Be Afraid
Posted by: Rockingdoc on 29 December 2004
From today, after over 20 years of being on-call, I no longer have responsibility for the provision of "out of hours" medical cover. The responsibility for all cover has shifted to the Primary Care Trust.
The Government offered the option to GPs to "opt out" for a cost of about 9000 GBP p.a. each. My personal belief is that the were taken by surprise when almost the whole profession practicaly snatched their hand off and took the offer.
I think this has been kept quiet and the public are in for a shock when they discover that home visits are a thing of the past. Many GPs have banded together in co-ops for the past few years, but these have been non-profit making arrangements based on goodwill, with the GP still carrying the can at the end of the day. From today it is a paid (skeleton) staff only, mainly nurses giving telephone advice. Additional cover will consist of the provision of an out of hours centre, usually at the "local" hospital, which of course may not be local at all. There simply won't be the staff to allow for visits.
This has come about because a minority of patients abused the out of hours service enough to totally demoralise the GPs over a number of years. To stem the recruitment and retention crisis the Government had to make the offer.
Personally, I am delighted to join the ranks of normal folk who leave work when they go home. Wouldn't want to be a poorly resourced, single parent with a sick child, living at the oppsite end of the borough from the on call centre, in the middle of the night.
My information really only applies to London, don't know what the country mice are up to.
The Government offered the option to GPs to "opt out" for a cost of about 9000 GBP p.a. each. My personal belief is that the were taken by surprise when almost the whole profession practicaly snatched their hand off and took the offer.
I think this has been kept quiet and the public are in for a shock when they discover that home visits are a thing of the past. Many GPs have banded together in co-ops for the past few years, but these have been non-profit making arrangements based on goodwill, with the GP still carrying the can at the end of the day. From today it is a paid (skeleton) staff only, mainly nurses giving telephone advice. Additional cover will consist of the provision of an out of hours centre, usually at the "local" hospital, which of course may not be local at all. There simply won't be the staff to allow for visits.
This has come about because a minority of patients abused the out of hours service enough to totally demoralise the GPs over a number of years. To stem the recruitment and retention crisis the Government had to make the offer.
Personally, I am delighted to join the ranks of normal folk who leave work when they go home. Wouldn't want to be a poorly resourced, single parent with a sick child, living at the oppsite end of the borough from the on call centre, in the middle of the night.
My information really only applies to London, don't know what the country mice are up to.
Posted on: 29 December 2004 by Bruce Woodhouse
I could not agree more that this change has 'sneaked up' on the public and is a major story waiting to break; sadly it will be when something goes wrong. FWIW I do not agree it has come because a minority have abused the service. I'd say that the general out of hours workload has escalated due to social changes (both parents working for intance) and a variety of other pressures rather than abuses. In short-the average person wants and uses OOH care more now.
As for the rural situation, we were in a huge Co-Op (the UK's largest I think) and it took the PCT contract from Oct. The system was efficient, effective, and well-liked by patients. Now it is struggling++, and it called in the administrators a week ago. The financial problems are caused partly because they are unable to fill shifts and are buying in locums, mostly because OOH has just not been properly funded. Local docs just do not want to take the shifts, almost at any price, and there are no easy alternatives in an area of such low population density (it can take over an hour to drive from call to call). I have done shifts in the evening and been asked to cover two areas due to unfilled shifts, that means one doctor (and driver) covering an area including Skipton, the Dales as far as Buckden, Otley and Yeadon, Guisely and all parts between. Check out a map. Not safe.
We have no stand-by system of paramedics/nurse triage. NHS Direct is not fully rolled out here, and where it is 'available' the response times can be 3 or more hours just for a ring back!
One thing is absolutely certain, when this goes belly up the government will make it very clear to the media that this is all the fault of greedy and lazy GP's.
Bruce
Still doing on-call. If everybody stopped, what would happen?
