How could the NHS save money?

[BazzaS]

Well,(as I tried to explain), it might be that she thinks you are awkward and argumentative, rather than thick as a dead cow ....

Sadly, though, if it is either, asking her if it is either may not help, as she'll likely either not want to hurt your feelings, or waste time on an argument, while trying to preserve the professional relationship.

 

Some jobs involve working weekends, and may mean that surfing the internet on a Saturday isn't an option when at work.

Some jobs might involve only working one weekend day, some no weekends.

 

I thought you have a job? You know, the one you posted about.....

 

I don't see how someone surfing the internet on a Saturday implies much about their employment : maybe they don't work Saturdays? Aren't working that particular Saturday? read and reply during their break times? Or while waiting for the next helpdesk call to come through.....

Not for the first time I'm wondering what point you are trying to make........

[honeybee13]

Err, guys can we keep CB's thread to suggestions about how the NHS can save money rather than rants about how we feel we have personally been let down? I'm many of us feel let down for one reason or another because GPs aren't clairvoyant.

 

Possibly we should have a different thread for people to let off steam about how they feel they could have been better treated, but that wouldn't be about saving money for the NHS. I can see both points of view.

 

HB

[BazzaS]

OK : how about this.... "become less efficient".

 

I don't really mean become less efficient, but more efficient by not focusing on "efficiency savings" that don't really achieve it.

 

Close beds because there "are too many"? (Late 1980's / early 90's) : bed occupancy rates become sufficiently high to cause their own problems (with both admissions and infection control).

 

Cut back on "over-staffing"?. Less ability to release staff from front line work to do training, less surge capacity, more stress -> more staff sickness.

 

"Increased efficiency" has been the mantra since the 80's / 90's.

If it hasn't already been found and used as an efficiency saving : it'll likely be a saving based on a new technology or new process, else it will likely already have been "found".

 

New way of doing things (especially if it "needs less beds" or "different beds") ; great.

Marvellous that it'll be even more efficient in the long term.... but the saving can only be realised in the long term, for the short to medium term funding / beds can't be cut until the long term benefits are being seen.

 

Oh, and as for the gov't's latest "make the GP surgeries open longer" : is the problem people can't get to the surgeries when they are open? Or

"There aren't enough GP's to have more appointment slots"?

 

Opening longer won't make a difference to the latter , unless there are more slots created.

Try that without more GP's to provide them & more will retire early / go abroad.

[king12345]

I thought you have a job? You know, the one you posted about

 

I mean a proper job, like yours, not just pressing a button for 10 hours a day on minimum wage...

[citizenB]

I believe everyone who earns a wage (say over £20k per annum) should pay an extra £1 per week NI contribution specifically to the NHS - that would soon get the coffers filled - millions of pounds would be collected each week. What can you get for £1 these days ? - I'm sure no-one would miss it and it would ensure there is plenty to go round all areas of the NHS.

 

 

 

https://www.theguardian.com/society/2016/dec/30/people-may-be-ready-to-pay-extra-penny-on-tax-for-nhs-tim-farron-says

 

 

 

People may be ready to pay extra penny on tax for NHS, Tim Farron says

 

People may be ready to pay an extra penny on income tax to fund the NHS and social care, Tim Farron, the leader of the Liberal Democrats, has said.

 

Farron said voters had reached the stage of not believing the NHS’s problems could be solved through efficiency savings and might be willing to pay more if they were convinced it would go to the health service.

 

 

If this is true, why has it not been put into practice. Obviously the money would need to be ring fenced.

[Ell-enn]

I actually brought this up with my MP who says he passed it on ........... I've no qualms about paying a little more to get the NHS on track, if we're not careful we'll end up like USA having to pay private medical cover.

[Guest]

for thread info;

there is the private members 'National Health Service Bill' (NHS Reinstatement Bill) currently in P, due a 2nd reading soon. (whether or not it will progress..)

http://www.nhsbill2015.org/the-bill/

do guys think the proposals in it is a current way forward for the Nhs?

