Abusing the NHS
A few weeks ago, I wrote an article for Hospital Doctor about the difficulties surrounding flu immunisations. Last year, we received lots of complaints because there was not enough vaccine to go round. That was because we stole half the NHS allocation of vaccine and re-sold it to the private sector making a huge personal profit. It is hard to get by on £250,000 a year particularly when, with our two day week, we have so much leisure time. Or that is what the government would have the public belief. Forget the rumours that Patricia Hewitt (remember her?) had miscalculated the amount of vaccine required.
The second commonest complaint we had last year was from people who had had to queue, some for as long as twenty minutes. We did our best. All the partners and practice nurses came in on three separate and well advertised Saturday mornings and immunised all comers. Despite our best efforts, the queue went out into the car-park, and the weather was not good.
Others said, “Why can’t you do the immunisations during the week?” They found it “inconvenient” to come at the weekend. I would prefer to do that but the weekdays are too busy to fit in a massive immunisation campaign.
It is easy to forget that most patients with genuine illness are either old or very young, and none of them work. They prefer to come during normal working hours. It is only the pretentious, middle-class, focus-group attending, Rolex wearing, alfresco dining, BMW driving, foreign-holiday booking (“Do you know how much the safari is costing? Why should I have to pay for those Malarone tablets?”), BUPA subscribing, well-off “worried well” who demand the “right” to see a doctor in the evenings and at weekends. Sebastian is 27 and wants to “pop in” on Saturday afternoon to discuss the merits of regular PSA monitoring. His partner, Harriet, is with him and wants to know if intestinal yeast is a possible cause of her Irritable Bowel Syndrome.
Sebastian and Harriet are destroying the NHS with their inappropriate demands and attract no sympathy from us. We are, however, sympathetic to our elderly patients, for whom queuing is onerous. So this year we decided to have an appointment system for the immunisations. Five minute slots for each patient, bookable in advance.
Last year the complaints came in after the immunisation sessions. This year, they started to come in before the sessions. “Why do we have to book in advance? Why can’t we just turn up on the day, as we always did? That’s a much better system, isn’t it doctor? As long as we don’t have to wait too long like last year.”
We did the first session last weekend. The doctors, nurses and this year, reception staff, all attended. We immunised 789 patients. And although the session took much longer than last year, there were no queues out into the car park. An anecdotal straw poll of those who came suggested that they preferred the new system.
There was one problem.
83 patients with booked appointments did not turn up. EIGHTY THREE. That is over ten percent of those who had booked. One or two of them telephoned on Monday to apologise. Most did not.
And that epitomises the problem we have with the NHS. If there were a charge of, say, £20 payable in advance but refundable to those with genuine financial hardship (provided always they turned up) the problem would be solved.
As would many problems if a similar system could be adopted across the NHS for all health care.
81 Comments:
So the problem with the NHS as you see it is that it doesn't work because no one has to pay for it?
Couldn't agree more.
Frankly, it's not Sebastien and Harriet's faults that they're destroying the NHS. As you rightly point out, they're both happily signed up to BUPA and would go private at the drop of a hat. The fact they HAVE to go through the public system before they can access the private services they've already paid for is ridiculous. You could happily put up BUPA fees by 20% without scaring these people away and ease the burden on the NHS.
My GPs get investigated by the CHC, and the report's public. They do very well on every indicator except one, guess which? Yes, patients are sometimes kept waiting. The CHC, who are arseholes, made them promise to do something about this.
I had an idea. Patients who want to be seen on time should get a promise that they will be, on the following conditions, to which they must agree by signature, as binding. 1, they will never be late, ever, whatever happens; if they get taken ill on the way, tough. 2, they will never take longer than the appointment time, measured from the moment they're called in to the moment they leave the consulting room, whatever happens; if they have a heart attack while they're in there, *tough*.
I think that might sort some of these people out.
(*Paying*, John, will only encourage complaints from people like the very middle class woman who was complaining to the receptionists about being kept waiting, the last but one time I was there; she was fizzing with anger. Her problem? She'd arranged for someone to come to the house -- an electrician, I think -- and would not be back in time... . So the facts that charging is wrong and that too many exemptions would have to be made, apart, it will not work.)
How can Harriet and Sebastien be destroying the NHS if they only come at a time at which no one else wants to?
