“I want to see my GP!”

[Jock42]

This crap serves one purpose, and one purpose only. It’s running the NHS down in the public eye, to soften up the voters for privatisation.

Go ahead and bookmark this.

GPs are already privatised.

There are aspects of the NHS that are either systemically broken or are failing patients and pretending otherwise is counterproductive.

The ambulance service says hi

[dpedin]

And still the hate goes on. Do you not realise this is precisely what the government wants? It wants you so steamed up about the perceived poor service that when they start selling clinical services off to private capital, you’ll cheer and wave them through. But that road does not lead anywhere good. At the very best, you’re looking at compulsory state health insurance (on top of whatever tax you pay now). At worst, you’re looking at co-payments and US-style HMOs. Just like the EU, people won’t appreciate the benefits of the NHS until it’s gone, and then it will be far too late.

The image of the greedy GP who is always on the golf course is still pervasive, I see. Well, I can’t speak for the whole UK, and I’m sure that there are examples of bad practice out there if you look. But I know plenty of GPs around here. They’re not ‘refusing to see patients’ - they’ve been doing face to face consultations the whole time. I can personally attest that when my wife found a breast lump last year she was in the surgery being examined in a matter of hours. What they have been doing - as directed by government - has been to move more of the service online, to avoid having a waiting room full of sick people with potential Covid. So now most things start with an e-consult. The problem is that when you have a certain number of appointments, you can manage demand, but you can submit multiple e-consults every day if you wish, and some people apparently do. All of these have to be reviewed and appropriate action taken. All the GPs I know are working flat out and ready to drop (though to be fair we had a major recruitment problem before Covid started). Just because your GP is doing fewer face-to-face consultations, it doesn’t follow that they are out playing golf.

As for whoever mentioned pensions - that gave me a hollow laugh. Medical pensions have been raided and raided and raided. If you retired a few years ago you might be fine, but the final salary schemes have been replaced with career average, the amount senior doctors pay in contributions is by far the highest in the public sector (17.5% currently - MPs exempted themselves from this, naturally), and due to reductions in the annual allowance and tapering over the last few years, many doctors have suddenly been presented with bills for tens of thousands of pounds in tax on income they have never actually received and can’t access until they retire. This has exacerbated staffing shortages, as senior doctors have cut their hours to avoid the risk of such charges, and in a system that depends on a lot of people doing a lot of extra work, that’s disastrous.

I’m not a GP. I’ll even admit to a little occasional schadenfreude at the concept of trying to cope with mushrooming demand (as this is a daily reality in my specialty). But if you genuinely believe that they are all lazy and work-shy, you’re off your head. And the government thinks you are a useful idiot.

This in spades! I'm not a doctor but agree entirely with above. If you run a health service running hot at 95% bed occupancy prior to pandemic and have the lowest number of docs and beds per capita compared with comparable health systems then of course it is going to struggle when the shit hits the fan basin a world wide pandemic.We get what we pay for, I'm not going to go through all the shit from before that shows the NHS is one of the most cost effective systems in the world - you can all look it up.

Also let's not forget that it was this Gov through Hancock et al who were pushing new tech as the saviour of the NHS and were investing heavily in remote GP appointments IT systems back in c2018 to address their chronic underfunding of the NHS primary care sector. Hancock was pushing this hard - google it - partly because he had some dodgy dealings with these private sector US IT companies. Is it any wonder that GPs are struggling to cope with a massive ramping up of demand and a workforce knackered and depleted by the current UK Gov.

Forget the headline numbers about the number of GPs in the service - the number working part time is growing even faster due to a number of factors such as feminisation of the workforce, reluctance to take on a GP partner role with the financial investment that requires, dissatisfaction with the job, etc. I looked at my own area and we had the same number of GPs but they were working, and getting paid for, a day less per GP.

From my own previous professional experience the vast majority of GPs work their bollocks off but as in any industry there are a few that take the piss and try and run the system for their own benefit. I've seen the same in finance, oil and gas, retail sectors as well, there is always a few who take the piss. Thankfully they are a small majority of GPs and usually benefiting from the current Gov attempt to privatise the GP service in England by stealth.

Lastly I have had to see a GP and hospital care during the pandemic and when required it was, following telephone triage, face-to-face, no problems, no panic but just excellent professional care from stressed out workforce. You'll miss it once this shithouse of a Gov privatise it!

[Torquemada 1420]

And still the hate goes on. Do you not realise this is precisely what the government wants? It wants you so steamed up about the perceived poor service that when they start selling clinical services off to private capital, you’ll cheer and wave them through. But that road does not lead anywhere good. At the very best, you’re looking at compulsory state health insurance (on top of whatever tax you pay now). At worst, you’re looking at co-payments and US-style HMOs. Just like the EU, people won’t appreciate the benefits of the NHS until it’s gone, and then it will be far too late.

The image of the greedy GP who is always on the golf course is still pervasive, I see. Well, I can’t speak for the whole UK, and I’m sure that there are examples of bad practice out there if you look. But I know plenty of GPs around here. They’re not ‘refusing to see patients’ - they’ve been doing face to face consultations the whole time. I can personally attest that when my wife found a breast lump last year she was in the surgery being examined in a matter of hours. What they have been doing - as directed by government - has been to move more of the service online, to avoid having a waiting room full of sick people with potential Covid. So now most things start with an e-consult. The problem is that when you have a certain number of appointments, you can manage demand, but you can submit multiple e-consults every day if you wish, and some people apparently do. All of these have to be reviewed and appropriate action taken. All the GPs I know are working flat out and ready to drop (though to be fair we had a major recruitment problem before Covid started). Just because your GP is doing fewer face-to-face consultations, it doesn’t follow that they are out playing golf.

As for whoever mentioned pensions - that gave me a hollow laugh. Medical pensions have been raided and raided and raided. If you retired a few years ago you might be fine, but the final salary schemes have been replaced with career average, the amount senior doctors pay in contributions is by far the highest in the public sector (17.5% currently - MPs exempted themselves from this, naturally), and due to reductions in the annual allowance and tapering over the last few years, many doctors have suddenly been presented with bills for tens of thousands of pounds in tax on income they have never actually received and can’t access until they retire. This has exacerbated staffing shortages, as senior doctors have cut their hours to avoid the risk of such charges, and in a system that depends on a lot of people doing a lot of extra work, that’s disastrous.

I’m not a GP. I’ll even admit to a little occasional schadenfreude at the concept of trying to cope with mushrooming demand (as this is a daily reality in my specialty). But if you genuinely believe that they are all lazy and work-shy, you’re off your head. And the government thinks you are a useful idiot.

Don't think we should conflate NHS medical staff (not the admin, management etc wasters) and GPs.

