Some interesting point from Kurdziel, and always useful to get another perspective. There are a multitude of problems with the way the NHS works, which need addressing, and yes I agree that patients need to be more responsible.
I had occasion to deal with PALS (Patient Advice and Liaison Service) recently to try and get some clarity and action on a referral for my wife, as we were just going around in circles. I was told that they couldn't get involved in GP referrals, as this came under a different trust. There you have one problem - the splitting up of what used to be a national health service into hundreds of individual trusts, all with their own agenda, budgets and management. This nonsense needs correcting.
The GPs have been allowed to dispense with out of hours services, handing this over at first to deputising services, and then to 111. Whilst I can appreciate that a one man practice would not be able to cover out of hours needs, when there are around 25 doctors in a practice, as with ours, covering out of hours would not be an onerous task. Instead, we have to deal with the 111 service, and although the call handlers and clinicians there are really good, they are a long way away. So, the ambulance service gets dumped on, and paramedics are expected to fill the gap in many cases.
The ambulance service is also dumped on regarding mental health crises. A third of calls to them are for mental health issues, because patients realistically have nowhere else to go, especially out of hours. This is not what paramedics should be for, and they are not trained for it, but once again they are expected to fill the gap in what are appalling local mental health services. The programme of closing mental hospitals that has been going on for decades just makes this problem worse.
The A&E departments at hospitals have been overrun for a long time. Part of the reason for this is the lack of effective out of hours GP services. They are also cursed with the drunken masses, who get injured/into fights/unwell due to alcohol poisoning, and have to deal with stupid people who are aggressive towards them. Personally, I think such people should be charged for services, or in extreme cases refused treatment, although of course in the latter case health professionals would not be able to refuse. The idiots who used to bug GPs out of hours with silly complaints are now turning up at A&E, and I agree that something should be done about this.
I have to say that during the pandemic, many GPs have been too quick to send patients to hospital instead of attempting to assess and treat them. I had to take my wife to hospital for a scan recently, during the day, and one after another person waiting there had been sent in by their GP, in one case a young girl with a sore throat. Whilst I can understand a reluctance to see surgeries full of people who may be infected, one GP told me that it was more a case of the GP not wanting to risk infecting patients. Since they were not seeing many people, I reflected that this was very unlikely. Their reluctance to see patients stands in stark contrast to the hospital doctors and nurses.
The grind of trying to get a GP appointment is well known these days - you have more chance of winning an Ebay auction. I appreciate that there is a national shortage of GPs, although from the number of them at our practice you wouldn't think so, but there again a lot of them are part-timers, which is another issue.
Back in the day, the GP used to be the gateway to services and treatment, and the buck would stop with them. This just doesn't seem to be the case these days. Restrictions on what they can prescribe (the green, amber and red lists) doesn't help, but we can thank Harold Shipman for this knee jerk reaction in the profession. The pronouncements of NICE on what we can and can't have don't help either, based on 'cost effectiveness' and some often questionnable research. Their credibility is also suspect in view of the full circle they have performed in some cases (such as the way in which things like multiple sclerosis are to be diagnosed)
At the risk of offending anyone, I also have to say that NHS managers are a breed on their own; I'll say no more.