UKC

Closed for sodding business between 12 and 3. Just when Daily Fail reporters are getting into their daily sesh in some boozer or other. Coincidence? I don't think so.

Oh, hang on a mo: one of them is running a clinic at a different surgery. They're all calling patients back with test results and telephone consultations. They're doing house calls. And they're having to do all that ridiculous paperwork like ... er ... catching up with referrals, checking records are complete, following up test results.

Anyone who thinks that Teresa May has the slightest idea of what is going on in the real world should take a few minutes of their GP's valuable time and get themselves checked out, because they are plainly bonkers.

Expecting GPs to wave a magic wand and solve the many, many issues in A & E is just disgraceful. And the BBC conducting some stupid poll in a surgery 'Do you think GPS should be open 7 days a week?' - 'Hmm, now you come to think of it - yes!' is almost as bad.

In reply to Rob Exile Ward:

I had higher hopes for Theresa May, but she's proving to be as bad as the rest. Her government has f*cked the NHS and she's now doing the typical divide and rule tactic.

In reply to Rob Exile Ward:
I don't imagine GP will be asked individually to do more hours just that the GP practice provide cover at weekends, might work quite well for some doctors and patients. It's how the GP service ran for most of my life.

In reply to Rob Exile Ward:

It's absolutely disgusting how the government are playing this. And with the large subtle agreement (or at least not very good questioning) of the media.

I watched Sky News today for the first time in years and it could have been a propaganda wing for the Conservative party.

Shut for 'three hour lunchbreaks'. Complete total bollocks.

Thing is, what's going on behind the scenes is "Oh the NHS can't provide 7 day care? Funnily enough I know some private companies that can step in and help with the crisis."

Disgusting.

In reply to Yanis Nayu:


You had higher hopes for *any* Conservative when it comes to the NHS? Are you deluded?

In reply to Rob Exile Ward:

I don't have a problem with the local doctors, the bloody receptionist are a different story though.
Just one example, on the 22rd of December I got a letter saying to contact them and arrange further blood tests ASAP.
They were shut by the time I got home from work and got the letter so I rang at 0830 on the 23rd and asked for an appointment.
January the 4th at 0850 was the earliest, I pointed out that the letter said ASAP but she was adamant that was the earliest.
When I got there on the 4th the nurse took me to task for not coming in sooner so I relayed the story to her and she went ballistic. Apparently she has told the reception time and time again that she keeps a few appointments open every day for ASAP things like mine.

This is not an isolated incident, both myself and the wife have had a myriad of problems with the receptionist.

In reply to JayPee630:

I meant in general, and in comparison with other Tories, so no, not entirely deluded)))

She lost me at 'red, white and blue Brexit'...

In reply to Yanis Nayu:
Problems are:

1) Funding cuts and problems which impacts on staff moral which impacts on care at work and performance and exhaustion and people leaving or being on the sick.

2) The lack of public education around health, an aging population, and social problems like individualized living conditions and mental health issues. (Mostly connected.)

The Tories are mostly to blame for the first (although not exclusively) and society and the way it's organized and going is to blame for the second.

GPs have f*ck all blame for any of it. Nor do nurses or receptionists or admin staff. To claim otherwise is to lay the problems at the wrong door. (Although of course you're going to get slack staff like in any organisation, but that's life/human nature, and not the cause of any fundamental issues we have with the NHS.)

Basically any problem is due to lack of funding and wider social problems caused by the way the modern world works.

In reply to JayPee630:

"Oh the NHS can't provide 7 day care? Funnily enough I know some private companies that can step in and help with the crisis."

Depressing thing is that its proven that private health care provides an inferior quality of service compared to the NHS. That's why, according to my doctor father, most medicine graduates choose not to work privatley on top of normal NHS roles

In reply to JayPee630:
FWIW My take on it is this. Firstly, there are aspects of the NHS that could be done better (no sh*t Sherlock!) But there's plenty of people working in the NHS who know this, and could contribute... unfortunately to get all these committed, talented, thoughtful, experienced people to work better demands leadership. Football teams are only as good as their managers; companies are only as good as their CEOs. The NHS has Jeremy Hunt.

Second, there is a MASSIVE issue in that the NHS is the only institution that many people believe they have a 'right' to, without necessarily understanding they have responsibilities too. If you are poor, elderly, (or a young mum), disenfranchised, at the receiving end of DWP indifference, the NHS is one institution where you are taken seriously, where you can get some experience of power over your circumstances, even if it is only by turning up at A & E and demanding to be seen. It's a patch for many, many social ills.

In reply to JayPee630:

I don't think your point one necessarily reflects reality

From Kings fund - are they a reliable source of stats? I don't know

'This means that between 2009/10 and 2020/21, spending on the NHS in England will rise by nearly £35 billion in cash terms – an increase of 35 per cent. But much of this increase will be swallowed up by rising prices. In fact, around £24 billion will be absorbed by inflation, leaving a real increase of just £11 billion (a 10 per cent rise over eleven years; equivalent to an average annual increase of just 0.9 per cent).'

A nearly one percentage increase per year for ten years, we should all be pretty pleased with that if it's true

In reply to Dax H:

Receptionists can be difficult - and they can be brilliant. Your GP probably has a suspicion that all is not well but it won't be top of his/her priorities. However it cannot possibly do any harm to write to the practice manager and senior partner to describe your experience and express your disappointment.

In reply to Rob Exile Ward:

Leadership
NHS 5th biggest employer in world, with, I'm guessing, the most difficult to achieve measures of success of any organisation worldwide - unsurprising politicians don't always come up to scratch as leaders

'Patch for social ills' - that's a massive workload, we are lucky that in general the NHS staff go the extra mile, but it will stretch resources.

In reply to Rob Exile Ward:

Done that, as has the wife, as has her mother and father.
Not just once either and talking to other locals it's not just us.
The woman is apparently fire proof though.

In reply to Rob Exile Ward:

I've only briefly heard this reported on radio news, but I frankly couldn't understand the gist of what Theresa May was trying to say.

Was she really saying that that GPs were just too lazy or disorganised to bother providing 12h access? I thought everyone knew that there simply aren't enough GPs in the country to provide the service, hence why no one can get an appointment, and when they do it's 10 minutes long (which makes me glad I very rarely need to use the service). Just brazenly demanding greater availability of a resource that is scarce just sounds like a 5 year old child demanding more sweets when they've knowingly eaten the whole bag themselves. It's beyond pathetic.

In reply to Jon Stewart:

What gets me is last year 13% GP training not taken up, this is for a job that earns just shy 100k a year. A medical career is an aspiration for many kids and parents, this is not the only job within NHS that's doesn't fill it's training quota, I don't get it, what's going on with allocation of these important training places

In reply to John Kelly:


I don't know, but my impression is that medics simply don't want to become GPs - which seems understandable. Good salary but the workload appears atrocious and the work not particularly rewarding in the context of medicine. I don't know if there a sufficient number of places on medical degree courses to begin with...

Maybe there are medics on here who could fill us in (but they probably don't spend their evenings idly discussing the days news stories on internet forums...)?

In reply to Jon Stewart:

Medic, yes hopefully having more fun

More generally we do as a nation spend a lot of time making our healthcare provision sound really grim often for political reasons, maybe there is a cost for that.

In reply to Rob Exile Ward:

We have a 7 day a week service here, with opening times between 8.00 am and 10.00 pm.

But there again, we pay upfront to see our GP.

In reply to Jon Stewart:

I think you do an injustice to 5 year olds.

In reply to Rob Exile Ward:

GPs surgeries vary wildly in service. Not surprising since they are self-managing, and made even more independent in re-jigging a few years back.

At some surgeries, you really do have to wait over a week for an appointment (for my parents, that's a good result).

My surgery manages to see me the same day if I ring up at 9am or 2pm.

The former case is one of the causes of the increase in A&E use; people can't get to see their GP, so go to A&E.