[Guest]

......... I've no qualms about paying a little more to get the NHS on track, if we're not careful we'll end up like USA having to pay private medical cover.

maybe its not just about paying more into it, to waste, but rather sorting out the system. if it is to remain.

otherwise, if someone is prepared to pay 'extra', then why not via a 'private' insurance scheme instead. (the current contributions is re the same principle re 'insurance', except it has been mismanaged). the difference though being re profit, and if so reinvestment. it is a difficult one that no govt seems to want to touch, until perhaps now re all those 'dreadful headlines'?

[citizenB]

http://www.bbc.co.uk/programmes/b08bgtw8

 

 

Hospital - tonight at 9.00pm on BBC 2

 

 

Discharge nurse Sister Alice Markey is trying to discharge a homeless Polish man, but until she can find a translator to explain what will happen to him when he leaves St Mary's, the man will remain in a hospital bed.

 

and

 

Another patient the hospital needs to discharge is 91-year-old Dolly. After breaking her ankle, Dolly has been in hospital for three weeks while she waits for a place in a rehabilitation centre. Dolly laments: 'They're so short of beds... but then I have to have somewhere to go where I'm going to be safe. I feel guilty because I've got nowhere else to go.'.

 

[think about it]

I guess that I can only really address that which I know as I am one of those much maligned NHS managers. So I’ll start with that, the reason I have a job is effectively to allow my employers, the GP’s to concentrate on actually being doctors and not circumnavigating the literally mountains of administrative and legislative work that it pushed our way. So, my job is to look after the accounts, make sure we’ve got staff in the right place at the right time, deal with complaints, look after the buildings, do all of the HR stuff that comes with having staff members, negotiating with suppliers and insurers and private companies all baying for a moment of our time and an NHS contract, arranging locum cover, recruiting staff, managing the quality and performance of our clinicians against the Qualities and Outcomes Framework, claiming for non NHS activity, making sure the electricity and gas don’t get cut off and that’s just this morning. Want to get rid of me? Get rid of the tedious box ticking and centralise the administrative side of things but for the love of god, don’t ask Capita to do it...

 

So, what of 8 til 8, seven days a week. Well, when we stopped laughing it was difficult not to cry. Here’s why, you don’t need an NHS manager to tell you (although I’m going to) that we’re in the midst of the most significant GP workforce crisis ever. Why? Because they’re getting old and retiring and younger doctors don’t want to do the job which has become the “whipping boy/girl” of the entire NHS. And, it’s not just managers and GP’s that are in the firing line, now it’s our receptionists too when the national press vilify them for asking a simple question so that they can direct you to the most appropriate appointment.

 

Do you know why they have to ask? Because there aren’t enough GPs for someone to just pop in for a chat about a slightly troublesome ache in their back, a physiotherapist is far more appropriate, want to discuss medication? Well, there’s a pharmacist that can help. And, for those who say “I only want to speak to a doctor” fine, we’ll accommodate your request as best we can but I’d ask this: do you only speak to the chef when you eat out?

 

Use of other health professionals to deal with day to day cases is unfortunately the only current viable path in primary care, there’s simply not the capacity to do it any other way and before Nigel Farage or one of his fiends (I made the spelling ‘error’ on purpose) turns up and starts quoting health tourism, well, it’s not an issue here and I still have a capacity problem. It’s driven by lack of education on self limiting conditions, by demanding employers expecting their staff never to be ill, by the DWP effectively hanging out the sick and disabled to dry and by an aging and increasingly chronically unwell population, not someone who’s travelled from somewhere else so they don’t get shot.

