Re: Crisis in the NHS
 

But France fund their Health Service with a combination of Tax and Private insurance...

https://www.theguardian.com/society/...his-is-the-nhs

Re: Crisis in the NHS
 

One could argue the UK needs to do the same if it is not prepared to increase public spending to fix the shortfall then we could adopt the french policy of making it income dependent, a good friend of mine told me of some of the better things about the french health system, e.g. in the UK if you need an X ray, you get sent to the hospital to have one, in France they have X ray machines at the GP surgery, thats just plain common sense, it makes things faster and more efficient.

To me I would adopt the following to improve workload on the system.

Grant extra powers to pharmacists to issue prescriptions.
Make some drugs not require a prescription when used in low dosage. So e.g. antibiotics, you can get issued one set without prescription per year, more require prescription which can be issued by either GP or pharmacist.
Implement more stuff to be carried out at GP surgery, such as X rays.
GPs open 7 days a week and 12 hours a day.
Ban doctors from doing private work if they wish to pull in a NHS salary.
Let HC1 cert owners reclaim travel costs to see GP (currently they dont). This can reduce home visits required.
Add video conference facilities. To reduce people needing to attend surgery for physical examinations.
Add email contact mechanism between patients and their GP, a GP can take 1 minute to respond to single query over email vs allocating a 5-10 min booking slot for someone to come in to ask the same question.

There is more but these I thought of off the top of my head quite easily.

Re: Crisis in the NHS
 

Doing half of that would create more opportunities for fraud and misuse and we would have a lot of doctors and medical staff leaving so not really practical. The NHS should have one central purchasing organisation that then distributes to the NHS facilities that way the massive buying power of the NHS could best be used and would provide valuable data to finetune patient care. The only thing you said i agree with is that whilst receiving a salary from the NHS they should be the only organisation they work for. I'd increase state support for nurse training with a clause that they serve a minimum of ten years in the NHS.

The amount of money is not so much the issue as the way so much of it is misused and until we sort that out absolutely no more money should be thrown at the NHS as it will just disappear like a lot of the current budget does.

Re: Crisis in the NHS
 

Having looked at the various health care models in use around the world I would agree that as a nation we probably should consider moving to more of a insurance top up based system or hypothecated tax system, which is what much of the rest of the world uses. My fear is we are heading more towards an American based health insurance based model with all the problems that this can entail to the individual.

With regard to the other points pharmacists already have more power than most people realise with regard to issuing medication, it is a myth that you need a prescription to get a prescription medicine. As long as you have already been prescribed that medicine by a doctor previously and it is reasonable that you would require that medicine on a long term basis a pharmacist can provide you with an emergency supply if you are unable to obtain a prescription from a doctor.

Making it possible to get some drugs without a prescription is looked at regularly and is generally based on the perceived benefit of making some medicines easier to get for example it is now possible to get PPI medication as an OTC medication without a prescription. Antibiotics are perhaps a bad example of a medicine that could be provided in this way as they are already possibly the most over subscribed class of medication. If you look at countries that do have a more relaxed attitude towards provision of antibiotics (Greece springs to mind) the associated incidence and prevalence of resistant infections is massively higher.

X-Rays in a GP surgery is something I like; however until we move to an alternative funding system I don't think it would be practical for every surgery to absorb the capital cost of the equipment plus the provision of qualified radiographers of which there is already a big shortage of.

In principle 7 day GP working is a great idea; however the big issue at the moment with this is there simply are not enough GPs in this country to make it work. There is also a growing body of evidence that suggests that when weekend appointments are available they are not always used. Personally I would prefer increased numbers of GPs working during the week when we do know that demand is massively out stripping the supply, hence why surgeries appointments are all fully booked within 5-10 minutes of opening!

How do you propose stopping GPs from doing private work? As far as I am aware the vast majority are not Technically employed by the NHS they are employed by their surgery which is an independent provider and is paid a sum per patient that is registered at that surgery.

As far as I am aware a lot of GPs already offer telephone consultations and some even use video conferencing for this as well. It is also already possible to email the surgery I am registered at with non urgent queries.

Re: Crisis in the NHS
 

http://www.bbc.co.uk/news/health-38853709

Interesting figures - seems to have been a steady increase since 2010, wonder what happened then?

Re: Crisis in the NHS
 

More people used the NHS?

In November 2010, there were 1.55 million attendances at English A&E; in November 2016 there were 1.9 million.