On the other hand, the funding streams for surgeries are bonkers; they have to apply for a vast number of streams for providing various 'initiatives', from different branches of the NHS, each with unique forms, which then have to be processed by different departments in the NHS. All crazy bureaucratic waste.

In reply to JayPee630:


an aging population

Most the the pressures in NHS are not by old people, but my much younger unhealthy people. We are seeing the first generation that is likely the die younger than their parents.

In reply to Lion Bakes:

I suspect it's a form of suicide to escape the Xbox

In reply to Lion Bakes:


What makes you say this? There's stacks and stacks written about the aging population with all the care for chronic conditions, and acute hospital admissions, and difficulty discharging patients. So why do you think it's young fatties that are the problem?

In reply to Lion Bakes:


Says who?

http://www.nhs.uk/news/2015/04April/Pages/UK-life-expectancy-expected-to-ri...

I'm intrigued as to where you've read this stuff, or if you just imagined it!?

In reply to Jon Stewart:

BBC linked to an apparently influential article that speculates obesity will cause longevity to decline

http://www.nejm.org/doi/full/10.1056/NEJMsr043743#t=article

In reply to John Kelly:

Thanks, interesting. I wonder how it'll pan out...

In reply to Jon Stewart:

'Pan out' - nice

In reply to Dax H:
That's poor show. My receptionists are fantastic, and one in particular is. I can go in and find that a prescription hasn't been processed properly, like which happened this week, and she printed one off and nipped into one of the GP's rooms and had it signed. They have to have the rule of people arranging to have the prescription for in a day or two days time, or it'd clog up the practice with people going to get them the same day, but if you're in a fix they'll sort things for you. It sounds like you need to make a complaint?

In reply to John Kelly:

Nobody wants to do it. A salary of £100k gross isn't actually that great once you knock off the 29% pension and 40% tax and fees of £10k. The job has become hateful. You have no control over anything, patient demand is through the roof- so many want x,y or z NOW. If you don't give it (often sick notes, antibiotics, benzos) you get a complaint that takes ages and a lot of stress to resolve. The media portray you as lazy- I worked 110hours a week for ten years, and gave my bloody soul to the NHS and now I'm just some lazy overpaid GP. My wife was a GP but reigned last week. I've quit my partnership. One of our partners is retiring. A solid partnership of 6 GPs is now down to three.

Blame GPs all you want. The public has had a significant hand in where we are with the "I want" culture stoked by politicians. All of this recent stuff just shows that the system is going to fail very soon, you reap what you sow.

What I don't get is this: who will do all this work once all the doctors quit/ retire/ go abroad? That is worrying.

In reply to bentley's biceps:

'Nobody wants to do it'

That sounds both surprising and sad, totally get its a difficult job and one I certainly wouldn't have the ability or fortitude required however it's a reasonable wage, good pension (from your figures), opportunity to make a real difference in people's lives and generally respected by community, where is it going wrong.

I can't help feeling that the political vitriol around health care which dwells on the negative and ignores the great stuff is unhelpful

In reply to John Kelly:

I worked 110hours a week for ten years, and gave my bloody soul to the NHS and now I'm just some lazy overpaid GP

110 hours a week?
If you worked a 5 day week, that would be 22 hours a day.
If you worked 6 days a week, that would be 18 hours a day.
A 7 day week would mean that you were working almost 16 hours a day.
All of the above for ten years continuously.
Really?

In reply to bentley's biceps:

^ this. Really sorry to hear of your experience, and it sounds absolutely like the right decision to go. The NHS is full of fantastic people working in some dismal and unpleasant environments, and faced with near infinite demand. With the changes in attitudes of so many, increases in litigation insurance, and toxic attitudes pervading managerial decision making it would be very hard to recommend primary care in the NHS these days.

http://paulsufka.com/decision-fatigue/ is an interesting article, and something I'm sure nearly all medics will understand (and is certainly not something unique to health, but may be managed much better elsewhere).

Busy GPs may need to make many hundreds or thousands of decisions a day on often incomplete information; many will be minor and inconsequential, whilst others may be absolutely critical to someone else's health. The same is true of an ED doctor or a Med Reg. This often takes place in an environment where no rest is available - as a senior med reg I might have grabbed a sandwich to eat whilst writing up an admission sometime in the late afternoon, and get home after a 14 hour day and realise I hadn't actually been to the toilet since before going to work - and with multiple distractions (my record being 132 pager calls to be answered in a single on call). While a lot of the decisions are easy, there's an incremental drop in concentration and processing power such that making the right decision after the first few hundred gets harder and harder.

It is well known - air traffic controllers work (I believe) 90 minute shifts with no interruptions and then get half an hour off. But telephone triage, not looked upon as physically demanding and felt by MoH to be 'easier than seeing patients' often leads to even the most resilient GPs giving it up ("taking between 80-100 calls in 5 hours, before a couple went sick and the rest of us cracked").

Some days I get home and the simplest questions can't really be processed - "do you want a drink?" - I have no idea. Probably - I don't think I've had one all day. Not sure. Just let me sit here for a bit and I'll get back to you. And I work in an environment that is several orders of magnitude nicer and easier than the NHS.

You could argue that extreme alpinism, say, involves similar continuous decision making without rest and whilst physically exhausted. But at least you are mostly your own master, and unlikely to be sued or investigated by the GMC over a spurious complaint, or assaulted by a patient or relative. Yes, the pay looks pretty good - especially in comparison to alpinism! - but if you want money, don't go in to medicine if you could live with being a banker.

Clearly Jeremy's previous publication on how to dismantle universal public health provision in favour of privatisation is entirely coincidental, and his leadership has been second to none during this entirely predicted crisis. Oh no, that should read "has been less than none".

b

In reply to FactorXXX:

Probably. Depends on if you count time spent on call, or sat on the sofa in the evening dictating letters, sorting results, and making referrals - as a junior my hours varied from a minimum of 70 to a maximum of 120+ per week physically at work, doing work.

b

In reply to ben b:

Probably. Depends on if you count time spent on call, or sat on the sofa in the evening dictating letters, sorting results, and making referrals - as a junior my hours varied from a minimum of 70 to a maximum of 120+ per week physically at work, doing work

I can see how you can do massive hours for a limited time. However, 110 hours a week for ten years continuously?

In reply to FactorXXX:

Are you trying to prove him wrong or prove yourself clever?

I just took him to mean he'd worked very hard, and might have worked close to 100 hour weeks at times.

In reply to Timmd:

Are you trying to prove him wrong or prove yourself clever?
I just took him to mean he'd worked very hard, and might have worked close to 100 hour weeks at times.

Maybe a bit of both...
However, do the maths and draw your own conclusion - 110 hours a week over a ten year period.
Question to you, is that actually realistically plausible?

In reply to John Kelly:

Usually they're spot on.

What is being missed in all these debates is hospital admissions have also risen from 3.8m to 4.9m over the same period. 28%.

Whatever the reason for that may be.

In reply to DancingOnRock:
28% wow that is a chunk, wonder what they consist of, and would a weekend GP service help (properly funded and staffed) reduce that?

Generally I think solutions will be found when we try to limit the emotion whipped up by political carpetbaggers for their own ends and do some really careful counting

In reply to FactorXXX:
When I worked the on call system, you'd do a 1 in 4 on call. Every day I'd work 8 to 8 but 1 in 4 weekdays you stay all night as well. Also 1 in 4 weekends you'd start 8 am on Friday and work straight through to 8pm on Monday (yes, that is 72 hours in a standard week plus on in four 84 hours straight with minimal sleep, an average of over 90 hours and 144 on a bad week). I'd often hallucinate on the way home.
And yes, it was for ten year. If someone went on leave you had to cover all their shirts.

Try watching Cardiac Arrest- that is the most accurate portrayal of working as a junior ever, and was made at the time I did it.

There was always the promise of a decent role at the end of it, which is why people put up with it- that has gone now.

