The Shape of Things to Come

[Gaz]

It isn't extra payment, it is the payment. From what I understand, healthy patients earn the doctor a per capita payment. Patients on health registers have to have certain tests done, and if the targets aren't met then the doctors don't get paid.

spot on, they took funding away and introduced evidence based targets based on NICE advice which must be met to achieve the same income level (which has reduced over the years since introduced)

 

[Mercia Blackcat]

that sounds like a shit surgery tbh which you can get, in fact it sounds quite shocking. I’d complain and consider moving Surgery. Hope your wife gets the care she deserves.

Your son isn’t the type of patient to target for pain meds either, its the longstanding high usage or those abusing it that should be looked at not someone taking it occasionally for pain

To be fair, they had the greatest GP I have known in my entire life but he left for Australia just before the pandemic began and it has been shit since. He was Vietnamese but like a family GP from the 1950s. They do have a female GP who is also Vietnamese that I have great respect for but the rest are a waste of space. Maybe that is the solution, more Vietnamese doctors, they really do seem to care about you.

I wrote to them when my wife first started having fits and that did shit them out but this is the last straw we are moving GPs in the coming week. I will probably write to them on my son's behalf this week and remind them of their duty of care.

 

[Gaz]

Which is what I said before. If the targets aren’t met then the doctor doesn’t get paid, and so sick people who need to see a doctor can’t get near because doctors are ticking boxes to meet targets.


Chance would be a fine thing.

they aren’t ticking boxes, most of the targets are for patients who are / were already taking up a high % of resource. So by meeting targets they are better controlled meaning more GP time is available for routine appointments

 

[peachy]

spot on, they took funding away and introduced evidence based targets based on NICE advice which must be met to achieve the same income level (which has reduced over the years since introduced)

GP budgets are so tight.

They might be making patients healthier by insisting on tests etc but cuts are being made elsewhere which leads to overloads of work and errors.

 

[Gaz]

To be fair, they had the greatest GP I have known in my entire life but he left for Australia just before the pandemic began and it has been shit since. He was Vietnamese but like a family GP from the 1950s. They do have a female GP who is also Vietnamese that I have great respect for but the rest are a waste of space. Maybe that is the solution, more Vietnamese doctors, they really do seem to care about you.

I wrote to them when my wife first started having fits and that did shit them out but this is the last straw we are moving GPs in the coming week.

Too many of the good GP’s are moving to other countries, its frustrating as hell for Practices. A sign of the NHS in this country unfortunately.

Hope you find a better Practice and get your Wife’s care sorted

GP budgets are so tight.

They might be making patients healthier by insisting on tests etc but cuts are being made elsewhere which leads to overloads of work and errors.

The last Practice i was involved with, the Partners were earning less than newly qualified salaried GP’s and locum’s. Earning significantly less, but having to do significantly more. Something has to give at some point

 

[Sir Lancelot]

they aren’t ticking boxes, most of the targets are for patients who are / were already taking up a high % of resource. So by meeting targets they are better controlled meaning more GP time is available for routine appointments

Nonsense. If it wasn’t for the constant checks and reviews forced on me the only care that i would need is my prescription once a month. Five minutes to tick a box, print out and sign and job done. I can’t remember the last time that I actually made an appointment of my own volition other than to try to see a GP to reverse medication changes forced on me by an anonymous voice on the telephone.

 

[Sam Handwich]

I am all in favour of local medical centres offering a wide range of services as they do now but I would aim towards developing AI as an alternative to GPs. If you are to told that your illness is terminal a specialist councillor could provide care rather than a GP to break the news.

Three close people to me have died during the pandemic but none for coronavirus. One an old friend of 50 years died as a result of COPD. She was 61. A nephew died who was severally disabled, he was 54 and recently my brother in law died of cancer at the age of 60. He was in remission from cancer but went to his GP just before Christmas who told him that he didn't think it was cancer returning but they would send him for a chest x-ray in a couple of months at Wolverhampton Hospital. Two weeks later he was dead.

People are dying and all my GPs are bothered about is ringing people to hassle them over codeine. I suppose targets must be met for the returns.

An awful time for you. My condolences.

 

[Gaz]

Nonsense. If it wasn’t for the constant checks and reviews forced on me the only care that i would need is my prescription once a month. Five minutes to tick a box, print out and sign and job done. I can’t remember the last time that I actually made an appointment of my own volition other than to try to see a GP to reverse medication changes forced on me by an anonymous voice on the telephone.

Have you actually worked in Primary Care or the NHS?

Those checks and reviews will be linked to your condition and/or medication, or the GP feels you need them or they are following NICE guidance.

