Scrap NHS reforms, doctors tell Lords.

Capodecina
Soldato
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Are you trolling Dolph?
I seem to recall Dolph saying some time ago that he believed his Wife and Mother-in-law had suffered at the hands of the NHS :confused:

That, added to his bitter dislike of any suggestion of equality, welfare provision or state involvement is inevitably going to lead to his scraping any non-existent barrel to pursue his quest.
 
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Are you saying that the gateway role couldn't be performed by (for example) a nurse with appropriate assessment technology? That many of the treatments currently only available on 'prescription' require significant medical training to diagnose?

The issue with GPs is not whether they have the training, but whether, in the modern world, it's necessary to have the training to complete the function they do.

There's a world of difference between saying GPs (as individuals) suck, and saying the role they currently do could not be done by other, cheaper to employ approaches.

Judging it from taking nurse led referrals in A&E, i`d say no nurses are not capable of that role. The triage nurses in A&E probably come closest to that level of general knowledge, but even then they largely aren't happy about sending patients home without discussing with a doctor or a doctor reviewing the patient. The urgent care center nurses in my last hospital were supposed to fill that role, but they fall back on a box ticking exercise of (aka NHS direct):

(regardless of whether the history and examination fit)
Chest pain = refer, could be MI
Back pain = refer, could be spinal cord compression
Headache = refer, could be meningitis
Abdo pain = refer, could be appendicitis

So we would basically end up with worse `GP` system that refers everything and make no decisions. Not really sure how this benefits anyone.
 
Soldato
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While I do (based on evidence) believe the NHS is a flawed system and in need of dramatic reform to align with the more successful european systems to bring our death rates and care standards more in line with our world position (Top 6 as opposed to barely top 20), my mind is changeable if evidence comes up to show that our healthcare performance isn't rubbish compared to international standards.

This fact doesn't make me biased, it makes me evidence driven. That you have yet to change my mind is because you haven't brought any good evidence to do so, not that it cannot be changed.

Except when you put forward a proposal there was no evidence behind it just conjecture and opinion and when people highlighted those errors it rapidly vanished off the front page of Speaker's Corner when you could not answer the obviously gaping holes.

Change yes sure but not change for changes sake and not moving from one poor system to another one. The evidence you cherry pick says one thing the evidence other people cherry pick says that with the level of funding it has with the demographic it treats then the NHS does not do a bad job. Having worked in the health sector in the US, Singapore, Australia, Germany, Austria and the UK I can pretty much sum up all their faults and strengths. So in summary, NHS poor functioning service in the main with a few notable strengths, poorly funded to meet such an extensive remit, with a notable skill drain to better climes, poorly managed, etc etc, but with an overall success rate that far exceeds what one would expect from being so poorly provisioned.

And as for your mind changing from such a concrete view - well I won't even bother there I have more chance of getting a certain evolutionary biologist to convert to Catholicism.
 
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Are you saying that the gateway role couldn't be performed by (for example) a nurse with appropriate assessment technology? That many of the treatments currently only available on 'prescription' require significant medical training to diagnose?

The issue with GPs is not whether they have the training, but whether, in the modern world, it's necessary to have the training to complete the function they do.

There's a world of difference between saying GPs (as individuals) suck, and saying the role they currently do could not be done by other, cheaper to employ approaches.

well clearly yes I do agree you have to be a DOCTOR to diagnose and dish out potentially dangerous drugs, id hate to see an nhs where nurses are the gatekeepers, there is a division between doctors and nurses knowledge for a reason.

just because its cheaper to employ a nurse doesn't mean its right, if i was a nurse and they wanted me to diagnose, I would ask to be paid as a doctor

clearly your just so clouded by your right wing ideology and hatred of social welfare to give a **** about anyone but yourself and what you think is right
 
Capodecina
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David Cameron said the letter praised the part of the bill that concerns public health. "We're saying public health - smoking cessation, diet, dealing with things like diabetes - these are incredibly important and they welcome that part of the bill" he said.
Yes, they do undoubtedly support preventive medicine - big deal :rolleyes:

Of course though, there are doctors in the health service who don't like the idea of greater choice and competition and other organisations being able to provide free health services to patients. But I believe patients want that sort of choice and rapid quality treatment and that's why it's right to make these reforms.
Talk about conflating unsupported opinions in order to muddy the debate and give the impression that most Doctors are wholeheartedly behind Cameron & Lansley's desperate attempt to reward their private wealthcare backers :rolleyes:

I wonder how many working GPs Lansley or Cameron have actually spoken to since they came up with their barking and generally unpopular privatisation plans :confused:
 
Caporegime
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Wow, that's an amazing assertion.

he is right though, it is a waste of a fully qualified Doctor to see the same old people every other day or the odd person with a cold, it would be better handled by a more junior/less well trained and paid role and the gp's stepping back to a second level judging the cases passed up from the computer assisted first level and not wasting their valuable time.


It's like putting a pit crew in kwik-fit.
 
Caporegime
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well clearly yes I do agree you have to be a DOCTOR to diagnose and dish out potentially dangerous drugs, id hate to see an nhs where nurses are the gatekeepers, there is a division between doctors and nurses knowledge for a reason.

Actually you have to be a pharmacist to dish out drugs, doctors are not considered qualified to do that and they regularly prescribe things with dangerous complications and the pharmacists advise them to correct it.

You can't expect doctors to have the same depth of knowledge of drugs and their interactions as a pharmacist unless you're going to add another 4 years to their training.
 
Caporegime
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Judging it from taking nurse led referrals in A&E, i`d say no nurses are not capable of that role. The triage nurses in A&E probably come closest to that level of general knowledge, but even then they largely aren't happy about sending patients home without discussing with a doctor or a doctor reviewing the patient. The urgent care center nurses in my last hospital were supposed to fill that role, but they fall back on a box ticking exercise of (aka NHS direct):

(regardless of whether the history and examination fit)
Chest pain = refer, could be MI
Back pain = refer, could be spinal cord compression
Headache = refer, could be meningitis
Abdo pain = refer, could be appendicitis

So we would basically end up with worse `GP` system that refers everything and make no decisions. Not really sure how this benefits anyone.


why would you use a nurse?

that would just be stupid, you'd have to train a new subcategory of health worker in mostly diagnostics and minor treatments but not needing the full and advanced knowledge of a fully qualified doctor.
 
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he is right though, it is a waste of a fully qualified Doctor to see the same old people every other day or the odd person with a cold, it would be better handled by a more junior/less well trained and paid role and the gp's stepping back to a second level judging the cases passed up from the computer assisted first level and not wasting their valuable time.


It's like putting a pit crew in kwik-fit.

The problem there is you just add another layer into the care system.
 
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Actually you have to be a pharmacist to dish out drugs, doctors are not considered qualified to do that and they regularly prescribe things with dangerous complications and the pharmacists advise them to correct it.

Regularly. You got any figures to back that up or is it from your experience?
 
Caporegime
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Regularly. You got any figures to back that up or is it from your experience?

well yeah it's the whole reason you have pharmacists, and doctors who specialise in drug complications (if you know any old people on a lot of pills you can bet they've been refereed to them at least once) it's just the nature of it when patients have so much medication, eventually something will end up contradicting.

oh and what my my brother says happens and what he was taught, he's a doctor.

The problem there is you just add another layer into the care system.

why is that a problem?:confused:


If you can clear out all the minor appointments (ie people like me who go to the doctor to get hay fever medication prescriptions ( means it's free rather than paying OTC) people with minor colds etc,) basically nothing too important, you've just freed up dozens of actual GP appointment slots per week which means there's no insane 2 week wait to get an appointment like there is now in many clinics, which reduces the number of people who go to A&E with minor things because they can't get a gp appointment which reduced A&E wait times and frees up hospital staff, and you speed everything up which ends up improving care on the whole.

and as the person won't require the same amount of training (they don't need to do a surgical rotation for example) they don't cost as much, and can be drawn fro ma wider pool of candidates as they don't need to be the same tier of quality as doctors.

which also means less people doing training rotations in hospitals which means you have more hospital (or the new second tier role the current GP will be playing) doctors as less are wasted in GP roles which could reduce waiting times/improve hospital care.


A doctor signing off on repeat prescriptions and minor things is a waste of their skills and reduces patient care because people who actually really need a doctor can't get an appointment.
 