In reply to bentley's biceps:

How long ago was that, obviously bonkers hrs and well outside Europe working time

In reply to John Kelly:


That's admissions. That's what pisses me off about the government rhetoric it that they are blaming GPs for unconnected issues. There are a multitude of reasons as to why there aren't enough beds in hospitals and why they can't cope, GPS running a 5 day service is not one of them. I believe there is a connection between access to GPs and some A+E issues and that the GP service could be improved but let's discuss that, not. Lame the woes of the NHS on one particular segment of the workforce. It was 'Junior' doctors, now it's GPs.....

I would hate to be a GP. You've got 10 minutes to work out whether the person in front of you has something benign or something life threatening. If you miss it, they're screwed and it's your fault. 9 times out of 10, or maybe 99 out of a 100 or 999 out of 1000 it'll be nothing, you can't just get scans/tests for everything but that one time you might miss something.... As an engineer I design lots of stuff that if it fails, people will die/get hurt but I get more than 10 minutes to make decisions and my work is checked. I don't have an angry patient in front of me with an internet diagnosis and a list of drugs they want closing the issue.....

I still believe that moving the support services (scans/x-ray/labs) and social services to a 7 day rota to allow hospitals to function better over the weekend and to discharge patients to free up beds and resources would be money better spent. However, the pay for those services is probably quite poor so it would require a financial incentive I imagine.

In reply to galpinos:

I'm just tempted to say you are wrong, lack of GP services at the weekend have definitely caused me to use A&E on quite a few occasions and I would assume that would count as an admission, kids eh
but we didn't use hospital beds, so maybe not completely wrong

GP - very tough job but also opportunity to make real difference, it's cup half empty cup half full, my belief is by focusing on negative reports we may end up damaging the very thing we seek to aid

Support services at weekend, of course, with agreement and sensible funding

In reply to John Kelly:


I'm sure Medics are the same as Vets in this regard - almost everyone 'voluntarily' opts out of the working time directive.

Lots of my colleagues still in Veterinary General Practice ( a job that I would argue is more interesting, more diverse and less trammelled with regulation that that of a Human GP) are also fed up to the back teeth. I think your point about perceptions is very good in that objectively they are often better paid, have better working conditions and do less hours than earlier generations - but perhaps have less 'respect' from the public and have higher expectations of and for themselves.

In reply to John Kelly:

We are talking 90s into 2000s.

There are a lot of people who did the same horrendous hours, so you can see why a lot feel very let down to be made into scapegoats. The standard attitude (as above) isn't "thanks for all your efforts" it's a negative response. You can see why morale is at an all time low and why things are falling apart.

In reply to John Kelly:
Two points:

There are 24/7 services every day. GP out of hours services will see you wheneve your usual GP is closed. GP services have always run 24 hours.

In our area we have had a big push for weekends. Most GP surgeries now open at weekends, and our place was offering 56 appointments at the weekend. After running this for a year we have the data. All appointments were used. Did A&E attendances go down? Not at all. People's behaviour isn't changed by offering more GP appointments, they just get used in addition. This has been reflected in most areas.

In reply to bentley's biceps:

24/7 - that wasn't our experience during late Noughties, however last few years there does seem more availability re. Hrs in local surgery - by the by always had great service and support from both docs and local hospital, spot on

Health care demand - limitless, unsurprised by your experience of ' all appointments taken' - how do we address that, is there a case for 'difficult receptionist'

In reply to Dr.S at work:

My understanding is you can only opt out of certain elements WTD, you have to take breaks, days off as per instruction I think. Feel free to increase my understanding.

In reply to John Kelly:



Our Doctor's receptionist is always delightful( when she tells us we will have to wait ages)

In reply to John Kelly:
That may be the law, but it is not enforced by the workers, and not insisted upon by the employers.

In reply to Jim C:

Sorry Jim - flippant comment on my part in response to an earlier post, I have likewise only had help and support from receptionists at my local, great bunch of people working hard to help.

Suppose the reason for my comment, it was my stupid suggestion for restricting the limitless demand highlighted by BB, not sure it's practical

In reply to Dr.S at work:

Open to legal action, very surprised by your suggestion that employer such as NHS could get away with not following employment law, robust paper trail from wages/timesheets, surely one disaffected employee out of the 1.7 million employed by NHS would have complained if this was commonly ignored

In reply to John Kelly:

And what would happen if we halved the hours worked by junior doctors tomorrow?

In reply to John Kelly:



You earn more as a consultant and get to work in a team, so you don't have to dip the urine yourself or take the blood because there's no one else to do it. Also if you run out of ideas you can discharge the patient as a consultant. As a gp cradle to grave! Plus hospital consultants can do private work. Briefly in 2004 gps earned more than hospital consultants for less work, guess what lots of doctors decided to be gp's. intelligent people work out fairly quickly that more money and less work makes a good career. Hence more locums and hospital consultants and less gp's at the moment.

Hope that explains it?

In reply to Dr.S at work:


Missed that bit- I think that you are right, while Doctors are still well respected the awe in which they were held in during my childhood (60's) has gone, many other professions have probably 'suffered' similarly. Is that a bad thing? not sure

In reply to John Kelly:

In some ways no - patients may be more engaged in their own healthcare - but if you think about the reward for work as a compound of kudos, joy of work, financial reward, vs the cost of work as time, difficulty etc, then it's clear that decreasing kudos and joy will make jobs less attractive.

In reply to John Kelly:

That is interesting. Until 2004 individual practices had to manage all their own out of hours work. After the changes to the 2004 contract it was done by teams of GPS in an organised hub system. That (IMHO) works well.

May wants to push it back to individual practices to cover what is currently out of hours. Practices (like pre 2004) just don't have the capacity.

I wonder what will happen.

In reply to Lion Bakes:



Fixed that for you.

In reply to Rob Exile Ward:

I'm not sure if I understand May's concept. Our surgery (which has a large number of GPs) always seems to have around a one week wait for an appointment. If a surgery has a given number of appointment hours in any one week, and they are always full, how does moving those full appointments to a weekend make any difference? They will still be full, and still need a one week wait. Maybe I'm missing something here?

In reply to bentley's biceps:

My kids were small in the late Noughties and did all the usual stuff, 20 miles to our local hospital so night time emergencies were a bit of a pain, probably used less services as a result, you had to be literally dying in our house to see an out hrs doc.

'What will happen', we are lucky that the medical community are in general hard working and of a generous nature so they will I think make stuff work,

To help
I think we need to be much more realistic about resources, volumes, demands and human nature
We could also help by ignoring folk who decry the achievements of health service to further their own agendas

In reply to rurp:

Thanks interesting

In reply to Jon Stewart:


The actual stats on who and what and where it is overwhelming the NHS right now rather than speculation on future trends. Have a read of NHS trust reports on this stuff. Rather interesting reading.

In reply to gribble:

Well maybe the simple reason that people are working during the week so a bit stupid to be closed during the week end ? If they have to close it would make sense to close another day of the week.

In reply to RomTheBear:

If you have to go to your GP then you can go when you are supposed to be at work. Not having time off for sickness went out in oh, I don't know, 1920 or something? And GPs are entitled to weekends too.

In reply to Rob Exile Ward:

Well, it depends, in many jobs going off sick is not easy, or will eventually get you fired.


Yes, but they don't have to be at the weekend, do they ?

In reply to Rob Exile Ward:

All this talk about GP hours, and people turning up at A&E without a hint of either accident or emergency, seems to me to miss the fundamental issue.

As health care costs rise due to new expensive drugs and treatments, and people living longer with chronic conditions, then the proportion of the population whose disposable income cannot pay for the health care they feel entitled to (even if their entire disposable income was taken in tax to pay for it) inexorably rises. So either the rest of the population has to accept an increasing tax bill to pay for universal quality health care, or we abandon the principle of universal quality health care on which the NHS was founded.

Our politicians try to tell us we can avoid this dilemma and expect high quality universal health care without paying for it. They are deluding us, but they know that few of us would vote for a party promising the required increase in taxation.

I would.

Martin

In reply to Rob Exile Ward:
The government will operate at the lowest level of decency and sense that is permitted by the Opposition.

