Christmas party time. Stay sensible folks.
Junior Doctors Strikes
- Thread starter Dr House
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Christmas party time. Stay sensible folks.
Caporegime
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There'll be plenty of doctors, just expensive ones.
Although this is going to be rough to cover so close to Xmas.
I am starting to winder if we should scrap GP's, pharmacists are pretty handy for medication stuff, move some of the resources to them, and the rest to secondary care. Allow self referral, then people can actually get treated instead of fighting GPs for years to get to secondary care.
The system would fall apart overnight. Very few (including many doctors in secondary care) really understand what GPs do. There is absolutely no way you can replace a GP with a pharmacist. A pharmacist can assess and manage a minuscule amount of conditions. They aren’t trained to provide what a doctor does. The whole way they are trained and even think about medical conditions is different. Ask any pharmacist about that as an idea and they would be sick in their mouth at the thought. If you allowed self referral without a gatekeeper of GP that manages most things ( certainly <10% would get a referral, I expect a lot less than that) without a referral you can watch all waiting lists be measured in years in secondary care and it would be very difficult for secondary care to decide what is urgent and not.
Of course I agree waiting lists would explode, we would finally see the true demand. I also agree it would fall apart, as we would see how under resourced it is on a much bigger scale. The transition would have to be a slow gradual one, the amount of issues pharmacists solved is surprisingly good, they have been dealing with a fair few for me in recent weeks due to GPs failing to do their jobs.
Ask yourself why would we need a gatekeeper if the service wasnt under resourced?
My experience with NHS GPs is they either mistakenly or deliberately play down conditions, ignore reported symptoms, love to prescribe medication, do blood tests, but they will die on a hill before they refer you even for a scan. The reported events where they misdiagnose is increasing as well, GP's seem to think they need to diagnose you before referral instead of referring as a precaution to confirm if is an issue or not. I dont think they this stupid, I think they are being misused by the NHS as a means of controlling waiting lists.
Then we allow secondary care teams to reject a referral without interacting with the patient. Something else that needs to be put right.
We triage at the level of a war surgeon.
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A GP isn’t just a triage service though. They are diagnosticians and the vast majority of conditions are and should be managed in primary care. The most important things GPs should be doing and need the time to manage more is the complex multimorbidity stuff, the chronic stuff that actually secondary care are very poorly setup to manage. This is much more an age group unlikely to be posting here
Any condition a pharmacist has helped you with shouldn’t actually see a GP at all as they are conditions for minor illness nurses and similar. If you were unable to get help from a GP for these, but were from a pharmacist then respectfully you were trying to see the wrong person. That’s not your fault per se, but neither is it the GP services fault
A switch to a secondary care led service isn’t something that can be done in a slow way. It’s something that can’t be done at all imo. You would have to have secondary care doctors managing things in a primary care way anyway, and the whole system would not be close to affordable. Primary care sees 90% + of all NHS contacts on a shoe string budget compared to secondary care’s slice.
Any condition a pharmacist has helped you with shouldn’t actually see a GP at all as they are conditions for minor illness nurses and similar. If you were unable to get help from a GP for these, but were from a pharmacist then respectfully you were trying to see the wrong person. That’s not your fault per se, but neither is it the GP services fault
A switch to a secondary care led service isn’t something that can be done in a slow way. It’s something that can’t be done at all imo. You would have to have secondary care doctors managing things in a primary care way anyway, and the whole system would not be close to affordable. Primary care sees 90% + of all NHS contacts on a shoe string budget compared to secondary care’s slice.
To make a tech analogy which is deeply unfair to the work of GPs but this is a tech forums so here goes:
GPs are the equivalent to front line technical support. They are there to diagnose and support people with a huge range of low level issues. 80% of the stuff they deal with is the equivalent of ‘I forgot my password’. You don’t need a database specialise or a java specialise to reset a password.
They generally do a fantastic job but at the same time it’s a thankless job because they don’t have the sexy title like brain surgeon.