As for the rural situation, we were in a huge Co-Op (the UK's largest I think) and it took the PCT contract from Oct. The system was efficient, effective, and well-liked by patients. Now it is struggling++, and it called in the administrators a week ago. The financial problems are caused partly because they are unable to fill shifts and are buying in locums, mostly because OOH has just not been properly funded. Local docs just do not want to take the shifts, almost at any price, and there are no easy alternatives in an area of such low population density (it can take over an hour to drive from call to call). I have done shifts in the evening and been asked to cover two areas due to unfilled shifts, that means one doctor (and driver) covering an area including Skipton, the Dales as far as Buckden, Otley and Yeadon, Guisely and all parts between. Check out a map. Not safe.
We have no stand-by system of paramedics/nurse triage. NHS Direct is not fully rolled out here, and where it is 'available' the response times can be 3 or more hours just for a ring back!
One thing is absolutely certain, when this goes belly up the government will make it very clear to the media that this is all the fault of greedy and lazy GP's.
Bruce
Still doing on-call. If everybody stopped, what would happen?
Posted on: 29 December 2004 by Mick P
Rockindgoc
This is no surprise.
The medical profession is now a highly lucrative one to be in and I only wish I had gone into it myself.
Basically the reality in the UK is that there is a two tier health service.
If you can pay for private treatment, you are fine. If you depend on the NHS, then you have a problem.
Three years ago, I needed an op to repair a dislocated shoulder, I was told to expect a two year waiting list by the Consultant, I mentioned BUPA. I was then taken to his private office and booked in for an op 10 days later.
That is the healthcare of the UK today.
Regards
Mick
This is no surprise.
The medical profession is now a highly lucrative one to be in and I only wish I had gone into it myself.
Basically the reality in the UK is that there is a two tier health service.
If you can pay for private treatment, you are fine. If you depend on the NHS, then you have a problem.
Three years ago, I needed an op to repair a dislocated shoulder, I was told to expect a two year waiting list by the Consultant, I mentioned BUPA. I was then taken to his private office and booked in for an op 10 days later.
That is the healthcare of the UK today.
Regards
Mick
Posted on: 29 December 2004 by Steve G
quote:
Originally posted by Mick Parry:
If you can pay for private treatment, you are fine.
Do you think having private medical insurance will help in the OOH situations described in this thread?
Posted on: 29 December 2004 by Bruce Woodhouse
Mick
Way to simple, although not totally untrue.
The NHS/Private split is less of an issue when discussing OOH care, certainly nothing provided by the private sector even approaches an OOH primary care service. On a wider note, the delays (and indeed the quality) of treatment available in the NHS vary hugely (by locality and even between specialities in one site) from the superb to the dismal. The issue is not a blanket 'NHS slow and poor/Private fast and good' by any means.
As for medicine being lucrative, what you are actually seeing is GPs choosing to work less and be paid less. This is of course only possible if you start at a decent wage, but the issues of morale and work intensity are making lots and lots of docs cut their hours. I have just gone part time for that very reason.
Bruce
Way to simple, although not totally untrue.
The NHS/Private split is less of an issue when discussing OOH care, certainly nothing provided by the private sector even approaches an OOH primary care service. On a wider note, the delays (and indeed the quality) of treatment available in the NHS vary hugely (by locality and even between specialities in one site) from the superb to the dismal. The issue is not a blanket 'NHS slow and poor/Private fast and good' by any means.
As for medicine being lucrative, what you are actually seeing is GPs choosing to work less and be paid less. This is of course only possible if you start at a decent wage, but the issues of morale and work intensity are making lots and lots of docs cut their hours. I have just gone part time for that very reason.
Bruce
Posted on: 29 December 2004 by Mick P
Steve / Bruce
The trend in the UK, righly or wrongly, is that waving a cheque book gets you better and quicker treatment.
The very week that I had my shoulder operated on in a private hospital in swindon was the same week that a good friend of mine was turned away from the the NHS hospital due to a shortage of resource, he had to wait amother 4 weeks. His condition was cancer of the stomach.