Do you think the UK could crowdfund a new opposition?

In reply to RomTheBear:

So who is going to school my children on a Saturday and Sunday while I am at work? Excuse me for being old fashioned but I quite like my time off to be family time. A Tuesday off is bugger all use to me.

It's fine when you work in a large surgery like I do as there are 10000+ patients, the weekend on call rate is approx 1 in 10.

If I worked in a smaller practice, say more rurally, then it could be more like 1 in 2 weekends, not sustainable.

In reply to Rob Exile Ward:
My only explanation is she is trying a bit more Trump like post-truth out of desperation. Any informed health commentator knows it won't work (GP arrangements are very different to 2004 and current GPs and other related surgery staff work bloody hard and we have a growing shortage). She really is in a difficult place ... big UK debt, wobbly world economy, no spare cash easily available, tons of urgent government work needed for brexit with a depleted army of civil servants, small majority with a few too many awkward tory MPs, growing military threats and severe financial and diplomatic risks from a hard brexit seemingly on the way. I'm surprised she hasn't gone for the foreign aid budget (even as a liberal I think its mostly ill placed apart from its utility as bribes..). maybe the foreign office has said they stand to lose more business than the savings, at a time with an urgent need for quick international trade deals. Her only luck is she is still facing Corbyn.

In reply to Thickhead:


Frankly a good deal of people work weekends, and for no extra pay whatsoever, I don't see the issue there as long as you get the same amount of time off some other time.

In reply to Thickhead:


Yesterday, a sunday here, I worked from 8.00 am, and was due to finish at 5.00 pm, but due to having to complete a "emergency action"*, didn't actually finish until 7.45 pm.

What's so special about you?


* Involuntary admission to a psyche ward.

In reply to RomTheBear:


Not very bright are you?

If plenty of people work weekends and have time off midweek in lieu what are the problems with current opening hours?

Most people who need a GP are sick and are off work or they are children or elderly.

What would you do about small practices with only 1 or 2 doctors?

In reply to Big Ger:




Good for you, but we're not talking about Australia are we?

If we were...

I currently work 8.30-5.30 during the week and do 1 in 10 on call so work until 10pm midweek or 8am until 10pm on weekends/public holidays.

What is 'special' about me is people pay at point of care for my service (if over 13) which substantially reduces abuse of the system.

In reply to Thickhead:


You don't think that mental health crisis teams work weekends in the UK?


I work a rostered 24 hour cover.


Which is what I've posited for the UK.

In reply to RomTheBear:


Where are the extra doctors going to come from? Bearing in mind GPs are already understaffed.

In reply to Big Ger:


Did I say that? Point out to me where I did.


Lucky you. I'm sure you get paid handsomely for it.


Then there we go. Another pointless circular argument between two people who actually concur. Who would have thought it on here?

In reply to Thickhead:

Frankly stupid comment, plenty does not mean all, many people can't get free time to see their gp other than the week end.



maybe, my personal experience is that I didn't go to the GPs many times when I probably should have simply because I couldn't get the time off work and my practice didn't do week ends.


They cover week ends in alternance ? Or hire more GPs.

In reply to Thickhead:


Nice innit?

In reply to RomTheBear:


I beg to differ. Employers need to show more flexibility not GPs.


You could have got time off. That is what leave is for. Blaming your GP for your own shoddy time management is just poor form.


Brilliant! That is the best comment I have ever read on here! They should either carry on doing what they already are or hire more GPs...

Only there aren't more GPs and there isn't the money for them anyway. Don't you read the news?

In reply to RomTheBear:


That sounds illegal. If you need to visit your GP then you need to visit them. What you are describing sounds like a chronic long term condition and you need to have that conversation with your HR department. If you're healthy then GP visits are few and far between.

In reply to Thickhead:


I don't know, it's seem pretty obvious to me that it's more convenient to most people if they have to possibility to see their GP at the weekend.
Nobody will ever force GPs to work during the week end if they don't want to.


I'm not blaming any GP. And it's not poor time managent, getting time off when you work in a high pressure environment with deadlines and arshole bosses is not easy.


Thank you.


Yes, I know, That is why I am all for giving them more money and getting more GPs.
I know that our government wants to do the exact opposite, but I can't do much about it.

In reply to Lion Bakes:


It's actually not illegal in the UK to fire someone if they go off sick.bMany companies have policies where being off sick more than three times a year can be grounds for dismissal.

In reply to RomTheBear:


Grounds for a conversation to see if they can help. You can't just sack someone because they've been off sick more than 3 times in 365 days. They'd be in breach of a number of employment laws and you'd have a good case to bring against them.

In reply to RomTheBear:
Illness

In reply to Lion Bakes:

Just to be clear this is not my situation currently, I'm self employed, I live in Cyprus and my doctor is a friend so I can go see him whenever and I never have to pay him ;-p

But yes I know personally someone who worked in a call centre for a major uk bank and got sacked for going off sick more than three times in a year...
Illegal or not, not sure , but I doesn't matter because it's too expensive to prosecute anyway.

And when I worked in the UK for companies with pressure and arshole bosses, quite often I just didn't go to the GP when I needed and just hoped whatever was wrong would just go away by itself... ended up with quite a serious pneumonia this way. Partly my fault but if I had been able to see a GP during week ends it would have helped.

In reply to Big Ger:

Just as well all that is enshrined in European law and so - oh, wait...

b

In reply to John Kelly:

Ha ha ha. Nice one. Made me chuckle.

We get hours monitoring exercises to ensure we are not breaching working hours limits and simultaneous warnings that if we record that we work excess hours due to short staffing we will held in breach of contract and disciplinary action will follow.

We get paid 11.5 hours for a 13 hour shift as we have an enforced 1.5 hour break. But seeing as i am the only person resident on site with the skill set for my job there is no break. I work through and get told i had the break and therefore wont get paid for that time.

If the nhs worked to the letter or spirit of emploment legislation it would shut the doors by the end of the 1st day. It runs on the goodwill of staff across all of the professions within it.

In reply to ben b:

It's UK law, although the EU may have enacted similar. In the UK, health and safety legislation is drawn up and enforced by the Health and Safety Executive and local authorities (the local council) under the Health and Safety at Work etc. Act 1974.

In reply to RomTheBear:


This is fine for bigger practices, but those with two or fewer GPs it just wouldn't work. Don't forget that to be open the practice needs two reception staff (lone working rules) and a nurse. The only way to achieve that and be cost neutral is to shut completely on a weekday, which just means moving deckchairs around on the sinking ship's deck - you'll end up having a gap elsewhere.

Some data coming through suggests that 8-8 opening over 7 days needs an increased spend on GP of an additional 50%.

In reply to RomTheBear:



First of all, believe it or not, most people don't work 9-5 Monday to Friday. Children, students, retired, shift workers etc make up most of the population.

Secondly and perhaps more pertinent to the debate is what bearing will this have on the current Emergency Department crisis? If people are well enough to work they are well enough not to visit an Emergency Department and even if that isn't the case, they wouldn't need a bed in ED so wouldn't be one of the old folks on a trolley in a corridor.

Thirdly you do realise there is a GP service 24hours a day, 365days of the year? It's called after hours care and is compulsory that everyone in the UK has access to this. This may be further from your home than your local GP.

What you want it appears is standard routine care at weekends which there just simply is not the capacity to provide. I don't know of any countries which do offer this to a population as a whole?

In reply to Rob Exile Ward:


Very much agree with this, there seems to be an embedded notion in the UK that the NHS is 'free' when it is anything but. I paraphrase JFK but I do believe the message 'Ask not what can your NHS do for you, ask what can I do for my NHS' is apt insofar as not taking the p*ss out of the service (not turning up to GP appointments, going to A&E for minor issues, drinking too much on a Saturday night etc) and taking some personal responsibility for your health through better lifestyle choices (diet, smoking, alcohol, exercise etc).

