UK (for opposite reasons). How about being sensible and comparing with elsewhere in the Western world?

I think that's going a bit far. The US system is clearly insane. However, the UK system does deliver cheap healthcare (as a percentage of GDP) and pretty good results. The questions are whether it is sustainable in its current form and whether it can be improved.

In reply to MG:


I didn't mean that the NHS *system* in insane, overall it works reasonably well. What I meant is that the specific and highly ideological mantra of "free at the point of delivery" and hysterics at the very idea of patient charges is "insane".

In reply to MG:

I can't help thinking that there quiet a few differences between the UK and Singapore that may account for better healthcare as well as the paying for appointments bit. They have the tidiest streets as well - perhaps there's some correlation?....

In reply to Rob Exile Ward:

Well you started making the comparison with the US, which also has quite a few differences.

If you want to focus on the UK, fine. You do seem desperate that nothing changes and are coming up with the most bizarre reasons to prevent change.

As above the NHS is not bad in terms of overall national health, and is cheap, so I don't want radical change like some propose because of inevitable unforeseen consequences, expense and chaotic transitional arrangements. However, I do think incremental change can be good and desirable to reflect changing needs and possibilities. Pretending online booking is impossible because aunt Agnes cant use the internet is absurd.

In reply to Rob Exile Ward:

They also have huge social problems bubbling under the surface. I've always seen it as a bit of a dystopia.

Neil

In reply to Rob Exile Ward:


OK, but about two-thirds of Western countries have some sort of payment to see a GP or stay in hospital. These are not full-cost payments of course, they are manage-demand co-payments.

Further, when Brits encounter other health systems across Europe or other parts of the developed world they usually have favourable impressions. We do need to move away from that idea that our system is much better and/or more virtuous than everyone else's (and, no, we don't need yet another comparison to the USA at this point).

Further, the vast majority of people are capable of both booking an appointment and handing over £10 in the form of a note or a plastic card. Yes, there will be a small minority who are not, but the GP receptionists, who are sensible, practical and compassionate people, will cope with that.

In reply to Coel Hellier:

I find it equally bizarre and equally pathetic that the one solution anyone has for a problem in the NHS is 'charge for it - everyone else does.'

Another problem that I have is that our local surgery seems to work incredibly well - it worked well for my children when they were growing up, it worked well for Mum when I was her carer, and it works well for me now I'm getting a bit decrepit myself. After a weekend of pain I *finally* decided to go the GP on Monday afternoon; I went at 3:00, was out by 4:30 (and had had an X-Ray by 9:00 am yesterday.)

You're the one saying that there must be better systems out there, why not study this one and see how universal it could be?

In reply to Coel Hellier:


That certainly is not how I would describe at least half of them. Many of them do fit that description, but many are complete jobsworths who would take no issue whatsoever with turning an obviously ill person away because they didn't have a tenner until pay day.

You can tell the bad ones quite quickly, because they're the ones that think they are medical professionals when they are not, and start enquiring as to the reason you want to see a doctor before letting you in.

Neil

In reply to Coel Hellier:

'GP receptionists, who are sensible, practical and compassionate people, will cope with that. ' They might be (not all are, in my experience); but move them to an environment when they are having to tae money off patients, or make judgements about who should pay and 'who can be let off' and I think you would come up across some limitations.

Just as a matter of interest, have you ever worked in a customer or patient facing role? And I don't mean being a lecturer, obviously.

In reply to Neil Williams:

(I think that's an example of Coel letting his imagination run away with him.)

In reply to Rob Exile Ward:

Prescriptions are paid for. Do we see people dying in the streets as result? If we are trying to control (spurious) demand, what is wrong with switching from paid prescriptions to paid appointments, or a bit of both?

In reply to MG:

Switching from paid prescriptions to paid appointments might indeed not be a bad idea, particularly if the charge applied to a course of treatment rather than a single instance, and it was revenue-neutral and the same exemptions applied as at present.

Neil

In reply to Coel Hellier:

'We do need to move away from that idea that our system is much better and/or more virtuous than everyone else's '

Of course there's always the off chance, the tiniest chance, that because of a fortuitous set of circumstances, our system, on balance, is in fact better than anyone else's.