He died of the condition 12 months ago and it was a constant source of debate whether the delay was a contributing factor.
My social group tend to be middle aged and health is a popular topic of conversation.
We now seem to be latching on that if you have any form of cancer, you are better off flying out to Spain in order to get quicker and more effective treatment. Just go over and dump yourself on them. They will treat you.
A friends wife is arranging laser surgery on her eyes in Praque of all places, again because you get better treatment than over here.
Healthcare over here is not good at all.
Regards
Mick
The trend in the UK, righly or wrongly, is that waving a cheque book gets you better and quicker treatment.
The very week that I had my shoulder operated on in a private hospital in swindon was the same week that a good friend of mine was turned away from the the NHS hospital due to a shortage of resource, he had to wait amother 4 weeks. His condition was cancer of the stomach.
He died of the condition 12 months ago and it was a constant source of debate whether the delay was a contributing factor.
My social group tend to be middle aged and health is a popular topic of conversation.
We now seem to be latching on that if you have any form of cancer, you are better off flying out to Spain in order to get quicker and more effective treatment. Just go over and dump yourself on them. They will treat you.
A friends wife is arranging laser surgery on her eyes in Praque of all places, again because you get better treatment than over here.
Healthcare over here is not good at all.
Regards
Mick
Posted on: 29 December 2004 by JohanR
Nothing new. This has been the situation in socialistic Sweden for many years.
Don't know when I've heard of a doctor actually coming home to his patient. If we get sick, we have to be well enough to get to the hospital by ourselves...
JohanR
Don't know when I've heard of a doctor actually coming home to his patient. If we get sick, we have to be well enough to get to the hospital by ourselves...
JohanR
Posted on: 29 December 2004 by 7V
Surely they'll still send an ambulance to take a sick person to hospital, won't they?
Steve M
Steve M
Posted on: 29 December 2004 by JohanR
quote:
Surely they'll still send an ambulance to take a sick person to hospital, won't they?
If they think you are bad enough. My neighbour cut his ear and was bleeding heavily (he's old), the wife called for an ambulance and had to have quite a long argument with them that, yes, hear husband did indeed need an ambulance.
Actually, it's about money and resources. The medical authorities doesn't have enough to give a 100% service.
JohanR
Posted on: 29 December 2004 by Steve G
As part of a corporate scheme I and my family have private medical cover but, like most schemes, it requires a referral from a GP before it comes into play.
In an out of hours or emergency situation I don't see how private cover would be a factor at all, and I'm not sure how "waving a cheque-book" would help either.
In an out of hours or emergency situation I don't see how private cover would be a factor at all, and I'm not sure how "waving a cheque-book" would help either.
Posted on: 29 December 2004 by Nime
quote:
Originally posted by Mick Parry:
The trend in the UK, rightly or wrongly, is that waving a cheque book gets you better and quicker treatment.
The very week that I had my shoulder operated on in a private hospital in swindon was the same week that a good friend of mine was turned away from the the NHS hospital due to a shortage of resource, he had to wait amother 4 weeks. His condition was cancer of the stomach.
He died of the condition 12 months ago and it was a constant source of debate whether the delay was a contributing factor.
Mick
Posted on: 29 December 2004 by Rockingdoc
quote:
Originally posted by Bruce Woodhouse:
Still doing on-call. If everybody stopped, what would happen?
Interestingly, out of concern for my patients, I originally tried to opt-in to continue to cover. The PCT was extremely displeased and said that as ours was the only practice opting in it would cause them administrative problems. We were actually leaned on heavily to opt out, i.e. "yours would be the first practice we will audit for any payments etc". Unfortunately, my PCT contains a few lazy and dishonest people.
Can't say I honestly mind being out, and I have a fairly clear conscience too.
Posted on: 29 December 2004 by Keith Tish
I left the NHS to work in New Zealand and Australia in 1994. I actually only planned to go for a year whilst arranging a PhD to come back to. After seeing the grass on the other side was in fact bright green I applied for NZ residency after 6 weeks!