In reply to Rob Exile Ward:

Roy Lilleys view this am: (he loves his joke names... Tarzan is Stevens, Tinkerman is Hunt)



News and Comment from Roy Lilley

Letter to The Maymite;

We've no idea why you want to fight with Tarzan. You can't win. He is right and his duty of candour means he can speak up if he wants to.

You can't sack him. Only the board of NHSE can do that. They won't.

Even if you did; it wouldn't get people through A&E quicker. Neither would it get the thousands, marooned in hospital, home safely.

You could sack the Tinkerman. With a majority of 12 you need friends and it strikes me you don't make them easily. Bad idea.

Anyway, would that stop ambulances queueing outside A&E? Would it create more doctors and nurses? No.

You inherited a bad hand... but it's yer own fault. You voted for the Lansley reforms and for Osborne's austerity.

The way things look; there's a fiver on Tarzan outlasting you.

Your latest idea is to punish GPs who don't open for longer. I agree with that. Tie them to a lamppost, give them 40 lashes with a stethoscope. Bound to work.

You talk about a few hospitals having 'problems' and it's 'always the same in winter' You are wrong again; all the data points to a longitudinal drop-off in performance and nearly half of Trusts parking patients in everywhere but the broom cupboard.

...I fear somebody is going to tell you they are!

Why can't we figure out what you are up to? My guess is you don't know what to do and who you can trust.

I don't want my prime minister to look like a klutz. I want my PM to be across it, on it... not run over by it.

In the spirit of being helpful here are some ideas.

Realise 1.3m people in the NHS have a vote. You are going to need them, or you'll be calling Pickfords.
Call-in ADASS; sort out how much they need, now, to get social care back up-and-running. Bring forward Better Care Fund cash to pay for it. Or, take the money from the contingency reserve. Claw it back from local government over 15 years.
Give LAs power to take over and run, failing care homes. We need all the care-estate we can muster. Yes, it's Corbyn's idea but it is a good one, steal it, you can deliver it, he can't. Call them social enterprises.
Block-book Premier Inns; create step down care. It's £45 a bed a night. Include a matron and care assistants and you'll do it for £150. Hospitals cost £400.
Find out where we really are; ensure bed-occupancy counts are consistent. Ensure Trusts are honest about their true position and not hiding it to avoid getting out of special measures. You need to know. Slim down the data requirements to something meaningful and less onerous to collect.
Phone or contact 'at risk' patients every other day and check for declines. Prevention is cheaper than care.
Change the threshold for care-home registration to require one qualified, prescribing nurse on every shift, a Telemed link to a GP 24-7 and a weekly visit from a pharmacist.
Get the GPs in and onside. Not the BMA, ask the NAPC; they are much more sensible. Ask them to explain their Primary Care Home system. It works.
Forget extending GP opening hours. 7 day appointments led to no reduction in emergency admissions. £45m was spent to save £3.2m. 26 extra appointments for 1 less A&E visit.
Instead; close struggling GP surgeries, move them to the local A&E, with open access for all comers. If that's where people want to go, let's make it happen safely, on our terms.
Use tax-breaks to encourage call-centres for telemed support for people with long-term conditions. Get these services up and running - pronto.
Promise to get NHS funding back to the EU average by the end of 2022. It's a vote winer.
Do some focus group work on '2p on income tax, hypothecated for the NHS'. My guess; it's a vote winner.
Talk to the CBI and IoD about making it easy for people with elderly relatives to have carer's-leave to look after older relatives at critical times. Take the pressure off the system.
Guarantee the rights of existing EU NHS staff to stay.
Oh, one more thing; stop saying the NHS is doing a wonderful job; we know you really mean, 'work your backsides off so I don't lose face and have to put more money into the NHS'.

You are seen as neither a leader nor a listener. No vision, no grasp, no smarts.

I hope this billet-doux will help you change that. Now, please, get on and do the people's business.
-----------------------
Contact Roy - please use this e-address
roy.lilley@nhsmanagers.net
Know something I don't - email me in confidence.

In reply to Offwidth:

Lilley knows what he's talking about. thanks for posting that.

In reply to Thickhead:


Well It was the case in France, when i lived there I was going to the GP on Sundays, rjey had walk in consultations.
I agree with you there probably isn't the capacity right now. And that's a shame IMO.

In reply to no_more_scotch_eggs:

He is also from the right (he used to advise Thatcher once). I don't agree with everything he says but the idiots here can't pretend the reports of NHS troubles are just liberal hot air.

In reply to bentley's biceps:

You don't neeed to convince me that it would mean having more staff to have a 7 day service.
That's the problem, I think a 7 day service really is beneficial for patients and just makes things more convenient for people working weekdays, bit somehow the government wants to make this happen without any extra money - not gonna happen

In reply to RomTheBear:

From above, this bits important too: "Forget extending GP opening hours. 7 day appointments led to no reduction in emergency admissions. £45m was spent to save £3.2m. 26 extra appointments for 1 less A&E visit."

Seven day GPs have been trialled multiple times; it's never been shown to have a benefit, either in broad economic terms, or to a specific healthcare economy.

Want to improve things in A&E? Put a GP + Nurse Practitioner + Pharmacist there: https://www.ncbi.nlm.nih.gov/pubmed/20883612

+ 17-20% of A&E attendances require no or minimal medical interventions.

In reply to no_more_scotch_eggs:
I never understand why more people don't listen to Lilley, he's been talking sense since at least since 1995 when I was studying the NHS as part of my masters. Why isn't he running the bl**dy show?

In reply to Rob Exile Ward:

He does talk some shit as well; asking why we don't put cameras in every A&E consultation room as a method of cutting down complaints for example. Also his inability to be entirely consistent on centralisation v local problem solving (proposing a national / centralised ambulance hub is one of his more... interesting ideas).

But in general, even when he's wrong he's engaging. Same in person too.

In reply to BFG:





I don't dispute that at all. I'm simply saying this is more convenient and a lot less stressful for many patients to see their GP during the week end.

I think that's part of the problem with NHS philosophy, it's geared towards trying to achieve the best overall health outcome possible given a limited budget, not necessarily towards doing what is best for each individual patient.

In reply to bentley's biceps:

I thought practices with two or fewer gp's were history following the Shipman debacle.Certainly round my way there are none left, consigned to the bin.

In reply to BFG:



Is that not just a walk-in center? The Manchester Royal Infirmary has a walk-in center located next to A&E, staffed by a GP and two nurse practitioners (I think). No idea what it's effect on A&E is but was a good service when i used it (weekend so no access to GP) and it seems sensible.

In reply to BFG:

I fail to undertsand why this is not almost standard these days- GP's and pharmacists in with A & E.

Again we have seen Pharmacists at GP's surguries- they work well especially out of hours.

In reply to neilh:
A couple of reasons; often A&Es aren't particularly well designed and there just isn't space, funding is a bit weird, Acute Trusts tend not to employ GPs and there are some old legacy rules around Acute Trusts running those kind of services which are a pain in the ass. The latter three can be overcome but, when Trust management is firefighting day to day long term planning tends to go on the back burner.

It does happen, it's just less common than it should be.


Edit: Yeah, it's basically a walk-in centre, although they don't always have GPs. But not everyone knows what they are so I tend not to use the term.

Edit2: It's also important to point out that, nationally, we're filling about 70% of GP training posts and full time positions (iirc). Basically, we're only just managing to run a GP service nationally, so increasing the strain on that part of the system by creating posts for them elsewhere might work in the long term (say, with more nurse practitioners) but, depending on local variances, isn't something you can just do tomorrow.

In reply to RomTheBear:



Well, depending on what you mean by the NHS, necessarily the policy is at the population level; it's the responsibility of doctors to provide personal care. Nationally administering the 185 million GP appointments per annum at the personal level is a big ask (not my estimate, but it is an estimate).

Also, given that both the NHS Constitution and all main policy documents state that moving towards personalised care is a crucial plank of creating the NHS of the future, I would say it's not really the NHS' philosophy that's the issue. It's more staff shortages, lack of resources, being asked to reconfigure services whilst shouldering cuts in real terms that does it.

