Michael Seaverns John Blackmore
Great confidence booster for the future - it took NHSE/DoH 10 years to realise they had made a balls of it! Pity they didn't think to ask a GP.
Why can't "returners", who would be experienced GPs, simply be offered a 12-18 month placing as a GP trainee (as we used to call them) and then awarded a new licence subject to a satisfactory "end of term" report from their trainer. Too simple I suppose.
Is there any evidence that newly appointed GPs are any better or safer than those who went thorough the excellent and sensible training schemes we had in the 1970's? Probably not but I am sure NHSE wouldn't let evidence get in the way of a "New Way of Working"
I finally retired in 2006 and wouldn't come back now for double the money unless I was left alone to do the job I understood in a way that NHSE or DoH never will.
Anonymous | Consultant21 Apr 2016 6:55pm has hit the nail on the head. NHSE just doesn't understand the NHS, what it's for or what it does. No surprise it's falling to bits around us all and so may are either leaving or planning to do so.
According to the report of this study in the Daily Telegraph (12/4/16) no doctors were interviewed by the think tank who concluded that "Only one in three" GP visits are necessary. This neatly illustrates the reason for the current mess in the NHS.
Some years ago my partners and I conducted a study of our practice to find out if some patients consulting us could have been seen by a nurse. We reviewed all surgery consultations over a month and found that very few patients attended inappropriately. In my own case I recall it was about five.
Maybe if more attention was paid to the views of those who actually deliver the service to patients the NHS would be better managed and many of its present difficulties would have been avoided.
Pub quiz question
Which is the most toxic brand acronym?
Answer? : FIFA NHSE EU BMA
Correct answer - hard to tell.
Who wants to bet that whoever negotiated this contract will be getting their bonus and probably promotion?
I look forward to the day when the letters "NHSE" are not inevitably followed by a tale of some similar unbelievable stupidity. I doubt I will live long enough.
I have to agree with John Glasspool here. Paul Cundy advances a very weak argument and shows he (and the BMA) to bean even weaker negotiator. By far the majority of gun offences are committed with illegally held firearms which this will not address.
If this is an example of how the BMA (paid by doctors to represent THEIR interests) negotiates no wonder the Junior Doctors are resorting to strikes to achieve any progress.
If the BMA had shown a bit more grit earlier in the negotiations the present crisis could have been avoided.
Negotiators need to learn that when the deal looks unattractive or unachievable it is better to walk away early and stop wasting time effort and political capital on flogging a dead horse.
The latest figures on manpower in the NHS released by DoH reveals the extent of the mess which the collective "negotiators" have created. Any halfwit could have predicted that WTEs would be drastically reduced as soon as it emerged that a majority of medical students were women. This is not discriminatory or sexist but simply a statement of fact. As more women showed that you could have a medical career as a part timer more men adopted the same lifestyle choice exacerbating the problem. As usual short term blinkered vision by DoH has created the problems which will take a decade or more to resolve.
Time to call a halt to lunacy.
I recall two pieces of advice from an elderly GP when I was a medical student.
1. Always wash your own thermometer (they were mercury in glass in those days), it will save you enough to pay for your pension.
2. There are some houses where its best to avoid washing your hands, they will be dirtier afterwards than they were before.
In those days one might still occasionally visit a house where not only was a clean white linen hand towel put out for the doctor but also a new piece of soap.
Sorry about the typos.
What about OOH services.
When I worked for Health-call and subsequently was Medical Director for Primecare we provided a good quality and safe OOH service form which patients could get advice (form a doctor) or treatment at any time. It was affordable and effective in the main. Management was streamlines and a minimal overhead.
Since GPs were relieved of the "responsibility" for OOH (they continued to provide it for quite some time as there was no one else to do it) OOH has gone to hell in a basket. Duplicated services have multiplied, costs uncontrolled,service appalling and unsafe. Why? Because it was handed over to those who had no idea how to provide it.
No lessons learned of course - just more of the same.
Of course prescription charges are the ultimate form of "Taxation without representation". Dr decides, patient pays. Many will be familiar with the experience of patients who tell the pharmacist that they cannot afford the charges and ask which are the most important items on the prescription.
As always it will be those at the margin (just above the threshold for any extra benefit) who will suffer from charges. The effect on dental and optical services (now virtually absent in NHS as NHS charges are so close to costs of private treatment of dental care).
The answer is more honest demand management and deciding what the NHS is for (not just to get more votes!)