Which isn't to say there isn't huge scope for improvement. I just don't think charging at the point of delivery is a sensible way of achieving that without fundamentally altering the nature of the service.

In reply to MG:
Not in Wales they're not. Nor are they in England for many, many people.

I'm not aware that since their abolition prescribing rates have gone up very much, if at all.

(Actually apparently they have - but just not as much as in England over the same period. Hmmm.)

In reply to Rob Exile Ward:
If i call my local GP it's allways a 2 week wait for an appointment or I have the option of calling at 8am on the day to try to get some kind of special appointment which inevitably means me missing an unknown amount of work time. However, if i wait until after 5 and call the NHS direct they get me an appointment at the local out of hours service which is excellent! Last time I called they booked me an appointment and was with a doctor within the hour. It's especially good seeing as ive got young kids. I think that the difference is the NHS direct consultation over the phone that weeds out all the old hypochondriacs that clutter up most GP surgeries.

In reply to Rob Exile Ward:

Experience shows otherwise, once you strip away the mythology and sacred cow status.

Most European systems are better, with far more patient focus and responsiveness. Enough people have comparative experience to know that, for various reasons and manifested in various ways, our sacred cow is in fact a donkey, and a geriatric, recalcitrant and vicious donkey at that.

It is pretty shit, creaking massively under the strain and wasn't that good in the first place. Any airline or supermarket that treated its customers like patients are treated would be out of business, but then customers have choice, despite the fact that careless airlines or supermarkets are quite capable of killing you, but don't seem to do so.

It is also virtually impossible to reform effectively as that would be like trying to persuade ISIS jihadis that Mohamed really wasn't a very nice man, in fact was a brutal warlord who happened only to differ from other warlords in that he heard voices that justified whatever he felt like doing anyway, for the highest of moral reasons of course. "Save the NHS" is one of those inane catchphrases like "think of the children", designed to negate thought and objectivity and to halt all rational discussion.

I doubt they would be very responsive to the suggestion, nor are die-hard defenders of the NHS and its GP system responsive to the suggestion that there might be a fundamental flaw in the current arrangements and that some serious revision of preconceptions is called for, rather than just throwing good money after bad into the bottomless pit and huge employer that is the NHS.

In reply to Simon4:

https://pbs.twimg.com/media/Byye_JgIAAAPNVx.jpgarge

In reply to Simon4:

Not a fan then? I don't suppose you checked out any figures before your rant - y'know, cr*p stuff like life expectancy, health outcomes and cost as % of GDP?

It's not a bottomless pit, as a matter of fact, we know perfectly well how much it costs and what that is as a % of GDP. And yes it does employ a lot of people, some of them even work, but there you go: we all want healthcare.

Yes it is bl**dy hard to reform, and as successive waves of stealthy privatisation have invariably resulted in more chaos - internal markets, commissioning bodies, centralised computer systems, anyone? - and totally f*cking incompetent and ignorant politicians of both hues, supported by equally ignorant and jobsworth civil servants, have fiddled with a system they don't understand to get sound bites on the Today program, it's not been made any easier.

In reply to doz generale:

Like!

In reply to Simon4:
Any airline or supermarket that treated its customers like patients are treated would be out of business, but then customers have choice, despite the fact that careless airlines or supermarkets are quite capable of killing you, but don't seem to do so.


Have you flown anywhere recently?

Comparing customer service to an airline is a bit disingenuous.

If I turn up to airport 5mins late gate closed, flight missed. If I turn up to GP appointment 5mins late chances are I will still be (or indeed, as per below, have to be) accommodated.



Its worth considering the following supermarket analogy:

Its 2mins to closing time and someone turns up at the supermarket hungry, starving even. Supermarket says "sorry, we're closed" and off goes hungry person. Hungry person then falls over down the road of a hypoglycaemic episode. Do you think the supermarket would face any disciplinary action?

Then switch it the other way around, man with chest pain walks to GP surgery 2mins from closing time, gets told "sorry, we're closed" then has a heart attack down the road. Do you think the GP surgery would face disciplinary action?

