[vikz55]

Originally Posted by JD6

From my perspective, much of the current A&E situation is caused by GPs having managed to offload their out of hours responsibility.

Just to add to my post above, many GPs still do out of hours. The out of hours service is run by GPs. 111 triages the call which then goes either to a GP on a phone, or a GP at an urgent care centre, or a GP visiting doctor in a car, or to A&E. Too many get sent to A&E yes, but don't be under an illusion that GPs don't do out of hours any more!

It is beyond me how people expect GPs to work any more hours than they already do and still practice safe medicine!

[vikz55]

Originally Posted by MWA

How about setting up government funded gyms to tackle obesity and psychological insecurity of feeling weak and vulnerable.

If the nation was more active, naturally we would be healthier, stronger and more tolerant to illnesses.

Last time I checked with my local gym (David Lloyds) their monthly membership was around £90 per month and your stuck on 12 months contract.

This already exists to some extent. Its NHS-funded gym memberships that aren't free but heavily subsidised. Its called the Active Lifestyle scheme. But for some reason the obese don't tend to be that keen on exercise.

[....,,,,..,,..]

Originally Posted by vikz55

Steering this back to the NHS, I agree with much of what has been said on this thread, however the media bashing and general demonisation of general practice needs to be addressed. Our A&E colleagues (who have to weather a shit storm every winter and do a remarkable job) at least get some appreciation and sympathy from the public. Yet comments about lazy, overpaid GPs remain rampant - as if they are somehow to blame for the problems in A&E and secondary care. Yes there are some bad GPs out there, but there are bad A&E doctors, bad accountants, bad lawyers, bad engineers and bad employees in every field (the nature of being human I guess). But I feel obliged to make a few points to educate some of the clueless with regards to GP's.

General practice NHS consultations account for over 90% of all NHS patient contact. Yet primary care receives less than 10% of the NHS budget.
Herein lies the problem. It's all very well people moaning about not being able to get a GP appointment but consider why - there is nowhere near enough GPs in the UK and this is for several reasons. Despite what the Daily Fail would have you believe GPs work extraordinarily hard for a reasonable (but by no means extravagant) salary and the problem is getting worse. Being shat on my the government, media and public in general is taking its toll - more GPs are emmigrating to places like Aus and NZ for better working conditions than ever before. By 50 burnout is widespread and many are taking early retirement, eating away at your pension being a far better option than losing your sanity. Medical school graduates are no longer choosing general practice because the hours are too long to make it worthwhile any more. In the East Midlands over 30% of GP training posts remained unfilled this year - we are heading for a crisis.

The major problem with the NHS is inappropriate patient demand. The general public are unfortunately for the most part, morons. GPs are inundated with people who should be self-treating or speaking to their pharmacist. We have so much bullshit to deal with that the patients who should be seeing their GPs can't get appointments and then rock up to A&E. Hospitals are full so A&E just becomes a holding unit for the sick whilst the wards are filled with elderly patients who can't be discharged because they need carers and packages of care in place, but social care is in the same shitter as the rest of the NHS.

One way of dealing with inappropriate attendance is to charge, but as usual only the poor will suffer this and those with serious medical problems will avoid coming to avoid charges. You could make the charge refundable if the medical problem is appropriate but then just like the benefit's system - there will be those who play the system, and doctors/nurse's by their very nature aren't the best people to be the fare enforcer's.

I firmly believe the only way to deal with the problem is patient education about what is and what isn't appropriate.
For example when I worked in A&E, the father who called an ambulance for his 3 year old because his ex-wife hadn't cut his toenails and he seemed to think this was a safeguarding issue.
Or the drunk who needs expensive scans to make sure his dickhead behaviour isn't because he has an intracranial bleed.
Or Jeremy Hunt who could be arsed to wait for a GP appointment for his kids so took them to A&E.
This winter I can't even begin to count the number of people we have had to bat away when they keep turning up with their viral coughs.