Getting rid of them will not expose ‘true demand’ because a massive % of that work will be dead weight and have no benefit because people are not doctors and don’t actually know what’s wrong with them.
We really don’t and that is a deeply unfair characterisation of the work they do.
If you are having problems with your GP, the might just be bad (you can move). An alternative explanation is the issue could be closer to home and you’ve not found the best way to advocate for yourself within that particular service.
We see this a lot locally, huge numbers of complaints about X service but whenever I’ve used it and Mrs Sk8 uses it we get the complete opposite experience.
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I never judge things just on my own experience, the data is out there, the news reports are out there.
What does front line tech support do? They triage, sometimes correctly sometimes incorrectly, GPs are the same, we have a bit of a trope right now, where people refuse to accept how bad things are.
The performance of the NHS is largely improving according to the data you refer to.
You’d be mad to drop GPs it would cause utter chaos and the fact you can’t see how necessary they are speaks volumes.
You say you don’t judge based on your own experiences but seeming this whole discussion seems to be based on your experience with your GP.
You’d be mad to drop GPs it would cause utter chaos and the fact you can’t see how necessary they are speaks volumes.
You say you don’t judge based on your own experiences but seeming this whole discussion seems to be based on your experience with your GP.
I know it would cause utter chaos. We have built our entire health service around it. I do think their roles could be reduced, which it probably needs to be, given it how hard it is to access them, and I think the referral system needs reform of some sort.
I have seen a proposal of a three strikes system, which is supposed to prevent in the future the ability of the system to keep people stuck in a never ending loop of nothing happening.
We shouldnt be scared of change, there is successful health services that work on much less intensive levels of triaging. Reforming is more than about funding.
Other health systems spend far more money on preventative measures, that’s the only fundamental difference to what we do.
Fix that and most of these problems go away because people simply need less healthcare.
Fiddling around with referrals systems isn’t going to make a jot of difference to nearly 6 million people having diabetes, of which 90% is type 2.
Invest in prevention and that number becomes significantly less and the burden on your healthcare system is lower overall even after accounting for the preventative spend.
Fix that and most of these problems go away because people simply need less healthcare.
Fiddling around with referrals systems isn’t going to make a jot of difference to nearly 6 million people having diabetes, of which 90% is type 2.
Invest in prevention and that number becomes significantly less and the burden on your healthcare system is lower overall even after accounting for the preventative spend.
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GPs come from a time when we had doctors that actually did something. When my wife was ill last year the GP said she didn't need to go to hospital. I phoned an ambulance the day after, and she died in hospital the day after that. So yeah, GP's. **** em.
The NHS gatekeeps access to specialist services more than most healthcare systems. There is probably some efficiency to be found in these areas but it'd be a significant upheaval for the NHS and likely lead to problems in the short term. The basic problem remains: the UK needs more GPs.
Only a very small part of what GPs do is triaging for other services. I don't know about you, but I've been referred on to other services only a handful of times in my entire life. Every other time the GP has diagnosed and dealt with the problem -- or told me that there isn't anything to do.
Thats too much common sense.
Money is made from people being sick, not healthy.
Thats the uncomfortable truth.
Caporegime
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That may be the case in a US type system.
In the UK its more the fact the health system is so busy focusing what resources it has on immediate problems they're cutting all preventative health measure to keep afloat. Everything is reactive, there's no planning, funding or appetite to tackle health issues early because the system is broken.
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Caporegime
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GPs do triage but they also manage a vast amount of complex health problems, increasingly so, every year.
I'm amazed at some of the things my wife manages as a GP, secondary care is constantly pushing more and more work on to GPs.
Don’t think my gp knows much either. Great at referring for the hospital to figure out though.
The problem with the UK health is system, it's too focused on keep old people alive who would have died a long time ago due to natural causes.
Hence having them pay out the nose to stay alive which the NHS is not going to turn down..... Why should they ?!?