I have always felt the NHS GP service is still the best solution for the patient. In Australia (where I am now) and NZ (where I was for 7 years) you have to pay to see your GP (v detrimental) and in Aus you usually end up out of pocket seeing your specialist. I am a General Physician/Gastroenterologist in a central Sydney hospital but we don't have outpatient clinics! patients have to come to our private practices and pay us. I'm relatively cheap and patients end up about $10 out of pocket after government rebates but again v. poor system compared to the UK.
It's amazing that governments can make such monumental mistakes as they obviously have with OOH cover. The NZ government did the same with ante/perinatal care, to improve womens' choices . The system pre was the UK shared care system. They introduced private midwifery and only allowed 1 lead carer ie. full hosp antenatal care/full GP care/full midwife care, all including the delivery. This set off a huge turf war at which point ~ 95% of all GP's thought getting a good nights sleep instead of having to go in to deliver some sprog for a pittance was a good deal and stopped doing any antenatal care. Go figure the benefit for the women.
Having seen a couple of systems now, I think the UK system for all its many faults is still generally a sound system. I have always found if you need something the NHS is actually there, butif you want something, which is very different, then there is your private sector.
Rockingdoc you have my sympathy. It is a very hard thing to have to walk away from something you know you could do better, but are not allowed to. It is an amazing release not to be on-call and at everyones beck and call (I wish). Enjoy the rest and freedom it gives you.
Mick, being a Gastroenterologist, I would very much doubt a 4 week delay was significant in your friends case. It is a disease that only presents with symptoms at an advanced stage and is almost always incurable at diagnosis.
Keith
I have always felt the NHS GP service is still the best solution for the patient. In Australia (where I am now) and NZ (where I was for 7 years) you have to pay to see your GP (v detrimental) and in Aus you usually end up out of pocket seeing your specialist. I am a General Physician/Gastroenterologist in a central Sydney hospital but we don't have outpatient clinics! patients have to come to our private practices and pay us. I'm relatively cheap and patients end up about $10 out of pocket after government rebates but again v. poor system compared to the UK.
It's amazing that governments can make such monumental mistakes as they obviously have with OOH cover. The NZ government did the same with ante/perinatal care, to improve womens' choices . The system pre was the UK shared care system. They introduced private midwifery and only allowed 1 lead carer ie. full hosp antenatal care/full GP care/full midwife care, all including the delivery. This set off a huge turf war at which point ~ 95% of all GP's thought getting a good nights sleep instead of having to go in to deliver some sprog for a pittance was a good deal and stopped doing any antenatal care. Go figure the benefit for the women.
Having seen a couple of systems now, I think the UK system for all its many faults is still generally a sound system. I have always found if you need something the NHS is actually there, butif you want something, which is very different, then there is your private sector.
Rockingdoc you have my sympathy. It is a very hard thing to have to walk away from something you know you could do better, but are not allowed to. It is an amazing release not to be on-call and at everyones beck and call (I wish). Enjoy the rest and freedom it gives you.
Mick, being a Gastroenterologist, I would very much doubt a 4 week delay was significant in your friends case. It is a disease that only presents with symptoms at an advanced stage and is almost always incurable at diagnosis.
Keith
Posted on: 29 December 2004 by Paul Ranson
What is 'out of hours medical cover' usually used for?
Do many surgeries offer evening and weekend appointments?
ISTM that it's unreasonable to expect a GP to visit you at home unless it's an ambulance level emergency.
Paul
Do many surgeries offer evening and weekend appointments?
ISTM that it's unreasonable to expect a GP to visit you at home unless it's an ambulance level emergency.
Paul
Posted on: 29 December 2004 by matthewr
Mick said "a good friend of mine was turned away from the the NHS hospital due to a shortage of resource, he had to wait amother 4 weeks. His condition was cancer of the stomach."
Maybe the doctor was busy fixing some rich guy's sore shoulder?