 

I know I’ll be making enemies as I type, but it’s true here, perhaps though it’s different elsewhere. So back to seven day opening; I have three GP’s here they each work from 8am until 6:30pm Monday to Friday. So they’re already working 52.5 hours each a week to stay afloat. There’s no such thing as the lauded 3 hour lunch break, use Monday just gone as an example, 08:00 to 08:30 processing Friday’s blood results and contacting patients with abnormalities, 08:30 til 12:00 a patient every ten minutes, 12:00 til 13:00 do referrals and look at incoming clinic letters, 13:00 til 14:00 ‘emergency appointments’ one every ten minutes (FYI, a sore finger that’s been bothering you for weeks now – not an on the day emergency), 14:00 til 15:30 – 16 home visits between the 3 GP’s to the housebound and palliative patients, 15:30 til 17:30 an appointment every ten minutes and from 17:30 to 18:30 emergency on the day appointments.

 

Theoretically the day (well, our contracted hours) ended there, we were here til 20:30 finishing things for the day off. Now, I don’t purport to be a time-management wizard but if you can tell me where I can lose a GP so they can have a midweek rest day to work over the weekend then I’m literally all ears. But, one thing is for certain, if you slice a cake 7 ways instead of 5 then everyone gets less, the cake doesn’t miraculously get bigger. This isn’t a funding issue, it’s a people issue, chuck all the money you want at me because if I can’t get a GP then you can’t have an appointment at 19:30 on a Sunday night it’s that simple.

[reallymadwoman]

I rarely remember to add rep for fabulous posts, but think about it deserves it - since this whole 7 day opening thing started, I've been asking where all those extra hours are going to come from - perhaps the government expects my surgery to close one day during the week so the GPs can work at the weekend instead. It's already difficult to get an appointment in less than 2 weeks, unless they get more GPs, opening an extra 2 days a week won't change that.

 

My surgery has 5 GPs, but only 2 are full time and they're both 'getting on a bit'.

 

Bottom line is that GPs simply don't have enough time to do what they need to do already, so giving them more to do is just going to make things worse. Going back to an earlier post of mine, had the GP had a bit more time to read my son's history, she may well have picked up his current problem before we ended up in A & E, saving at least 4 appointments with her plus 3 days in hospital. Presumably, he would then have received the treatment he needs a little bit earlier and wouldn't now be having to go back to A & E 3 times in the last 4 weeks when the pain got unbearable. There's now also a distinct possibility that by the time he's waited another 22 weeks to see a consultant and then however long it takes to actually get to the operating theatre the operation will have already been done as an emergency, which we all know is both hugely more expensive and a lot more risky for the patient.

 

A lot of problems are bound to be due to delay - if someone can't get to see a GP for two weeks, either by then they'll be better or they'll have got worse and be in A & E.

 

I can't now see any alternative but for the NHS to become means-tested, not free. I'm a bit vague on details, but the French system is that a proportion of your treatment is free, varying according to the type of treatment, but you can buy insurance to cover the rest. I'm not sure how it works, but overall it is also means-tested, so the poorer you are, the less you pay, in some cases nothing at all.

[Guest]

when i mentioned 'mismanagement', i didnt mean frontline as such. but, rather the whole system itself. its unsustainable as it is. and that just more funding (even with the 'rubbish' promise of 350m extra post exit ) may not necessarily solve things. something which 'think about it', i think , touches on?

as you say, G forbid if capita or the like get involved!

 

i asked #32, but noone responded; does anyone think that the proposals in that current bill is/could be a way forward for the nhs?

 

what then is the way forward. something like madwoman posted..or.....?

[Sali]

How long have you been in your role, TAI?

I’m interested to know how things have changed.

How many patients do you have on your books now as opposed to, say, 5 or 10 years ago and what was/ is the GP-patient ratio? Are you obliged to take on new patients when you believe you are at capacity? (Yes, I know people need to go somewhere).

How does the amount of face-time with patients compare with the past? What treatments/responsibilities have you lost or gained in that time (for example minor surgery seems to have moved to the hospital in my area)?

I was interested to read what you see as the causes of the current crisis:

It’s driven by lack of education on self limiting conditions, by demanding employers expecting their staff never to be ill, by the DWP effectively hanging out the sick and disabled to dry and by an aging and increasingly chronically unwell population, not someone who’s travelled from somewhere else so they don’t get shot.