Long ago I proposed that treatment for any condition that threatened life or livelihood (with inclusion of retired and children as if they were working) would be treated free and to high standard and quickly. Decision to be made by GP as doc of first contact. Patient may appeal but if appeal is judged frivolous they would have to pay costs of appeal. If appeal succeeded then costs incurred by patient would be reimbursed. No sanction to be applied against GP. I believe this would make NHS affordable and ensure that "Patients got the treatment they NEEDED" (NB Needs not wants) at affordable cost. Any other treatment patients "wanted" would be paid for by the patient.
Needs a mix of political courage and effective management of the system neither of which appear to be very evident at the moment.
How sad and indicative of the low morale and anxiety about persecution that the majority of comments are now "Anonymous". Speaks volumes about the state of the NHS.
How long will it be before we reach the point where having screened for everything we will be unable to treat anything as all the available resources have been spent?
Is "prevention cheaper than cure"? Where is the evidence? Prevention usually means a continuing process and continuing cost. Cure, although sadly not as easily achieved as the proposition suggests, is a once only cost.
As has already been proposed no lives are "saved". Everyone will die.
In any serious situation I always asked the question "Will it be better next time?". There will always be a next time.
As with most important matters none of this this is simple but it can be analysed and broken down into "simple" components so that simple minded folk like me might be able to understand it. Of course our "political masters" (I always thought they worked for us) being so much cleverer (maybe I should have written "more cleverer") don't need to do this. Maybe that's why they have never really understood it.
Sounds a bit negative to me. After I "retired" form my partnership in 2003 I spent the happiest time I have had in medicine as a locum for 3 years. In fairness I was cushioned by my pension but I mostly had more offers to work than I wanted to take up. No meetings, no guff from "managers", ignored anything from the HA or DoH. No pressure, controlled my own workload for the first time in 30 years. "Just fixed the broken people"
How refreshing and wise of Sam Everington to focus on using performance indicators to stimulate enquiry and sharing of ideas as the means of improving standards.. This used to be the case in Dorset until the HA abolished them. "Driving down and forcing up" has never and will never work. Doctors don't want to do their work badly but they need encouragement to adopt new ideas and the ideas need to be tested to ensure they are sound, effective and practicable. I wish him every success and hope he will continue to be "awkward".
I remember many of our "traveller" patients often complained of "wind round the 'art". Of course as they had poor diets and smoked a lot they were, in fairness, at high risk.
Sir Bruce Keogh is falling back on the old HMG trick of overruling DDRB awards because of "exceptional and overriding circumstances" in this case "a surge in demand",, Not too hard to engineer as we enter the usual winter crisis. What an intellectually and ethically bankrupt position to adopt. The concept has been so degraded by HMG invoking it for nearly every DDRB award over the past 10-15 years unless they gerrymandered the "independant" DDRB by setting out the terms of the award in advance and relying on the ineffectual DDRB not resigning (I think they only threatened it once and quickly changed their mind). You have been rumbled Sir Bruce.
The present situation is a direct result of incompetent management at the top, never held to account and usually rewarded with Knighthood, Dame, promotion or golden goodbye. Those doctors and nurses who have sold their souls for "a mess of pottage" (albeit a pretty rich one) should examine their consciences. I hope they are shunned by all honourable professionals who work or have worked in the NHS. If they were at my table at a dinner I would walk out.
As always the devil is in the detail. The problem is the lack of trust in HMG and its subsidiaries (NHSE, DoH, NHS Data etc etc). This lack of trust is well founded and until we can be confident that there will be no more sales of patient data to commercial organisations or unauthorised sharing with those not directly involved in the care of individual patients sharing data cannot go ahead. Its a pity as the benefits are potentially enormous but while "authorities" remain so demonstrably untrustworthy it has to wait.
He has not said anything new here. The original statement said it would be cost neutral and AVERAGE pay would not be reduced. Hence this "statement" means nothing.
What he very carefully did not say was that no junior doctor would be paid less than they are now for the same workload.
Remember the old phrase "Within existing resources"? Nothing changes. Its politics.
I remember my old chief telling me a story in 1963. He was in US and on a ward round one of the juniors was asked about a patient. He produced a long printout of results and pronounced that all seemed well. My chief asked him "Have you examined the patient?" The US doctor looked a bit nonplussed.
When we were young (and knew everything) the old farts who were teaching us told us to "Listen to the patient, they are telling you the diagnosis" After "practicing" (and practising) for thirty years I realised that they might have been right.
Mr Hunt is still quite young and therefore has a lot to learn - bless him,.