Oh sorry. Well yes, paying would do something to stop no-shows, but a fixed charge, show or no-show, would only further encourage the entitled lot.
(John, are you saying you never dine al fresco?!)
anonymous, I'm with BUPA. They'd have to hike their fees by a lot more than 20 per cent to offer a drop-in GP service etc. etc., co-payment free.
But the people John's describing certainly could afford to pay for their immunizations.
It's a problem of perception... It costs nothing, therefore it is valueless - or that seems to be the accepted "wisdom" of our "knowing the cost of everything and the value of nothing" society.
I had to go for an MRI a little while ago and was actually "done" and out before my scheduled time - because the two patients prior to me had not turned up for their appointments and talking to the radiographers it would seem that tbhis is not an uncommon occurrence! It makes you despair at the waste of time and valuable equipment - perhaps having to pay if you don't turn up might do something.
Oh... And welcome back Doc! :-)
anonymous- I'd go private and get a brain transplant, you couldn't do worse than you have already!
The likes of Sebastien and Harriet are a common problem, and they are dragging the system down
Doctors need the backing and power to be able to politely tell their kind that they will not be indulged on the NHS
Good to have you back Dr Crippen.
I'm with you on the "moaning Malarone patients. Yes £50 to prevent you getting malaria isn't much compared to a £2500 safari, is it?
"Can I not take this Avoclor I got for the Dominican Republic, or how about some Doxycycline??"
Heaven forbod that you might have to spend some of your own money to prevent your own ill health.
too many anonymouse folk
ah well
its the patients is it?
"“worried well” who demand the “right” to see a doctor in the evenings and at weekends" what bollocks, its the working hard but need to see a fucking doctor thanks who are LET DOWN BY THE NHS
my partner is diabetic, i could list the tens of appointments she has had to attend over the last few months, all pretty routine by diabetic standards, but ALL she has had to i) attend in the daytime taking time off work ii) wait way past the assigned time iii) been messed around had the time reassigned iv) been filtered by nurses before being allowed to see the person she really needs to see, HOW IS SHE EXPECTED TO HOLD DOWN A NORMAL JOB AND CONTRIBUTE TO SOCIETY? is this really the most cost effective use of her and the medical staff time? we have friends in belgium, some of them are diabetc, we are able to compare and contrast quite easily. THE NHS IS A FUCKING SHAMBLES COMPARED TO THE BELGIAN SYSTEM. now fuck off and stop blaming the patients and get a fucking grip.
yes there will be patients who want to talk about trivia, if they are prepared to pay for it, who cares.
Yes there should be a charge at the point of access to keep some of the dross away from GPs (refundable in the most extreme cases of lack of cash and genuine medical need)
dont blame the patients
oh and my parents are old and they get shit service too despite being able to attend at any bollocks hour the nhs decides
funnily enuf a few years ago my GP was pushing flu jabs at me, with a real hard sell, nowadays Im not in the qualifying groups, how the fuck did that happen? nhs fashions changing year on year! never get it fucking right
and we the patients will turn up more than 80% of the time when there is actually a doc to see us promptly more than 80 % of the time
I agree we need some money to change hands, then I sure as fuck wouldnt be taking mine to the shit GP I AM FORCED TO USE
choice and commercial reality needed on both sides
no one
I don't believe you can match supply and demand even approximately.
And also that more choice = more cost, and more waste.
A moderately short (short in time) waiting list for non-medically urgent situations has at least the possibilty of reducing waste.
The UK can have all the choice in the world if the population was prepared to pay for it.
Reminds me of the 'all you can eat for £12' restaurants, the amount many people stuff themselves with is phenomenal (likewise whats left on the plate) And all because they've paid for it, so they'll have as much as possible.
