Scrap NHS reforms, doctors tell Lords.

[DRZ]

Unfortunately further training for GPs is not mandatory and IMO not enough is done to train GPs that are notorious for very poor referrals to hospitals. There should be systems in place to address this, give feedback on referrals and give training when required.

This is a hugely salient point. A lot of GPs are absolutely fantastic but there are a huge number of them that are no better than minimally competent (any below competent shouldn't be practicing at all). Minimally competent GPs are going to have their hand in running the entire show if the Government get their way!

I'm not entirely sure what can be done to "fix" this kind of GP other than natural wasteage - Increase junior doctor training around patient pathway management and incorporate direct feedback on referrals would be a fantastic start and try our best with the existing GPs whilst waiting for them to leave the system.

 

[Xordium]

You are forgetting one very important and fundamental fact. Hospital based medical staff NEVER see 95% of the cases that the GPs deal with. The GPs send only the top 5-10% to the hospital. All hospital nurses will never have the experience of seeing "cold" cases where there may actually be nothing wrong, or having something seriously wrong.

Maybe the hospital staff you work with and the hospitals you have worked at. But that is then a big leap to say that is the same across the country and across the world. So your use of never is wrong. You should have said in my experience which is rather ironical consider you are posting further on about acknowledging ones limitations and experience ...

No matter how you train them, there will never be a substitute for having experience in primary care. Something that unless they actually go out to "GP land" and see all comers, they will never be able to sort the sick from the not. Dont forget they will have no access to bloods, x-ray or any other basic hospital test. Not even oxygen sats.

So let me guess this correctly in a specific setting for a specific client group someone who has a vast amounts of experience, both practical and theoretical, can not perform aspects of an other professionals role who has very limited practical experience and works from the same theoretical viewpoint purely and solely because they are a nurse. Right and we wonder why doctors get discredited and changes forced upon us.

If you take 2 doctors graduated in the same year from med school. One becomes a chest specialist the other a GP. The chest physician will tell you that he will not be able to manage even the simplest of respiratory cases in a primary care setting. The mere realisation of this fact, is in itself a mark of a true clinician who knows his limits.

Really and should the less skilled GP not be acknowledging the same in the example we are using.

Nurses in defined clinical setting have their role, and i agree are superior to doctors. Patients already have a KNOWN problem, eg on dialysis, major trauma, etc. Even those who are "referred to" by primary care. The problem/diagnosis has already been made, and further specialist management needed. Even if you discharge blindly all patients, you will be right 95% of the time. Since a large number really have nothing life threatening to begin with.

Yes and the people I am talking about in a specific role for a specific group where it is economically viable could do this as they have broad experience of working with unknown problems.

To sort out all comers walking in off the street is not easy.To think it is, is the mark of a dangerous practitioner, who should not be allowed near ANY patients.

And the blind placing of ones professional territory above everything else irrespective of cold hard logic is the mark of a very traditional kind of doctor.

I just find it rather funny that you think that such experienced practitioners can not be put into such roles were applicable to facilitate a better service. If you seriously think that these people can pootle around the world for MSF and their ilk, perform advanced assessment and clinical lead at tertiary hospitals and then wo-betide, even with specific further training, never do such a role better than a overall generalist would in that specific area then I really have to wonder. But hey everyone said this when all the Vietnam vets returned and started the modern day paramedic service - what encroaching on your territory and getting better results too - how dare they!

 

[Xordium]

I take the more cynicalview that the GPS are being setup to be the fall guys for the road to privatization, which is the ultimate aim. What better way to deflect attention than to get them to take the heat, and then once it is all done, further screw over the GPS and come to the "rescue" of the people.

Well people have not forgotten the strongarm tactics used by GPs to force through the formation of the NHS. But personally I take the even more cynical view that what is happening is the government has not got the balls to really take on the medical profession so they will allow the more onerous parts of the profession to setup super-practices and then farm out cheap work to poorly qualified and unsupported staff rather akin to the chap in Handsworth (think it was). That way they can wash their hands and say well we didn't do that was a medical choice. Divide and conquer - it's how empires are forged.

 

[ubersonic]

And still the Government will persist with their repeated lie that the medical profession support Lansley & Cameron's covert, back-door privatisation of the NHS

/care, the NHS is messed up beyond belief due to Labours management, the gov is trying to fix it, I say let them try, it can't get much worse than it is now >.>

 

[Xordium]

/care, the NHS is messed up beyond belief due to Labours management, the gov is trying to fix it, I say let them try, it can't get much worse than it is now >.>

And yet indicators show ample evidence that quality went up during Labour's time and that quality is decreasing now. When your PC is not working do you examine what's going on and make careful adjustments or do you just get the sledgehammer and think well if I whack it hard enough here and there I can squish it down and it will look like an Xbox - result - most people want PCs to play game I have given them something to play games on. Except the they don't look as good, end up costing more longterm and don't do half the things you really want.