[dpedin]

And still the hate goes on. Do you not realise this is precisely what the government wants? It wants you so steamed up about the perceived poor service that when they start selling clinical services off to private capital, you’ll cheer and wave them through. But that road does not lead anywhere good. At the very best, you’re looking at compulsory state health insurance (on top of whatever tax you pay now). At worst, you’re looking at co-payments and US-style HMOs. Just like the EU, people won’t appreciate the benefits of the NHS until it’s gone, and then it will be far too late.

The image of the greedy GP who is always on the golf course is still pervasive, I see. Well, I can’t speak for the whole UK, and I’m sure that there are examples of bad practice out there if you look. But I know plenty of GPs around here. They’re not ‘refusing to see patients’ - they’ve been doing face to face consultations the whole time. I can personally attest that when my wife found a breast lump last year she was in the surgery being examined in a matter of hours. What they have been doing - as directed by government - has been to move more of the service online, to avoid having a waiting room full of sick people with potential Covid. So now most things start with an e-consult. The problem is that when you have a certain number of appointments, you can manage demand, but you can submit multiple e-consults every day if you wish, and some people apparently do. All of these have to be reviewed and appropriate action taken. All the GPs I know are working flat out and ready to drop (though to be fair we had a major recruitment problem before Covid started). Just because your GP is doing fewer face-to-face consultations, it doesn’t follow that they are out playing golf.

As for whoever mentioned pensions - that gave me a hollow laugh. Medical pensions have been raided and raided and raided. If you retired a few years ago you might be fine, but the final salary schemes have been replaced with career average, the amount senior doctors pay in contributions is by far the highest in the public sector (17.5% currently - MPs exempted themselves from this, naturally), and due to reductions in the annual allowance and tapering over the last few years, many doctors have suddenly been presented with bills for tens of thousands of pounds in tax on income they have never actually received and can’t access until they retire. This has exacerbated staffing shortages, as senior doctors have cut their hours to avoid the risk of such charges, and in a system that depends on a lot of people doing a lot of extra work, that’s disastrous.

I’m not a GP. I’ll even admit to a little occasional schadenfreude at the concept of trying to cope with mushrooming demand (as this is a daily reality in my specialty). But if you genuinely believe that they are all lazy and work-shy, you’re off your head. And the government thinks you are a useful idiot.

Don't think we should conflate NHS medical staff (not the admin, management etc wasters) and GPs.

About 85% of NHS staff are involved directly in providing care services to patients, including labs, HCSW, medical secretaries, receptionists, etc. The remaining look after buildings, IT, transport catering, cleaning, etc and arguably are also contributing directly to patient care. Managers and admin ie finance, HR etc are a tiny proportion of the overall workforce and even then most are directly involved in healthcare provision, such as managing training programmes for doctors, providing essential training, apprenticeship schemes, etc. We have been here before and gone through all the workforce data that proves this, let's not have to do all that again! I thought we had dispelled all that shite?

GPs are mostly self employed independent practitioners but increasingly more are choosing to be salaried GPs. However of those self employed GPs the vast majority work wholly for the NHS under their GP contract. They work hard providing primary care services. Only a small percentage work privately.

I think most folk know all of this so I am not sure what point you are trying to make?

[JM2K6]

This crap serves one purpose, and one purpose only. It’s running the NHS down in the public eye, to soften up the voters for privatisation.

Go ahead and bookmark this.

GPs are already privatised.

There are aspects of the NHS that are either systemically broken or are failing patients and pretending otherwise is counterproductive.

The ambulance service says hi

Is that not purely a funding issue? Down here it's spread incredibly thinly.

[Jock42]

GPs are already privatised.

There are aspects of the NHS that are either systemically broken or are failing patients and pretending otherwise is counterproductive.

The ambulance service says hi

Is that not purely a funding issue? Down here it's spread incredibly thinly.

Nah its down to a triage system that isn't fit for purpose. The service/SG throwing money at initiatives (mental health cars, SORT) that take paramedics off the front line to do very little (we have firies and squaddies - who can't carry out emergency drives - driving in some areas). An inept management that genuinely want (more) team leaders to sit in an office doing paperwork rather than staffing ambulances/RRUs when we're multiple crews down (I've not seen any managers on the road despite several times in the last week being on the verge of declaring a major incident). An inept management than have no idea who/how to recruit and fucking about with training pathways to a detrimental effect (there's currently no plans for a pathway for technicians who wish to progress to paramedic after next year - new paras will require a degree). The recent demand and capacity review has determined the need for a shit load of extra vehicles (we're going from having between 2 to 4 double crews to having 5 or 6 depending on the time of day), the funding is there but the clinicians aren't. Skiving cunts. Pressuring crews that already have low morale. No form of TRiM. A pathetic excuse for ongoing training (2 to 3 days a year that basically constitutes someone who doesn't work on the road having a discussion with us and not really answering any questions) that is usually the top complaint from crews in annual reviews.

I feel better after that.

[Torquemada 1420]

About 85% of NHS staff are involved directly in providing care services to patients, including labs, HCSW, medical secretaries, receptionists, etc. The remaining look after buildings, IT, transport catering, cleaning, etc and arguably are also contributing directly to patient care. Managers and admin ie finance, HR etc are a tiny proportion of the overall workforce and even then most are directly involved in healthcare provision, such as managing training programmes for doctors, providing essential training, apprenticeship schemes, etc. We have been here before and gone through all the workforce data that proves this, let's not have to do all that again! I thought we had dispelled all that shite?

GPs are mostly self employed independent practitioners but increasingly more are choosing to be salaried GPs. However of those self employed GPs the vast majority work wholly for the NHS under their GP contract. They work hard providing primary care services. Only a small percentage work privately.

I think most folk know all of this so I am not sure what point you are trying to make?

Argue all you like. The NHS is the world's 5th largest employer (and I don't think that even takes in all the outsourcing) behind the US military, the Chinese Army, Scumdonalds and Walmart. Of those numbers, only about half are professionally qualified clinical staff. It has to be the most monumentally mismanaged organisation in the history of human kind. I can't recall which MP when asked "How much money would be needed to fix the NHS" replied "Think of any number and then add zeroes".

Anyway, the point I was making was that clinical staff in the NHS at hospital/care levels generally are doing a good job. GPs are not. I'm sure you think they are on a tough gig at £100k pa average income but some of us disagree.

[dpedin]

About 85% of NHS staff are involved directly in providing care services to patients, including labs, HCSW, medical secretaries, receptionists, etc. The remaining look after buildings, IT, transport catering, cleaning, etc and arguably are also contributing directly to patient care. Managers and admin ie finance, HR etc are a tiny proportion of the overall workforce and even then most are directly involved in healthcare provision, such as managing training programmes for doctors, providing essential training, apprenticeship schemes, etc. We have been here before and gone through all the workforce data that proves this, let's not have to do all that again! I thought we had dispelled all that shite?

GPs are mostly self employed independent practitioners but increasingly more are choosing to be salaried GPs. However of those self employed GPs the vast majority work wholly for the NHS under their GP contract. They work hard providing primary care services. Only a small percentage work privately.