Gully Foyle
no one,
your arguments are weak and based on individual examples,
there are many more stories of excellent GP services where people are not inconvenienced with their visits to the GP,
if you want individual examples, then I saw a lady today who presented two weeks ago with a non urgent problem, had her operation today and was very happy, does this prove the NHS is great?
of course not, it's a one off example, I do not base my arguments on individual cases,
in fact the more money that is moved around, the more money is wasted on bureaucracy, as in the US, and in the UK with the internal market,
scrapping the internal market would massively help efficiency and reduce bureaucracy, this would be a good idea,
there is no perfect solution, your incessant ramblings about such perfect foreign systems are frankly deluded
until the government started screwing the NHS up with excessive interference and the internal market, first by Thatcher, we had a damn efficient health service
unfortunately there is no going back, the NHS is not good enough in many ways, but this is not because it is a public system! it is because it has been completely mismanaged from on high, this is the damn point
The world has changed – people now expect services to be provided in a way and at times that are convenient to them. This is relatively easy for many commercial operations, such as supermarkets and banks, to do – they can use generally low-skilled people outside the normal working hours of their senior staff, plus they have plenty of technology that automates and simplifies many processes. However it is very difficult to do this in a healthcare system – because the use of low-skilled staff and technology is not sufficient. To provide quality healthcare requires professionals, i.e. doctors, to be there.
So, the NHS and the politicians that run it face a dilemma – on the one hand the genie of consumerism is out of the bottle, and they face increasing opprobrium if they ignore the demands that consumers make, on the other hand many doctors clearly don’t want to have to make themselves available 24/7 for elective work.
So the medical profession has to choose. It can:
1. attempt to squeeze the genie back in. Demand that politicians explain to the public that they can’t have what they want. Write abusive blog entries that make it clear that whilst in many other aspects of their lives British people are indeed “consumers”, able to make demands on suppliers, with regard to healthcare they are “patients”, and will be seen and treated on a timescale decided by medics.
2. innovate to find new ways of working. Accept that the genie has escaped and adopt new processes and practices that go some way to meet the demand. Find doctors who are prepared to work outside normal hours.
My view, for what it is worth, is that option one is untenable in the long term. It will just not wash with voters who are handing over about £90bn this year to the NHS, rising to about £110bn in four years time. Choosing option one will mean a long, bloody and unpleasant fight that ultimately doctors will inevitably lose, but in the meantime they will have lost enormous amounts of public sympathy.
Adopting option two will be painful for many in the profession, but it will at least gives doctors the chance to steer the agenda and mitigate the worst excesses of the consumer culture. It might be like democracy - the “least bad” alternative.
I suspect, however, that option one is just too tempting for many doctors – who feel it is completely unreasonable of them to be subject to consumer whims – and that is the path down which they will head. In which case there is much pain to come.
Patients who don't turn up for their appointments make me so cross. For every one that doesn't turn up, I have atleast 5 who need to be seen, then there's choose & book giving free access to my waitlist irrespective that the problem in question is non urgent, (my routine waitlist for clinic slots is currently 3 weeks but full of 'worried well') so god help you if you are sick and want to avoid hospital admission, I can't see you, I'm too busy dealling with Sebastian and Harriet's problems.
I'd really like to see a penalty system inplace for repeat offenders, black marks allround to identify those repeat offenders who have absolutely no interest in their health!!
A distressed doc
Your continuous sneering at the middle classes does you no credit. You appear to have rather more empathy with wife-beating druggies (not that I am suggesting you should not care for them) than decent tax payers. An attitude that goes down well, I have no doubt, with the chattering classes, it is much easier to make sneering comments about the medical demands middle class folk who actually CARE about their wellbeing, than say immigrants from Pakistan.
In any case, I detect that you are in the wealthy home counties, probably in Surrey, and suffice to say your experiences are not exactly representative of the UK. It is quite clearly bollocks to suggest that these people are ruining the NHS. Perhaps you meet a lot of them in wealthy Surrey, but when I've been sitting in doctors in various parts of London I can't say I've come across too many of them.
Suffice to say, that it is not Sebastian and Harriet's fault that you cannot meet their expectations. They doubtless pay a good amount of taxes, although I doubt it is arrogance that gives them their expectations - rather, they but are taught by the government and the media that there is free health care in this country. Being middle class they take more care about they eat and their health than others. They are consistently told that the NHS is wonderful, better than ever, that spending has doubled in 10 years and will keep on soaring.
It is hard to counter 50 years of NHS propaganda with the truth about NHS care - that while in many ways it is good (medical care), in other ways it is diabolical (nursing, hospital administration, and that not everything is free.
Of course if you are told that medical care is free you will not expect to pay for it. But whose fault is that? It is certainly not theirs. They are understandably confused, when they know that smokers don't pay for cancer treatment, drunks for A&E care, or fatties for obesity-related problems.