In reply to Neil Williams:

Sorry, still not sure what your saying about part privatisation. Is it against the current GP structure?

In which case, how are you going to change it?

1) Full privatisation or

2) Full salaried which there isn't enough money to do.

In reply to Rob Exile Ward:
Not on topic, but I thought I'd share.

I'm having a colonoscopy this morning (wish me luck!) Did the picolax thing yesterday, and found it disappointing. It was mildly unpleasant, nothing like as dramatic as I had been warned.

I was expecting a massive explosion last night,got no such thing. I was on and off the bog 17 times.

To quote the Big Yin; "My @rse was in tatters..." Bloody cleaned me out though, I'm sure I saw the silver sixpence I swallowed when eating Christmas cake when I was 10

I was starving all day yesterday. Then my wife went and made the family their tea and filled the house with mouth watering aromas. Not feeling hungry any more,


How I slept last night I do not know, but the gamble paid off. Just taken the second dose of picolax, looking forward to getting it all over with.

It's cost me $1000.00 (my health fund will pay some of that back.)

I got it on a day of my choice, within three weeks of my GP deciding I need one.

In reply to Thickhead:

I agree - airlines are not exactly the pinnacle of good customer service. Nor are supermarkets. Both are run, M&S, Booths and Waitrose excepted, to low cost rather than high service.

Neil

In reply to Thickhead:

Yes, it's against the current GP structure. Or against the rail system, or the bus system, or the refuse collection system - lots of things that are semi-privatised to get things off Government books but do not necessarily gain any economies of scale nor (with a few exceptions) any customer service benefits.

How to change it? Well, that's a different question. (2) would be my ideal. (1) probably worse. So it might not be feasible to change it. But that doesn't stop discussion on what it should be if we started from first principles.

Neil

In reply to stroppygob:

Where are you located - the US?

Neil

In reply to alasdair19:




You think wrong.

Unless you have pretty much zero commute to work 8am-5.30pm is utterly useless to most working people, a group of which I assume you are not a part.

My wife, for example, leaves for work at 7.45pm and returns at 6.15pm.

In reply to John_Hat:

In London commuter areas before work is basically useless (most London commuters are on the train already by 7am, let alone 8am), and the evening surgery would need to be available until 9pm to be useful.

If anything a Saturday surgery is likely to be a lot more useful for people working in all sorts of professions.

Neil

In reply to Neil Williams:

No, he's in Oz. It would be at least 3x that price in the US (if you had insurance, more if you didn't). You might, or might not, have to pay the lot, depending on how "good" your insurance was.

It includes general anesthetic.

In reply to Thickhead:

If you go into our local hospital with almost anything but minor ailments they very likely ship you off 20 miles to a hospital with qualified staff .

If you are lucky enough to survive the journey, you might eventually be well enough to ask yourself why no one faces disciplinary action for essentially doing what the above mentioned supermarket did, I.e say sorry you are not our problem.( even though they are not closed)

It is commonplace for road accidents to happen close to the hospital, and the ambulance that comes for the casualty, will drive right past the local hospital as it has been stripped of consultants.

They really should come up with a new name for such places, as Hospital is overstating what they really are.

In reply to Jim C:

We're talking about GP surgeries not hospitals.

Although I would agree with renaming such places.

In reply to Neil Williams:
Canberra.


All done and dusted. Its just a case of waiting for the biopsy results from the bits of my insides he carved out.

In reply to stroppygob:
So perhaps you're a good example of insurance-based systems working well? It seems they do in mainland Europe as well.

The key to an insurance based system being fair is that for what is determined to be the basic package (which for the UK would I guess be what the NHS provides now), the fee is based on ability to pay rather than insurance risk, and that if the insurance is provided privately rather than by the state (as it is in Switzerland) an insurance company cannot refuse to accept a customer for the basic package (as I believe is the case in Switzerland), so has to set their basic package price range such that they can afford this.

Neil

In reply to Thickhead:

Such hospitals usually have a very clear H - No A&E sign, don't they?