Patient expectation is also huge issue. People who believe the NHS is their birthright to exploit however they want.
At my practice every day we have an open access system so any patient attending between 8 and 10.30am can come and WILL be seen by a GP. Our workload has gone up massively. I see up to 35 patients in the morning and then deal with 25 more on the phone. Starting at 8am, we finish morning surgery by 2pm - without a break. Then there is on average 2-3 home visits before afternoon surgery starts at 3pm. In between that there will be 100 repeat prescriptions to deal with, up to 20 medication reviews, 100 sets of blood results, 50 hospital letters to deal with, sick note requests, insurance reports. If you're a GP partner there is the practice admin too.
This after a minimum 10 years of training to be a GP. For between 80-100k a year! Its no walk in the park.
You might think that giving EVERY patient access to their GP on the SAME day would mean our patients are happy - no, they now just complain about waiting and the fact that we ask them to attend with one problem at a time only in order to get through all the patients. Despite the fact we have doubled our workload in order to improve patient access

So you're GP who can't be "arsed to work" during his 12-14 hour day with hardly a free moment to fart works a lot harder than you think. So next time think twice before you call you're GP lazy.

Agree with pretty much everything you say there.
My wife works at a Practice, so fully appreciate all that goes on not home until 8pm on Fridays etc.

Agree the general public are incredibly moronic or uneducated as to health and taking self treatment.

There is a severe lack of either first aid training or health training within schools or colleges, first aid for example should be a core bit of say PE or other lessons - yes I know teachers stretched etc.

so how should the health service deal with crap but safe doctors/ GP's?

A crap engineer or burger flipper would lose their job.

[NISFAN]

Originally Posted by MWA

How about setting up government funded gyms to tackle obesity and psychological insecurity of feeling weak and vulnerable.

If the nation was more active, naturally we would be healthier, stronger and more tolerant to illnesses.

Last time I checked with my local gym (David Lloyds) their monthly membership was around £90 per month and your stuck on 12 months contract.

How about setting up a lifestyle banding.....you keep yourself fit and healthy within a prescribed BMI range, you get free treatment. You go outside of the range....you get a chance to get yourself back into shape (coaxing, diet plans, etc), if not you start paying to see GP, Hospital, prescriptions, etc.

That would be a much more effective method than a pasty tax.

I also think you should pay a 'booking fee' to see the docs. My practice has one of those electronic banners saying how many thousand people a year don't turn up for their appointment. Should be bloody fined.

[vikz55]

Originally Posted by Brigand

so how should the health service deal with crap but safe doctors/ GP's?

With difficulty I accept. The GMC is hot on negligence and unsafe practice. But bad GPs have been able to reign free for a long time. There is recourse through complaints to practice managers or commissioning groups. You can take the matter quite far, but whilst I have heard stories of doctors who have had to undergo mandatory retraining, it would be difficult to take action unless a doctor had complaints from several patients.

[....,,,,..,,..]

Originally Posted by vikz55

With difficulty I accept. The GMC is hot on negligence and unsafe practice. But bad GPs have been able to reign free for a long time. There is recourse through complaints to practice managers or commissioning groups. You can take the matter quite far, but whilst I have heard stories of doctors who have had to undergo mandatory retraining, it would be difficult to take action unless a doctor had complaints from several patients.

I am not just singling out doctors, same with teachers, managers within public sector - some of whom are rightly call cockroaches as they will still be there at end of the world.

[Tengocity]

Originally Posted by NISFAN

I've got to say......as a keen snowboarder.......I have to pay insurance in case I need a medivac in the Alps. It costs thousands of Euro for a helicopter medivac, and that is on a pretty simple 'route' not using a winch, using a fairly small machine (You'd not get anything bigger than a Eurocopter), crew of no more than 2.

Why shouldn't it be the same for UK hill climbers, and fisherman?

One of the differences is that the Alps is typically a tourist destination, so many of those on the slopes are from another country, so I think it somewhat understandable that they wouldn't want subsidise non-nationals of that country.

I'm not really sure I see why someone walking in a remote area, be that a gamekeeper, mountain biker or recreational walker should have have to have insurance, and folk in cities shouldn't?

If you walk through a town centre on a Saturday night, and get bottled by a drunkard, I could say you were as stupid as the hill walker in winter who willingly put themselves in a potentially dangerous environment. So should that person have insured themselves?

Personally, I think that would absurd, same as it would be for anyone enjoying the countryside.

[F30AM]

In Latin: Mens sana in corpore sano.
In English: A sound mind in a sound body.

[....,,,,..,,..]