What you really are calling for is an American-style system, where the middle class KNOW that they have to pay for their care, and the NHS is just for the poor. That is of course already the reality. I am better off paying £50 to see a private doctor than use my valuable time waiting in the NHS, I would sooner pay for private treatment than go through the eight month disaster of cancelled appointments, doctors with no case notes, followed by the operation in a hospital with inadequate nursing care. The reality is, as you pointed out yesterday with your comments regarding 'Alice', that the NHS is quite akin to the American system, there just for the poor, but the government has not felt fit to tell anybody.
You know it is, but Sebastian doesn't. He is not to blame, and your sneering about his BMW and his private safari is wide of the mark.
You have it right in one respect. The only way people will value health care (and education) is when they have to pay for it. Until then, its perceived worth reflects its cost to the user (i.e. zero).
We already have two-tier dentistry, I see no reason why medical care should be far behind.
Let me get this straight you're begrudging the people paying the most into NHS (BWM driving nitwits) the use of NHS? So it's OK to soak them in taxes to the tune of 40% but god-forbid they demand actual services from the government.
Sorta like cops refusing to file criminal complaints so the numbers look good.
Anonymous 1, 2, 3! Is there no originality, for gods sake choose a name or add a number so we all know which anonymous is talking.
John well said! Patients who do not attend for appointments also irritate me greatly; I’ve now taken to phoning them, which I have found has stopped repeat offenders. I agree that a charge should be imposed, if I don’t attend for my appointment with my dentist and have not cancelled in the 24-hour period I will be charged!
that's about the size of it, anonymous. Taxes are kind of a charitable donation I guess, to help people that can't be bothered to work, for third world aid, etc.
Just don't expect anything back in return for your £50k/year - any actual service you have to pay for on top.
Truth Will Out said
"We immunised 789 patients ....."
at how much each?
Go on then John tell us how much the NHS paid you per patient for something that is widely believed to be worse than useless.
i like the many different anonymouse contributions
spices up the comments somewhat
stops me be boring on my own
think the good dr has lost the plot during his time off
Guilty. After 25 years with the practice, I clean forgot my flu jab appointment. Not used to such things on a Saturday morning, you see. I phoned to apologise of course. Unlike the bloody NHS which never apologises. Which will keep me hanging around some over-heated bacteria-ridden hospital for a whole afternoon just so that I can be told "Your results don't seem to be in the file". Repeatedly. You GP chappies may be OK (mine certainly are) but the generation of consultants who have let the hospitals go down the pan have much to be ashamed of.
He he, glad to see not only that the good doctor is back but all his trolls with him...
If you charge people (or put a penalty charge if they're late) they will probably behave worse because they've 'paid' for that appointment and will be even more demanding (Freakonomics has an interesting example of how charging people who were late picking up their kids actually exacerbated the problem).
Oh and if (as always happens at my GPs - even if I have the very first appointment of the day) my doctor is late seeing me, will I get twenty quid if I had turned up on time? I'm getting very sick of month old Hello magazines, I'm sure being forced to read them entitles me to some form of compensation...
anonymous said...
Truth Will Out said
"We immunised 789 patients ....."
at how much each?
Go on then John tell us how much the NHS paid you per patient for something that is widely believed to be worse than useless.
Actually he did, last year. Around £12 per vaccine gross for eligible patients. Only GP I know of who has had the bollocks to volunteer the details, either.
Gully Foyle
re freakonomics, the plural of anecdote is not proof.
But when they charged enough, the pricing was a deterrent. I.e. £20 for an appointment, or £30 if you are 5 minutes late.
I wonder if you could get a significant number of practices in the area to introduce charges?
If so, the question is whether the relevant parts of government could stop you from doing so, and if they actually would.
the lack of availability of decent nhs GPs in many inner cities is introducing private GPs by stealth
the main things stopping the landslide is that private GPs cannot write nhs prescriptions or refer to nhs consultants, once these little restrictions get lifted i expect the nhs GP to die just the same as dentists
and it will take a generation or two but commercial reality will lead to a better deal for the patients and the GPs
i dont think nhs GPs could get away with charging unilaterally without changing the rules, but I would welcome such a change, if appropriate safeguards were in place the the genuinely most sick and unable to pay
Yes, as someone points out, I revealed the precise details of the remuneration we get for the flu jabs each year.