I think most folk know all of this so I am not sure what point you are trying to make?

Argue all you like. The NHS is the world's 5th largest employer (and I don't think that even takes in all the outsourcing) behind the US military, the Chinese Army, Scumdonalds and Walmart. Of those numbers, only about half are professionally qualified clinical staff. It has to be the most monumentally mismanaged organisation in the history of human kind. I can't recall which MP when asked "How much money would be needed to fix the NHS" replied "Think of any number and then add zeroes".

Anyway, the point I was making was that clinical staff in the NHS at hospital/care levels generally are doing a good job. GPs are not. I'm sure you think they are on a tough gig at £100k pa average income but some of us disagree.

[dpedin]

About 85% of NHS staff are involved directly in providing care services to patients, including labs, HCSW, medical secretaries, receptionists, etc. The remaining look after buildings, IT, transport catering, cleaning, etc and arguably are also contributing directly to patient care. Managers and admin ie finance, HR etc are a tiny proportion of the overall workforce and even then most are directly involved in healthcare provision, such as managing training programmes for doctors, providing essential training, apprenticeship schemes, etc. We have been here before and gone through all the workforce data that proves this, let's not have to do all that again! I thought we had dispelled all that shite?

GPs are mostly self employed independent practitioners but increasingly more are choosing to be salaried GPs. However of those self employed GPs the vast majority work wholly for the NHS under their GP contract. They work hard providing primary care services. Only a small percentage work privately.

I think most folk know all of this so I am not sure what point you are trying to make?

Argue all you like. The NHS is the world's 5th largest employer (and I don't think that even takes in all the outsourcing) behind the US military, the Chinese Army, Scumdonalds and Walmart. Of those numbers, only about half are professionally qualified clinical staff. It has to be the most monumentally mismanaged organisation in the history of human kind. I can't recall which MP when asked "How much money would be needed to fix the NHS" replied "Think of any number and then add zeroes".

Anyway, the point I was making was that clinical staff in the NHS at hospital/care levels generally are doing a good job. GPs are not. I'm sure you think they are on a tough gig at £100k pa average income but some of us disagree.

I'm not arguing I'm trying to introduce facts to your rant!

I am not sure what the size of the organisation has to do with it? I have seen numerous examples of 'monumental mismanagement' in almost every industry I have worked in, large and small - oil and gas, manufacturing, retail and civil service.

Yes - I agree that demand for healthcare is probably elastic and will continue to expand as funding increases - for example there is always pressure to do cosmetic type procedures ie varicose veins, breast reduction, loose skin removal, etc This is however a contentious area and dividing line between cosmetic and clinically required is often a debate. However much of the increased demand is because we are getting successful at treatment - for example many more people survive cancer but may end up requiring long term expensive medication or numerous episodes of treatment as their cancer returns and is treated. Many would argue that prevention rather than treatment would be the longer term solution but this would mean increased investment in primary care, public health and GPs!

Far more than 50% of staff are professionally qualified or registered with professional bodies - for example in Scotland - 42% are nurses, 10% are doctors, 8% AHPs, 6% labs and med support staff, 2.5% ambulance staff, 5% are other types of qualified staff - all of these folk are professional and need to be qualified to do their clinical jobs. As I note in previous post many of the admin staff are also directly involved in patient care - med secretaries, patient record staff, outpatient receptionists, ward cleaners and caterers, etc. My 85% of staff who are directly involved in healthcare is indeed accurate.

Of the 15% who are not these guys run hospital facilities, ensure medical gasses are supplied, ensure ambulances are safe and on the road, drive patients about, ensure IT systems which clinical staff use securely, administer training programmes for clinical and non clinical staff, recruit staff safely, run payroll, procure medical supplies, etc. Without all them the NHS grinds to a halt.

The Commonwealth Fund rates healthcare systems performance compared to spend and the UK sits above the average of the 10 developed countries used in the analysis, although not by much - in other words the UK is at least as efficient as the others if not more so.

I am not sure what measures or facts you are using to rate GPs performance other than what you read on the front page of the Daily Heil or the Express?

GPs are paid on national pay scales and those working less hours are paid on a pro rata basis. They will have done a 5+ year undergraduate degree, 2 years foundation training and then 3-4 years GP training and numerous exams throughout this 10+ years to qualify. In Scotland they will each have an average of 6,200 patients on their list. Many will work part time but also undertake other roles such as Forensic Medical Examiners - they are the ones who are called out, usually OOHs, in rape cases and take genital swaps of the victims and the accused. Others will specialise in child abuse cases and have to deal with children who have been sexually or physically abused. Are they worth £100k full time? Others can decide.

Data around patient numbers seen by GPs is difficult to get but patients seen by practices, repeat prescriptions, new prescriptions have all gone up markedly during covid plus you need to add in covid vaccinations and the number of GPs and staff working extra in vaccination centres. Survey data I have seen would suggest practices overall workload has increased by 34% during the pandemic and consultations have gone up by c8% during this period. By necessity they have had to use telephone/video consultations to achieve this. Number of GPs per patient in UK has fallen by 10% over past 5 years due to Gov underfunding.

As I said facts are useful and help support an argument.

[Openside]

I got sent to a patient who was feeling a little under the weather, the GP deemed it too risky for her to attend as the patients wife tested positive on lateral flow. So the GP phoned 999.

This isn't an isolated incident.

That’s utterly spineless

[Torquemada 1420]

I'm not arguing I'm trying to introduce facts to your rant!

I am not sure what the size of the organisation has to do with it? I have seen numerous examples of 'monumental mismanagement' in almost every industry I have worked in, large and small - oil and gas, manufacturing, retail and civil service.

Yes - I agree that demand for healthcare is probably elastic and will continue to expand as funding increases - for example there is always pressure to do cosmetic type procedures ie varicose veins, breast reduction, loose skin removal, etc This is however a contentious area and dividing line between cosmetic and clinically required is often a debate. However much of the increased demand is because we are getting successful at treatment - for example many more people survive cancer but may end up requiring long term expensive medication or numerous episodes of treatment as their cancer returns and is treated. Many would argue that prevention rather than treatment would be the longer term solution but this would mean increased investment in primary care, public health and GPs!

Far more than 50% of staff are professionally qualified or registered with professional bodies - for example in Scotland - 42% are nurses, 10% are doctors, 8% AHPs, 6% labs and med support staff, 2.5% ambulance staff, 5% are other types of qualified staff - all of these folk are professional and need to be qualified to do their clinical jobs. As I note in previous post many of the admin staff are also directly involved in patient care - med secretaries, patient record staff, outpatient receptionists, ward cleaners and caterers, etc. My 85% of staff who are directly involved in healthcare is indeed accurate.