Originally Posted by F30AM

In Latin: Mens sana in corpore sano.
In English: A sound mind in a sound body.

There is a hell of a lot of truth in that statement.


Unfortunately a lot of shoplifters are really fit and healthy but thick as the custard they are stealing

[JD6]

Originally Posted by NISFAN

I've got to say......as a keen snowboarder.......I have to pay insurance in case I need a medivac in the Alps. It costs thousands of Euro for a helicopter medivac, and that is on a pretty simple 'route' not using a winch, using a fairly small machine (You'd not get anything bigger than a Eurocopter), crew of no more than 2.

Why shouldn't it be the same for UK hill climbers, and fisherman?

I believe that a French citizen is entitled to that service free in the Alps. I don't think that was always the case though. A French friend and skier has told me that it has had a knock on effect of people taking greater risks and calling a helicopter when it all gets a bit much! They just charge foreign visitors I believe.

While I don't like the idea of people taking stupid risks and expecting the state to bail them out (sounds a bit like banking in the 2000s), the alternative of charging is a slippery slope from my point of view. If you have no cover and may have to pay £10k for a rescue (our recent and only one took 3 hours of helicopter time and a team of 20 people) there is likely to be an increase in poorer people dying on the hills. I think we just have to accept that while it isn't a perfect situation, 'free' rescue is probably better than the alternatives.

[73henny]

Originally Posted by Tengocity

Sorry, I don't get why a fisherman gets rescued for free but not someone walking along the coast or walking up a hill?

The fisherman is out there for their for profit, so the government should subsidise private enterprise you're saying?

This sounds very socialist...

The fisherman is at work earning money to provide for his family, pay taxes and feed people. The walker has put himself in harms way. Fundamental difference I'm sure you'll agree.

[Tengocity]

Originally Posted by 73henny

The fisherman is at work earning money to provide for his family, pay taxes and feed people. The walker has put himself in harms way. Fundamental difference I'm sure you'll agree.

Nope sorry don't agree at all. Why wouldn't he have rescue insurance as part of his business costs then?

So you're saying the gamekeeper up on the estate trips and breaks his leg gets taken off the hill, but not the recreational walker who is out walking their dog?

[JD6]

Originally Posted by vikz55

Just to add to my post above, many GPs still do out of hours. The out of hours service is run by GPs. 111 triages the call which then goes either to a GP on a phone, or a GP at an urgent care centre, or a GP visiting doctor in a car, or to A&E. Too many get sent to A&E yes, but don't be under an illusion that GPs don't do out of hours any more!

It is beyond me how people expect GPs to work any more hours than they already do and still practice safe medicine!

Our local GPs seem to work 3 days a week from 9-6 as far as I can tell. Perhaps they have a lot of homework to mark I guess this varies a lot from place to place, but out out of hours GP cover is at the hospital 20 miles away, and they don't answer their phone. They are right next to the A&E dept, hence A&E picks up the slack when they don't do their job. This is a failing NHS trust so perhaps it is untypical...

[gangzoom]

Originally Posted by vikz55

Steering this back to the NHS, I agree with much of what has been said on this thread, however the media bashing and general demonisation of general practice needs to be addressed. Our A&E colleagues (who have to weather a shit storm every winter and do a remarkable job) at least get some appreciation and sympathy from the public. Yet comments about lazy, overpaid GPs remain rampant - as if they are somehow to blame for the problems in A&E and secondary care. Yes there are some bad GPs out there, but there are bad A&E doctors, bad accountants, bad lawyers, bad engineers and bad employees in every field (the nature of being human I guess). But I feel obliged to make a few points to educate some of the clueless with regards to GP's...........

So you're GP who can't be "arsed to work" during his 12-14 hour day with hardly a free moment to fart works a lot harder than you think. So next time think twice before you call you're GP lazy.

100% agree with this. Even though I don't work as a GP, I think the WORST thing that has developed in recent years is the GP bashing that the government and media is serving up to the public. How politicians and people who haven't got a clue about how health care is actually delivered at the front line, or what pressures clinicians are under can comment is beyond me .

The job of a GP is incredibility hard, having to work out who is unwell and needs admission and who can be managed at home. All without access to all the investigations/specialist support we have in hospital. I'm happy to manage extremely sick people in hospital under ITU conditions, but doing what a GP does....forget it, I simply couldn't do it!!