It isn’t 5 mins to print and sign medication, the GP is liable and responsible for giving you it as well as being liable and responsible should things go wrong. What do you think happens if the GP has continued to issue meds to you without doing recommended monitoring because you don’t fancy it?

 

[Mercia Blackcat]

Nonsense. If it wasn’t for the constant checks and reviews forced on me the only care that i would need is my prescription once a month. Five minutes to tick a box, print out and sign and job done. I can’t remember the last time that I actually made an appointment of my own volition other than to try to see a GP to reverse medication changes forced on me by an anonymous voice on the telephone.

My wife has had several conditions for 24 years now, fibromyalgia, osteoporosis, asthma, suppressed adrenal and thyroid glands among them. She had been monitored by a hospital consultant for 12 years when we moved this area 12 years ago and the first thing they said was that she didn't need a consultant anymore. We had doubts from the start but the Vietnamese GP was so good that we stayed with them. Last year the neurologist who wrote to them expressed concern at the large amount of sedative medication she was on, 150 mg amitriptyline and 200 mg of morphine sulphate (twice a day). She reduced the amitriptyline of her own volition to 50 mg (the correct dose for neuropathic pain) so then she approached the surgery to begin lowering the morphine. On the phone the GP suggested reducing the morphine by 50 mg each dose (100 mg a day). The recommended reduction is 10% at a time. When she expressed concern he said "Well we have to start somewhere". So they got a letter. I reminded them that the NHS had put my wife on that dosage for 23 years and so had a duty of care to ensure that its reduction was done as humanely as possible. The issue was handed over to the pharmacist who had a much greater understanding. Monitoring the frequency of the fits they have increased as the morphine is reduce and they have been told but they couldn't give a flying fuck. I am talking from 24 years of being a carer for someone seriously ill but the problem is doctors have read books and think they know it all.

 

[Gaggoears]

Have you actually worked in Primary Care or the NHS?

Those checks and reviews will be linked to your condition and/or medication, or the GP feels you need them or they are following NICE guidance.

It isn’t 5 mins to print and sign medication, the GP is liable and responsible for giving you it as well as being liable and responsible should things go wrong. What do you think happens if the GP has continued to issue meds to you without doing recommended monitoring because you don’t fancy it?

I'm supposed to be monitored and have not hear a peep.
Spoke to my doctor in October about blood test due for diabetes and immune disorder and have heard nowt, prescriptions ok though.

My wife has had several conditions for 24 years now, fibromyalgia, osteoporosis, asthma, suppressed adrenal and thyroid glands among them. She had been monitored by a hospital consultant for 12 years when we moved this area 12 years ago and the first thing they said was that she didn't need a consultant anymore. We had doubts from the start but the Vietnamese GP was so good that we stayed with them. Last year the neurologist who wrote to them last year expressed concern at the large amount of sedative medication she was on, 150 mg amitriptyline and 200 mg of morphine sulphate (twice a day). She reduced the amitriptyline of her own volition to 50 mg (the correct dose for neuropathic pain) so when the approached the surgery to begin lowering the morphine. On the phone the GP suggested reducing the morphine by 50 mg each dose (100 mg a day). The recommended reduction is 10% at a time. When she expressed concern he said "Well we have to start somewhere". So they got a letter. I reminded them that the NHS had put my wife on that dosage for 23 years and so had a duty of care to ensure that its reduction was done as humanely as possible. The issue was handed over to the pharmacist who had a much greater understanding. Monitoring the frequency of the fits they have increased as the morphine is reduce and they have been told but they couldn't give a flying fuck. I am talking from 24 years of being a carer for someone seriously ill but the problem is doctors have read books and think they know it all.

Sad to hear about your situation, can only wish you well.

 

[Gaz]

I'm supposed to be monitored and have not hear a peep.
Spoke to my doctor in October about blood test due for diabetes and immune disorder and have heard nowt, prescriptions ok though.

Doesn’t sound good, i know our GP’s are still doing routine reviews etc.

 

[Sir Lancelot]

Doesn’t sound good, i know our GP’s are still doing routine reviews etc.

Those ‘routine’ checks are being done at the expense of seeing patients who have current problems. I could understand it better if doctors were actually doing those routine checks themselves, but they aren’t, they are delegated to non medical staff. Which leaves the question what are GPs actually doing?

If I were the only person claiming it was impossible to get an appointment to see a GP then I would agree that I was being impatient, but I’m not. Thousands of people are saying the same thing.

Maybe the whole system of primary care needs to be revisited and we need to see if GPs are actually the right people to be holding the purse strings anymore.

 

[Mercia Blackcat]

I'm supposed to be monitored and have not hear a peep.
Spoke to my doctor in October about blood test due for diabetes and immune disorder and have heard nowt, prescriptions ok though.