On weekend appointments, they just aren't that effective. When we don't even have enough GPs, nationally, to staff a mon-fri, 9 to 5 service, a national policy to open up at the weekend just isn't feasible.

In reply to BFG:

Well yes, that's part of the issue, the fact that the NHS has a set limited budget.
What you have for example in France or Germany is a semi private/public system, the patient basically pays for his own care with the help of the state, that means the patient is a paying customer and the patient gets whatever they need, not whatever the NHS can afford to give him without jeopardising funding for other patients.
I appreciate that the NHS has recognised that and is trying to move to a more patient centric care, but that's just not going to happen with the limited budget.


I don't dispute that given the current budget, it would be a stupid idea.
I dispute the idea that it wouldn't be a good thing to have.

Your comment illustrates quite well the mindset I was referring to, the NHS will always tries to go for the most cost effective option that delivers the best health outcome overall given the budget constraints, but will not necessarily be the best option for each individual patient.

They frankly do an extraordinary job of it, and the level of dedication you see in NHS staff is quite amazing, but they can't do the impossible, when the service is stressed and short if funding, they have no option but to prioritise and compromise.

In reply to BFG:

Accepted it will take time.it took a few years for GP surguries to start have pharmacies, which is clearly sensible.I am sure that has annoyed the private pharmacies who will have lost buisness.

I guess one of the other issues is that GP's tend to own the buildings of the surguries in a private capacity, and then rent them back to the business. A nice little earner on the side.

In reply to RomTheBear:

'the NHS will always tries to go for the most cost effective option that delivers the best health outcome overall given the budget constraints,' - You say that as though it's a bad thing! :0)

And the daft thing is that a health service will ALWAYS be constrained, because ultimately nobody wants to die. You could even say that nearly all deaths are a result of compromise - we don't get hooked up to life support machines at the end because it just isn't worth it. It doesn't matter how much money is extracted, what proportion of GDP is spent, it will - can - never be enough.

Personally I am happy to delegate decisions about my care to socially responsible and expert bodies like the NHS, NIHCE and the other wonderful institutions we have in this country, I don't want some private healthcare provider persuading me to sell my house to fund some obscure drug or treatment that may - or may not - extend my life by a few miserable weeks,

In reply to neilh:

Another's good little earner; my GP who is a friend retired, started to draw his pension and then went back to work, but only 3 days a week, still drawing said pension He told me that's quite common. The logic being that although he's drawing the pension the NHS still gets a valued GP albeit only 3 days a week ?!

In reply to rocksol:

What's the problem? It's his pension, he paid into it, it's his money.

In reply to rocksol:

What on earth wrong with that? Pension is deferred pay people have earned and that they can take (with or without actuarial deductions depending on their circumstances) below normal pension age under the rules of their contract. If someone is going to take their pension but still wants to do some work do you seriously want to say sorry you can't do that and throw away their expertise at a time of major shortages? Its not a givaway... if you retire early you get less pension than if you work longer... and there are rules on how much you can earn in the same scheme after retirement.

In reply to neilh:

There are still a large number of small practices in many areas. Around us it's a good proportion.

The building ownership but is one of the big issues as you're potentially taking on a huge financial risk. Many GPs don't want to put 100k into owning something that may well fall over very soon. Hence why recruitment to partnerships has tailed off significantly.

In reply to Rob Exile Ward:



You're mixing up everything, this has nothing to do with your extreme example of terminal illness or even with a privatised service.

Even for everyday illnesses or injuries NHS is substandard, they just don't have the funding to give the best care available.

It's the model of funding that's wrong, the NHS gets a fixed budget and as a result they have to make hard choices, and have guidelines on what they can or can't afford, inevitably that means that patients will not always get the best treatment available, or will be discharged from hospital much sooner than they should, because you need funding space for other patients.

In a model where each patient comes with its own funding, this is less of a problem, because the patient is not a cost and a burden that needs to be processed out of the system as cheaply and quickly possible.

All I am saying is that the funding should be per patient, health professionals shouldn't have to worry about the costs, they should just worry about giving the patients the best care they can possibly give them.

Of course this is a more expensive system and would need people to pay more taxes, but I wouldn't have a problem with that.

In reply to RomTheBear:




Is it standard practice across France to provide routine GP appointments 7 days a week? Even in rural areas with only small practices?

There is no probably about it... there is not the capacity.

In reply to Jon Stewart:

Much of the increase in life expectancy yet to come in the next 20 or so years is from people who have already managed to get past 45 or 50 in reasonably healthy state.

Our Western obesity epidemic will hit us a bit slower, but will eventually cut life expectancy in the same way that alcoholism dropped life expectancy of men in post Soviet Russia (which was more immediately obvious as booze kills you more quickly).

CB

In reply to Thickhead:

Yes. At least this was the way it was when I grew up and I think this is still the case, there was only one gp in my practice and he was open every Saturday and Sunday morning for walk in consultations, the rest of the week was appointments only.

The big difference is that in France GP own their own business, the price is regulated and you get your money back from the state and your Health insurance, which are quite cheap.
But critically that means that you're not a burden on the GP practice, on the contrary you're valuable business for them.

It also mean that the job is probably a lot more enjoyable for the GP, they can take their time and focus on the patient instead of desperately trying to process as many people as possible to meet cost targets.


I know, and I said, the funding model is screwed up.

In reply to RomTheBear:

Fair enough.

That must rely on an extraordinary level of goodwill from a single handed GP. Some years ago there were some like that in remote areas but it would have been fairly unusual to consider it standard practice (in the UK).


Completely agree.

In reply to Rob Exile Ward:

I say this with some reservations and expect I'l get flamed to some extent, but this whole thing smacks of a propagandist divide-and-rule tactic aimed at the less well informed. GPs, teachers, police, social workers are soft targets and it's real easy for politicians to create a simple "them and us" division based on misperception and misrepresentation. My GP rang me this evening at 6.30 after a long day of seeing patients and making home visits; my sister's a GP in Cornwall and doesn't go home until every patient's been seen, regardless of whether they have an appointment - they turn up, they get seen. If the Government wants 12 hours per day 7 days per week availability, it needs to fund it and train more medics.

In reply to Rob Exile Ward:

We have these;



http://www.health.act.gov.au/our-services/walk-centre

In reply to RomTheBear:





I feel your friend has not painted the true picture of what happened and the grounds for dismissal. If it is as you say he'd have a strong case at an employment tribunal and certainly be due sizeable compensation if successful.

In reply to Rob Exile Ward:

Forgot, we also have these;


Ginniderra Medical Centre provides affordable and accessible general practice care to all patients. The centre operates as a ‘walk-in only’ service that can offer bulk-billing* to patients who have either:

- A current Medicare Card,
- Are an adult/ child who is the holder of a Centrelink Healthcare Card,
- A pensioner who is a holder of a Centrelink Healthcare/Pensioner Card.

The services provided at Ginninderra Medical Centre include:

- Children’s health,
- Women's health,
- Men's health,
- Wound management,
- Chronic disease management
- Management for diabetes, asthma and heart disease,
- Immunisations (influenza, travel and childhood), and
- Aged care.

Opening Times:

Weekday: 7:00 AM - 10:00 PM - open now as at 7:23 AM EST
Weekend: 8:00 AM - 10:00 PM
All Public Holidays: 8:00 AM - 10:00 PM


*Bulk billing = no upfront fees, govt is billed direct for your consultation.

In reply to John Kelly:

Inflation only accounts for doing what the NHS was currently doing in 2009/10. It doesn't include:
- Population growth
- Population ageing (demographic shift)
- Cost of new therapies (these cures for cancer don't come cheap)
- Increase in 'social' bed days/admissions due to social care cuts
- Cost of temporary staff to patch up rota gaps caused by permanent staff leaving due to being treated like s**t by the Tories.

