Under the current NHS regime GP’s are more powerful than ever. All GP’s belong to Clinical Commissioning Groups and they are responsible for each patient’s treatment.  They are meant to evaluate each patient and to arrange for suitable treatment for them be it, local at the GP surgery, at the local hospital or even private treatment. The CCG has that patient’s budget and that is what pays for the patient’s care at the hospital.

This is the basis of the NHS “internal market”.

It breaks down for several reasons:

People don’t become doctors to manage services: they are mainly interested in caring for patients so some groups have handed over the manager role to commercial companies which do all of commissioning work (and take a cut of the money). They often have links to people who operate private clinics and the like and seem to want to direct GP’s to use those services. Some have been accused of encouraging patients to pay “top up fees” which goes against the grain of an NHS free at the point of use. Is this first step to full privatisation?

A lot of patients that GP’s see are described as the “worried well”: people with no clear symptoms who probably don’t have anything wrong with them. The doctors really want to get through these patients as quickly as possible as there is nothing they can do for them other than tell them to adopt a more healthy life style etc. In the past they would dose them with the currently fashionable drugs: in the 50’s antibiotics, in the 60’s tranquilizers, in the 80’s Prozac etc. As the cost of these drugs now comes out of their budget they tend to be a bit more cautious about over subscribing. In countries which rely on some form of medical insurance that is not the case. So you have the opiate epidemic in the US, in France they will arrange some sort of test as a matter of course as this comes out of the standard 50 euro payment for a GP visit   etc.

During the current COVID19 outbreak doctors on the whole don’t want patients in their waiting rooms spreading their diseases.  For most patients a chat with the doctor is probably enough and that can be done by phone etc. There has been a significant drop in the general numbers visiting A&E at least in my local hospital. But as people get back to normal this might change.

The role of the GP is changing in part as many of the GP’s recruiting in the 1970’s are retiring and the NHS is finding it difficult to replace them. In some nursing practitioners are taking over some of basic stuff that GP’s used to do. Patients are being asked to go to pharmacists for basic medical advice (they should no longer be called “chemists” which is a completely different job-all qualified pharmacists are trained to take a medical history).

People are going to have get it into their heads that the NHS is not “free” ie it costs money to run and that budget is limited and it should focus on the really important stuff. A few years ago my wife took ill (she suffers from epilepsy) and we were told to attend and an emergency clinical with the local GP (were staying with relatives) as it was a Sunday. We had to wait for nearly 2 hours to be seen. The person before us went in to see the GP. She announced to her friends who had all come along:  “I’ve got a cold”. So she wasted an afternoon of her own time and the GP’s time and spread whatever it was around the waiting room. Perhaps we should start charging people to see the doctor then they would value the service a bit more

I keep hearing about the ‘silver bullet’ for the COVID19 virus in the media. Even the WHO seems to be going on about it. Silver bullets are effective against werewolves and it has been clearly scientifically established that werewolves are not a carrier of the virus. Perhaps they’re thinking about the ‘magic bullet’ which is a drug or other medical treatment that takes out a particular pathogen while leaving the patient unharmed eg injecting a vaccine as opposed to injecting bleach.  

As much as it is mainly the public who will sway the need for further COVID lockdowns across the country, it is also us safety professionals who have the task of ensuring control measures are adhered to in the workplace.

Due to some businesses still working from home not all workplaces may have safey managers or advisors roaming the shop floors, however if we can ALL lead by example and obey the controls in place, this may influence those employees and visitors to also do the right thing, then hopefully this will empower others to challenge negative behaviours suurounding COVID 19 control measures. 

Billy McPheat   

One thing that has changed is the ABV in products.

Reminiscing over the weekend about Berni Inns and my first sip of white wine was a heady 7% nowadays the Aussie Red tips the scales at 13%.

Same with beers the originals being less than 2.5% and now we are overrun with lagers at 5%

There are 50 million ffp2 masks going cheap, please contact uk government. Disclaimer you may have face fit problems. No dubious deals to see here!!!

You couldn’t make all this up could you.

you could sell them a ferry service even though you have no ships-remember the good old pre-covid days when all we had to worry about was brexit!

Like the shipment of masks to the US that originated from "camps" in Xinjiang?

The OECD, and allegedly the RoW, frowning upon forced or slave labour.

Originally Posted by: biker1

And provide and fit out Nightingale hospitals that were never used. And there were cases of companies selling COVID related products that had no experience in making anything like them. Ah, this might be where we started with the face masks.

Has the irony escaped anyone that so much of the stuff to help with COVID came from China?

The govt was informed that the staff did not exist to operate these "hospitals".

Throughout this crisis there has been a severe shortage of trained critical-care staff.

There was talk about putting troops into the hospitals to cover for the lack of trained staff!!!!

Here is [part-of] the requirements for becoming part of the critical-care-team:

Entry requirements

You're likely to be already trained in a role such as nursing or on one of the allied health professions, such as physiotherapy, and have significant clinical experience in that area. Most current ACCP trainees have a background in nursing.

As well as having a healthcare qualification, you'll also need to meet all of the following requirements to apply for ACCP training:

• be registered as a healthcare professional, with recent experience of working within critical care and be able to demonstrate evidence of appropriate continuing professional development
• ​have a bachelor-level degree or be able to demonstrate academic ability at degree level
• be in a substantive recognised trainee advanced critical care practitioner post, having successfully met individual trust selection procedure in terms of skills and relevant experience
• be employed as an ACCP trainee in a unit recognised for medical intensive care training by the Faculty of Intensive Care Medicine and with the capacity and ability to offer ACCP training
• be entered into a programme leading to an appropriate postgraduate diploma/Masters degree with a higher education Institution, including non-medical prescribing

Training

Trainee ACCPs must complete a two-year programme that leads to a postgraduate diploma or Master's degree.