I don't what it is yet this year, but last year the GROSS profit was about £12 per immunisation. We did just over 2000 so the total gross take was around £24,0000 AFTER the cost of purchasing the vaccine.
Out of that, though, we have to pay for all the advertising costs, the office costs and the time of the nurses and receptionists who come in on Saturdays. We both receptionists and nurses very generously.
The NET profit before tax for each full time partner was therefore approximately £1400 for three four hour sessions on a Saturday morning. That is about £115 an hour before tax.
Worth doing, but when you cost it in detail, I would not want to be doing it every Saturday.
+++
If the flu immuisation any value? Well, there is a question. None of the doctors or nurses in the practice ever have it, that is for sure.
John
But the ones who didn't attend are the first to complain that they can't get an appointment when they want to.
We did over 800 flu jabs last Saturday and the Saturday before, but today we had a request for a visit for a flu jab "I came on Saturday but the car park was full".
The problem is overwhelming demand, for appointments with a professional whose time is valued as worthless by patients and NHS organisations alike.
No child of mine will go into medicine, they're too intelligent to fall for that.
I'd really like to see a penalty system inplace for repeat offenders,
where I live, distressed doc, people who miss a hospital appointment get a nasty letter, copy to their GP, implying they've been thrown off the consultant's list (I know because I was sent one by mistake). Not a bad idea.
You appear to have rather more empathy with wife-beating druggies (not that I am suggesting you should not care for them) than decent tax payers.
the middle classes aren't wife-beating druggies? 'Decent tax payers' pay all their taxes? where have you been living all these years?
(The Sebastian/Harriet problem, as the blog post says, is that they want to 'pop in' well outside normal surgery hours. My local private GP wouldn't see them then, why should an NHS one? I think GP surgeries should be open for more than 4.5 days a week [maximum] but not open when people just feel like 'popping in'.)
A previous post:
>>the lack of availability of decent nhs GPs in many inner cities is introducing private GPs by stealth
>>the main things stopping the landslide is that private GPs cannot write nhs prescriptions or refer to nhs consultants, once these little restrictions get lifted i expect the nhs GP to die just the same as dentists......
Dr. Crippen, this Yank is interested. I'm a USA Family Practitioner, your General Practitioner, we thought Family Practice sounded classier.
If I wanted to set-up in the UK. Assume I got past your GMC licensure process. Personally I think USA and UK licensure processes should be transparent to each other, you're like another state and we're like a Commonwealth country.......but no one asked my opinion.
So imagine I satified your licensure process and decided I wanted to set-up across the street from Dr. Crippen and see patients for whatever they chose to pay for my services. I do a lot of that Country Doctor stuff because there are no specialists within a 50-miles of my location.
I have a rich uncle willing to capitalize building my surgery.
Would I somehow not be able to do that? Or would I somehow be restricted in writing prescriptions or referring to NHS consultants?
....arf
Actually he did, last year. Around £12 per vaccine gross for eligible patients.
USA, that's about the cost of the vaccine. Medicare, the majority of insured getting the vaccination, our actual profit (what Medicare pays over cost) is about £4. A little higher for private insurance. Medicaid, you about break even. The only reason I hedge on that is, for me I'd break even. In a public health clinic seeing far more Medicaid (for the poor), gets different funding and is far more profitable for this.
Easy. You CHARGE anyone who books an appointment and doesn't show or cancel in a timely manner. Oh wait, that would be a rational response. Never mind.
arf
i see a private GP from time to time, usually cos its impossible to see an nhs GP for some trumped up reason or another, you really wouldnt want to work here and have to deal with the nhs...
all the private GPs I have seen have to write private prescriptions, and refer to private consultants, so they can give the drugs and refer on, but not into the nhs
nhs prescriptions are heavily subsidised, and indeed free for many of the underclass who never work
paying for private prescriptions for someone with a long term condition such as being diabetic rules out going to a private GP, even if you could afford the price of the GP consult, you really would have to be above the normal middle class salary bands to be doing this
so yes you can set up as a private GP, but you are competing on a very uneven playing field
and for the patients its crap, cos often there is no practical way of choosing another GP, no way of getting on another GP list without moving house, so there is little incentive for the worst GPs to improve
interestingly private dentists can refer to nhs consultants and write nhs prescriptions, i guess because there just are no nhs dentists at all in many areas, hopefully private GPs will be able to do the same soon
no one
re "Easy. You CHARGE anyone who books an appointment and doesn't show or cancel in a timely manner. Oh wait, that would be a rational response. Never mind." only when i can charge the doc for similar and frankly more frequent letdowns
"Never mind." only when i can charge the doc for similar and frankly more frequent letdowns
In a rational system, ie one of CHOICE and a real marketplace, a doctor who did that on a regular basis would be what we call in the colonies "unemployed".