Since 2010, the NHS has been expected to meet the 'Nicholson challenge' (aka the cost efficiencies to end all cost efficiencies, £20 billion 'saved'/cut), now is being expected to make £22 billion more savings in exchange for £8 billion more funding this parliament, which is actually more like £4 billion seeing as the Tories moved money from one NHS pot to another and called that an increase...

To avoid any confusion in 2014 Simon Stevens, Head of the NHS, stated the NHS needed a £30 billion increase for 2015-2020, was promised £8 billion and is receiving £4 billion.

In reply to munro90:

You got a dislike for bringing some aactual evidence to the debate. As did poppydog.

I think it's Jeremy Hunt, lurking...

In reply to munro90:

Sorry, I don't understand your post - numbers unclear, the Kings fund numbers I quoted earlier are widely believed, I now understand, and very clearly explained.

In reply to Lion Bakes:



I think you're a bit naive, it's perfectly legal in the U.K. to sack someone for repeated short term sickness absence, especially if there is a policy in place placing a limit on them. It's very common in places such a call centres.

In reply to Rob Exile Ward:

This is interesting:

https://www.theguardian.com/commentisfree/2017/jan/17/nhs-crisis-act-self-s...

In reply to Offwidth:

...and another Roy Lilley view:


Organise it


News and Comment from Roy Lilley

I'm typing this LOUD! I'm trying to get your attention.

Perhaps I should just be saying; please read. You've got this far so you might as well read on and see.

It's this money fing what's got me so discombobulated... what is being said about the money.

Everyone I hear talking about the money-thing is falling into the same trap.

A trap for the trusting. A trap for the people content to let other people do their thinking. The parrots and the repeaters.

The House of Lords are guilty, the Health Select Committee is guilty. The spiky-gel-hair brigade from the 'think-tanks', with their lap-tops, are doing it. Journalists are doing it. Conference speakers doing it. I just hope I don't catch you doing it!

People keep asking how the NHS is going to survive without a public debate, a rethink, a different approach. A new way of funding... it's driving me to DISTRACTION!

Ok, I've taken a deep breath... let me explain.

When it comes to funding, over the years, the NHS has enjoyed mixed fortunes. Famine and feast. You need no links from me; you can Google a graph.

A look back to the John Major days; NHS funding was pretty dire. Tony Blair swept into Downing Street and NHS fortunes looked-up.

In 2000, after a disastrous NHS winter crisis, he promised to get spending up to the European average by 2006 through annual cash injections increases of around 5% in real terms each year. This compared with an average increase of 3% over the previous two decades.

Blair told BBC1's Breakfast with Frost;

"Spending is too low at the moment so we'll bring it up to the average of the European Union..."

...and (give or take) he did.

It produced astonishing results. It produced what the public wanted then and want now; access and shorter waits.

That was a long time ago and there has been a lot of water under the bridge. The money bought shorter waits and overdue acceptance of the recommendations of the pay review bodies but it is also true; not really an impact on innovation or productivity.

Fast forward to the banking crisis. The coalition government, faced with what looked very like national bankruptcy, had three options. Print money (they did), borrow (they did) and slash public expenditure. Oh boy... they did that!

All public services got hammered. Not least local government, and social care. Social care is a statutory obligation for local government. They have to do it but they can set eligibility criterial and they can set their performance requirements. The upshot... you know...

The NHS faired best of the lot. A small increase, a fag-paper the right side, against 4% growth... for five years 2010-5 and a £20bn gap. The 'Nicholson Challenge'.

A combination of flat wages, tariff hokey-pokey, pharma-cuts and using both sides of the bog roll, the NHS got close.

Come the 2015-20 spending cycle; still more-or-less flat line funding and a row over £10bn or £8bn, or £4.5bn, up front funding. It's the latter.

Is the NHS sustainable?

Yes, get the funding back to the EU average, get off its back, dump any new malarky, let it get it's breath back. Roll the Better Care Fund money forward, restore adult social care funding. Job done.

Blair stepped in when NHS funding was just over 6.3% of GDP. Sixteen years later we are heading for 6.6%. Thirteenth, out of the original 15 countries of the EU. Each of whom faced austerity battles.

No need for conferences about sustainability. There is nothing systemically wrong with the NHS model. Through no fault of its own the wheels came off in 2010. We can put them back.

Centrally collected taxes, redistributed through the Treasury, to fund the NHS, is the cheapest way to syndicate our risks of illness, injury and maternity.

The government's first objective; to protect its citizens, can be achieved. As far back as April 2015 the public have been willing to pay more for a decent health service.

We just need some decent politicians to organise it.
-----------------------
Contact Roy - please use this e-address
roy.lilley@nhsmanagers.net
Know something I don't - email me in confidence.

In reply to Offwidth:

A lot of sense here. Just grabbing a brew , escaping the endless ambulances and walk in patients. I'm looking at things from an A&E perspective, 10 yrs as a consultant . We pay little for the NHS but expect a Stella world beating service . People can't see their GP's and do come , despite our co location of services already described . Our care homes need constant medical input and qualified nurses , spot on. We are often blocked by endless lines of poor elderly patients who just should not be here. We need more staff , and if you need a 24 hour service you will have to train more , so that's a minimum of 15 yrs for hospital doctors , not a quick fix. It's due to years of multi party head in the sand quick fix lets get re elected politics ! In our hospital staff work hard , take a lot of abuse and moral is low for all types of staff member.
Hope it gets colder and we can start swinging some axes to get away from it all. Enjoyed my brew. Back to work

In reply to RomTheBear:

All the GPs I have been registered at have had some weekdays when they do 12 to 8 instead of 9 to 5. It's not a new idea. There are also walk in centres and minor injuries open weekends. Sounds to me like you just couldn't be bothered looking after yourself and want to blame the system.

In reply to marsbar:

Well where I lived it was basically 8 to 6, closed completely during the week end, and every time I called to try to get an appointment I was basically told to feck off, only way was to come in the morning before 10, which obviously if you're working is impossible. Never been given any alternative either. May I point out this was a busy practice with many GPs, in a big city centre.

In reply to RomTheBear:

No, if you need to see a doctor you take time off work.

In reply to JayPee630:

Well yes, indeed, that's the problem, you have no choice.
A very simple solution would to have weekend or out of hours appointment for an fee. Everybody is happy, the NHS can make some money that can go towards more GPs, and patients who work during the week have the option to see the GP during the week end if they can afford it, and those who can't benefit from a better service during the week.

In reply to RomTheBear:
A) That already exists - it's called private healthcare. You also have walk in centres, phramacists, 111 and minor injury units.

B) It won't currently scale nationally. The problem isn't the funding but a fundamental lack of GPs. You can always talk about 're-arranging the system' to have more but that's easier said than done. Apart from anything else, medical students are capped by national govt, and you can't just remove that cap; it takes 15 years, give or take, to train a GP. Scunthorpe and Scarborough filled 0 training places for GPs last financial year - we fundamentally don't have enough doctors in the system. Increasing the NHS's funding - unless you do it to ludicrous levels - will not change that. Unfortunately, we're still a public body, subject to the whims of national govt.

Realistically, what will happen in the next 10 ish years is you're going to see an upskilling of the non-doctor workforce, with the addition of Physician Associates (ppl with science degrees upskilled to be clinicians) and advanced practitioner nurses / paramedics supplementing the GP workforce, along with multi-specialty centres and more use of technology (although that last one is a bit of a red herring).

However, all these things take time. Medicine is an inherently humane industry - it requires vast numbers of people. Plus, the net impact of Tory policy over the last few years has been a drop in the number of nurses (removal of bursaries, fiddling with caps etc) so there's no ready workforce to take up the increase in demand.


We aren't alone in this btw - the entire Western world is facing the same basic demand / supply problem with healthcare staff. The NHS is inherently cost efficient and, whilst I'm not anti private involvement, I don't see any basic problem with 'free at the point of care' services as an economic model - we have, demonstrably, one of, if not the the most (depending on which model / source you use), cost effective healthcare system in the world.

There might be good reasons for introducing a cost to visit your GP / A&E as a method of demand management, but you have to recognise the negative impact that any such cost would have. It doesn't really matter how low you set it, you will have people staying away from A&E because of it and becoming more acute and therefore more expensive to treat.