Paul said "What is 'out of hours medical cover' usually used for?"
In my experience (a good friend is a GP in North Wales) it's sick children and terminal cancer care.
"ISTM that it's unreasonable to expect a GP to visit you at home unless it's an ambulance level emergency"
In that case I think you'd be better off phoning an ambulance rather than waiting for the GP to arrive in his Mondeo.
Matthew
Maybe the doctor was busy fixing some rich guy's sore shoulder?
Paul said "What is 'out of hours medical cover' usually used for?"
In my experience (a good friend is a GP in North Wales) it's sick children and terminal cancer care.
"ISTM that it's unreasonable to expect a GP to visit you at home unless it's an ambulance level emergency"
In that case I think you'd be better off phoning an ambulance rather than waiting for the GP to arrive in his Mondeo.
Matthew
Posted on: 29 December 2004 by Rockingdoc
quote:
Originally posted by Mick Parry:
Steve / Bruce
The trend in the UK, righly or wrongly, is that waving a cheque book gets you better and quicker treatment.
Mick
I'll be interested to hear what waving your cheque book achieves when you wake at 2.00 am with abdominal pain.
Posted on: 29 December 2004 by Derek Wright
I have called out the GP - (actually his cover service) twice - both times for renal colic - kidney stones, on both occasions a dose of morphine or the equivalent pain killer was given and I was able to to hang on waiting for the stone to pass thru the narrow tube.
I get renal colic every 12 years - RD's news does not give me much cheer for the next occurence in 6 years time. I must rely on drinking more water to try and avoid the stone
Derek
<< >>
I get renal colic every 12 years - RD's news does not give me much cheer for the next occurence in 6 years time. I must rely on drinking more water to try and avoid the stone
Derek
<< >>
Posted on: 29 December 2004 by Rockingdoc
quote:
Originally posted by Paul Ranson:
What is 'out of hours medical cover' usually used for?
Do many surgeries offer evening and weekend appointments?
Paul
Like most GPs, I have worked evenings and nights and weekends, including Saturday morning surgeries, my whole working life. For example, I have never had a whole Christmas holiday free of some work.
I shall finish at 6.30 pm today, and for the first time can actually be unavailable, with my mobile switched off, until 8.00 am tomorrow.
Up to now, even when someone else was covering for us, we still had to be available in case something went wrong. We remained responsible for our patients. Our contract was for a genuine duty to provide care 24/7, as Buffy would say. I have in the past had to "stand trial" at a complaint hearing, for the actions of a locum doctor, engaged by an out of hours service, for his alleged failings when I was out of the country on holiday. He did not have to appear as the patient was registered with me.
Tonight for the first time since I qualified as a GP, if the locum doctor is negligent, gets sick, gets drunk, doesn't turn up etc. it isn't my problem.
Posted on: 29 December 2004 by Simon Douglass
I agree that this has been "sprung" on an unsuspecting public.Interestingly, the GP out of hours co-operative was a very successful venture in the mid 90s.It relied on GP involvement[driven mainly by an increasing level of frustration at the mounting out of hours pressures allied to an increasingly busy day],a sense of ownership of the problem, some money [small amount, but enough to get things started] and practically no govt. interference apart from a relaxation on the contractual obligation to do home visits.This paved the way for successful co-ops.Then came the out of hours govt. review,which in one fell swoop made it almost impossible for vast majority of co-ops to meet some of,in my opinion,ridiculous call handling targets.Allied to this was the new GP contract allowing GP opt-out.
The govt.also had a problem in pricing it up: a realsistic figure would mean a daytime income that would be derisory, so it was priced cheaply[6k per whole time equivalent GP].Now GPs can be paid a fair sum to offer out of hours work.Because many PCTs are strapped for cash, they are desperately trying to find "cheaper" ways of doing this.Of course this may lead to more expense in secondary care due to more admissions as a result of risk-averse call handling systems based on computer software rather than human intuition,communications skills and experience etc.