Also, comparing usage from a decade ago is quite illuminating...

http://www.nhsconfed.org/resources/k...ics-on-the-nhs

Re: Crisis in the NHS
 

To add to this thread, my sister had to travel to loughborough yesterday (saturday) to see an out of hours GP, as after waiting 4 hours in the royal infirmary only for the receptionist to tell everyone there is no doctors available.

What a mess.

---------- Post added at 01:39 ---------- Previous post was at 01:26 ----------

Thats why I said just one pack of antibiotics per year enough for a 5 day run.

Whilst it may be easy to say they over subscribed its worth bearing in mind some people really over estimate the ability of the immune system to fight infections, before antibiotics were invented people died at a much younger age from minor ailments that could get out of control. So something that starts of as trivial without treatment can become serious. This risk that you talk about can be mitigated by only supplying one type of antibiotics this way, e.g. so most of the antibiotics remain prescription only.

I have never been refused antibiotics whenever I have suggested it either to a dentist or GP, so the system as far as I am concerned has never blocked the use of antibiotics but only delayed it.

This is of course without taking into consideration like people been absent from work etc. whilst waiting to see a doctor.

Re: Crisis in the NHS
 

It is slightly dangerous to think of antibiotics as this panacea that can be taken with no risk to the individual or long term consequences to the population as a whole.

Whilst I would be one of the first to acknowledge their benefit to overall life expectancy as well as their ability to cure diseases that at one time were a death sentence. It is also important to acknowledge that they have to an extent been abused and dished out like smarties by doctors for a variety of reasons and we are now left with a situation where resistant bugs are becoming more and more common! MRSA, VRSA, carbapenemase producing enterococci to name a few of the top of my head.

Sad fact is that most antibiotics that have been prescribed were not needed and have simply been used to treat viral infections or mild bacterial infections that the bodies own immune system would have dealt with if it had been given a chance. These infections are largely self limiting and whilst they can be unpleasant they are not in themselves any threat to the individual. In fact there is increasing evidence that show a correlation between increasing antibiotic use and increased incidence and prevalence of autoimmune disease.

Your idea of only making one antibiotic available to prevent resistance is unrealistic as it assumes that any antibiotic can be used to treat any type of bacterial infection and this quite simply is not true. Most antibiotic regimens are tailored to the likely bug that is causing the infection for example trimethoprim and nitrofurantoin tend to work well on bacteria that cause UTIs whereas amoxicillin and clarithromycin tend to work well on bugs that cause chest infections, and for dental infections metronidazole tends to be the antibiotic of choice. That's not to say there aren't antibiotics that have a very broad spectrum and can be used against multiple types of infections, the problem with these though is they tend to need to be given intravenously such as tazocin or ertapenem and often have very nasty side effects such as in some cases liver failure.

All that said there are advantages to making antibiotics available to certain groups of high risk patients where the benefit of ensuring they receive prompt antibiotic therapy outweighs the risk, for example patients with COPD will often get a "rescue pack" from their GP which contains steroids and an antibiotic usely doxycycline. When these patients get the start of an infection they can start their rescue pack medication and then book to see a GP.

It's difficult for me to comment as to why you have always been given antibiotics when you have suggested it to the GP or dentist without knowing the circumstances around it. My slight worry though is that as you had to suggest it, they may not actually have been needed but this may have simply been a way to get you out of the door quicker! It's a sad fact that GPs are heavily constrained by time with 10 minutes for a consultation at a good practice and some have just 5 at poorer practices. Faced with a patient who questions whether they should have antibiotics the GP may have to weigh up the time taken to explain the rationale of not giving antibiotics which can take 1-2 minutes if the patient is understanding or much longer if the patient wants to argue! Compared to the 10 seconds it takes to print of a prescription. In this circumstance especially if the GP is already over running they may simply be taking the path of least resistance.

Re: Crisis in the NHS
 

Source

Maybe the impure placebos, such as improper antibiotic use should be changed to just pure placebos which can often be as effective as an active product and doubtless is much cheaper for the NHS as well as addressing some of the resistance issues.

Re: Crisis in the NHS
 

It would definitely be a lot safer for the patient! Couldn't find any figures for the UK but in the U.S. Iatrogenic causes of death which includes death caused by medication is the 3rd largest cause of death.