 

[stockhausen]

... Unfortunately further training for GPs is not mandatory ...

Is this actually true I was under the impression that continuing training was a requirement of the appraisal process.

... IMO not enough is done to train GPs that are notorious for very poor referrals to hospitals. ...

How would you suggest that this could be addressed?

... There should be systems in place to address this, give feedback on referrals and give training when required. ...

Indeed there should. The medical profession, much as is the case with the Accountancy & Legal professions is far too preoccupied with the ideas "There but for the grace of God . . ." and "People who live in glass houses . . .".

It would be a damned good idea if there was a greater sense of peer review, criticism and feedback. From my discussions with GPs, they find it nigh on impossible effectively to critique or provide feedback on the behaviour of Doctors in Hospitals.


As a matter of interest, assuming that your are a Doctor working in a Hospital

• have you ever actually tried giving a GP feedback on an unwarranted referral?
• how did you do it?
• was it successful?
• If not, why not?
• what have you learned from this experience?

 

[ubersonic]

And yet indicators show ample evidence that quality went up during Labour's time and that quality is decreasing now. When your PC is not working do you examine what's going on and make careful adjustments or do you just get the sledgehammer and think well if I whack it hard enough here and there I can squish it down and it will look like an Xbox - result - most people want PCs to play game I have given them something to play games on. Except the they don't look as good, end up costing more longterm and don't do half the things you really want.

Mate all I know is ive been dependant on NHS treatment since 1984 and it was always good till Labour took over then they made changes that caused massive problems and now the NHS is rubbish by comparison (im not saying the people who work for the NHS are bad now, they are still great just their ability to do their job to the same level has been greatly compromised).

 

[stockhausen]

Mate all I know is ive been dependant on NHS treatment since 1984 and it was always good till Labour took over then they made changes that caused massive problems and now the NHS is rubbish by comparison ...

What did New Labour do that "caused massive problems" and in what way has the NHS become "rubbish by comparison"

 

[DRZ]

What did New Labour do that "caused massive problems" and in what way has the NHS become "rubbish by comparison"

Huge emphasis on particular targets and waiting times for a start. Mismanagement at a top level, billions wasted on ineffective programmes of change.

Rubbish by comparison was his personal experience of the service he received - what is so hard to grasp about that?

 

[casaubond]

''As for saying doctors aren't overpaid, a lot of doctors aren't, GP's are MASSIVELY overpaid, and they are under qualified as doctors, you go into an ER and find a doctor who can diagnose just about anything, perform emergency surgery and hundreds of procedures, a GP can barely do anything these days, you can get a doc who hasn't performed a procedure on a patient in 40 years and hasn't seen a wide range of cases in decades either.'' Says drunkmaster

Before I trained and qualified as a GP, I was a qualified surgeon (still member of the royal college of surgery) and before that, worked for a year in a/e as a senior staff grade doctor (you know the one that the trainee doctor you see first in a/e goes and ask for advice). Now as a GP I found it too be more challenging.
But yeah I take your word for it that I am under qualified.

 

[Xordium]

What did New Labour do that "caused massive problems" and in what way has the NHS become "rubbish by comparison"

I think that was just his qualitative assessment - I would disagree because whilst I have seen and experienced some real shabby care on the whole I think it did get better under their tenure. Whether we got sufficient improvement for the extra money is another question. I quick look on NHS jobs tells a very telling picture of whether the frontline is being hit and being hit hard and the evidence suggests a very emphatic yes. And for those arguing for greater usage of the private sector I see the Priory have just had to close a whole unit due to exceptionally bad results and standards.

 

[Xordium]

Is this actually true I was under the impression that continuing training was a requirement of the appraisal process.

How would you suggest that this could be addressed?

Indeed there should. The medical profession, much as is the case with the Accountancy & Legal professions is far too preoccupied with the ideas "There but for the grace of God . . ." and "People who live in glass houses . . .".

It would be a damned good idea if there was a greater sense of peer review, criticism and feedback. From my discussions with GPs, they find it nigh on impossible effectively to critique or provide feedback on the behaviour of Doctors in Hospitals.


As a matter of interest, assuming that your are a Doctor working in a Hospital

• have you ever actually tried giving a GP feedback on an unwarranted referral?
• how did you do it?
• was it successful?
• If not, why not?
• what have you learned from this experience?

You might want to address those questions to the person that made that post rather than me who was quoting them. The last part sounds like some PDR - heaven forbid!