And, yes, I do disagree on some points, but welcome hearing a view from somebody working within the industry.

[king12345]

Incidentally, after taking my son to a private consultant who also works in NHS, things have moved very fast.

Friday last week seen consultant who sent an email to gp and I suppose someone higher up, stressing that my son was too young to be put on drugs for life and curative treatment must be considered.

We were called by MRI clinic two hours after leaving the consultant.

Mri done next day at 8am.

Last Monday we got an appointment to see a spinal surgeon closer to home on Wednesday.

Wednesday the spinal surgeon looked at MRI and my son in a 1 hour no rush visit.

Administered cortisone injection in the back and explained everything in MRI.

Today my sono came to see me on his own feet and didn't even limp.

I don't know what the private consultant wrote in the email or who he contacted, but this shows that things can be done properly instead of keeping people on drugs for life.

Before professors of medicine point out that cortisone is not the solution and all the rest, this was needed to get him out of pain and suppress the severe inflammation in two of his spinal joint.

Now he can start a physio and exercise program and see what results he gets long term.

The surgeon said that maybe he will need a disk replacement after all, but best to get fit before op so this transition time is not lost.

Imo NHS doesn't need more money but just a change of attitude high up in the gold towers where managers decide how to spend/waste the budget while sipping champagne.

One doctor feeling empathy for a young man in unnecessary pain did what up to previous day had been "impossible", "a dream" (long queues, NHS tourists, no money and all other rubbish excuses we are fed daily).

Do not give up is my advice.

It is not normal for young people to be put on drugs for life for a mechanical / articulation problem.

I would accept that for someone in their 70s, but not at 35.

[think about it]

Hi Sali, in one way or another I've been around the healthcare system for as long as I can remember, professionally however my first experience was in 2002 working for a national out of hours deputising service. I was there in one capacity or another for about two years before being made redundant after the new GP contract came in in 2004. Fast forward nine years and a chance application found me in my first GP Practice management post after a long stretch in the charity sector.

 

I'll do what I can to answer your questions in turn, but if I miss one please feel free to remind me.

 

How have things changed? Well, there has been a considerable shift to 'near-patient' care, so we have a whole list of patients whom we care for under 'shared care agreements' with hospital consultants, these patients come to us for blood testing / egg / consultations / dosing and treatment rather than going back to the local hospital. Undoubtedly it's better for the patients but it adds two full mornings of work each week to our schedule. We're seeing this in a less formal manner with things like pre-operative assessments, discussing results and other interventions. It can be challenging to fit those things in around our routine care. So, more patients? No, not really. More face-time? Definitely.

 

There's another layer to that, a far more scary one in our opinion.

 

I'll apologise now for using analogies, it's easier for my brain after the week I've just had. In order to keep this clear in my mind at nearly 11pm on a Saturday I'm going with this...

 

General Practice and A&E are the 'front door' of the NHS, gatekeepers if you will. It was/is our job to see 90% of the NHS' patients and move them around as necessary. Most of 'em we'd send home with a smile and reassurance, others we'd refer to more qualified colleagues for specialist opinions and the very worst we'd blue-light in for lifesaving interventions. We're jointly reliant on there being capacity in the system beyond that gate that we're charged with keeping. Or, to use my hospital colleague's analogy we're the open end of the funnel.

 

Funnels are great until you block up the narrow end. Once you stifle that flow the water starts to back up. Once you slash funding to social care and close cottage hospitals, once you close wards and create a perfect storm of recruitment issues, falling morale and make the whole system work harder to achieve the same results as before then you're blocking the exit door from the system and telling the person at the front door that it's their fault there's people queuing outside. Capacity is just that, once it's reached you have to reduce occupation rates somewhere except you can't. There's nowhere to send those well enough to leave hospital but who still require a helping hand, councils are slow to react, families no longer see it as their duty to care for their elderly relatives and still we're closing those cottage hospitals that provided that step-down from a full-blown hospital bed to somewhere to convalesce.