As Rockindoc said, be afraid....
ps to GPs: the sec.of state can overturn any contractual aspect in exceptional circumstances:I have used this lever to encourage my colleagues locally to get involved in our OOH service.It is not cheap,but thankfully we have local GPs involved and we are keeping the emergency admissions to a reasonable level.Sorry to talk shop.
The govt.also had a problem in pricing it up: a realsistic figure would mean a daytime income that would be derisory, so it was priced cheaply[6k per whole time equivalent GP].Now GPs can be paid a fair sum to offer out of hours work.Because many PCTs are strapped for cash, they are desperately trying to find "cheaper" ways of doing this.Of course this may lead to more expense in secondary care due to more admissions as a result of risk-averse call handling systems based on computer software rather than human intuition,communications skills and experience etc.
As Rockindoc said, be afraid....
ps to GPs: the sec.of state can overturn any contractual aspect in exceptional circumstances:I have used this lever to encourage my colleagues locally to get involved in our OOH service.It is not cheap,but thankfully we have local GPs involved and we are keeping the emergency admissions to a reasonable level.Sorry to talk shop.
Posted on: 29 December 2004 by cunningplan
Mrs CP here.
I'm a full time GP and have been for the last 15 or so years. For the first 5 years or so, I was on call every third night, and every third weekend from Friday morning until Monday morning. Initially, we got called out rarely and only for fairly important stuff, but as time went by, it got busier with more demands (as opposed to needs) from patients.
Eg; 7am call from a parent who wants their child seen ASAP to know whether it is well enough to be sent to nursery.
Phone call Saturday evening from someone who's booking a cheap holiday on the internet and wants their jabs before Monday.
Saturday lunchtime request for a coil to be fitted as its the right time of the lady's cycle.
I could go on, but you get the picture.
In the last month of this system, as I was covering colleagues on holiday, I worked 15 nights. On 11 of them, I was woken overnight and had to go out. Not to mention keeping going with my normal hours - that's roughly 50 hours a week; rather more "full time" than most jobs. I was on my knees, exhausted and demoralised; every time my bleep went off, my (then) toddler screamed and wrapped her arms round my knees to stop me leaving. And then people were rarely apologetic or grateful.
We then went to the co-op system which has been described above - MUCH better, but still no choice about it, unless you could afford to pay a locum to do your shifts - which I couldn't. Medicine is not badly paid, but compared to solicitors and similar jobs, its not that well paid either, especially when you take the hours into account. The trouble with the co-op system is that the buck still stopped with us. Had I been off sick, I would have had to pay my replacement.
What we have now is much better again. I have just spent the whole of Christmas with my family for the first time in a decade. All of it.
Here, our new system is fairly good, though it got very busy over Christmas. We have a mixture of paramedics, nurses, GPs, social services carers, mental health teams etc. The patient speaks to NHS direct nurses first, who direct them in the most appropriate direction (too many "directs" in that sentence, but you get the picture!). Sometimes that is an ambulance, but often its not; it may be the pharmacist, or the mental health crisis team. Often people may WANT a doctor, but it may not be the most appropriate professional; its just what they've been used to because no-one else used to cover 24 hours a day.
I've been left dealing with the stuff that genuinely needs a GP - rather than dealing with all the crap that comes to us because nobody else is available. GPs have even been called by elderly people with plumbing problems because they cannot afford an out of hours plumber. Unfortunately, the fact that we are "free" means that people do not always think before they call us. I don't support charging people at the point of delivery as I think it will distort the system even more - I wouldn't want to see Mick Parry at 2am even if he is waving his cheque book - unless he is ill enough to need me. And more importantly, other more vulnerable patients would lose out on care that they really need.
I think that the system simply had to change - too many of us were burnt out and exhausted, and needed a break from hours and conditions that would not be tolerated in any other circumstances. Airline pilots, for example. Whilst people may not always get what they want from the health service, I do think they can usually get what they need - but as has been pointed out, its not always the same thing.