Of the 15% who are not these guys run hospital facilities, ensure medical gasses are supplied, ensure ambulances are safe and on the road, drive patients about, ensure IT systems which clinical staff use securely, administer training programmes for clinical and non clinical staff, recruit staff safely, run payroll, procure medical supplies, etc. Without all them the NHS grinds to a halt.

The Commonwealth Fund rates healthcare systems performance compared to spend and the UK sits above the average of the 10 developed countries used in the analysis, although not by much - in other words the UK is at least as efficient as the others if not more so.

I am not sure what measures or facts you are using to rate GPs performance other than what you read on the front page of the Daily Heil or the Express?

GPs are paid on national pay scales and those working less hours are paid on a pro rata basis. They will have done a 5+ year undergraduate degree, 2 years foundation training and then 3-4 years GP training and numerous exams throughout this 10+ years to qualify. In Scotland they will each have an average of 6,200 patients on their list. Many will work part time but also undertake other roles such as Forensic Medical Examiners - they are the ones who are called out, usually OOHs, in rape cases and take genital swaps of the victims and the accused. Others will specialise in child abuse cases and have to deal with children who have been sexually or physically abused. Are they worth £100k full time? Others can decide.

Data around patient numbers seen by GPs is difficult to get but patients seen by practices, repeat prescriptions, new prescriptions have all gone up markedly during covid plus you need to add in covid vaccinations and the number of GPs and staff working extra in vaccination centres. Survey data I have seen would suggest practices overall workload has increased by 34% during the pandemic and consultations have gone up by c8% during this period. By necessity they have had to use telephone/video consultations to achieve this. Number of GPs per patient in UK has fallen by 10% over past 5 years due to Gov underfunding.

As I said facts are useful and help support an argument.

1) This took a bit of time but
https://digital.nhs.uk/data-and-informa ... april-2021

Professionally qualified clinical staff* Professionally qualified clinical staff make up over half (52.5%) of the FTE HCHS workforce. 627,556 FTE in April 2021. This is 3.5% (21,027) more than in April 2020.
698,750 Headcount in April 2021. This is 3.3% (22,285) more than in April 2020.
* This group includes all HCHS doctors, qualified nurses and health visitors, midwives, qualified scientific, therapeutic and technical staff and qualified ambulance staff.

2) Size of the organisation has plenty to do with it when you account for relative to size of population. I doubt even the most myopic would dare claim (maybe Boris might) that the NHS was the best provider in the world and yet it dwarfs other countries'. Accept that there are other problems too driven by patient size
- unnecessary ops as you alluded to (I'm in the camp of clinical and not cosmetic)
- Brits are now the biggest lard arses in Europe and that brings massive problems (1m hospital admissions last year for obesity related illness?)

But we are straying here from the GP bit. Here's some of my personal experience of GPs in the last few years

A) Try getting an appointment
This part is a joke.
- My practice only permits appointment booking on the morning. Errrrr...... try getting through on the phone. And besides, I work for a living. I am fortunate it's my business so I can go when I like but f**k knows what normal employees do.
- A few years ago my father could not get an appointment with his GP for weeks. In the end he took a taxi down in desperation to reception..... where he promptly had a heart attack. I've kept all the "Please don't sue us letters" that ensued.

In essence, if you have a mild condition, by the time you get to see a GP you will have recovered or it gotten so serious you will have bypassed the surgery and gone direct to hospital. Oh. And one contributor to time wasters blocking A&E is the inability
of some of those people to see a GP.

B) Clinical incompetence
- A very close friend told me last week he has stage 4 cancer. On Friday he had to tell his 13 year old daughter. How did this happen? He spent months going back to his GP with a surface lump on his knee which his GP insisted was a wart and prescribed wart cream for. When my friend demanded he saw a dermatologist, it turned out to be skin squamous cell carcinoma which by now had metastasised.
- My mother had a dry cough for years. Her GP continually prescribed something for acid reflux. Never sent her for cancer checks. In June my mother died suddenly. From IPF. Dry cough is a classic symptom of IPF. The hospital contacted me post death to tell me they felt this was such a serious case of (GP) negligence that they would support us in any action our family took against her practice.
- My mother's partner died 2 years ago from myasthenia gravis. He'd had a drooping left eye for 2-3 years before. His GP passed it off as nothing serious. 1st symptom of myasthenia gravis? Look it up.

And I could go on for pages like this of experiences from friends and family. To be clear, I'm not saying all GPs are like this or even the majority: I don't have enough data for that. But my view is that far too many are Generally Poor.

I will throw in an exception. My father now has a new GP. She is brilliant. She does everything on a practical basis (i.e. puts the patient's health first). She rings me for anything and disregards Data Protection in doing so. If I contact her with a concern
over my father, she will have him in the surgery within a day even if it means shuffling less important cases or working late. She is a saint. But I think she's very likely a minority.

[Paddington Bear]

Think we need to be realistic about the NHS' performance. It's a standing joke in France, Germany, Netherlands etc.

[dpedin]

I'm not arguing I'm trying to introduce facts to your rant!

I am not sure what the size of the organisation has to do with it? I have seen numerous examples of 'monumental mismanagement' in almost every industry I have worked in, large and small - oil and gas, manufacturing, retail and civil service.

Yes - I agree that demand for healthcare is probably elastic and will continue to expand as funding increases - for example there is always pressure to do cosmetic type procedures ie varicose veins, breast reduction, loose skin removal, etc This is however a contentious area and dividing line between cosmetic and clinically required is often a debate. However much of the increased demand is because we are getting successful at treatment - for example many more people survive cancer but may end up requiring long term expensive medication or numerous episodes of treatment as their cancer returns and is treated. Many would argue that prevention rather than treatment would be the longer term solution but this would mean increased investment in primary care, public health and GPs!

Far more than 50% of staff are professionally qualified or registered with professional bodies - for example in Scotland - 42% are nurses, 10% are doctors, 8% AHPs, 6% labs and med support staff, 2.5% ambulance staff, 5% are other types of qualified staff - all of these folk are professional and need to be qualified to do their clinical jobs. As I note in previous post many of the admin staff are also directly involved in patient care - med secretaries, patient record staff, outpatient receptionists, ward cleaners and caterers, etc. My 85% of staff who are directly involved in healthcare is indeed accurate.

Of the 15% who are not these guys run hospital facilities, ensure medical gasses are supplied, ensure ambulances are safe and on the road, drive patients about, ensure IT systems which clinical staff use securely, administer training programmes for clinical and non clinical staff, recruit staff safely, run payroll, procure medical supplies, etc. Without all them the NHS grinds to a halt.

The Commonwealth Fund rates healthcare systems performance compared to spend and the UK sits above the average of the 10 developed countries used in the analysis, although not by much - in other words the UK is at least as efficient as the others if not more so.

I am not sure what measures or facts you are using to rate GPs performance other than what you read on the front page of the Daily Heil or the Express?