Sad to hear about your situation, can only wish you well.

Thanks but when you live in a bubble as we have for so long doctors become an irritation at times rather than a help. What I find frustrating is that I have my own health conditions and have been prescribed 120 mg of codeine a day for ten years for arthritis in my neck. It has never been challenged by GPs yet my son who was occasionally prescribed co-codamol for the post shingles neuralgia in his head has had his treatment stopped. It just don't make sense. Although I expect they will get round to me and suggest I use paracetamol instead.

 

[Gaggoears]

Doesn’t sound good, i know our GP’s are still doing routine reviews etc.

I have given up as so many are in more urgent need, it's a very messy time for them and us and my sympathy is with cancer patients as it must be terrifying.

 

[Mercia Blackcat]

Those ‘routine’ checks are being done at the expense of seeing patients who have current problems. I could understand it better if doctors were actually doing those routine checks themselves, but they aren’t, they are delegated to non medical staff. Which leaves the question what are GPs actually doing?

If I were the only person claiming it was impossible to get an appointment to see a GP then I would agree that I was being impatient, but I’m not. Thousands of people are saying the same thing.

Maybe the whole system of primary care needs to be revisited and we need to see if GPs are actually the right people to be holding the purse strings anymore.

I totally agree and that is why I am beginning to think AI would be more effective and to be honest more humane at times. Never thought the day would come when I said that.

I have given up as so many are in more urgent need, it's a very messy time for them and us and my sympathy is with cancer patients as it must be terrifying.

Same here as I am waiting for a blood test for IHD. When I rang last week the surgery told me to wait a few more weeks as I had shingles for three weeks and could infect someone even though I was getting much better. I didn't think I could infect someone with shingles but if they haven't had chickenpox...although I was probably past the infectious state anyway. They are so f***ing paranoid.
Don't worry about having a heart attack...just come near us with you shingles.
PS ...don't come near us that should read.
I know a young nurse with children that works on the covid war at Coventry Walsgrave hospital and I know what a hell of a time her and her colleagues have had, heroic. Then there are others who have gone invisible.

 

[Gaz]

Those ‘routine’ checks are being done at the expense of seeing patients who have current problems. I could understand it better if doctors were actually doing those routine checks themselves, but they aren’t, they are delegated to non medical staff. Which leaves the question what are GPs actually doing?

If I were the only person claiming it was impossible to get an appointment to see a GP then I would agree that I was being impatient, but I’m not. Thousands of people are saying the same thing.

Maybe the whole system of primary care needs to be revisited and we need to see if GPs are actually the right people to be holding the purse strings anymore.

I’ll tell you what my local GP did on a typical day last week as i was working with her on Friday and we were looking at an audit she had to do. Might surprise you seeing as you think they aren’t doing much.

dealt with approx 30 blood / pathology results, dealt with over 50 script requests / med reviews, dealt with 10+ hospital letters for patients, seen 5 or 6 patients, approx. 10 telephone triages, several online consultations, 1 video consult, 2 home visits, i palliative care visit, 1 death certification, 1 PCN meeting re covid vaccs, 2 hrs in out of hours hub after 6pm

The routine checks are being done in addition to day to day appointments, the most relevant staff member will deal with it - thats sensible, why would you want a GP doing bloods or BP monitoring when they could be dealing with cancer/palliative/Mental Health patients?

GP’s don’t hold the purse strings anyway. They are accountable to the CCG’s by default. Maybe if we didn’t have a national shortage of GP’s and Nurses due to government incompetence over last 20 years then Practices would have enough staff needed, but they don’t so do the best they can

even then, its down to each individual Practice to offer whats needed. My personal experience is i’ve had at least 10 appointments face to face in last 12 months, as well as several telephone appointments. My family have several telephone, Nurse and 2 video consults too. None of us have had an issue, obviously some Practices aren’t as good as others but they should all be providing a routine service at some level

I totally agree and that is why I am beginning to think AI would be more effective and to be honest more humane at times. Never thought the day would come when I said that.


Same here as I am waiting for a blood test for IHD. When I rang last week the surgery told me to wait a few more weeks as I had shingles for three weeks and could infect someone even though I was getting much better. I didn't think I could infect someone with shingles but if they haven't had chickenpox...although I was probably past the infectious state anyway. They are so f***ing paranoid.
Don't worry about having a heart attack...just come near us with you shingles.
PS ...don't come near us that should read.
I know a young nurse with children that works on the covid war at Coventry Walsgrave hospital and I know what a hell of a time her and her colleagues have had, heroic. Then there are others who have gone invisible.