Can just see it now "Here you go Mrs Smith just take one of these pills (Tic Tacs) three times a day and not only will your sore throat be better within 7-10 days but your breath will be minty fresh as well"

Re: Crisis in the NHS
 

I think that's a unproven fact but rather speculation.

What is a fact tho that the strict auditing of drugs this country has is burdening the system.

You even went on to prove my point in that I said the immune system is over estimated in its abilities by many people, and then you went onto say that the immune system would cope anyway. I got news for you it does not always cope. A moderate bacterial infection without antibiotics can grow out of control rapidly. When antibiotics is pointless is when it is a viral infection, of which antibiotics will have no affect, however if a doctor cannot be sure it is a viral infection then they should play it safe.

I have an ongoing eye infection for the past 5 years, the immune system clearly cannot cope, likewise whenever I have had infections via my teeth antibiotics have always been needed.

Before antibiotics were invented people would routinely die of teeth abscesses at a young age.

Resistance will grow, its inevitable, I find it a weak reason to hold treatment back, if you holding treatment back, its the same affect as the treatment not working is it not? Requiring GPs to approve minor drugs simply takes up resources.

Also I spoke to my GP this morning about some problems, she is clearly under a ton of pressure to save money as she has started to take the NHS line where my illness is my fault and more specifically all under my control, by this if you look at the NHS website, various articles disagree with the common global opinion and blame the patient for specific health issues. After a heated conversation I have to go in for an examination to see if I warrant the support I have asked for. It looks like I am going to need to put some cash aside for private treatment as the NHS is becoming more and more unfit for purpose with the state it is in.

When my eye infection blown up I had to get private treatment then to get it in a manageable state.

Back on to the subject of drugs it is clearly more dangerous to withold drugs than to issue them "just in case" something happens like the person developing a resistance. It is also clearly a expensive policy to audit the use of such drugs as they are currently.

Instead of telling me whats wrong with the ideas I listed why not come up with some of your own? or do you think the NHS is fine as it is and doesnt need changing?

http://www.dhdeurope.com/blog/antibi...fe-expectancy/

Mind you I suppose if we withdrawn antibiotics it would help the NHS given people would die earlier and there would be less pensioners tieing up the beds.

An interesting read as an example. Am I fat because of a slow metabolism? Check "Am I fat because of a slow metabolism?" and "Can certain medical conditions cause a slow metabolism?", assumptions been made abou tthe patients to justify a cheap type of treatment.

http://www.nhs.uk/Livewell/loseweigh...etabolism.aspx

Also interesting is comparing how american doctors talk about conditions and comparing it to the UK NHS guidelines. Differences can be quite stark. e.g. American doctors consider withdrawing antibiotics too early as dangerous because the affect is that they withdrawn before the infection is beaten, then if they are represcribed later it can then be too late as the infection has time to develop a resistance during the gap of treatment.
There is also certian conditions in america that are treated as an emergency whilst for the same conditions in the UK the NHS advises people to wait it out "just in case you recover on your own".

One big problem with the NHS which is used to save money is to make assumptions based on probability e.g. if a hospital doctor has a choice of sending someone for a scan or discharging them with the merit that people in their age group only have a 2% chance of having a condition they can use the probability as a justification which is dangerous. A lady died in her 20s 3 years ago of a condition that typically only people 50+ get, the doctors continued to refuse to diagnose it simply based on her age.

Re: Crisis in the NHS
 

https://www.theguardian.com/politics...y-unacceptable

https://www.sochealth.co.uk/wp-conte.../04/Hunt-1.jpg

Hunt really is a bit of a smug turd. What he wants to do is find out who has been in charge of this predictable shambles for the last few years.... If it wasn't costing lives it would be funny.

Nhs appalling crisis
 

http://www.msn.com/en-gb/news/uknews...-bed-shortages

Reading this article made me want to be sick. How can the NHS get into such a state.
A woman could have been saved. Except due to the appalling NHS crisis and the way its being run by this horrible Tory Government

I hope that the Muldowney sue the NHS England and Mr Hunt for damages

Re: Nhs appalling crisis
 

There are many many reasons the NHS is in a state Arthur as stated very succinctly by many others on this forum as it goes far beyond the two main political parties as well as up to now they have both made a bloody great mess of it with their own dogmatic doctrine of policies rather then running it how it should be run in the best interests of the country.

Re: Nhs appalling crisis
 

A fantastic organisation that is being slowly dismantled by the government and having to do more with less money.

And your answer is to sue them

You really are a weapons grade helmet.