Neil

In reply to Neil Williams:

I have to say - what is the NHS if it isn't a insurance system based on the ability to pay (i.e. by tax?)

Privatising the financing - by letting private companies provide the funding - will straightaway increase the cost by 10% (that's the NET profit private companies will have to make to satisfy their shareholders), plus a huge element of administration as well. It will introduce all sorts of bias as well. What insurance company will take you on if they discover you have a genetic predisposition for an expensive condition? It will distort the effectiveness of healthcare research, as clinical reporting gets increasingly biased towards clearly identifiable episodes that can be costed, even though healthcare isn't like that.

In reply to Rob Exile Ward:


It isn't an insurance based system, it's a monolithic provider. The outcome is the same, but then it will be in any system that is free at the point of use.

Where an insurance based system can come in is in patient choice - but you're right that that might make the overall system more expensive.


You did read what I wrote about the Swiss system and the law meaning that insurance companies cannot refuse for the basic package, and that pricing is based on ability to pay rather than risk, again by law?


Possibly so. Yet such systems work - and work well - throughout mainland Europe. Isn't it only the UK and Cuba that have monolithic health services?

Neil

In reply to Neil Williams:



Yes.

You would be amazed how many people f*ck up though and rock up to the wrong place.

The thing is, also, if you're travelling through a small country town and you start feeling, e.g chest pain, if you see a large H sign with or without "no A&E" you're going in that direction.

Plus, after the Tories have annihilated the NHS, there will be a whole load of H signs pointing to closed hospitals

In reply to Thickhead:

True, because at the very least it's likely they can call you an ambulance. If you don't need an ambulance, continuing to the nearest hospital with A&E is going to be unpleasant rather than life threatening.

Neil

In reply to MG:

Funding for the scheme is 400million over 5 years. 80 million a year. 60 million population.
take a bit off for admin etc approx 1 pound per patient per year.

average gp has 2000 patients. £2000 quid per year for a gp to work an extra (24hours a weekend times 52 weeks = 1248 hours)

Need one receptionist to cover front desk paid minimum 8 quid an hour.
£8 times 1248 hours =£9984.

So Gp gets £2000 quid pays receptionist £9984= £-7984

gp therefore works an extra 1248 hours a year payable at £-6.39 an hour!

STILL LOOK LIKE INCREDIBLY HIGH PAY TO YOU????

So any surgery with less than 10000 patients will work for nothing if they employ one receptionist at the weekend.

if you have 20000 patients you would get minimum wage but then you may need more than one person to answer the phone!


Secondly, we need more GP's. Given a medical student can decide to be a hospital doctor or GP why would they choose the less well paid longer working option. Why wouldn't they take their highly valuable qualification abroad? Simple laws of supply and demand would show you that you need to pay more than -6.39 an hour if you want to employ more.

In reply to rurp:

Interesting post. I've been dipping in and out of the thread over the last few days. My husband is working with various GP federations to implement this seven day working and he says similar, that there isn't currently enough money in the pot (and enough desire amongst GPs) to successfully deliver this.

In reply to Tall Clare:


Yes federations are one option, economies of scale so that one gp and receptionist look after 30000 patients would pay a gp £20 an hour. Currently a locum gp. Would typically charge 75 pounds an hour!
So to reach market rate one gp and one receptionist would need to cover 85000 patients.
The gp out of hours service does this already.

Alternatively to fund your own practice to have a gp available for each 2000 patients increase the funding by 40 times...... The government cannot afford 40 times 400 million. There are more sensible things to buy when we are supposed to be cutting back.

Good luck to your husband!

In reply to rurp:

I can't follow your numbers but GPs pay starts somewhere above £60k and goes up to several £100k. They can work pt and as locums and there are jobs all over. That is what I was referring to.

Clearly more hours requires more money. Different hours however doesn't. necessarily.

In reply to Thickhead:



They are related, the GP's ( around here in Scotland) have rooms in the evenings in the 'hospitals'

In reply


Gp's are working at capacity, to increase cover by 2/7ths whilst maintaining current cover 8-6.30 mon to sat (it cannot be reduced as it is running at capacity) would require more staff ( this scheme provides insufficient money to even employ a receptionist) or no more staff and to work 12 hours a day 7 days a week until we drop or find a more sensible job.

