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A Kurdziel  
#481 Posted : 04 August 2020 11:32:56(UTC)
Rank: Super forum user
A Kurdziel

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

CdC  
#482 Posted : 04 August 2020 11:44:55(UTC)
Rank: Forum user
CdC

Originally Posted by: biker1 Go to Quoted Post
Although I would not tar all young people with the same brush, I would observe that if a lot of the young people of today were around in the two world wars, this country would not have survived.

Is that the same argumentation technique as: "I am not racist, but..."  ?

Not directly relevant to Covid obviously, but this kind of generalisation fed by unqualified judgement, stereotypes & lack of evidence really gets me angry.

Now let's just say we had a major conflict pushed upon us all: what is the empirical performance led evidence to say that our homes would be worse off because of drunk people down at our pubs? How does this statistically significant differ to a generation or two ago in this same area, going to the same pub consuming alcohol and then be involved in WW1 or WW2?

How about treating people as individuals based on their merit and improving one's personal insight into human behaviour and motivation?

Personally I am surprised that this crept up in a professional area within IOSH unchallenged. Now go back and enjoy your COVID rants.

thanks 1 user thanked CdC for this useful post.
WatsonD on 04/08/2020(UTC)
A Kurdziel  
#483 Posted : 04 August 2020 13:51:21(UTC)
Rank: Super forum user
A Kurdziel

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.  

biker1  
#484 Posted : 04 August 2020 15:25:04(UTC)
Rank: Super forum user
biker1

Originally Posted by: CdC Go to Quoted Post
Originally Posted by: biker1 Go to Quoted Post
Although I would not tar all young people with the same brush, I would observe that if a lot of the young people of today were around in the two world wars, this country would not have survived.

Is that the same argumentation technique as: "I am not racist, but..."  ?

Not directly relevant to Covid obviously, but this kind of generalisation fed by unqualified judgement, stereotypes & lack of evidence really gets me angry.

Now let's just say we had a major conflict pushed upon us all: what is the empirical performance led evidence to say that our homes would be worse off because of drunk people down at our pubs? How does this statistically significant differ to a generation or two ago in this same area, going to the same pub consuming alcohol and then be involved in WW1 or WW2?

How about treating people as individuals based on their merit and improving one's personal insight into human behaviour and motivation?

Personally I am surprised that this crept up in a professional area within IOSH unchallenged. Now go back and enjoy your COVID rants.

Generalisation? No, I specifically did not include all young people. Unqualified, lack of evidence? No, what do illegal raves attracting thousands all have in common - young people. What age group have been observed most often resisting or flouting rules on face coverings- young people. What age group apparently have the most reported problems in tolerating lockdown - young people. What do so many reports of violence in public have in common - young people. What this all has to do with drunk people in pubs I have no idea, that is a problem that affects all age groups and has existed for generations. Problems in society have not been restricted to young people, there are some pretty idiotic older people, but young people seem to be disproporionately represented. There are some really great young people around, hence I referred to 'a lot of young people'. Don't accuse me of condemning an entire generation without the evidence you look for.
geordierfc  
#485 Posted : 04 August 2020 15:39:42(UTC)
Rank: Forum user
geordierfc

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   

Roundtuit  
#486 Posted : 04 August 2020 15:45:40(UTC)
Rank: Super forum user
Roundtuit

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%

Roundtuit  
#487 Posted : 04 August 2020 15:45:40(UTC)
Rank: Super forum user
Roundtuit

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%

biker1  
#488 Posted : 05 August 2020 10:32:30(UTC)
Rank: Super forum user
biker1

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.

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