Oh well.....bring in the troops

As I have ranted about this many times before: the government has failed in its legal duty under the Civil Contingencies Act 2004 to prepare for an outbreak along the lines of the current pandemics. Two years ago they had an exercise to test what they had in place and it was a disaster. The main issue was that most of the government saw this as purely a healthcare issue and did not grasp that it would have a wider social and economic impact. They did not appreciate that they needed to create surge capacity for things like PPE and ICU beds and testing. They assumed that you could just nip down to Boots and buy a few boxes of masks. The government as a whole was completely mesmerised by Brexit and the pointless power struggles within the government.  They did not just take their eye off the ball, they went off to play some completely different sport, leaving the goal wide open (award for the most convoluted metaphor ever!)

One my first H&S course   the tutor said “Prior Proper Planning Prevents Poor Performance” something that the people in power apparently never grasped.

To pick up on a point made earlier, if there weren't the staff to operate the Nightingale hospitals, why did they bother kitting them out? Comes across as a publicity gimmick - look what we've built to help with the crisis.

Today we see publication of another entry to this years NSS awards with Duke University publishing research that shows N95/FFP2 to be the most effective at controlling Covid.

What was interesting is the comment that trendy Neck Fleeces may actually exacerbate infection rates as they appear to split droplets in to finer forms that hang in the air for longer.

But then when the specification reads "cover the nose and mouth" and little else what can you expect.

I explain that they don't protect you, they protect other people, therefore by definition they are not PPE. Maybe they could be classed as a guard, or barrier, but most certainly not PPE, in the same way that putting a lid on a dangerous substance isn't PPE.

Agree with both the above comments and Cpt thats exactly what i tell them - and then send the link to the hse guidance when they wont take my word for it.

Mind you it does not help when they start printing this in the Government guidance documents.

"There is growing evidence that wearing a face covering in an enclosed space helps protect individuals and those around them from COVID-19."

I note they dont publsih the evidance! I would think anything infront of your nose and mouth will "Help Protect" but how much?

Originally Posted by: biker1

Never mind, we are in for a period of world peace, aren't we? After all, Donald Trump says that the Spanish flu pandemic brought WW2 to an end (?!), so we don't have to worry about any country kicking off.

To be fair to Trump, it did stop the tension build up after he starting assasinating Iranians.

There has been an anti-science/expert rhetoric for a long time now. Pushed on by social media and politians with agendas. As I said before, every disaster movie starts with someone ignoring a scientist.

Originally Posted by: Brian Hagyard

. As I said before, every disaster movie starts with someone ignoring a scientist.

A ridiculous situation, John Murray, and not what I was getting at when I said patients need to be more responsible. I was referring to the calls to out of hours services for trivial complaints that could be sorted through normal services the next day, and the number of drunks turning up at A&E demanding treatment.

The whole trust business is a nonsense. We were sold this on the basis that it would increase patient choice, but in fact the opposite has happened. We are limited by which places your trust has a contract with, as you observe, and if the services you need are only provided by another trust, then cross-trust funding has to be secured, which is akin to winning the lottery. At the end of the day, it's just figures flicking around on a computer, but it determines what care you get. Successive governments of both persuasions have tinkered around with the NHS for decades without having a clue what they were doing. A&E departments have been swamped for a long time, and the brilliant idea of imposing time targets for dealing with patients was brought in, which just served to distract staff and have an impact on what is done with you. It doesn't seem to have dawned on the powers that be that the way to get waiting times down is to simply employ more staff to deal with the backlog. Governments proudly announce how many extra millions they are putting into the NHS, but when you divvy this up amongst all the trusts, it isn't very impressive at all. Anuerin Bevan must be turning in his grave at the state the NHS has ended up in. And don't even start me on the shambolic state of care provision for the elderly.

http://www.constructionleadershipcouncil.co.uk/wp-content/uploads/2020/08/The-Use-of-Face-Coverings-in-Construction-during-Coronavirus.pdf

When is "NOT PPE", PPE?

When it is a face covering used in the construction sector that the Construction Leadership Council states employers should make available under certain conditions.

Next stance shift to follow: with or without charge?

Captcha du3t

Ironic that you should say this. Recent news report about 7 (young!) guys who came back from Spain, then broke their quarantine to go drinking in several local pubs, and all 7 tested positive for the virus. This kind of idiocy is going to send us into a second wave, but some people just don't seem to get the message.

This is not a GP referral.

This is a hospital referral.

The hospital has contracts with other providers, the oncology one is with a London Hospital.

Yes, it can be refused. Not wanting to travel is not a valid reason. Been there.

I was working on a new build housing estate in South Wales, yesterday.  During the induction, the site management said due to covid19 restrictions, only one at a time in the toilets (OK, Fine I thought).  Then 'there is no access to a canteen, microwave or fridge or drying room'.  I had to say something at this point.  Can I boil some water for a drink?  No, was the reply.  I got on site, and the covid19 wash basins, didn't have any water, just bottles of alcoholic hand cleaner - pathetic.  

I am perturbed how this pandemic maybe assisting cowboy management practices. 

It's always said that we have a special relationship with the USA (have we ever actually formally recognised their independence, but never mind). Well, we do have something in common with them at the moment. Both of our countries are led by the worst possible person, ably assisted by like minded incompetents. Come back Bodicea, all is forgiven.

Its OK we are saved - just need a bottle of fly spray!

https://www.mirror.co.uk/tv/tv-news/dr-hilary-explains-how-insect-22584996

Just waiting to see if i can drink it?