Either the scheme is as dumb as it seems or........

It is a gifted attempt to destabilise general practice encouraging mass retirement/resignation to allow the opening for a large us style healthcare company to ride to the rescue snapping up closing gp practices and staffing them with cheaper nurses and physicians assistants.

I would rather think of our government as slightly disingenuous but clever than dumb........

In reply to Thickhead:

Well after the Tory conference everyone South of the border( I'm in Scotland) could not possibly believe that Cameron (after he brought his dead son into the debate - if re-elected) will annihilate the NHS.

Unless you believe he would be low enough to stand up there and say anything at all just to get votes?
He is trustworthy is he not? What has he ever lied about previously, that would call that into question?

The NHS is now safe with the Tories under Cameron and Osborne, you have HIS word on that.

In reply to Ferret:



As used to be the case. Many people are too young to remember that doctors were effectively on call, albeit on a rota, twenty four hours a day and would also make home visits.

In reply to mypyrex:
It would be a good start if early and late appointments were reserved for working people.
The old system at my doctors was no appointments, just turn up and wait at 8am.
The problem is though people start to que at 0730 and the majority are pensioners so by the time you are seen half the morning has gone.

The new system is Ring at 8 and when you do finally get through be told there is nothing available today so please try again tomorrow, this repeats until you either get better or die.

In reply to Neil Williams:

I'm not sure about that. Seeing as I opted for private treatment, I thought the nurses dealing with me would have been a bit more tasty.

In reply to rurp:


I love the way people like you invest so much in finding negatives, look to prove that nothing can change, and show contempt for anyone daring to moot a different system, yet have nothing positive to offer yourself.

Meanwhile here we have;
http://www.youtube.com/watch?feature=player_embedded&v=pBr71mZadqQ

In reply to stroppygob:


No contempt. Not negative. It's just numbers that don't add up.
Bringing in kaiser permenante etc may be better, who knows. Important when people are offered unrealistic unfunded ideas to realize where the thing might end up.
Go and have some more beer and relax Bruce, living in oz it's not your problem

In reply to rurp:

Oh but it is my problem, as I intend to return in 4-5 years time. Also, when looking to solve a problem, looking at solutions from other countries is a g-o-o-d i-d-e-a.

In reply to stroppygob:

While it may seem to be good that people can use walk-in centres the reality is that they are not cost effective.
They see relativly few people and cost a lot to run.
In these days of austerity we have to have a cost effective & efficient health care system
Traditional General Practice, with partners & salaried Drs & nurses is the best system.
European GPs provide fewer services than UK ones. They dont do any children's care for example.

In reply to mypyrex:

GPs still make home visits where needed.
GPs still provide the Out of Hours service in the evening and at weekends. Its just not done by individual practices anymore but by GPs working for a co-op or a private company

In reply to Coel Hellier:

Yes, I agree that zero charge should not be a mantra...I'm just not sure what the solution is, either how effectively demand could be managed and how equitably a system would work.

I' m sure you're right in your inference(?) that the lack of any real public discussion of this (it does get discussed) is mainly political.

Gaining access to GPs effectively functions as a (in the sense of just one) rationing point in the system. With our current system it is the resourceful and the chronic sick (who have learnt the system) who best negotiate their way through, relatively excluding the less resourceful, especially those with mental health problems, who have the worst health outcomes of any group.

In reply to Rob Exile Ward:

Not directly addressing OP but hovering in the background of such discussions are some very complex health economics.

The last time I looked at attempts to compare health systems across countries the results broadly showed (I'm not an expert in health economics tho'):

i. Scandinavian countries spend most and get the best health outcomes

ii. Japan spends lots and get one of the worst and some others are not much better

iii. We spend moderately and get pretty good results and better than or equal to some countries who spend far more % GDP eg USA

In reply to Nigel Modern:

I am repeating something mentioned in a previous thread, but I lived in the states for a while with an American nurse she spent some time working in an “hospital” that was primarily an upmarket long term care home. She would often lament the very expensive equipment that was unused or underutilised IE the place had a CAT scan. Because this place was in “competition” for the lucrative middle class American buck it had to have all the bells and whistles for its marketing brochure, a short bus ride away in the other areas of the city there are people struggling for the most basic access to medical treatment. Free market doesn’t mean more efficient by any means, numerous international 3rd party surveys put the NHS down as one of the most efficient in the world £ for £ treating people and everyone has access to it. We should be celebrating a system that works, looking at how we can improve it not trying to ape an American system that doesn’t work.

