Welcome Guest! The IOSH forums are a free resource to both members and non-members. Login or register to use them

Postings made by forum users are personal opinions. IOSH is not responsible for the content or accuracy of any of the information contained in forum postings. Please carefully consider any advice you receive.

Notification

Icon
Error

13 Pages«<111213
Options
Go to last post Go to first unread
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.

chris42  
#489 Posted : 06 August 2020 12:41:08(UTC)
Rank: Super forum user
chris42

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.

biker1  
#490 Posted : 06 August 2020 13:33:58(UTC)
Rank: Super forum user
biker1

No, you couldn't make it up. According to this, you could sell the government anything, especially if you know somebody who knows somebody, if you know what I mean, allegedly.

A Kurdziel  
#491 Posted : 06 August 2020 13:37:36(UTC)
Rank: Super forum user
A Kurdziel

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!

thanks 1 user thanked A Kurdziel for this useful post.
biker1 on 06/08/2020(UTC)
biker1  
#492 Posted : 06 August 2020 15:10:37(UTC)
Rank: Super forum user
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?

Roundtuit  
#493 Posted : 06 August 2020 21:58:11(UTC)
Rank: Super forum user
Roundtuit

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.

Roundtuit  
#494 Posted : 06 August 2020 21:58:11(UTC)
Rank: Super forum user
Roundtuit

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.

John Murray  
#495 Posted : 07 August 2020 06:17:36(UTC)
Rank: Forum user
John Murray

Originally Posted by: biker1 Go to Quoted Post

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

Todai  
#496 Posted : 07 August 2020 06:47:12(UTC)
Rank: Forum user
Todai

Originally Posted by: chris42 Go to Quoted Post

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.

Does anyone have any evidence that around the head in comparison to the ears has any measurable difference in protection? or is it on the basis of opinon? 

A Kurdziel  
#497 Posted : 07 August 2020 07:55:23(UTC)
Rank: Super forum user
A Kurdziel

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.

thanks 2 users thanked A Kurdziel for this useful post.
CptBeaky on 07/08/2020(UTC), biker1 on 07/08/2020(UTC)
biker1  
#498 Posted : 07 August 2020 10:35:19(UTC)
Rank: Super forum user
biker1

The roots of this crisis go back a long way. It has been known for some years that we have a serious shortage of doctors and nurses in the NHS, but as far as I can see, nothing much was done about it. In fact, bursaries for nurses in training were stopped. One fairly recent estimate put the shortage of doctors at seven thousand, and the shortage of nurses at thirty thousand. The poor pay levels for nurses has clearly been a factor in attracting to the profession, but even with the pandemic and the wonderful work they did, nothing is still being done about this, so the problem will persist. Recruiting from overseas has been used to some extent, although this is not without its problems, and with political changes is likely to become more difficult. The other option used is bank staff, which costs the NHS a lot of money with agencies. All of this put us in a poor position for tackling a pandemic.

What happened to the call up for recently retired medics? I understand that a lot responded to this, but the advert mentioned doesn't seem to allow for this; in fact it is contradictory (how are you going to recruit people who are already in a relevant position?).

Users browsing this topic
Guest
13 Pages«<111213
You cannot post new topics in this forum.
You cannot reply to topics in this forum.
You cannot delete your posts in this forum.
You cannot edit your posts in this forum.
You cannot create polls in this forum.
You cannot vote in polls in this forum.