I'm off to enjoy New Year as well! But I will keep doing some OOH partly to support the new system and partly because I think it is worthwhile medicine.
Oh yes, they now pay me as well, whereas before I had to do it for nothing. Which keeps CP in Hi-Fi so cannot be a bad thing,
Apologies for the hi-jack.
Mrs CP
I'm a full time GP and have been for the last 15 or so years. For the first 5 years or so, I was on call every third night, and every third weekend from Friday morning until Monday morning. Initially, we got called out rarely and only for fairly important stuff, but as time went by, it got busier with more demands (as opposed to needs) from patients.
Eg; 7am call from a parent who wants their child seen ASAP to know whether it is well enough to be sent to nursery.
Phone call Saturday evening from someone who's booking a cheap holiday on the internet and wants their jabs before Monday.
Saturday lunchtime request for a coil to be fitted as its the right time of the lady's cycle.
I could go on, but you get the picture.
In the last month of this system, as I was covering colleagues on holiday, I worked 15 nights. On 11 of them, I was woken overnight and had to go out. Not to mention keeping going with my normal hours - that's roughly 50 hours a week; rather more "full time" than most jobs. I was on my knees, exhausted and demoralised; every time my bleep went off, my (then) toddler screamed and wrapped her arms round my knees to stop me leaving. And then people were rarely apologetic or grateful.
We then went to the co-op system which has been described above - MUCH better, but still no choice about it, unless you could afford to pay a locum to do your shifts - which I couldn't. Medicine is not badly paid, but compared to solicitors and similar jobs, its not that well paid either, especially when you take the hours into account. The trouble with the co-op system is that the buck still stopped with us. Had I been off sick, I would have had to pay my replacement.
What we have now is much better again. I have just spent the whole of Christmas with my family for the first time in a decade. All of it.
Here, our new system is fairly good, though it got very busy over Christmas. We have a mixture of paramedics, nurses, GPs, social services carers, mental health teams etc. The patient speaks to NHS direct nurses first, who direct them in the most appropriate direction (too many "directs" in that sentence, but you get the picture!). Sometimes that is an ambulance, but often its not; it may be the pharmacist, or the mental health crisis team. Often people may WANT a doctor, but it may not be the most appropriate professional; its just what they've been used to because no-one else used to cover 24 hours a day.
I've been left dealing with the stuff that genuinely needs a GP - rather than dealing with all the crap that comes to us because nobody else is available. GPs have even been called by elderly people with plumbing problems because they cannot afford an out of hours plumber. Unfortunately, the fact that we are "free" means that people do not always think before they call us. I don't support charging people at the point of delivery as I think it will distort the system even more - I wouldn't want to see Mick Parry at 2am even if he is waving his cheque book - unless he is ill enough to need me. And more importantly, other more vulnerable patients would lose out on care that they really need.
I think that the system simply had to change - too many of us were burnt out and exhausted, and needed a break from hours and conditions that would not be tolerated in any other circumstances. Airline pilots, for example. Whilst people may not always get what they want from the health service, I do think they can usually get what they need - but as has been pointed out, its not always the same thing.
I'm off to enjoy New Year as well! But I will keep doing some OOH partly to support the new system and partly because I think it is worthwhile medicine.
Oh yes, they now pay me as well, whereas before I had to do it for nothing. Which keeps CP in Hi-Fi so cannot be a bad thing,
Apologies for the hi-jack.
Mrs CP
Posted on: 29 December 2004 by andy c
HI,
In my part of the world the health co-operative operates by combining several practices (I think) and having a gp surgery outside of normal operating hours - ironically near to the locah hospital (Kingsmill). My wife and I have had to use this service, on three occasions, and we go to see a gp in less than 90 minutes after making the initial call.
Sure we went to see him/her.
On each occasion we asked the gp if they felt we were wasting their time, and also asked them to be honest. They replied no on each occasion.
I am well happy with this service they provide, and as such try my best not to misuse it.
andy c!