In reply to jethro kiernan:

Pre Obama the US system was more expensive per capita than the UK on just state funding. This was before its people spent a penny on their own insurance. At the same time it was failing to one extent or another somewhere around a half of the population. If you wanted a lesson in why US style free market ideas en masse wont help the NHS, there was hardly a better one. Cuba in contrast has arguably the best outcomes for per capita spending in the world yet no one in UK politics seems to want to learn from them

In reply to Offwidth:

Actually someone upthread mentioned Cuba: ' Isn't it only the UK and Cuba that have monolithic health services?' without noting outcomes, just assuming that that must be a bad thing.

Reminded me of an old Tom Paxton song:

We got to bomb Castro, got to bomb him flat
He's too damn successful and we can't risk that

In reply to Rob Exile Ward:

http://www.ted.com/talks/gail_reed_where_to_train_the_world_s_doctors_cuba?...

In reply to Offwidth:


Anyone who'd want to follow the US in anything organsisational would be a fool.

In reply to mypyrex:


Very true. They had many great attributes. They also had very few effective treatments, near universal respect that meant very few people took the piss when asking for visits, and expectations were very different back then. The clock is not turning back, ever.

I work in a part-funded system too - in a healthcare system that on the whole is very favourably thought of internationally. Some decades back the govt decided both hospital and GP visits would need part payment including overnight costs etc. There was, quite rightly, outrage - and in the end they settled for part payment of GP visits only, which seemed like a whole lot better bet than the alternative.

Which means now a GP appointment (usually 15 mins) costs about $80 (GBP40). To put it another way, I can fill up the car with diesel for less than the price of a 15 minute appointment.
There's some variation but not much.

To everyone who is saying online booking is needed as some sort of basic human right, just google 'choose and book'. The majority of my patients struggle with cellphones and texts let alone trying to book online. The NHS is vast - online booking is a privacy nightmare, and the stakes are much higher than someone hacking your current account.

Finally the 'open all hours doesn't employ more staff just redistributes them' argument - other than manning reception longer hours, cleaners moving to double pay night shifts, nurses running extended hours to keep up with the doctor-directed workload (or see the GP tonight and still come back tomorrow to see the nurse for whatever), etc. etc.

ukc is mostly healthy, younger people with some disposable income for fripperies like climbing; with an understanding of risk and responsibility who generally make reasonable health decisions. It is absolutely unlike vast swathes of society who are the ones who need the most assistance, often in a completely different way to that which a few of them may feel entitled too.

b

In reply to ben b:



Which suggest online booking in the NHS is entirely possible.

The NHS is vast - online booking is a privacy nightmare, and the stakes are much higher than someone hacking your current account.

So if its possible as above, why not for GPs? How is it a privacy nightmare any more than talking to a receptionist is? I go online, I select an appointment with Dr Y at 10.45 on Wednesday, end of story.


Obviously open all hours does. However, opening say 10-8 instead of 8-6 a couple of days a week shouldn't.

In reply to ben b:


The wonders of penicillin, eh? We're not going back that far. GPs did out of hours appointments when I was a kid - it was the mid-90s when doctors stopped. Treatments for common ailments were pretty much exactly the same as they are now.

In reply to MG:

It seems my surgery has just started doing it. You have to go in person to sign up for it which I reckon I will do this afternoon, but once done you can then book online.

Neil

In reply to MG:

Re: Online appt booking and access to your medical record online.
This is happening already all over England. Those surgeries not offering it already will be undertaking to do it from next year.

Agree shifting from 8-6.30 some days to 10-8pm would be a good idea.
Slight hitch in the system is government says no!
Not allowed to reduce access or appointment numbers during core hours from 8-6.30.

