Doctors again.

[Yellow Bear]

39 minutes ago, 7daysinaweek said:

What irks me is when people do not turn up for the appointment. I have done four locum sessions so far this week in which I have 20 patients booked in a 4 hour session. Without fail, every session will have one or two who do not attend. Some cancellations will be genuine and patients do sometimes call when they need to cancel, others inform the surgeries by app, however, plenty do not.

Each consultation is costed out at around £60 for the 10 minute appointment. It's difficult enough to get an appointment and in my opinion, sadly things will not get any better.

The nhs is a bottomless consumer, however, the money that funds it is not bottomless and for some who are employed within it, they simply milk the services and system. 

Recently It took me 6 weeks to get an appointment with my gp and i had never met him before. The last time I went was 24 years ago, at least I am thankful for that.

 

A good case for charging for appointments at booking, if genuine the charge easily can be "returned" but no shows would pay unless good, and I mean genuine good, provable reason can be given. Our practice  nurse was telling me she has a 30% no show for asthma reviews alone.

Edited November 6 by Yellow Bear

[armsid]

Charging a fee to see a doctor is good it stops the shirkers going and genuine patients can get appointments France charges 25 Euros to see a doctor chemists dispense anti biotics and other drugs etc that is normally done by doctors taking pressure off the system plus the French equivalent of NI both worker / employer goes to fund healthcare why can we not follow likewise?

[Houseplant]

It costs quite a lot to see a GP here in New Zealand (despite allegedly having a free-at-the-point-of-service public healthcare system). My wife is a GP. A lot of time wasters still come through the doors, but fewer than if there wasn't a charge. She says that people are more demanding because they are paying for a service which is fair enough. Regardless, we have a massive GP shortage, probably not far behind the UK. Reasons are varied. More obese/diabetic patients, people living longer and increased population size all increase demand. Feminisation of the workforce meaning time out to have children and part time working (my opinion). Part time working in general. No one seems to want to work these days. People just don't want to do the job. It's miserable. It might look like an easy job to patients, but I can assure you it's not. I've been a hospital doctor for 16 years and there is no way I would work in general practice. 

[clangerman]

funny how there’s all these no show patients yet the gp can still be running up to an hr late it’s no accident the clock in our waiting area was removed! 

[shaun4860]

45 minutes ago, clangerman said:

funny how there’s all these no show patients yet the gp can still be running up to an hr late it’s no accident the clock in our waiting area was removed! 

Few years ago I was the first patient booked in to see the GP that day and he was running 25 minutes late 🤦🏻‍♂️

[7daysinaweek]

41 minutes ago, Yellow Bear said:

A good case for charging for appointments at booking, if genuine the charge easily can be "returned" but no shows would pay unless good, and I mean genuine good, provable reason can be given. Our practice  nurse was telling me she has a 30% no show for asthma reviews alone.

I wonder how a system like this would work, beleive me, the data systems in the nhs are years behind. That said, in the nhs I don't think it would ever get past the ethics, governance boards.

Something has to change, I agree.

50 minutes ago, armsid said:

Charging a fee to see a doctor is good it stops the shirkers going and genuine patients can get appointments France charges 25 Euros to see a doctor chemists dispense anti biotics and other drugs etc that is normally done by doctors taking pressure off the system plus the French equivalent of NI both worker / employer goes to fund healthcare why can we not follow likewise?

I had a patient in recently who has dual nationality uk and Ireland, he said fee now to see a gp was about 50 euros and additional px charge of 20 euros, he was surprised that he left the consulatation only 10 quid lighter for the px I issued.

In the UK the 'pharmacy first' scheme has been underway for a couple of years, you can book (if you can find a pharmacy that is part of the scheme) and see a community pharmacist for some simple presentations such as sore throats, uncomplicated uti (in females) and a few other bits and pieces, think the cost is the price of a px if issued and not exempt.

21 minutes ago, Houseplant said:

It costs quite a lot to see a GP here in New Zealand (despite allegedly having a free-at-the-point-of-service public healthcare system). My wife is a GP. A lot of time wasters still come through the doors, but fewer than if there wasn't a charge. She says that people are more demanding because they are paying for a service which is fair enough. Regardless, we have a massive GP shortage, probably not far behind the UK. Reasons are varied. More obese/diabetic patients, people living longer and increased population size all increase demand. Feminisation of the workforce meaning time out to have children and part time working (my opinion). Part time working in general. No one seems to want to work these days. People just don't want to do the job. It's miserable. It might look like an easy job to patients, but I can assure you it's not. I've been a hospital doctor for 16 years and there is no way I would work in general practice. 

I work in the nhs in a unit with other clinicians and see around 100-130 patients per day between a team of us. I work a 14 hour shifts, I do not come up for air, I probably get to grab a small snack for about 20 minutes a day. I am used to it, one thing for sure, it is never a dull day. 

I agree with your sentiment on many of your points.

