Be Afraid

"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."

Both my kids were normal, trouble free deliveries and in both cases the only times a doctor made an appearance was to stick his head round the door and check with the midwives that everything was fine and his attendance was not required.

That seemed perfectly satisfactory to me as the midwives appeared entirely competent to deal with the deliveries, but it was re-assuring to know that a consultant was immediately available if required.

Be Afraid? I don’t think so, this is just more moaning from the most whinging group of public sector employees who run a closed shop. If you don’t like it do something else, I’m paying your wages. The PCT's should be in control of what the medical profession is up to as they spend the money, I don’t necessarily agree with this, its just the way it is at the moment; I used to work in the NHS - now a major Pharma company, my wife used to work in the NHS till about 10 months ago - she now works at St Peters Hospice in Bristol. We weren’t medics in the Dr sense but we know what we're talking about. The NHS is now a dinosaur of money wasting combined with a medical profession from the 40’s and 50’s - sorry but its true.
Martin

So that must be why countries such as France with almost bankrupt health services are starting to look enviously at our primary care based system then?

Before you start accusing the NHS of wasting money,perhaps you should look at the overall costs of the NHS in comparison with other countries and the ratio of health professions to pop.counts.I think you will see the NHS does pretty well.All healthcare systems are underfunded.All are over-stretched.Much of this is due to an increasingly elderly population and a growing disease burden caused by smoking, overeating and lack of exercise.

Simon

Simon
I do agree with what you're saying, I'm just saying I dont think its the best system.
Martin

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The NHS is now a dinosaur of money wasting combined with a medical profession from the 40’s and 50’s - sorry but its true.

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What do you mean a medical profession from the 40's and 50's? I can fully defend my wife, and other Doctor friends we have that they would see this as a total insult, as should the Docs on this forum.

My wife is dedicated to her work and adapts and changes to the needs of the profession. She certainly doesn't have any old practices, or attitudes to medicine, and certainly didn't become a doctor for the money either!

Clive

Martin

If you read the early posts in this thread you'll not see whinging docs moaning about attacks on their 'closed shop'. You will see them worrying about a system which has been set up to provide OOH care which is untested, regionally uneven and quite different from the expectations of many patients.

As for money wasting-many, many examples on all sides I've no doubt. A good one is NHSDirect, a system set up by central govt, against the advice of the profession, unsupported by evidence of effectiveness and astonishingly expensive and inefficient.

Bruce

Martin,
Point taken.The NHS as a system has suffered for years from politcal tinkering.I work for our local PCT as well as being a full time GP[this is not a whinge!]Clinicians and managers are beleaguered by the pace of change and expectations heaped on by a government,which like most, does not have the balls to start the debate on what the NHS can and can't afford to provide.Unfortunately until [a] government starts to explain to the gen.public what personal responsibility for ones own health means, we don't have a chance of improving the system, as you say.We'll just go on being a mainly reactive organisation to the demographic pressures I mentioned in my last post.[oh, I forgot to add alcohol-related problems which is another growth area]

Can I add as a defence, patients I see who have experienced other countries health care systems when on holiday or living abroad often say how much better they think the NHS is? Not perfect, but better.

Simon

Yesterday to my suprise I recieved a European Health Card (via my insurance form AOK Berlin) which covers me across the board including the new lands ! I fe3el you pro's out there know exactly what the real reason for NHS burn out is, and its been well documented and reported by the seriouis press for years, ie, no suprises please.(The thread title is very aptly named innit)
Happy New Year. Fritz Von Blame Culture�

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A good one is NHSDirect, a system set up by central govt, against the advice of the profession, unsupported by evidence of effectiveness and astonishingly expensive and inefficient.

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What evidence do you base this on?

I'm curious as NHS direct, being a recently-created organisation, removes many of the legacy issues of change and existing working practices, that can surround some of the pre-existing NHS departments and their efficiency. It has measures in place to ensure it's efficiency and effectiveness.

According to some estimates, NHS Direct was off-setting around half of its running costs by encouraging more appropriate use of NHS services and it's useage seems to be growing at a very rapid rate.

It's had some downsides as there's some evidence to suggest that it has increased the number information requests from hospitals and other health services, but seems to be valued by those that use it.

It's also seen by many that work there as a considerably nicer and more rewarding place to work than many hospital-based jobs.

We shouldn't forget that whatever the rewards in some areas of the profession, many who work in services like health care do so not for the finacial rewards, but the emotional ones and abusing their services as has been seen, only comes back to haunt us all.