Suggested 7 day a week 8-8 scheme is unworkable, numbers are out by a factor of 40:1 see calculations above.
Any number of options would be perfectly workable so any non rocking horse shit options are welcome. Just cannot provide an extra 32 hours opening a week for 1 quid a patient per year.

In reply to MG:

You looked at the cost? 356 million, and it's being taken out the back for a long lie down in a field.I remember the introduction of C&B - it was an utter shambles.

As many others have said, MoH won't countenance reducing in hours cover to allow OOH.

b

In reply to ben b:


How does shifting opening hours by 2hrs changes costs?


Which sounds just like (yet another) excuse for GPs refusing any change whatever. On this thread in response to the rather minimal suggestion of online booking, we have had the following objections

-Impossible
-Too complicated
-Too expensive
-Lacks privacy
-Old people cant use the internet

Any yet we have examples of it working in Australia, working here, working in the rest of the NHS and we now learn it is in any case going to become standard. All of which make me think objections to shifting opening hours are similarly stuck-in-the-mud, obstructive and, well, nonsense.

In reply to climbwhenready:


The mid 90s was c.20 years ago, a fact that never fails to make me feel old!

Emergency treatments for a stroke, myocardial infarction, acute worsening of emphysema, heart failure are all very different these days - not so much in terms of best practice, but availability of best practice. Stroke thrombolysis, primary angioplasty, non-invasive ventilation etc were either state of the art super-hospital stuff or research tools; now most places in the UK have access to all of them either locally or within a regional network. People's expectations are also radically different - generally this is a good thing, although not always. At the same time the population is getting older, and the treatments more expensive. Health is the perfect storm...

b

In reply to MG:

356 million was the estimated cost of C&B. National IT projects in the NHS make for interesting reading....

The MoH dictate what GPs can or can't do; either directly, or indirectly financially. If they won't reduce daytime provision, they won't. Until a passing government changes the rules on a whim, which appears to have been their modus operandi for a while now.

Your list of reasons why online booking is not the answer is quite accurate - you have had some self-selecting examples of it working well overseas from the comparatively privileged ukc population, who overall are a fairly fit, well and young tech savvy group.

Someone up the thread was mentioning the BMA as a cabal of powerful sparts holding the government to ransom. Nothing could be so far from the truth. The BMA are an extraordinarily supine organisation, a few good folk trying hard but overall devoid of political clout and regularly outmanoeuvred by a couple of third rate spin doctors. Doctors as a group aren't good at pulling all together in the right direction, unfortunately, because 95%+ of them are actually doing it to look after patients directly, rather than being politicians or managers.

b

In reply to ben b:


Absolutely, but for most of that, you phone 999 and get seen by paramedics. GP home visits were for people who couldn't easily make it into surgery, either because they were in too much pain or other reasons, not medical emergencies.

In reply to MG



Online booking is difficult but manageable , as a result Gp's ,those people who' refuse any change whatsoever' are changing and doing it for free with their staff costs to achieve it out of their pockets.

7 day opening for 1 pound a patient per year is not achievable and if it goes through in current form I will need to close my practice and go back to work in a and e . If the numbers change this experts opinion would change.

This is your argument in climbing terms.

I managed to climb elder crack last week difficult but I could do it.

Therefore I can climb la dura dura with one hand, it's just another problem that's difficult.


If a road contractor told you that you couldn't build a bridge between stanage and London for a million quid the correct approach would be clearly this guy is stuck in the mud , obstructive and talking nonsense...

Thought of applying for jobs at the department of health? They need men with vision!

In reply to rurp:

You're being a bit ridiculous. No one has claimed 7 day opening would be cost free, or even desirable (except for a conference sound bite). Most of this thread has been suggestions for small changes, possibly money saving or at worst cheap, . The responses have followed a pattern

Person 1) No, can't be done for spurious xyz reasons
Person 2) Umm, hang on, its already happening here

In reply to rurp:


How is it difficult? Any sports centre, hotel, and even restaurants manage it. There must be endless off the shelf booking systems available for next to nothing. If 80% of appointments are booked online, there would be corresponding reception staff savings. The other 20% can still be taken over the phone.