In my part of the world the health co-operative operates by combining several practices (I think) and having a gp surgery outside of normal operating hours - ironically near to the locah hospital (Kingsmill). My wife and I have had to use this service, on three occasions, and we go to see a gp in less than 90 minutes after making the initial call.
Sure we went to see him/her.
On each occasion we asked the gp if they felt we were wasting their time, and also asked them to be honest. They replied no on each occasion.
I am well happy with this service they provide, and as such try my best not to misuse it.
andy c!
Posted on: 29 December 2004 by Tim Jones
This is one of those policies (like abolishing CHCs) that was got seriously wrong. As usual, in an attempt to match 'skills' with what was 'out there' (ie 'how many OOH calls really need a GP?') DoH threw the proverbial baby out with the bathwater.
The irony is that we used to cite some of the horror stories involving the coops as evidence for reforming the system.
Tim
The irony is that we used to cite some of the horror stories involving the coops as evidence for reforming the system.
Tim
Posted on: 31 December 2004 by Rockingdoc
The point is that very few of the requests (demands) for home visits really needed a GP to attend at the patient's house. The present work load of a GP would not allow them to visit every request. Trying to persuade patients of this is often difficult.
I enjoyed my night off in front of the telly thanks. The Peter Cook thing on Channel Four was particularly good.
I enjoyed my night off in front of the telly thanks. The Peter Cook thing on Channel Four was particularly good.
Posted on: 31 December 2004 by Andrew L. Weekes
quote:
The trend in the UK, righly or wrongly, is that waving a cheque book gets you better and quicker treatment.
Your perception is it buys you better treatment, but I know for a fact that in many cases it doesn't.
In many cases you'll get far worse treatment, but you'll be cosied up in a room of your own, so you'll think it's better.
It's a perception thing.
I don't blame GP's for wanting to give up the OOH stuff either, they deserve to see their families and have a life as much as anyone else. My only beef with GP's is how bloody difficult some of them make it to get an appointment. they might think it removes time wasters, in my view it just exacerbates their problems.
I rarely visit my GP, maybe once or twice a year, yet when I 'phone up to try and determine whether I do need an 'urgent' appointment or not that decision always seems to be lef to me, the most singularly ill-equipped person to decide.
When faced with the choice of being made to feel guilty because you'd like an appointment that day, or maybe wait a week, it would be nice if you could talk to someone better equipped to help that decision, I mean I don't know whether I'm likely to drop dead if I wait that long, am I?
That's why you use professionals!
The result is usually that you end up requesting an appointment same day, when maybe it could wait.
Andy.
[This message was edited by Andrew L. Weekes on Fri 31 December 2004 at 9:57.]
Posted on: 31 December 2004 by Rockingdoc
I would add that his cheque book is likely to get him MORE treatment and investigations (but not out of hours). As no procedure in medicine is risk free, this isn't a good thing.
Posted on: 31 December 2004 by Andrew L. Weekes
quote:
I would add that his cheque book is likely to get him MORE treatment and investigations (but not out of hours). As no procedure in medicine is risk free, this isn't a good thing.
Indeed, it's about ignorance and the impact of selfish behaviour on others.
The same applies to money-grabbing and overly litigous behaviour of a certain section of the populace too, it just makes the lawyers overly paranoid and results in restrictions on the freedoms of medical staff to perform their normal duties.
In areas such as midwifery, for example, it can take away the most experienced and skilled staff (Midwives) and replace them with far less experienced consultants and can reduce quality of care, not increase it.
But again, the perception is the attention of a consultant will always be a good thing, as they must be the best, mustn't they? The fact they only deal with 'problems' for the most part is unlikely to affect their judgement at all, or is it?
All of this is easy to generalise and there's exceptions on both sides, but frankly people need to realise the implications of their actions, be it OOH abuse, unnecessary litigation or removing valuable NHS resources by paying for them.
My own experiences of the NHS recently have been little short of astounding, far exceeding my expectations.
Andy.