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I think the idea that most of what a GP does is see coughs and colds and dishing out antihistamines all the time is at best naive and at worst offensive. It actually makes up quite a small amount of what a GP does do in reality. Every reasonable sized practice I have ever worked in has nurse practitioners who look after these conditions to already take the workload of the GP from minor illnesses.
As has been mentioned already it often is the case that A+E triage nurses and nurse practitioners need doctor support and opinions as a fair few illnesses don't behave quite like a textbook always says, and any decision tools will ere on the safe side and could end up actually increasing secondary care need and therefore expense. The experienced GP will hugely cut down the use of secondary care and acting as a gateway actually takes a lot of time and experience which you need before you can deal with the uncertainty of GP practice, and I don't believe you can just simply train up people quickly to do this. Its the broadness of the training and the depth of knowledge that a doctor and GP has in many areas that will set them aside from a nurse practitioner in being able to deal with uncertainty of diagnosis and that is something that takes a lot of experience. If you took the average hospital doctor into a GP role then they would also struggle with some of those aspects, and it is probably one of the biggest differences of GP specialism than a hospital specialism
 
Capodecina
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... it is a waste of a fully qualified Doctor to see the same old people every other day or the odd person with a cold, it would be better handled by a more junior/less well trained and paid role ...
You do realise that many larger practices do use a Nurse to triage where possible, don't you? As it happens, many patients hate it and we all know how keen both this and the previous Government are/were on giving patients the illusion of "choice", don't we? ;)


Actually you have to be a pharmacist to dish out drugs, doctors are not considered qualified to do that and they regularly prescribe things with dangerous complications and the pharmacists advise them to correct it.

You can't expect doctors to have the same depth of knowledge of drugs and their interactions as a pharmacist unless you're going to add another 4 years to their training.
Pharmacists cannot of course prescribe drugs since they are not qualified to do that. I am sceptical that GPs "regularly prescribe things with dangerous complications". GPs will frequently reference MIMS online and the BNF when prescribing. I'm not entirely convinced that Pharmacists will always know exactly what drugs a patient is taking.

I do agree however, that Pharmacists are a very important 2nd check.
 
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I would prefer if the doctors (local gp) had more power (as in could do more on the spot). They can not even do a blood test at a local GP. They have to send you off to a hospital and it is such a big deal, it can also take weeks for a 2 min job. They can just stick a needle in your arm and send it off to one of the many labs for testing for whatever reason. Then they can receive it back and give you a call and let you know. Then you can go back and speak to the doctor about the results.

But the problem is that the doctors said to me the reason was some excuse about my address or something. I realy think it is either money constraints, ie budget. They would rather send me off to another place and use their budget, rather than "waste" his budget on my blood test. I also doubt whether the doctor would know how to interpret the results especially as he could barely speak english...
 
Caporegime
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You do realise that many larger practices do use a Nurse to triage where possible, don't you?



You do realise that a nurse has no ability to prescribe?

Don't you?


Pharmacists cannot of course prescribe drugs since they are not qualified to do that. I am sceptical that GPs "regularly prescribe things with dangerous complications".


You realise not all doctors are Gp's

there are 200 thousand + licensed doctors many in hospitals prescribing many many drugs often to patients on lots more drugs complications happen a lot especially because some drugs may have complications with others in some people but not all.


I am not saying 100% of doctors regularly prescribe drugs with complications and I thought that any reasonable person would be able to see that, I'll attempt to reword things more simply for you in future.


However the large number of doctors prescribing a large number of drugs every day across the country means complications and interactions are a regular occurrence on the whole.

even if every doctor only did it once a year that would still be tens to hundreds of thousands of complications a year.


Pharmacists cannot of course prescribe drugs since they are not qualified to do that.

never said they could but no doctor can prescribe and supply you with a drug (outside of emergences) it has to pass through a pharmacist.
 
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why would you use a nurse?

that would just be stupid, you'd have to train a new subcategory of health worker in mostly diagnostics and minor treatments but not needing the full and advanced knowledge of a fully qualified doctor.

If you read my post, I was replying to dolph's post where he suggested nurses with technology replace GP as front line staff.
 
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