I'm sure much of it is owing to the general impatience and 'must have now' attitude so prevalent in modern society.

Andy.

The evidence base to support NHSD was entirely absent when it was introduced. Since then we have seen bits of scanty research to suggest it reduces load various parts of the system, or moves work to appropriate provision in terms of site and time but it is hardly impressive. A quick Cochrane search kicks up a nice summary from August 2004. This is the BMJ paper you are referring too, here is another. Far from conclusive.

NHSD has 3 x higher cost-per-call than the GP co-operative, without providing any actual care byond phone advice, it also has much higher response times. Locally staff recruitment and retention have been major issues in delaying the rollout.

I have no great axe to grind over NHSD, I was using it as an example of poor value for money which was not the 'fault' of the 'money-wasting dinosaurs' whom MartinD criticises. It is a classic example of political agenda driving system change in the absence of rigorous planning.

Bruce

[This message was edited by Bruce Woodhouse on Fri 31 December 2004 at 13:47.]

Couple of points, if I may.

When I triage OOH calls, I sit across the room from NHSD nurses. They take approximately 20 mins to deal with each call (my average is 6-7). They are very protocol driven (as you have to be unless you have a lot of experience of actually working in primary care). They have to ask many questions of each patient, whether relevant or not. I feel that on the whole they are not responsive enough to individual patient need; if the protocol says call an ambulance, they do so; and document the patient's "refusal" if they decline. I have only ONCE agreed with the NHSD nurse when they suggested an ambulance but the patient wanted to talk to a GP instead. In some cases - eg a terminal care patient with chest pain - it is positively cruel to send am ambulance and admit them to hospital when they want to die at home. I've seen this happen twice.

(And WHY do they need a uniform, when they are only ever in contact with patients on the phone - this alone shows that an inappropriate amount of money was spent setting it up!)

To Andrew Weekes;

I fully appreciate your concern about whether to decide an appointment is urgent; but the fact is that receptionists are not sufficiently experienced either, and so the patient is usually the only person who can decide. In my own practice, we have set up an entirely new system, where the GPs speak to every patient who wants an appointment; then you are getting the most experienced person making the decision, in conjunction with the patient. We speak to most people within three hours (in fact, 40% within an hour) so the decision gets made quickly. As a lot of people don't actually need an appointment with a GP, but can see a nurse, have a prescription, use over-the-counter medicines, or see another health professional, we have more time to spend with each patient we DO see, so can give a much better service. 68% of our patients prefer this system to any other we have tried.

With respect to Martin D's view of doctors, thanks to my husband for his robust defence. My job has changed rapidly since I started it 15 years ago, and I continue to learn and change with it. If he wants to stand on his high horse, may I suggest that the pharmaceutical industry is probably one of the least ethical places to come from!

Mrs CP

Mrs CP -

At first everyone was given the impression that NHSD would be a "nurse at the end of the phone". This was not exactly how it stacked up, but I think the uniforms are a leftover...

From our point of view in an acute Trust,all NHSD ever seem to do is say "go to A&E" which is a bit of a pain.

Their protocols are a mixture of total risk paranoia (there were a few horror stories in the early days) and lack of any real clinical or diagnostic experience.

Incidentally, the idea of NHSD was actually thought up in the dying days of the Conservative Government. It was going to be called "A&E Care in the Community" until some bright spark advised them that would be a bad name.

Watch out for some big changes to NHSD soon.

Tim

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Originally posted by Mick Parry:

The medical profession is now a highly lucrative one to be in and I only wish I had gone into it myself.

Mick

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Fortunately, greed has never been the sole entrance requirement, so you might have found the interview difficult (and perhaps the A-levels, given your spelling).

Mick Parry as a Doctor, the thought is bloody frightening!!

Clive

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Originally posted 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?


Matthew

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I think it's absolutely appalling that the NHS should be responsible for training Doctors who then go on to work privately. If BUPA and the like want doctors, they should set up training facilities of their own.

IMHO, anyone who is trained by the NHS should have to work for the NHS. Why should private health care be subsidised in this way?



Stephen

But the Doctor had to make the initial gamble in taking the degree course, and then when he/she was being "trained" by the NHS he/she was working for a relatively low wage and probably working an excessive number of hours a week.

By the time the Doctor is qualified - he/she has done his time and should continue to be allowed to work in both the private and public health service.

It probably could be argued that the NHS benefits from having a captive audience of medical graduates that are required to work in a specified environment to qualify and so can exploit them

Derek

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Originally posted by Derek Wright:
But the Doctor had to make the initial gamble in taking the degree course,
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Where is the 'gamble' in taking a medical degree? You may fail if you spend the time mucking around or have personal problems, but you're certain of a job at the end if you pass.