From everything you’ve said i’d defo be looking for a new Practice

 

[Mercia Blackcat]

I’ll tell you what my local GP did on a typical day last week as i was working with her on Friday and we were looking at an audit she had to do. Might surprise you seeing as you think they aren’t doing much.

dealt with approx 30 blood / pathology results, dealt with over 50 script requests / med reviews, dealt with 10+ hospital letters for patients, seen 5 or 6 patients, approx. 10 telephone triages, several online consultations, 1 video consult, 2 home visits, i palliative care visit, 1 death certification, 1 PCN meeting re covid vaccs, 2 hrs in out of hours hub after 6pm

Home visits? I must be in another country. The last time I managed to get a doctor to come to the house was 21 years ago. I must admit to having doubts regarding phone triage. My daughter called the out of hours service where she lived and it was a private company handling the triage on the phone. The doctor told my daughter to bedrest and she died before morning due to pneumonia. Although the doctor did admit openly at the inquest that she had failed in her duty of care despite warnings from the coroner she could incriminate herself by doing so. She was a young doctor and so honest. I thanked her afterwards for her honesty and wished her well. I am sure she has gone on to save many lives.
I have to be honest and say the team of barristers I was up against were a waste of money and that could be the only reason they turned up...for the cash. Bizarre what you are up against in what is supposed to be a non adversarial inquest.

 

[Gaz]

Home visits? I must be in another country. The last time I managed to get a doctor to come to the house was 21 years ago. I must admit to having doubts regarding phone triage. My daughter called the out of hours service where she lived and it was a private company handling the triage on the phone. The doctor told my daughter to bedrest and she died before morning due to pneumonia. Although the doctor did admit openly at the inquest that she had failed in her duty of care despite warnings from the coroner she could incriminate herself by doing so. She was a young doctor and so honest. I thanked her afterwards for her honesty and wished her well. I am sure she has gone on to save many lives.
I have to be honest and say the team of barristers I was up against were a waste of money and that could be the only reason they turned up...for the cash. Bizarre what you are up against in what is supposed to be a non adversarial inquest.

Sorry about your Daughter, sounds horrific.

I suppose different areas might work differently, but up here they still do home / care home visits (albeit less with covid) and their own triages during Practice hours. 111 take calls / triage out of hours

 

[Mercia Blackcat]

Sorry about your Daughter, sounds horrific.

I suppose different areas might work differently, but up here they still do home / care home visits (albeit less with covid) and their own triages during Practice hours. 111 take calls / triage out of hours

Phone triages are great for routine issues as I have myself experienced at times but there is an inherent weakness in the method when dealing with vulnerable patients and/or more serious issues. We are all human and doctors make mistakes but I can't avoid analysing methods, procedures and systems. Just a side effect of my own previous jobs.
My daughter lived in Nuneaton at the time and her GPs had handed over out-of-hours to a private company. At the inquest all the company barristers did was remind the coroner that the doctor was self-employed to which he got a bit pissed off with to be honest. I saw fault in their system which fed incorrect information to the doctor and needed a fudge to get around by the call handler. They had been ripped off in my opinion as the system was essentially basic and would never have been accepted by myself or anyone else at Rolls Royce. Still, that's the nature of the beast.
I felt as if I was the doctors own defence.

 

[Harry Angstrom]

With respect, I'm not saying it would be easy. I'm not setting out a fully fledged and costed policy on the SMB at 8pm on a Saturday evening, I'm just saying I would advocate a tax that had the broad aim of reducing the intake of unhealthy food.

Your first criticism of the sugar tax is not one of the sugar tax, it is one of the behaviour of shopkeepers.

How do we define healthy and unhealthy food? Well, I'd refer you to my first paragraph in which I state I am not trying to set out a fully-formed policy but broadly speaking, you could look at the overall nutritional value or relationships between them, as well as calories and weight of food, etc. I am not a nutritionist or a dietician, I would leave such decisions to the people who are experts in that field.

It's not about putting "a couple of pence" on a steak bake, ideally it would be significantly more than a few pence, but we do need to balance issues of personal choice with this. A world with no unhealthy foods would be disastrously f***ing boring. I don't want Greggs to stop selling steak bakes, I don't want McDonalds to stop selling Big Macs and I don't want Coca-Cola to stop making cans of Coke.

What I want and what I think society needs, is a multi-faceted approach to tackling patterns of unhealthy consumption. One arm of that is using taxation to disincentive consumption of certain products, but that's tackling a symptom and not the cause, it does need to go deeper than that, but I don't think that limiting the range of available products is the option. What we need is broad, sweeping change that educates people to make the right choices.

Banning fast food deliveries would be a start. No tax involved.