My patients do not pay a fee at the point of need, however the expectation of generations has changed in my opinion, younger patients now seem to have greater demands and expectations to a greater extent than the older generation. For example, it can be commonm place for waits to be fully assessed and treated in the unit of up to 4 hours on a daily basis. Many patients believe that the longer they wait, the more that they are wholly entitled to a px for some form of medication despite them not requiring any, and see the episode of care as a waste of time.

For some a prescription validates their health anxiety.

It sound very much the same here, many staff don't seem to want to the job due to workload pressures, poor management structures and policy targets, kpi among other things.  For sure, I see more and more employed staff who go off at the drop of a hat, apparently without conscience with regular short term sickeness. Junior staff are constantly rotated into new and senior management/governance rolls and they do not challenge or hold these staff to account. The rest of the team then has to pick up that staffs lack of input which makes the rest feel undervalued.

In the nhs, once employed, it is dam nigh impossible to remove a member of staff who has even the poorest of work ethic. They will go on action plan after action plan, support plans, skip from role to role, never consolidate skills and ultimately be a poorer experience for the patients on the whole and cost the public purse.

With the older generation I find them more understanding of todays expectations.

You can soon get burnt out in general practice, last year for a quite a few months between working in a gp's and in my own unit I was seeing arount 200 patients per week. You simply cannot keep that up for any length of time, I cannot anyway.

As with all of the above, I strongly suspect the same

themes are just as common in most working lives.

I am back in tomorrow morning so will have seen this week around a 100, that is before I back in the my own unit Saturday and Sunday. I am fortunate that I have flexibility now after 34 years and I still emjoy my job very much even if I do moan a lot. Lol! 

Lots goes on behind the scenes and delays are inevitable at times, having to use interpreters for patients , more complex findings which the patient has not booked in with, acutely presenting unwell patients. The other week I was having to give back to back nebulised and 02 therapy to a baby who was peri respiratory/cardiac arrest whilst i was awaiting the ambulance in the practice, this delayed the consultations by about 40 minutes, the patients were very understandable.

Right, Off to bed!

 

[shaun4860]

Our surgery uses an online portal for contacting them for appointments/prescriptions and generally for everything.

I completed it this afternoon, 5 minutes later had a call from them offering an appointment on the 20th.

Personally I can’t fault the NHS, have always been there when I needed them 

[Vince Green]

On 07/11/2024 at 00:23, shaun4860 said:

Few years ago I was the first patient booked in to see the GP that day and he was running 25 minutes late 🤦🏻‍♂️

Twice I have had a hospital appointment at the outpatient eye clinic cancelled on the day. First time I booked in sat in the waiting room with a couple of others

Gradually the time went by and the waiting room was filling up. You couldn't help overhearing the conversations of the nurse and the admin. The doctor was no show. In the end we were sent home and told our appointment would be rebooked. We were told she had been "called away on an emergency" but we knew that was a lie because we had all overheard that she was on study leave.

When I went back for my rebooked appointment I got turned away at the booking in stage and told the clinic had been cancelled and I should have had a letter

So it's not just the patients who are no shows.

Third appointment I was seen

Edited November 8 by Vince Green

[marsh man]

10 hours ago, shaun4860 said:

Our surgery uses an online portal for contacting them for appointments/prescriptions and generally for everything.

I completed it this afternoon, 5 minutes later had a call from them offering an appointment on the 20th.

Personally I can’t fault the NHS, have always been there when I needed them 

I couldn't agree with you more Shaun , over the last six months I have had many appointments both at the doctors and my local hospital , all on time and received excellent service , give credit where credit is due .             MM

[7daysinaweek]

14 minutes ago, Vince Green said:

Twice I have had a hospital appointment at the outpatient eye clinic cancelled on the day. First time I booked in sat in the waiting room with a couple of others

Gradually the time went by and the waiting room was filling up. You couldn't help overhearing the conversations of the nurse and the admin. The doctor was no show. In the end we were sent home and told our appointment would be rebooked. We were told she had been "called away on an emergency" but we knew that was a lie because we had all overheard that she was on study leave.

When I went back for my rebooked appointment I got turned away at the booking in stage and told the clinic had been cancelled and I should have had a letter

So it's not just the patients who are no shows.

Third appointment I was seen

A poor experience Vince, I can understand how frustrating that must have been.

I would have asked to raise the concern. I do hope you got sorted.

 

Mrs 7days and I travelled down to a hospital for an appointment pre pandemic, the clinic had been cancelled and rescheduled and we certainly hadn't been notified. Over a 100 mile round trip. Grrrr!

 

24 minutes ago, marsh man said:

I couldn't agree with you more Shaun , over the last six months I have had many appointments both at the doctors and my local hospital , all on time and received excellent service , give credit where credit is due .             MM

Good to hear MM.

[amateur]

I also get excellent service from my GP, but my being a T1 diabetic probably pushes me up the priority list and I'm not a "frequent flyer", so if I need an appointment, it's invariably because there is something wrong with me.

[Vince Green]

On 07/11/2024 at 00:52, 7daysinaweek said:

 having to use interpreters for patients 

 

The NHS paid £114 million for translators in 2020. It's probably more than that now. You can get really good translation apps on your phone. Why not use them?