The reason I started the thread is simply because in my view the current system is not sustainable, no amount of work flow changes, efficiency saving will be enough without either a major change in demand, or a increase in capacity. This is something the government needs to communicate to the public, and not pretend that doing minor changes will work.

The A&E waiting times are the tip of the problem, though the 4hr wait target has slipped to under 90%, there has been a 200% increase in how many patients are waiting on trolleys in A&E because there are no hospital beds for them. These are patients who NEED to be in hospital, but theres no space for them!!!

Reducing the number of people turning up in A&E inappropriately does will NOT reduce the number of patients waiting on trolleys for a hospital bed.

The concept the government is selling to the public that there are loads of patients in hospital 'blocking' beds is also rubbish...yes that are people waiting to go home, but how can you possibly send a 90 year old patient with dementia back home to live alone without adequate social support in place?? They may not need a hospital bed, but its sending an elderly patient home without social support is not only unfair on the patient, but there a 100% guarantee they will be back in 24hr with a fall/dehydration because theres no one to look after them at home......but the current government has been busy cutting back the social support funding in an attempt to cut the deficit.....great planning from short sighted politicians as usual

[....,,,,..,,..]

Originally Posted by Tengocity

Nope sorry don't agree at all. Why wouldn't he have rescue insurance as part of his business costs then?

So you're saying the gamekeeper up on the estate trips and breaks his leg gets taken off the hill, but not the recreational walker who is out walking their dog?

It is pretty much impossible to seperate these things out.

What if that recreational walker lives next door to the estate, same route/path etc.

Wild life photographer out in hills has accident, someone living rural has accident.

My insurances would go through roof lol.

It would kill a lot of rural places as they would attract higher premiums etc.

[NISFAN]

Originally Posted by JD6

I believe that a French citizen is entitled to that service free in the Alps. I don't think that was always the case though. A French friend and skier has told me that it has had a knock on effect of people taking greater risks and calling a helicopter when it all gets a bit much! They just charge foreign visitors I believe.

While I don't like the idea of people taking stupid risks and expecting the state to bail them out (sounds a bit like banking in the 2000s), the alternative of charging is a slippery slope from my point of view. If you have no cover and may have to pay £10k for a rescue (our recent and only one took 3 hours of helicopter time and a team of 20 people) there is likely to be an increase in poorer people dying on the hills. I think we just have to accept that while it isn't a perfect situation, 'free' rescue is probably better than the alternatives.

I had no idea that locals didn't have to pay.....sounds very un-european union to me.

Don't you think that because it is a free service in the UK that the expectation is significantly higher? And this I feel is the case for many 'free' services. There is no monetary 'value for money' calculation in your head, you just expect the best.

In the Alps you get a Eurocopter 145 or even a squirrel, here we get a Sea King. I'm sure someone like Brigand can give you an rough cost difference on operating a Sea King versus a small EC145 or equivalent.....I bet it is huge. The Sea King is required if you run a military type 'fool proof' service, but can we afford it?

To me hikers in notorious areas should have to carry a transponder, to at least take the Search part out of the rescue service, it costs thousands to actually find a missing hiker.

[DieselRocket]

Originally Posted by Brigand

It is the biggest concern

Allowing debt to continue at unsustainable levels is the surest route to the UK economy reaching a point where it is no longer feasible to fund the NHS, irrespective of one's political outlook.

Be in no doubt about the importance of the national debt and the national deficit. Those who would handle them irresponsibly, in return for short-term political gain, are the same people who would heavily darken our future, and that of our children's children.

BTW I'm a huge fan of the NHS - of the passionate and caring people who work themselves to the bone every day to give us what is too easily taken for granted. I had a major operation last year and got to see a lot of the NHS and how they care for people, even when they're under pressure and worn out. The commitment and work ethic of those people makes me proud.

Watching pretentious politicians making a political football of the NHS, while failing to address any of the real issues makes me feel ashamed.

[Tengocity]

Originally Posted by Brigand

It is pretty much impossible to seperate these things out.

What if that recreational walker lives next door to the estate, same route/path etc.

Wild life photographer out in hills has accident, someone living rural has accident.