GPs are paid on national pay scales and those working less hours are paid on a pro rata basis. They will have done a 5+ year undergraduate degree, 2 years foundation training and then 3-4 years GP training and numerous exams throughout this 10+ years to qualify. In Scotland they will each have an average of 6,200 patients on their list. Many will work part time but also undertake other roles such as Forensic Medical Examiners - they are the ones who are called out, usually OOHs, in rape cases and take genital swaps of the victims and the accused. Others will specialise in child abuse cases and have to deal with children who have been sexually or physically abused. Are they worth £100k full time? Others can decide.

Data around patient numbers seen by GPs is difficult to get but patients seen by practices, repeat prescriptions, new prescriptions have all gone up markedly during covid plus you need to add in covid vaccinations and the number of GPs and staff working extra in vaccination centres. Survey data I have seen would suggest practices overall workload has increased by 34% during the pandemic and consultations have gone up by c8% during this period. By necessity they have had to use telephone/video consultations to achieve this. Number of GPs per patient in UK has fallen by 10% over past 5 years due to Gov underfunding.

As I said facts are useful and help support an argument.

1) This took a bit of time but
https://digital.nhs.uk/data-and-informa ... april-2021

Professionally qualified clinical staff* Professionally qualified clinical staff make up over half (52.5%) of the FTE HCHS workforce. 627,556 FTE in April 2021. This is 3.5% (21,027) more than in April 2020.
698,750 Headcount in April 2021. This is 3.3% (22,285) more than in April 2020.
* This group includes all HCHS doctors, qualified nurses and health visitors, midwives, qualified scientific, therapeutic and technical staff and qualified ambulance staff.

2) Size of the organisation has plenty to do with it when you account for relative to size of population. I doubt even the most myopic would dare claim (maybe Boris might) that the NHS was the best provider in the world and yet it dwarfs other countries'. Accept that there are other problems too driven by patient size
- unnecessary ops as you alluded to (I'm in the camp of clinical and not cosmetic)
- Brits are now the biggest lard arses in Europe and that brings massive problems (1m hospital admissions last year for obesity related illness?)

But we are straying here from the GP bit. Here's some of my personal experience of GPs in the last few years

A) Try getting an appointment
This part is a joke.
- My practice only permits appointment booking on the morning. Errrrr...... try getting through on the phone. And besides, I work for a living. I am fortunate it's my business so I can go when I like but f**k knows what normal employees do.
- A few years ago my father could not get an appointment with his GP for weeks. In the end he took a taxi down in desperation to reception..... where he promptly had a heart attack. I've kept all the "Please don't sue us letters" that ensued.

In essence, if you have a mild condition, by the time you get to see a GP you will have recovered or it gotten so serious you will have bypassed the surgery and gone direct to hospital. Oh. And one contributor to time wasters blocking A&E is the inability
of some of those people to see a GP.

B) Clinical incompetence
- A very close friend told me last week he has stage 4 cancer. On Friday he had to tell his 13 year old daughter. How did this happen? He spent months going back to his GP with a surface lump on his knee which his GP insisted was a wart and prescribed wart cream for. When my friend demanded he saw a dermatologist, it turned out to be skin squamous cell carcinoma which by now had metastasised.
- My mother had a dry cough for years. Her GP continually prescribed something for acid reflux. Never sent her for cancer checks. In June my mother died suddenly. From IPF. Dry cough is a classic symptom of IPF. The hospital contacted me post death to tell me they felt this was such a serious case of (GP) negligence that they would support us in any action our family took against her practice.
- My mother's partner died 2 years ago from myasthenia gravis. He'd had a drooping left eye for 2-3 years before. His GP passed it off as nothing serious. 1st symptom of myasthenia gravis? Look it up.

And I could go on for pages like this of experiences from friends and family. To be clear, I'm not saying all GPs are like this or even the majority: I don't have enough data for that. But my view is that far too many are Generally Poor.

I will throw in an exception. My father now has a new GP. She is brilliant. She does everything on a practical basis (i.e. puts the patient's health first). She rings me for anything and disregards Data Protection in doing so. If I contact her with a concern
over my father, she will have him in the surgery within a day even if it means shuffling less important cases or working late. She is a saint. But I think she's very likely a minority.

I think we are using different definitions! I also include all those staff who need a qualification or registration in order to do their job in the NHS - this includes HCSW, ODPs for example. This group in the spreadsheet - Support to Clinical staff - adds another 341,282 staff to the numbers which equates to c81% of NHS England staff in that data. % is probably higher in England rather than Scotland given they still have remnants of tory Gov internal market fiasco.

I also see from the spreadsheet you link to that managers make up 0.034% of all NHS staff and senior managers account for only 0.01%. Hardly a high number?

Getting an appointment is difficult but do you not think this is due to the lack of GPs and the chronic underfunding of the primary care service? As I said earlier the GP:Patient ratio has got worse not better over the last 5 years, demand far exceeds supply. We need more GPs and a different primary care workforce - more practice/community nurses, physios, pharmacists, OT, etc - but they are also in short supply due to the chronic underfunding bu this Gov over last 10 years.

Personal experience is always a difficult place to generalise from. For every one person who has had a bad experience there will be many others who have had a good experience or vice versa. For example I went and got petrol this morning and there were no problems, no queues hence there is not a petrol shortage in the UK. Why the feck are we bringing the army in?

If you honestly think the majority of our GPs are clinically incompetent then that's your view. I am more confident that the vast majority are competent. I have no doubt that everyone will have an example of a GP getting a diagnosis wrong but that needs to be put into context of all those that they got right. Also medical diagnosis isn't just a science but also depends upon a range of other factors including patients being honest (how many of us lie when the GP asks how many drinks we have per week), actually going to follow ups/tests as requested and doctors trying to piece together a variety of different bits of info. Unfortunately the reality is it is professional judgement in many cases and they get it wrong on occasion hence why there are rigorous audits and mortality and morbidity meetings etc. The days of Shipman have long gone and any unexpected, unexplained deaths or misdiagnosis is followed up in practices and in hospitals. Incompetent doctors are identified and dealt with, however there is always the very odd one who get away with it for too long - Shipman or Patterson for example. Interestingly in the Patterson case it was a the vigilance of a couple of GPs who helped uncover his criminal activities.

The bottom line is all the stick being thrown at GPs in the last few weeks, and the debate on this board, is because the Gov were putting their Health & Care bill through its 2nd reading in the house a week or two ago and is now at Committee stage. They were using their right wing press buddies to whip up a storm about GPs in order to push public opinion against the existing GP service. The bill relaxes procurement processes and will allow private sector onto the new Integrated Care Boards and influence the procurement decisions. Lots of GP practices in England are already owned and run by US private care providers who rip out a tidy profit from them. Unfortunately some folk fall for this hook, line and sinker!