In reply to MG: 'Any sports centre, hotel, and even restaurants manage it.' You keep on saying that, and a) it isn't true - I stay in hotels a LOT and big chains manage it, small ones don't, fewer still restaurants, and b) even if it were the idea that booking a GP appointment is easier than booking a room in a hotel is risible. And your idea that 80% of the typical people wanting actually to see their GPs (which is not a simple cross section of the population) could actually do so is plain wrong. 10% maybe - 20% at a push?

In reply to rurp:

I'm not clear what's hard about online appointment booking, apart possibly from cost, and linking to existing IT systems? Our practice does it through "Patient Access", which seems to be a big outfit with website, app, etc.

From the (IT literate) patient perspective, it's great - no endless hanging on the phone for a routine appointment (it was so bad I used to turn up at the practice in person to book an appointment than try to do it over the phone). Repeat prescriptions in the same system - again, much more convenient than paper slips or telephone lines. And automated text messages - eg for drop in flu clinics.

I've no idea what proportion of patients have registered, or what proportion of appointments are booked through it, though. 80% sounds wildly optimistic to me.

In reply to Rob Exile Ward:


Oh come one! They practically all do, either themselves or through e.g. Trip Advisor.

b) even if it were the idea that booking a GP appointment is easier than booking a room in a hotel is risible.

You keep saying that. Why? 10 minute slots, click and book. Where's the problem?


And your idea that 80% of the typical people wanting actually to see their GPs (which is not a simple cross section of the population) could actually do so is plain wrong. 10% maybe - 20% at a push?

Eh? I think you are being rather condescending. The elderly, mothers, etc - they are mostly quite capable, you know.

In reply to MG:




No one had suggested 7 day opening is cost free. Correct
Someone has suggested 400 million over 5 years, the prime minister
Our practice does online booking, all practices will do soon. Many other minor changes like this will be manageable.
7 day opening will cost a lot more than 400 million over 5 years.
GP's will not manage to do 7 day opening for what works out at 1 pound per patient per year.

These are simple points.

They are all I would like you and the followers of the thread to understand.

Cannot say them any more simply.

In reply to rurp:

Well good we agree, it seems.

REW might wish to note what you say about booking

In reply to MG:


Do you reckon? Mothers I'll give you, but I doubt even mothers with young kids are really particularly heavy users of GP services.

The figures I've seen are that over 10% of the adult population in the NW have *never* used the internet. I'd imagine that overlaps fairly strongly with heavy users of GP services.

Even just looking at my parents and parents-in-law, who are all early 70s, literate, pretty healthy - only my father would choose to book by Internet. My PIL could probably manage it between them with the odd phone call to us when things didn't quite go as expected). My mother still refuses to touch a computer....

In reply to Carolyn:

That 10%, or even 50%, of people wouldn't use online booking is not a reason not to have it, provided the other channels remain available. It will increase satisfaction of the 90%, or 50%, who will. It will make fewer of them just ring up for an emergency appointment in the morning, as booking will be easier, reducing waste of those appointments. And it'll keep the phone lines free for those who prefer to phone.

I fail to see a downside, other than cost. I doubt the cost is all that high. And it might well save on administrative staff time.

Well, that's what online booking and automatic ticket machines have done on the railway, even though a very large proportion of people won't use either, particularly the latter.

Neil

In reply to MG:

Most practices in London offer online appointment booking (and prescription ordering, etc.) - they use something called EMIS access

In reply to rurp:

Are you allowed to charge for 'extras, as a GP practice in the same way dentists can?

If so maintain core hours with current funding and offer late/weekend slots at some form of economic rate.

You could charge what Vets do if you like.

In reply to Carolyn:



You were allowed to do this? My sister was advised at her nurse's appointment that she should make an appointment with the doctor so as she is leaving she walks up to reception to book an appointment. She is told by the receptionist that appointments can only be made by phone. So she pulls out her mobile and calls up the receptionist who makes the appointment……..

In Scotland. I blame Salmond