 

Sorry if I'm going on a bit but I'll get there I promise; because there's nowhere to discharge people to safely, the new patients haven't got beds to go to - neither us or A&E have yet been fitted with pause buttons to let those closer to the spout of the funnel catch up so people end up on trolleys waiting, they end up visiting their GP on multiple occasions as their hospital referral is taking months not weeks, they end up having their routine surgery cancelled because there's no vacant critical care beds because those well enough to vacate the critical care beds don't have vacant medical beds to go to because those well enough to vacate the medical / surgical beds don't have a social care place to go to and all along more people keep arriving at the front door.

 

This is a capacity and flow issue. If you block up the drain, the sink will overflow. Make the sink smaller and it overflows even quicker and it spreads to the floor and along the unit, keep it like that for long enough and the damp sets in.

 

Moving on. Yes, we're obliged to treat anyone that asks us who reside in our practice area. We're currently in conversation with the NHS and a lot of other stakeholders as our practice population may be about to double over the next ten years due to proposed development in the area. Our building can't accommodate any more clinicians so if this actually happens we will need to move, to where? Who knows, I'm not sure there's a suitable building in the area. It's a major cause of concern for us all at the moment.

 

How else have things changed in GP-land? We cannot get GP's, in an almost bizarre twist I feel the recruitment process is about to turn on it's head and rather than having to advertise vacancies those GP's looking to move will end up being bidded for. Top of my head figures are something like 1/3 of all GP surgeries currently have a vacant post.

 

I mentioned the lack of education / awareness and increasingly chronically ill population. I'm not a Dr. Never once thought I was but as part of my role is to monitor usage of appointments sometimes I can't help but wonder what some people are thinking. If you've got the vomiting bug and you're otherwise healthy, don't share it with us unless you're a good few days down the line. Follow the guidance available almost anywhere. Sore throat? Well, research suggests that even if it is bacterial (and it probably isn't) then taking antibiotics will only reduce the duration of the illness by 24 hours (again, if you're otherwise healthy). I could go on but I won't.

[citizenB]

I rarely remember to add rep for fabulous posts, but think about it deserves it

 

Indeed, two extremely good posts - sadly I have to 'spread it around a bit' before I can add rep to think about it.

[Guest]

- sadly I have to 'spread it around a bit' before I can add rep to think about it.

no worries, have put one in. which has bumped up the rep

 

still no one in the industry any thoughts about the actual proposed measures currently before parliament, rather than chit chat? never know, the private bill might turn into something significant with enough interest.

[think about it]

no worries, have put one in. which has bumped up the rep

 

still no one in the industry any thoughts about the actual proposed measures currently before parliament, rather than chit chat? never know, the private bill might turn into something significant with enough interest.

 

Thanks all for your kind words, they're much appreciated.

 

Ford, to be absolutely honest I've only skimmed over the bill as it's 'English' and the Welsh NHS is devolved so we're separated from it in a number of ways. That said, on the face of it it seems like a good idea but I really need to sit down with it and pull it to pieces to fully understand it all and tonne able to comment fairly on it.

 

It's always with interest that I read about de-marketisation, of course General Practice is and forever has been the acceptable face of privatisation in the NHS with it's GP partner model and contracts. I've likened it to a franchise arrangement in the past, lots of separate companies all wearing the same uniform and working to the same ends under a brand. A bit like Subway without the MSG and badly mixed fizzy drinks.

[Guest]

fair do's.

had just thought that it (something actually being proposed in parliament rather than just the media headlines) wld've attracted more interest/comment given the current concern/climate re the nhs. even if it doesnt end up proceeding, it may well end up bringing things to the parliamentary fore and leading to something helpful. or maybe not...!