[robmatic]

Getting an appointment is difficult but do you not think this is due to the lack of GPs and the chronic underfunding of the primary care service? As I said earlier the GP:Patient ratio has got worse not better over the last 5 years, demand far exceeds supply. We need more GPs and a different primary care workforce - more practice/community nurses, physios, pharmacists, OT, etc - but they are also in short supply due to the chronic underfunding bu this Gov over last 10 years.

I know everything that is wrong in the country is the fault of the Tories, but getting an appointment was an absolute pain in the arse 10 years ago as well.

[robmatic]

Think we need to be realistic about the NHS' performance. It's a standing joke in France, Germany, Netherlands etc.

There's still a lot to admire about the NHS, but here in Turkey I can at least get an appointment at the neighbourhood health centre without giving myself an aneurysm.

[Paddington Bear]

Think we need to be realistic about the NHS' performance. It's a standing joke in France, Germany, Netherlands etc.

There's still a lot to admire about the NHS, but here in Turkey I can at least get an appointment at the neighbourhood health centre without giving myself an aneurysm.

Yeah 'envy of the world' isn't the first thought that comes into my head as I join a phone queue at 8am in the vague hopes of getting an appointment.

[Calculon]

Think we need to be realistic about the NHS' performance. It's a standing joke in France, Germany, Netherlands etc.

There's still a lot to admire about the NHS, but here in Turkey I can at least get an appointment at the neighbourhood health centre without giving myself an aneurysm.

Yeah 'envy of the world' isn't the first thought that comes into my head as I join a phone queue at 8am in the vague hopes of getting an appointment.

I lived for many years in the UK but since I was healthy and young, for most of those years, I didn't use the NHS. The one time I did try to get an appointment, in 2015, I would have had to wait about 3 weeks. I didn't bother and got some stuff from the pharmacy instead. In contrast, I did use the NHS dentist on a regular basis, a certain Dr Garcia, who was absolutely brilliant. The cost was very reasonable too.

[sockwithaticket]

There's still a lot to admire about the NHS, but here in Turkey I can at least get an appointment at the neighbourhood health centre without giving myself an aneurysm.

Yeah 'envy of the world' isn't the first thought that comes into my head as I join a phone queue at 8am in the vague hopes of getting an appointment.

I lived for many years in the UK but since I was healthy and young, for most of those years, I didn't use the NHS. The one time I did try to get an appointment, in 2015, I would have had to wait about 3 weeks. I didn't bother and got some stuff from the pharmacy instead. In contrast, I did use the NHS dentist on a regular basis, a certain Dr Garcia, who was absolutely brilliant. The cost was very reasonable too.

I've needed to see a doctor once in the last 14 years or so. I woke up incredibly disoriented one day, kept falling over when trying to even stand still. With these as my symptoms they insisted I come to the health centre rather than anyone come to see me. £40 on taxis as I was living alone at the time. They sorted me out readily enough, it was a minor thing with dramatic symptoms, but it felt like process was dominating common sense.

[Dinsdale Piranha]

Yeah 'envy of the world' isn't the first thought that comes into my head as I join a phone queue at 8am in the vague hopes of getting an appointment.

I lived for many years in the UK but since I was healthy and young, for most of those years, I didn't use the NHS. The one time I did try to get an appointment, in 2015, I would have had to wait about 3 weeks. I didn't bother and got some stuff from the pharmacy instead. In contrast, I did use the NHS dentist on a regular basis, a certain Dr Garcia, who was absolutely brilliant. The cost was very reasonable too.

I've needed to see a doctor once in the last 14 years or so. I woke up incredibly disoriented one day, kept falling over when trying to even stand still. With these as my symptoms they insisted I come to the health centre rather than anyone come to see me. £40 on taxis as I was living alone at the time. They sorted me out readily enough, it was a minor thing with dramatic symptoms, but it felt like process was dominating common sense.

I guess I need to see a doc about once a year. To get an appointment I turn up at the surgery about 20 mins after it opens. I'll generally have an appointment within the next couple of hours as I've bypassed the 'phone queue.

The NHS is a government department therefore impressively bureaucratic. It's not organised for your convenience but for theirs. Once you accept this you can start making the system work for you (mostly this means kicking up a fuss)

I have various friends and family who have had to make extensive use of the NHS over the years. Results have been mixed, varying from high quality, life saving expensive treatment to lying about mistakes for 2 years and everything in between.

[JM2K6]

The ambulance service says hi

Is that not purely a funding issue? Down here it's spread incredibly thinly.

Nah its down to a triage system that isn't fit for purpose. The service/SG throwing money at initiatives (mental health cars, SORT) that take paramedics off the front line to do very little (we have firies and squaddies - who can't carry out emergency drives - driving in some areas). An inept management that genuinely want (more) team leaders to sit in an office doing paperwork rather than staffing ambulances/RRUs when we're multiple crews down (I've not seen any managers on the road despite several times in the last week being on the verge of declaring a major incident). An inept management than have no idea who/how to recruit and fucking about with training pathways to a detrimental effect (there's currently no plans for a pathway for technicians who wish to progress to paramedic after next year - new paras will require a degree). The recent demand and capacity review has determined the need for a shit load of extra vehicles (we're going from having between 2 to 4 double crews to having 5 or 6 depending on the time of day), the funding is there but the clinicians aren't. Skiving cunts. Pressuring crews that already have low morale. No form of TRiM. A pathetic excuse for ongoing training (2 to 3 days a year that basically constitutes someone who doesn't work on the road having a discussion with us and not really answering any questions) that is usually the top complaint from crews in annual reviews.

I feel better after that.

Cheers, v useful info! Only reason I mentioned being spread thin just because after my niece had a seizure the other day, my sis was told to take her to hospital herself as it'd be >2hrs for an ambulance, and apparently it's one service covering Sussex, Kent, and Surrey(!)

[Torquemada 1420]

I think we are using different definitions! I also include all those staff who need a qualification or registration in order to do their job in the NHS - this includes HCSW, ODPs for example. This group in the spreadsheet - Support to Clinical staff - adds another 341,282 staff to the numbers which equates to c81% of NHS England staff in that data. % is probably higher in England rather than Scotland given they still have remnants of tory Gov internal market fiasco.

I also see from the spreadsheet you link to that managers make up 0.034% of all NHS staff and senior managers account for only 0.01%. Hardly a high number?

Getting an appointment is difficult but do you not think this is due to the lack of GPs and the chronic underfunding of the primary care service? As I said earlier the GP:Patient ratio has got worse not better over the last 5 years, demand far exceeds supply. We need more GPs and a different primary care workforce - more practice/community nurses, physios, pharmacists, OT, etc - but they are also in short supply due to the chronic underfunding bu this Gov over last 10 years.

Personal experience is always a difficult place to generalise from. For every one person who has had a bad experience there will be many others who have had a good experience or vice versa. For example I went and got petrol this morning and there were no problems, no queues hence there is not a petrol shortage in the UK. Why the feck are we bringing the army in?