I'd agree with you Derek if there were a surplus of Doctors in the UK; but there is not. Medicine isn't like business-it's a vocation. If you train to be a Doctor with the NHS you should work for the NHS.

Doctors tell patients that they have to wait for an operation and then spend their valuable time working for private companies. How can that be right.

I mean, it's not like GPs or Consultant Doctors in the NHS is badly paid are they?

Stephen

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Originally posted by cunningplan:
My wife is dedicated to her work and adapts and changes to the needs of the profession. She certainly doesn't have any old practices, or attitudes to medicine, and certainly didn't become a doctor for the money either!

Clive

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Does she do private work?

Regards

Stephen

Gamble - cost of getting the degree, the length of time before ultimate qualification and then you probably find that it is not all it is cracked up to be.

Re Is it a shortage of doctors or a shortage of provision for doctors to practice - if the opportunity to practice is miserable why go in for it - hence the shortage of doctors.

I see you are a musician how were you trained?

Derek

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Originally posted by Derek Wright:
Gamble - cost of getting the degree, the length of time before ultimate qualification and then you probably find that it is not all it is cracked up to be.

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But you will get a job and you will eventually get a good salary. There's a lot less gamble than other degrees.

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Re Is it a shortage of doctors or a shortage of provision for doctors to practice

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But some of the lack of provisiion has to be NHS doctors using their time to work privately.

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I see you are a musician how were you trained?

Derek

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The school of hard licks. I've paid my dues. (I'm self taught.)

I assume you ask that to compare it to medicine? I have a Biology degree though.



Stephen

I am assumimg your profile is inaccurate re DOB - and I guess that you were a student before the introduction of tuition fees - so why are you not working for the state in a lab examining medical samples instead of indulging yourself in being a musician - I cannot see the difference between you being a musician and a doctor doing a bit of private practice -

The only difference is that I do not mind about either situation whereas you do not like the doctor doing private practice

Derek

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Originally posted by Derek Wright:
so why are you not working for the state in a lab examining medical samples instead of indulging yourself in being a musician.

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I am! Well, an Environmental science lab. I am a musician & writer in my spare time. It pays little - hence the 'proper' job.

However, I think medicine is a special case anyway.

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The only difference is that I do not mind about either situation whereas you do not like the doctor doing private practice

Derek

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Why don't you mind? What did you do before you retired? Can you afford private care?

Regards

Stephen

Stephen Bennett said

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Does she do private work?

Regards

Stephen

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Do you mean, do patients pay her for treatment? then no! She's a GP and you'll find that the vast majority of GP's don't see patients privately.

The private work they do is limited to things like Insurance and Employment and Medico Legal reports.

Their pay from the Government is arranged so that 90% of the work is NHS, afterall the NHS should not be paying for these type of things, but the time and the resources need to be covered.



Clive

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Originally posted by Stephen Bennett:
Maybe the doctor was busy fixing some rich guy's sore shoulder?


Matthew

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I think it's absolutely appalling that the NHS should be responsible for training Doctors who then go on to work privately. If BUPA and the like want doctors, they should set up training facilities of their own.

IMHO, anyone who is trained by the NHS should have to work for the NHS. Why should private health care be subsidised in this way?



Stephen[/QUOTE]

I couldn't agree more, and believe private health care in the UK to be a bad thing.

It must be remembered that virtually all UK GPs are self-employed, and therefore don't enjoy many of the benefits of Consultants who are salaried. Yet, GPs rarely have private patients while Consultants usually do.

Unfortunately, if banned from making money in private practice, I think we'd see even more UK trained doctors sneaking off to more lucrative countries. This would be an even greater loss to the NHS.

Why don't you mind? What did you do before you retired? Can you afford private care?


I do not mind because I believe that a prson who is able to make their own decisions is overall going to be more productive than a person who is confined to a specific regime.

What did I do - I was associated with software development and deployment

Can we afford private care - we have to accept to that ensure a reasonable quality of life in the UK that one will have to pay for medical care, therefore we have had to budget for medical costs and also consider other age related costs that a working lifetime of tax paying will not provide for.

This year 04 the bill has been half the cost of a CDS3 and XPS2 to bring forward a treatment by 9 months to a year (minimum).

Last year 03 we were lucky no costs.


Would the banning of private practice resolved the wait perhaps by a month - but it might have caused the specialist to off sod to another country and so no treatment would have been available

Derek

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