 

[DRZ]

snip

What are your feelings on becoming a commissioner? Do you think you have the skills and experience to manage a budget on that scale (hundreds of millions)?

What did you make of my posts on the matter earlier?

 

[casaubond]

What are your feelings on becoming a commissioner? Do you think you have the skills and experience to manage a budget on that scale (hundreds of millions)?

What did you make of my posts on the matter earlier?

I personally have no such skills, but a few other GP's in the region I work, seem to have quite keen business-like aptitudes. Sufficient to say we have elected shadow consortia already and they are working towards taking over PCT responsibilities in 2013.

 

[DRZ]

I personally have no such skills, but a few other GP's in the region I work, seem to have quite keen business-like aptitudes. Sufficient to say we have elected shadow consortia already and they are working towards taking over PCT responsibilities in 2013.

Yeah, most areas seem to have worked towards something. Interesting that the PCTs have or are working towards stripping out the commissioning from the provider side and forming new trusts despite any legislature forcing them to do so and the real (but diminishing) chance that the changes won't happen at all...

 

[ubersonic]

What did New Labour do that "caused massive problems" and in what way has the NHS become "rubbish by comparison"

Ill answer those questions in reverse order, firstly its now rubbish in comparison to what it used to be, sorry I thought I had made that more obvious.

Secondly they changed the way the NHS was administrated which has had massive repercussions, one of which being if you live in Wales but have to be treated in England because the is nowhere in Wales to treat you (my situation) then your basically screwed. I have an artificial limb which sometimes requires maintenance, this is the process for getting problems sorted:

How it used to work:
Have a problem.
Make an appointment.
Get seen in a couple of weeks and everything sorted there and then.

How it works now:
Have a problem.
Make an appointment.
Get seen in about a month.
Get told they will have to get funding authorization from the Welsh NHS trust as they can't use their own funds on people from outside their area any more (So its not even a national health service any more its a group of regional health services >.>).
Wait a month.
Get told the Welsh NHS have ignored the letters sent and could you ask your GP to try and start the ball rolling from your end.
Make appointment with GP.
Get seen in a month or so as its not of medical urgency.
See GP and explain everything, they get working on their end.
Get asked if you would rather be treated in Wales instead, the is a new clinic just 90% of the distance from you house the English one (just over the boarder) is and its almost as good.
Refuse to transfer (not being picky, I've been treated in England for 27 years, I know the staff and its better than the Welsh centre anyway).
Get told they will deal with it.
It doesn't get dealt with.

^ This ^ is where I am at the moment, its been ongoing for about half a year now, last time I had a problem they spent nearly a year attempting to get the Welsh trust to authorize payment for a small (5mm diameter) elastic band used to hold a sensor in place, in the meantime I stopped the sensor falling out with duct tape, in the end the English centre used a band from an old limb that was being scrapped to fix it for me (against the official rules, like most things that waste taxpayers money).

I'm slowly coming around to the mindset that I will eventually have to transfer to the Welsh clinic but I don't want to, I went to see it when it was opened (they invited the patents they assumed they would be taking over), I personally don't think its better than the English one, I pay taxes, I should have a choice of where im treated, yet because Labour screwed up the NHS I'm in the ****

 

[stockhausen]

Health service managers have called on the government to be more honest about the financial challenges facing the NHS in England.
...
One trust chief executive said ministers were not being straight with the public: "What people cannot tolerate is the lack of honesty about some of the tough choices that we're having to make. Wrapping it up in a language of modernisation and patient choice is simply unacceptable."
...
Anita Charlesworth, former director of public spending at the Treasury who is now with the health research group the Nuffield Trust, says their real-terms funding increase has become a real-terms cut. "The government has increased the money available to local health authorities to buy care by 3%. But when you take into account inflation and the fact of those health authorities being asked to hold back some money to prepare for contingencies and pay for one-off investments, the money that they've got available to spend with hospitals is 3% lower in real terms on average."
...
The chief executive of the Royal College of Nursing, Peter Carter - who ran a mental health trust for 12 years - says he hears this from managers all the time. "They feel that they're being duplicitous for having to sell it to their staff, the public, their stakeholders by saying all of this money is coming back in. It is not coming back in. There is no evidence of any re-investment." (BBC online)

I suspect that the Government hopes that by lying about their real plans and the consequences for the NHS, the public will continue to blame health professionals for the deteriorating service.

As to the repeated bleating about "Patient choice", that is a complete lie. The Government are forcing GPs to restrict patient choice in terms of the range of drugs they may prescribe, the treatments they can offer and the hospitals to which they can refer.

I know that the usual suspects her will pop in to say "Politicians lying, what's new, who cares?". However, the day will come eventually when you will care and will bitterly regret your selfish, short-term indifference to the demise of the NHS.