If you honestly think the majority of our GPs are clinically incompetent then that's your view. I am more confident that the vast majority are competent. I have no doubt that everyone will have an example of a GP getting a diagnosis wrong but that needs to be put into context of all those that they got right. Also medical diagnosis isn't just a science but also depends upon a range of other factors including patients being honest (how many of us lie when the GP asks how many drinks we have per week), actually going to follow ups/tests as requested and doctors trying to piece together a variety of different bits of info. Unfortunately the reality is it is professional judgement in many cases and they get it wrong on occasion hence why there are rigorous audits and mortality and morbidity meetings etc. The days of Shipman have long gone and any unexpected, unexplained deaths or misdiagnosis is followed up in practices and in hospitals. Incompetent doctors are identified and dealt with, however there is always the very odd one who get away with it for too long - Shipman or Patterson for example. Interestingly in the Patterson case it was a the vigilance of a couple of GPs who helped uncover his criminal activities.

The bottom line is all the stick being thrown at GPs in the last few weeks, and the debate on this board, is because the Gov were putting their Health & Care bill through its 2nd reading in the house a week or two ago and is now at Committee stage. They were using their right wing press buddies to whip up a storm about GPs in order to push public opinion against the existing GP service. The bill relaxes procurement processes and will allow private sector onto the new Integrated Care Boards and influence the procurement decisions. Lots of GP practices in England are already owned and run by US private care providers who rip out a tidy profit from them. Unfortunately some folk fall for this hook, line and sinker!

We can park up the disagreement over qualifications because we won't agree but needing a qualification or registration in order to do their job in the NHS is not the same as being part of medical services. By that definition, a CV would count as a qualification!

I did not state the majority of GPs were incompetent (although I don't rule it out): just that there were too many who were lazy, disinterested or actually medically incompetent. Yup: personal experience is just that but I did say I could go on for hours in regards similar sh*t for friends and relatives:
- I'll spare you the misogynist GP who effectively killed one friend by ignoring her cancer symptoms (she was in remission from breast cancer spot on 5 years previous) and insisted it was all psychosomatic. Turned out he'd done the same to a number of other women (seems one family went the whole mile down the complaint route). Ironically the bastard died of cancer himself before he got to see the results of the enquiry.
- My close friend who I have to take to Addenbrookes for her 6 monthly check-ups (she is not allowed to drive now) who spent 3 years complaining to her GP of increasing headaches and flashes in her vision before the 1st scan she was submitted for uncovered a now incurable brain tumour.
- Similarly, my mother's neighbour having severe headaches for nearly 2 years being told they were migraines. Ironically she was a nurse and when she collapsed on duty at the hospital, she was immediately scanned to find a brain tumour the size of a small orange.
- My friend's father who went to his GP to be told he may have had a heart attack and should drive (yes: drive himself FFS. They did not call an ambulance) to the hospital asap.

[Happyhooker]

I think we are using different definitions! I also include all those staff who need a qualification or registration in order to do their job in the NHS - this includes HCSW, ODPs for example. This group in the spreadsheet - Support to Clinical staff - adds another 341,282 staff to the numbers which equates to c81% of NHS England staff in that data. % is probably higher in England rather than Scotland given they still have remnants of tory Gov internal market fiasco.

I also see from the spreadsheet you link to that managers make up 0.034% of all NHS staff and senior managers account for only 0.01%. Hardly a high number?

Getting an appointment is difficult but do you not think this is due to the lack of GPs and the chronic underfunding of the primary care service? As I said earlier the GP:Patient ratio has got worse not better over the last 5 years, demand far exceeds supply. We need more GPs and a different primary care workforce - more practice/community nurses, physios, pharmacists, OT, etc - but they are also in short supply due to the chronic underfunding bu this Gov over last 10 years.

Personal experience is always a difficult place to generalise from. For every one person who has had a bad experience there will be many others who have had a good experience or vice versa. For example I went and got petrol this morning and there were no problems, no queues hence there is not a petrol shortage in the UK. Why the feck are we bringing the army in?

If you honestly think the majority of our GPs are clinically incompetent then that's your view. I am more confident that the vast majority are competent. I have no doubt that everyone will have an example of a GP getting a diagnosis wrong but that needs to be put into context of all those that they got right. Also medical diagnosis isn't just a science but also depends upon a range of other factors including patients being honest (how many of us lie when the GP asks how many drinks we have per week), actually going to follow ups/tests as requested and doctors trying to piece together a variety of different bits of info. Unfortunately the reality is it is professional judgement in many cases and they get it wrong on occasion hence why there are rigorous audits and mortality and morbidity meetings etc. The days of Shipman have long gone and any unexpected, unexplained deaths or misdiagnosis is followed up in practices and in hospitals. Incompetent doctors are identified and dealt with, however there is always the very odd one who get away with it for too long - Shipman or Patterson for example. Interestingly in the Patterson case it was a the vigilance of a couple of GPs who helped uncover his criminal activities.

The bottom line is all the stick being thrown at GPs in the last few weeks, and the debate on this board, is because the Gov were putting their Health & Care bill through its 2nd reading in the house a week or two ago and is now at Committee stage. They were using their right wing press buddies to whip up a storm about GPs in order to push public opinion against the existing GP service. The bill relaxes procurement processes and will allow private sector onto the new Integrated Care Boards and influence the procurement decisions. Lots of GP practices in England are already owned and run by US private care providers who rip out a tidy profit from them. Unfortunately some folk fall for this hook, line and sinker!

We can park up the disagreement over qualifications because we won't agree but needing a qualification or registration in order to do their job in the NHS is not the same as being part of medical services. By that definition, a CV would count as a qualification!

I did not state the majority of GPs were incompetent (although I don't rule it out): just that there were too many who were lazy, disinterested or actually medically incompetent. Yup: personal experience is just that but I did say I could go on for hours in regards similar sh*t for friends and relatives:
- I'll spare you the misogynist GP who effectively killed one friend by ignoring her cancer symptoms (she was in remission from breast cancer spot on 5 years previous) and insisted it was all psychosomatic. Turned out he'd done the same to a number of other women (seems one family went the whole mile down the complaint route). Ironically the bastard died of cancer himself before he got to see the results of the enquiry.
- My close friend who I have to take to Addenbrookes for her 6 monthly check-ups (she is not allowed to drive now) who spent 3 years complaining to her GP of increasing headaches and flashes in her vision before the 1st scan she was submitted for uncovered a now incurable brain tumour.
- Similarly, my mother's neighbour having severe headaches for nearly 2 years being told they were migraines. Ironically she was a nurse and when she collapsed on duty at the hospital, she was immediately scanned to find a brain tumour the size of a small orange.
- My friend's father who went to his GP to be told he may have had a heart attack and should drive (yes: drive himself FFS. They did not call an ambulance) to the hospital asap.

