Looking at Choose & Book for local NHS hospital services, earliest appointments (across a range of hospitals) are:
Cardiology 30 days
Dermatology 41 days
ENT 41 days
Neurology 50 days
Opthalmology 21 days
Orthopaedics (knee) 40 days
Urology 36 days.
General practices face the same problems of trying to provide appointments with finite resources as hospital clinics do, and on this basis compare well.
Retired people are the most important demographic for all political parties, because they are much more likely to vote than other age groups. Particularly so for the Conservative party, whose membership is notably older than that of other parties.
All parties tend to adopt policies designed to favour the older population. For example, retired people are the only demographic not to have seen their living standards fall as a result of the coalition's austerity program.
Health (and general practice) matters particularly to this age group.This is therefore another policy tailored to appeal to the party's core support.
If that's £810 million of new funding, plus £1 billion for new premises, then that's a significant investment. If London GPs don't want it, send some of that up North!
It's worth reading the Professors' article in the Mail, and noting his quotes :
"While many foreign graduates undoubtedly make fine doctors, the fact is that these professionals from overseas are four times as likely as British graduates to be struck off by the General Medical Council".
"Despite the failings of its profession, the GPs’ lobby has been allowed to hold the public and the NHS to ransom because it is represented by the powerful, uncompromising British Medical Association..."
"What exactly do our 40,000 GPs do that makes their services so essential to the NHS? Do they spend all their day making complex diagnoses? Hardly.
In fact, the most serious cases they come across that show ‘red flag symptoms’ — from breast lumps to gastro-intestinal problems — can be referred to specialised hospital consultants. No letter of referral is required; they simply have to tick a box and send a fax. That’s why the incidence of referral is high and often unnecessary."
"About two-thirds of general practice work involves the supervision of diseases such as asthma, diabetes and hypertension, as well as care of the elderly. But here again, GPs cannot keep up with developments in these fields nor do they have the necessary equipment for monitoring the health of their patients properly
"Because I am a senior consultant in an NHS hospital, Mr Lansley sent me an early outline of his plan for reorganisation and asked for my advice.
I told him: ‘GPs are the problem in the health service, not the solution.’ He did not ask my advice again, but instead pressed ahead with his misguided scheme."
"Those are my principles, and if you don't like them, well, I have others"
Collings Report Summary from March 1950:
"The overall state of general practice is bad and still
"The development of other medical services ... has
resulted ... in wide departure from both the idea and
the ideal of family doctoring"
"Some [working conditions] are bad enough to
require condemnation in the public interest"
Inner city practice is "at best. . . very unsatisfactory
and at worst a positive source of public danger"
Rural practice is "an anachronism" and suburban
practice a "casualty-clearing" service
"An attempt should be made to define the function of
general practice within... the NHS"
"Group practice units... should be formed"
One of the key issues here is that pensioners have a disproportionate political influence in the UK (they are the demographic with by far the highest voting turnout). Policies are therefore crafted to appeal to (and not to offend) this sector - particularly by the Conservative party, who (again) rely disproportionately on elderly voters.
Hence dementia - which has been identified as one of the top concerns of this demographic - is selected as an issue for the coalition government to be seen to take action on.
We know our patients and our patients know us. It's common for there to be a relationship with patients and their families that can extend over generations. Galling as it is to see negative comments on a public forum, the vast majority of patients form their own opinion on personal experience - reflected in patient surveys showing consistently high ratings for practices.
"And if the building blocks of the NHS crumble, the NHS collapses too"
General Practice is, alarmingly, now like a game of Jenga: keep pulling out the bricks, pile more bricks on top. In an effort to get higher and higher, there comes a critical point, and that's getting closer and closer.
CBT and antidepressant therapy are proven to be of approximately equal effectiveness
A month's prescription of an SSRI costs £2
How much does a course of CBT cost? Factor in the delay involved, and the immensely high DNA and dropout rates, and you have to question the economic sense. For all the investment, therapists are probably twiddling their thumbs for half of all appointments. Meanwhile, for most patients (6 month wait for 6 sessions) CBT as delivered by the NHS is arguably not really worthwhile.
However, there's other ways to deliver some of the benefit of Therapy cheaply, effectively, and immediately. Books (such as Feeling Good, by David Burns) will suit many patients. Also, for example, our CCG commissions Foundation for Positive Mental Health audio tracks on CD and downloads. Both these approaches are probably a better way to deliver CBT to a population
Hard figures would be useful
"He said: ‘We estimate this have led to a reduction of 27% in primary care attendance at Central Manchester University Hospitals NHS Foundation Trust A&E compared to last year."
3 instead of 4?
"There has also been a reduction of 50% of people turning up to A&E saying they are because they could not get an appointment with their GP."
1 instead of 2?
How do you kill 20 GPs?
Roll a penny under a bus!
"The think tank Reform’s study of 31 developed countries found that 22 countries require patients to pay for an appointment with a GP, ranging from 85p in France to £17 in Sweden"
Patients in Ireland over the age of 5 have to pay for consultations, with a typical charge for a consultation of approximately 50 euros.
A range of charges from a typical practice are as as follows
Consultation 50 euros
Review appointment (same problem) 30 euros
Family appointment 2 persons 80 euros, 3 persons 100 euros
Blood test 20 euros
Repeat prescriptions 20 euros
Blood pressure check 20 euros
These are fairly typical charges - there is no set national rate
Of course, patients there have to pay for their medication too
English patients are apparently 'notorious' when they join practices - whether they have to pay or not - because their expectations of treatment and standards are so high, 'that they always complain'
A scheme like this can only succeed by drawing upon reserves of locums and other GPs who might otherwise choose to supplement their income with out of hours work. However, in any given region there is a limited supply of such doctors. If the central Manchester scheme is successful, it will do so by effectively monopolising that workforce in the Manchester area. In the short term, there may be immediate consequences for overnight rota cover. In the longer term, other local areas won't be able to replicate the scheme, because the additional workforce required will already be committed.
How can a single named GP with 24/7 responsibility fit with a workforce where GPs work part-time and/or are salaried (with contracted hours of employment)?
Training practices face paying part of GP trainee salaries in education funding shakeup from next April
Why stop at General Practice? Surely our consultant colleagues also benefit from having junior doctors on their teams. A small deduction from consultant salaries to cover their reduced workload only seems fair- say 10% for each Foundation Year doctor, 15% for an ST1, and an extra 5% for each additional year's experience to a maximum of, say, 50%. What reasonable person could possibly object to that?
When a system is working at maximum capacity and maximum efficiency, that makes it vulnerable. Any additional stress, any hitch, can cause a breakdown. General practice in the UK is running perilously close to that threshold.
"The results indicate around 200,000 fewer people than previously thought now have dementia, a relative reduction of 24%. Co-investigator Professor Louise Robinson ... told Pulse that primary prevention strategies and improvements in care through QOF have been key to cutting the risk of dementia"
Clearly, yet another intended consequence of the 'disastrous' 2003 GP contract
Isn't it strange how there has been no coverage on the difficulties patients face obtaining routine NHS dental care, let alone the impossibility of accessing dental care out of hours.