My insurances would go through roof lol.

It would kill a lot of rural places as they would attract higher premiums etc.

So this is my point, where on earth does anyone draw the line?

Somebody needing rescued is just that, a person in need. I don't think their motivation for being there (to make money or for recreation) is particularly relevant.

If I applied this logic then I'd equally say that all those having children, never mind child benefit, pay for schooling yourself!

I don't have any kids so why am I subsidising yours? I keep myself fit and healthy so why am I subsidising fatty's gastric band treatment?

Well, because that's what happens in a modern and compassionate society.

[....,,,,..,,..]

Bristows are going to be running Sikorsky S92 and AgustaWestland AW189.

Will be interesting to see if business model changes and I don't think insurance would work in this country, too small, too many rural places, just think of where you can mountain bike, road bike, go walking, climbing.

If we had insurance I would need it for going to Derbyshire area but not when I lived in yorkshire dales or down from Cairngorms.

[vikz55]

Originally Posted by JD6

Our local GPs seem to work 3 days a week from 9-6 as far as I can tell. Perhaps they have a lot of homework to mark I guess this varies a lot from place to place, but out out of hours GP cover is at the hospital 20 miles away, and they don't answer their phone. They are right next to the A&E dept, hence A&E picks up the slack when they don't do their job. This is a failing NHS trust so perhaps it is untypical...

Maybe they have decided that they don't want to risk their own health and wellbeing by working full time; and they can't recruit more full time GPs because of the shortage of them. Here in Leicester the local CCG is offering £20k golden handshakes to any GP who takes up a job in the inner city such is the short supply. The problem is no one wants to take jobs where the working conditions are diabolical. Its the same reason A&E has a recruitment crisis.

A failing NHS trust usually has poor management in place which has to struggle with the usual government failings.

As far as I am aware, walk in centres are often positioned next to A&E so that A&E can divert patients who don't belong in A&E to the GP and vice versa, helping to ensure that the right team see's the right patient.

The fact that you only have GP cover 20 miles away serves only to highlight the lack of GPs. >40% of GPs do out of hours (OOH) work. But forcing GPs to do OOH will only lead to a further crisis. Morale back then was at an all time low, and its heading back to that level again now. Tired doctors don't make safe doctors. I already do OOH (12 hour shift yesterday actually), but if I am FORCED to do it, I like I know many of my other colleagues will, be swiftly heading to the warm shores of Australia where our GP colleagues work shorter hours, get paid more, are better respected and spend their weekends on the beach :-)

Gangzoom, I see you're in Leicester - do you work in A&E at the LRI? If so, I feel for you. At one point I wanted a career in Emergency Medicine. I spent 4 months there in 2012/13 when Dec wait times often exceeded 9 hours. Unsafe and unsustainable.

[vikz55]

Originally Posted by DieselRocket

Watching pretentious politicians making a political football of the NHS, while failing to address any of the real issues makes me feel ashamed.

+1111111

[73henny]

Originally Posted by Tengocity

So this is my point, where on earth does anyone draw the line?

Somebody needing rescued is just that, a person in need. I don't think their motivation for being there (to make money or for recreation) is particularly relevant.

If I applied this logic then I'd equally say that all those having children, never mind child benefit, pay for schooling yourself!

I don't have any kids so why am I subsidising yours? I keep myself fit and healthy so why am I subsidising fatty's gastric band treatment?

Well, because that's what happens in a modern and compassionate society.

We have lines drawn every day. You can have car insurance for personal or business use. Why not anything else? I don't see for a moment how some deluded amateur sailor should expect to be rescued 'for free'. Nor do I see why a mountaineer should expect it. Put yourself in harms way, then either pay for it or tough.
I have house insurance, travel insurance, I've even got golf cover in case I hit someone on the head. Why not rescue insurance for pot holers, rock climbers, gorge jumpers etc?

As for 'that's what happens in a modern and compassionate society', therein lies the problem - everyone expects someone else to pay. Its also a bit of an idealistic view. Great in theory, but not in practice.
The reality is everything has a cost. The simplest, and fairest way to fund it is 'if you want to use it you pay for it' I don't expect you to pay for my kids, no one but me should. But neither do I want to pay for some scrounger who has kids to obtain a bigger council house.