Jesus lads, if you only take one thing from this thread, make it this; don't be friends with torq

[shaggy]

Is that not purely a funding issue? Down here it's spread incredibly thinly.

Nah its down to a triage system that isn't fit for purpose. The service/SG throwing money at initiatives (mental health cars, SORT) that take paramedics off the front line to do very little (we have firies and squaddies - who can't carry out emergency drives - driving in some areas). An inept management that genuinely want (more) team leaders to sit in an office doing paperwork rather than staffing ambulances/RRUs when we're multiple crews down (I've not seen any managers on the road despite several times in the last week being on the verge of declaring a major incident). An inept management than have no idea who/how to recruit and fucking about with training pathways to a detrimental effect (there's currently no plans for a pathway for technicians who wish to progress to paramedic after next year - new paras will require a degree). The recent demand and capacity review has determined the need for a shit load of extra vehicles (we're going from having between 2 to 4 double crews to having 5 or 6 depending on the time of day), the funding is there but the clinicians aren't. Skiving cunts. Pressuring crews that already have low morale. No form of TRiM. A pathetic excuse for ongoing training (2 to 3 days a year that basically constitutes someone who doesn't work on the road having a discussion with us and not really answering any questions) that is usually the top complaint from crews in annual reviews.

I feel better after that.

Cheers, v useful info! Only reason I mentioned being spread thin just because after my niece had a seizure the other day, my sis was told to take her to hospital herself as it'd be >2hrs for an ambulance, and apparently it's one service covering Sussex, Kent, and Surrey(!)

However poor your view of the NHS is it pales into insignificance with Pharmacies.

How can they take an electronic prescription and turn the simple task of trying to collect (& pay) into a process whereby they break it down into multiple person and paper oriented tasks with a filing system from the 18th century that takes on average 30 minutes to be carried out only to be told the prescription is incomplete despite the SMS system informing you it is ready to collect. And then when you do open it you find they have ‘substituted’ some items or just have got it plain wrong.

[Jock42]

Cheers, v useful info! Only reason I mentioned being spread thin just because after my niece had a seizure the other day, my sis was told to take her to hospital herself as it'd be >2hrs for an ambulance, and apparently it's one service covering Sussex, Kent, and Surrey(!)

My English geography isn't great but I'd imagine SEAC cover more than that. I think there's 6 ambulance trusts in England.

I know a lot of the complaints are similar but I can't comment on the funding. One of the main reasons there's such long delays is the wait at hospital. It hasn't really been an issue up here until fairly recently but there are waits of several hours to handover and often patients have to wait in the ambulance (thankfully my nearest receiving hospital is usually good and we don't wait outside). I was sat outside the hospital in Kircaldy for 2 hours and I can bet it won't count as a breach I waiting times!

Hope your niece is doing well. Shite situation to be put in.

[Torquemada 1420]

Jesus lads, if you only take one thing from this thread, make it this; don't be friends with torq

PS Hope your own travails are on the way out now.

[dpedin]

Nah its down to a triage system that isn't fit for purpose. The service/SG throwing money at initiatives (mental health cars, SORT) that take paramedics off the front line to do very little (we have firies and squaddies - who can't carry out emergency drives - driving in some areas). An inept management that genuinely want (more) team leaders to sit in an office doing paperwork rather than staffing ambulances/RRUs when we're multiple crews down (I've not seen any managers on the road despite several times in the last week being on the verge of declaring a major incident). An inept management than have no idea who/how to recruit and fucking about with training pathways to a detrimental effect (there's currently no plans for a pathway for technicians who wish to progress to paramedic after next year - new paras will require a degree). The recent demand and capacity review has determined the need for a shit load of extra vehicles (we're going from having between 2 to 4 double crews to having 5 or 6 depending on the time of day), the funding is there but the clinicians aren't. Skiving cunts. Pressuring crews that already have low morale. No form of TRiM. A pathetic excuse for ongoing training (2 to 3 days a year that basically constitutes someone who doesn't work on the road having a discussion with us and not really answering any questions) that is usually the top complaint from crews in annual reviews.

I feel better after that.

Cheers, v useful info! Only reason I mentioned being spread thin just because after my niece had a seizure the other day, my sis was told to take her to hospital herself as it'd be >2hrs for an ambulance, and apparently it's one service covering Sussex, Kent, and Surrey(!)

However poor your view of the NHS is it pales into insignificance with Pharmacies.

How can they take an electronic prescription and turn the simple task of trying to collect (& pay) into a process whereby they break it down into multiple person and paper oriented tasks with a filing system from the 18th century that takes on average 30 minutes to be carried out only to be told the prescription is incomplete despite the SMS system informing you it is ready to collect. And then when you do open it you find they have ‘substituted’ some items or just have got it plain wrong.

My personal experience of pharmacy differs you will be surprised to know! I order prescriptions on line from GP Surgery, it is then sent to local Pharmacy and I get text to say ready for collection with code so I can use the 24 hour automated 'hole in the wall' to collect. Usually takes about 48 hours max and so far no problems. Did it last week for a couple of items and no problem. It may be different if a medication isn't available but so far this hasn't been an issue. Of course in Scotland we don't pay for prescriptions so no financial transaction required.

[Torquemada 1420]

[Yr Alban]

Think we need to be realistic about the NHS' performance. It's a standing joke in France, Germany, Netherlands etc.

For what reason? If it’s waiting times for non-emergency problems, fair enough, but if it’s anything else then the criticism is unjustified. NHS emergency care is as good as it is anywhere else.

A couple of things from elsewhere in the thread:

Shipman was not an incompetent doctor. He was a psychopath. The patients he didn’t kill actually thought he was a good GP. He certainly wouldn’t have had any difficulty passing the ham-fisted revalidation system that was foisted on doctors after his trial (and for which we were forced to pay, by means of a four-fold increase in the GMC fee we have to pay in order to work).

Getting a GP appointment has indeed been a bloody nightmare for years. But why do you think surgeries will only give out appointments on the day? It’s because of government edicts that force them to provide a certain number of same-day appointments.

The NHS is often described as one of the largest employers in the world, but that’s been a bit of a myth for years now. Firstly, there are now four separate NHSes which do not work together. Secondly, the advent of trusts (health boards in Wales now) made single hospitals or small groups essentially self-governing.

It’s also worth pointing out that there is a vast amount of confirmation bias in stories about incompetent GPs. GPs carry out something like 90% of patient contacts in the NHS - about 300m of them every year. Everyone remembers the ones that went wrong, but nobody remembers the ones that didn’t, which represent the vast majority. I couldn’t be a GP. Various reasons, but one major one is that it’s their job to pick out the one person who is properly sick from hundreds of people who aren’t, and they are hideously exposed if they get it wrong. I am a generalist too, but at least I only have to determine whether people need to be in hospital or not, which is considerably easier.

[Torquemada 1420]

Firstly, there are now four separate NHSes which do not work together.

[Sandstorm]