[7daysinaweek]

8 minutes ago, Vince Green said:

The NHS paid £114 million for translators in 2020. It's probably more than that now. You can get really good translation apps on your phone. Why not use them?

I don't think they are ratified by nhs commissioners and integrated care boards for use as far as I am aware. The nhs 'obligates' it's employees to use language interpretation services when patient language communication may be an issue, this includes not using relatives or friends as a preferred method as they may affect impartiality and discretion. 

We use human translators on a daily basis via a telephone language service which have a service level agreement with the nhs. I suspect the nhs would cite governance and confidentiality concerns on using a open source app? 

You would think with the advent of AI that the nhs could have a simple language app coded for use within the nhs which would be used via confidentail workphone or desktop app via speaker.

I too have seen some very, very good translation apps.

Human translation adds a cost and is more time consuming, it almost doubles the length of any of my consulations, however, communication is central to any consulatation so has to have some form. 

I can seen that the cost will have risen, in my experience anyway.

[Houseplant]

Surely anyone that is eligible for NHS care can speak English 😂😂😂

[TIGHTCHOKE]

40 minutes ago, Houseplant said:

Surely anyone that is eligible for NHS care can speak English 😂😂😂

Maybe in a "perfect world"............................................

[Vince Green]

8 hours ago, Houseplant said:

Surely anyone that is eligible for NHS care can speak English 😂😂😂

Nobody checks who is eligible and who isn't 

[old man]

12 hours ago, Houseplant said:

Surely anyone that is eligible for NHS care can speak English 😂😂😂

We provide free care to the world, seemingly some very undesirables if only we knew who they were?😃

[Mungler]

On 05/11/2024 at 11:12, oowee said:

One of the reasons we need to put more money into health services. No one wants to pay for it but we all use it. 

Good lord, more money is the last thing the NHS needs. 

Have you ever worked in business / an open market commercial environment?

In fact I’d guess you haven’t, because no one who has ever run a business or been in senior management position within a business (and to be clear not a faux public sector ‘business’) would ever suggest that the NHS needs more money; it needs fewer users, fewer abusers, better management, more productive staff, less wastage, an economy drive, all the non productive resource and overhead culling (etc) -  the list of what the NHS needs before money is very long. 

20% of all tax raised in the UK is spent on the NHS - that’s not just the income tax bucket but includes all the other taxes we forget about - IHT, CGT, Corporation, VAT, Fags, booze, the lot.

I hope we’re all enjoying our ‘free’ NHS - the economically literate amongst us will appreciate that there is no such thing as ‘free’.

.

Edited November 9 by Mungler

[oowee]

1 hour ago, Mungler said:

Good lord, more money is the last thing the NHS needs. 

Have you ever worked in business / an open market commercial environment?

In fact I’d guess you haven’t, because no one who has ever run a business or been in senior management position within a business (and to be clear not a faux public sector ‘business’) would ever suggest that the NHS needs more money; it needs fewer users, fewer abusers, better management, more productive staff, less wastage, an economy drive, all the non productive resource and overhead culling (etc) -  the list of what the NHS needs before money is very long. 

20% of all tax raised in the UK is spent on the NHS - that’s not just the income tax bucket but includes all the other taxes we forget about - IHT, CGT, Corporation, VAT, Fags, booze, the lot.

I hope we’re all enjoying our ‘free’ NHS - the economically literate amongst us will appreciate that there is no such thing as ‘free’.

.

🤣 Wow you do have it bad.

Might be worth reading the rest of the thread for context. 😘

[old man]

10 hours ago, oowee said:

🤣 Wow you do have it bad.

Might be worth reading the rest of the thread for context. 😘

Well, it certainly needs a large injection of common sense which seems to be all that Mungler is highlighting?

[oowee]

21 minutes ago, old man said:

Well, it certainly needs a large injection of common sense which seems to be all that Mungler is highlighting?

Exactly the gist of the discussion. 

[old man]

58 minutes ago, oowee said:

Exactly the gist of the discussion. 

One thing that I am fairly sure of from observation is that like all other facets of life those involved in health care would not miss any opportunity to take a bit more from the pot?

An easy target?

[oowee]

14 minutes ago, old man said:

One thing that I am fairly sure of from observation is that like all other facets of life those involved in health care would not miss any opportunity to take a bit more from the pot?

An easy target?

Or being human?

[dessyb]

we have 2 surgeries in my village the car parks are always full if you go into any one of the surgeries they are empty in one surgery there is never a doctor on site ifyou ring up all you get is the doctor is working from home [😉] how s that work

[amateur]

2 minutes ago, dessyb said:

we have 2 surgeries in my village the car parks are always full if you go into any one of the surgeries they are empty in one surgery there is never a doctor on site ifyou ring up all you get is the doctor is working from home [😉] how s that work

Yes, my GP surgery has 4 parking slots reserved for doctors.

They are usually empty.

I presume that they are all out on house calls.