I wouldn't say NHS direct was excellent - if you are ill get some eyes on it not follow an algorithm. Seen far too many mistakes that way. People put too much trust in protocols, algorithms and machines. Need to open their damn eyes and look, listen and feel what is going on.
Interesting I was at a clinic today following up a few people and I glanced at their figures.
Total Outpatients appointments for last week 16500
Total DNA for last week 1500.
Out of interest, could the clinic have coped with seeing the 10% that didn't show, or is it built into their protocols to have additionals booked knowing several won't show for each session?
From my own POV, the 'practice' in theory admin bills people for not turning up, I never see any of that, and its waived as often as its applied. It was a deterrent when introduced, and when people short notice cancel, and are not giving an excuse of actually being ill, they often change their minds and realise they can actually make it when told the FTA charge.
I don't overbook, I expect things to take as long as is needed, and I book times that suit what I plan to do, as such I don't tend to run late by much, rarely overrun, unless something unexpected occurs, have my own slots for emergencies morning and afternoon, and am in a big enough practice that our slots even out, so 3 of mine turn up sore some day, someone will see the other two, as I have seen theirs the day before etc.
We might deliver 90% NHS work, but its a private business, it has existed within the NHS since its first incarnation, and clearly works to some degree. How well it works in England after them messing the contract around twice is debatable, as anecdotal evident I have heard would suggest if you want professional care you either get lucky somewhere or you go private. In Northern Ireland the base standard is much higher, but will diminish over the coming years due to cuts, and the rise of 'corporates' which are trying to trounce the market currently, squeezing everyone and frankly hurting overall healthcare in the role we fulfil. Bigwigs won't care, they employ a Spanish graduate for 30K a year, they grind and perform cutting shop treatment, then disappear home before they are queried questioned or removed from practice. The corporate suffers no ill effect, as it isn't them who is ultimately responsible for the treatment.
The service is about to introduce cuts to stop the budget rising, specifically they are trying to treat 1M registered patients with the same amount of money they spent on 900K 3 years ago. Means to do this involve attempting to set savings in the region of 3-4%, but with the eras they are cutting and the way things filter down, actual cuts to my income would mean I will have to do between 18-20% more gross income to actually take home the same amount.
I can see applied savings elsewhere having similar effects if they are as poorly thought through. The NHS doesn't need saving, its needs a top down cull, not in staff or wages or anything or the sort, but in exactly what it should be providing, or should be claiming to provide. We should consult, we should agree and disagree and then come up with a rational for in the future, maybe starting ten years exactly what will and won't be available, and how people might cover themselves for the shortfall, and I don't mean means testing, or we'll always cover the poor or the old, I mean this is available, and this isn't. Tighten NICE like a vice around the service.
Then see what we do provide is superb, and what isn't available some other company will, for a cost.
In other areas of healthcare when super-duper technologies became available the NHS jumped to spend all its money providing them. In dentistry it didn't.
A very good, well provided treatment with a now excellent long term result could be provided but isn't, due to cost. Dental implants. 2k a tooth, is too much.
This could be applied to every single other area of healthcare until either the costs come down or alternatives are available, as technology gets better, treatments do, but cost increases and the pot of gold isn't infinite.
No politician would have the balls to ever consider such a prospect, as the Ed's would spend 4 years bleating about how they would fix it by spending money they don't have, and indeed didn't have in the boom either, yet they'd win the election.