[Nystagmite]

We need to educate people on how to use services properly. I have a relative who if she can't get an answer from her GP, takes her children to A&E. And then she moans about the wait.

 

I had to go to minor injuries last week and explained that I wasn't too sure if I really should be there because I felt fine. (I hit my head) But was aware at the same time, that it can also be a serious injury that doesn't always show anything obvious straight away.

 

And yes, I was absolutely fine.

[reallymadwoman]

I also have concerns about the 111 service. In my experience, the initial call takes far too long as the handlers can't/won't skip any of the script even where it's obviously not needed. The last two times I used the service we knew exactly what the problem was and what was needed - stronger painkillers plus a visit to the GP the next morning for antibiotics - but I expect to try to avoid anyone suing them if they get it wrong, we still had to go through the whole 20 minute interrogation only to be told someone would have to call back.

 

Well before the call arrives, the pain is so bad that my son is rolling around on the floor ended up taking him to A & E. On each occasion, the call back has actually only happened at least 4 hours later, by which time we could have just spoken to our own GP anyway. Of course the obvious alternative to all this is to give us a couple of doses of oramorph, but that would be far too easy! There does seem to be an assumption that any young person given a morphine based medication is either going to abuse it themselves or sell it, along the lines of guilty until proven innocent.

[think about it]

I think there's a few sides to this, the call handling team aren't clinically qualified so don't have any discretion over what is relevant and what isn't even though their inner common sense alarm is howling. What's an annoyance for patients is even more so for the staff as they're doing it on every call they receive. The consequences of not doing so however are probably a short cut to a p45.

 

I'd go and have a chat with the GP if you're son is experiencing breakthrough pain so severely. I was given a small bottle of oramorph for my post operative recovery after having my back done. I only ever used it once but it was comforting to know it was there if I needed it.

[Sali]

Very interesting Think About It and I echo others comments on your excellent post.

 

 

It is estimated that the UK population has increased by over 4 million in the last ten years, clearly not evenly distributed. It can only get worse.

I’m not surprised councils drag their heels in providing home care or seeking care homes placements. Every day they delay, they save money . Would it help if all social care were funded by the NHS, removing the responsibility and money from local government?

I would agree with you that some people rush to their GP at the mere hint of malady and not even because they are require a sick certificate. Do you operate a triage system, as they do in A&E?

One thing I am confused about is the BMA’s proposal to allow GPs to charge private patients for minor surgery like mole removal in their spare time. It rather makes a mockery of their continual insistence that there are too few (overworked) GPs. Are they hoping that the lure of money will encourage more doctors to become GPs?

[Guest]

one gp's thoughts, re gp

'...We have had a winter of hospitals on red alert, and A&E departments overloaded. General practice is effectively on “red alert” all the time. The service is terrifyingly close to collapse. If the Government won’t fund it properly, we urgently need to look at how to fund it ourselves.'

http://www.telegraph.co.uk/news/2017/01/27/no-146-per-patient-not-enough-time-gps-charge-fees/

[citizenB]

Mother died after being turned away from three hospitals

 

 

http://www.telegraph.co.uk/news/2017/02/15/mother-needing-surgery-died-turned-away-three-hospitals-bed/

 

 

A woman died from a brain haemorrhage after at least three hospitals refused to admit her for surgery because they had no intensive care beds.

 

A coroner ruled that 57-year-old Mary Muldowney would probably have survived if she had been given immediate life-saving surgery to stem the bleeding.

 

 

 

Ms Muldowney was admitted to East Surrey Hospital in Redhill on July 20 last year where doctors immediately suspected a bleed on the brain.

 

A CT scan carried out just over an hour later showed heavy bleeds and doctors requested an immediate transfer to a specialist neurosurgical unit for surgery.

 

But three units - St George's Hospital in Tooting, south-west London, the Royal Sussex County Hospital in Brighton, and King's College Hospital in London - refused the request due to having no beds.

 

 

 

Other hospitals also said they had no available Intensive Care Beds.

 

Shocking.