In reply to JayPee630:


Easier said than done for some people!!

It would be nice to be able to book a time though, then at least you can be away from work for as little time as possible.

The mad rush for 8am calls for an appointment means blocked telephone lines and massive frustration, or just turn up and wait for a no show or emergency appointment.

We need more doctors, the same as we need more intensive care beds, but the government seem intent on running the NHS down.

Training to be doctors isn't as attractive as it used to be, because you're basically signing up to massive debts, initially then a stressful job at the end of it.

In reply to krikoman:

There is no significant problem with recruiting students for medical training despite the debt and job stress. The simple issue is too many GP's are leaving and not enough are being trained or recruited otherwise (which includes the differential attractiveness of what you can do once trained currently acting against signing up as a GP... and the suspect future of the immigration we use to fill gaps). Similar issues affect other medical staff in surgeries. There is, quite simply, no quick full system fix for Primary Care. Lilley makes sensible suggestions for reforms on a smaller scale but even they are difficult and will take time.

In reply to Offwidth:

But Teresa, said it's OK we're training loads of new doctors and she's just made funds available to do this

I'm sure it only takes a bit of money and a couple of weeks to train a doctor or two doesn't it?

My BIL is a GP and my sister is a nurse, they are both pissed off with the constant underfunding and meddling of the government, for what they can see is no good reason, except to make things worse.

In reply to BFG:

Yes, but what's the point having a free service if you can't use it, and then have to pay a private company, when that money could go to the NHS ?




Well I completely agree with you here, regardless of any healthcare system one of the most important factor is the number of physician per head of population.

Unfortunately given the aging population, and tje pressure to keep foreign workers out, this is only going to get worse.

In reply to RomTheBear:


My doctor's used to do the turn up and wait system, not perfect but at least it meant the time off work was used to see a doctor.
Now they have the ring at 8am for a same day appointment system and its crap.
I start at 6 so that's 2 hours lost before I can start trying to ring them then it's 10 to 15 mins of constantly engaged phones and by the time you get through all the appointments are full and your only option is try again the next day.
You can't go to work and ring from work because if you do Sods law says you are the first through but can't get back in time to get there.

I would love to go back to the wait system.

In reply to Dax H:

I've said this so many times, we live in nice area and our GPs seems to be pretty well organised; if I want to be seen first I get there for 8:00 and will be seen by 8:30. I turned up at 8 one time, was seen at 8:30, referred to hospital for an X-Ray at 9:30, and was seen and discharged by a consultant by 10:00.

Yes I am smug...

A friend of ours is a partner in practice I suspect not as well organised and certainly in a much poorer area, when they tried the wait system they had queues round the block...

In reply to Rob Exile Ward:
It's an unfortunate consequence of the GP funding model that the sicker (and therefore usually poorer) your patient population, the more difficult it is, financially and otherwise, to run your surgery.

@Offwidth: Whilst I don’t disagree with anything you say, it’s important to note that the medical student university places cap is below the replacement rate required to keep the system going, let alone expand it. That ignores the attrition ‘in the system’ – people who start a medical degree but don’t stay in the vocation. We are fundamentally reliant on non-UK trained doctors to keep everything going.

I really don’t understand why this situation is allowed to continue. National govt constantly complains about the cost of doctors (capping locum fees for example). But it’s simple economics; as long as demand so completely outstrips supply, the power will be with supply. This was exacerbated by the internal market policies introduced in 2012. What happens when organisations are ‘encouraged’/forced to compete over a scarce resource…?

Fundamentally, the govt of the last 7 years has constantly complained about cost whilst making the matter worse.

In reply to BFG:
Of course the training places are massively below where they need to be, even if fewer doctors were leaving the profession (and in this case more who have been trained were chosing to be GPs). My point to krikoman is a common one I make to lazy leftist thinkers... training spaces are full despite the obvious stress in the job and debt from the study. Its a UK planning failure not a UK recruitment failure. What happens with overseas recruitment will be a difficult act to resolve, as they can't block the flow (a dishonest practice in my view as we in the west use foreign governments to fund our training) or the system will collapse. Yet the same can be said about many vital UK professions and remember St Teresa insisted international students also must be counted as immigrants (a multi billion export market on the UK balance sheet). Its really hard to see where they can cut immigration... maybe they have to destroy british fruit farming?

In reply to Offwidth:

Its like he knew this would come up:...


Good enough: News and Comment from Roy Lilley

Responding to recent concerns about staffing numbers in the NHS the DH press office said;

"We expect all parts of the NHS to make sure they have the right staff in the right place at the right time to provide safe care. That's why there are already almost 26,000 extra clinical staff, including almost 11,400 additional doctors and over 11,200 additional nurses on our wards since May 2010."

If I have my sums vaguely right;
• There have been 57 months between May 2010 and now.
• Divide 26k extra staff by 57 and you discover;
• about 456 new members of staff per month.
There are 157 main acute Trusts. If they exclusively employed this new army of staff (which they won't), I make that nearly 3 new members of staff a month.

Thirty six a year, if your lucky. Take out sickness, retirees, holiday, study leave and 'stuff-this-for-a-game-of-soldiers'... and you can see it's a pretty daft answer.

Does the DH press office think no one has a calculator or a bit of common sense?

The RCN guess there might be as many as 24,000 vacancies for nurses across the NHS. I don't know if their numbers are any better than mine? Or for that matter, the DH. My guess is they are smack-on.

There is a neat trick with staff numbers. The establishment of staff measured in whole time equivalents is the top line.

If you happened to be the boss of the St Fabulous NHS Trust and said; my WTE nursing compliment was 100 smiling, happy nurses giving me a safe patient to staff ratio, everyone would be happy.

The reality might be; out of that one hundred, 20 were vacancies that you can't afford to fill, 5 were off sick and your agency ceiling had been reached, you're struggling with controls totals... a different story emerges.

Safe staffing? Yer avin' a larf.

We've got just in time staffing, just good enough staffing. Just keep your fingers crossed staffing.

The simple truth is; there is safety in numbers and we don't have the numbers...

From April 2014 all hospitals are required to publish information about the numbers of nursing and midwifery staff working on each ward, together with the percentage of shifts meeting safe staffing guidelines.

For most places it's a paper and pen box filling nightmare. If they are 60% accurate I'd be astonished.

Well, we've done that. The answer is, it looks like the majority aren't even getting close to compliment.

What happens now? We could ask Amazon Prime to deliver a box of nurses.

My guess; continued attempts at a coverups by the DH press office and a likely calamity in the making.

Robert Francis' report into the events at Mid-Staffs is the foundation of our concerns. The root-cause of that debacle was a board being pushed into balancing the books, to deliver the political imperative... becoming an FT.

They cut staffing levels. It's an easy and quick way to balance the books.

Apart from Robert Francis now becoming invisible, nothing much has changed.

Special measures Trusts will not want to draw attention to their staffing problems. Front-line staff are terrified to speak out for fear of workplace bullying. Safe staffing is redefined as; we scraped through another shift without major grief.

With patients stacked and warehoused and beds as rare as a good hair day for Donald Trump, I'll never know how we are getting away with it.

It's time to abandon the charade. Admit, we can't do it.

If the RCN's real concern is for the safety of patients they have a choice. Either campaign to close hosptials because there are not enough nurses and not safe, or get a lot less snooty about apprentice schemes, health care assistants and the third sector.

Regulators have got to swallow a dose of reality. AHPs are a fulcrum point in workforce redesign and have some really good ideas. As do the Vanguards.

Workforce redesign... that might mean you. Ouch. And, certainly an urgent shake-up at Health Education England.

The sky is dark with chickens coming home to roost. Health planners and the government have made some really bad decisions about training and education. We are paying the price.

For now; good enough is going to have to be good enough and I know, you know, that's not good enough...
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Contact Roy - please use this e-address
roy.lilley@nhsmanagers.net