The last dentist I was registered with charged £5 for any appointment missed (but didn't charge if you phoned to cancel the day before). As a patient on a limited income I didn't think that was unreasonable - not even on the occasion that I had to cancel my appointment same-day and got charged. It seems like a sensible way of doing things.
You're probably right that a lot of the people with ongoing conditions aren't working and can therefore come in to the surgery, but you could take into account that a significant part of the reason it is so difficult for these people to *get* jobs is because employers fear they will be taking time off left right and centre for medical appointments.
You then end up with people using up most if not all of their holiday entitlement in order to attend their *necessary* medical appointments, because if they take the time off as "for medical appointments" they're in for any amount of derision and unfavourable consideration from bosses and co-workers ("grumble grumble she gets 20 days holiday AND she has a thursday afternoon off twice a month, that's SO unfair, skiver, etc, grumble").
Missed appointments are becoming a bit of a hot potato at the moment. As usual, rather than looking for a simple solution, the latest bit of NHS madness is to spend even more money by texting people to remind them that they have an appointment- correct me if I am wrong about this but I highly doubt that BT or whoever are going to let us have thousands of free texts per month. The problem with starting to charge directly for things is who do you charge and how much...looking at the problems with dentistry at the moment- we see around 60+ people a month in our A&E with dental problems who cannot find an NHS dentist and cannot/will not pay to go privately.
60+ people a month in A & E for teeth?
bloomin heck
if we stopped taxing them for a service they are not getting they would be able to afford a private dentist
http://news.bbc.co.uk/1/hi/scotland/tayside_and_central/7047079.stm
to spend even more money by texting people
I read about that. Crazy. My local physio dept simply sends standard appointment letters with an addition: patients must ring 24 hours before, to confirm attendance, ot their appointment will be reallocated.
to be honest sending appointments out be 2nd class royal mail, when in some parts of the country around 2% of the post never arrives, is inviting a minimum of 2% no shows
if the providers really wanted the patients to turn up (cos they needed the money) they would do what the private hospitals do and customise their approach to the patient
I am usually defending doctors around here but £ 115 / hr before tax sounds like an awful lot to me, even for a w/end morning.
A more practical point is that you could probably get an experienced hourly-rate doctor (though possibly not one officially trained as a GP) to do the jabs for rather less.
To give you an example, Mrs PhD, who has 10 yrs experience in general medicine across numerous specialties, currently does hospital sessions as a "Clinical Assistant" earning about £ 86 (before tax) for three and a half hours. It usually takes four hrs once she has done all the paperwork (no time allotted in her clinic schedule for doing the paperwork and calls). She does get 4 wks holiday but even so it works out as £ 25 /hr, which is not a lot after 5 yrs of medical school and a dozen yrs assorted slogging away for the NHS.
If you offered her £ 50 / hr to dish out jabs of Saturday morning I reckon she would be beating a path to the surgery door. Also a salutory reminder that not all the doctors working in UK medicine are all that well paid. Pay rates for clinical assistants and staff grades (who are disproportionately non-white, non-UK educated, women with families etc etc) are crap, basically.
they would do what the private hospitals do and customise their approach to the patient
My local BUPA sends me exactly the same kind of standard appointment letter UHW sends.
phd scientist, I'm pretty sure the last time I had a flu jab (in my former GP practice, in the North) the practice nurse (a nursing sister, but not an NP) did the vaccinations. And why not? (Why not, well, because mrs phd scientist could do with the money... she is rather badly paid, yes.)
yea well the times i have interacted with private hospitals they have been happy to interact via phone, letter, or email, any channel we choose
they tend to ring to confirm closer to the time cos THEY WANT THE MONEY
the nhs in contrast sends out a letter, with little info on it, no choice of when or where to be seen, no confirmation phone call, patient gets engaged tone for hours if trying to ring the appointments desk and gets very rude admin staff to talk to, the general attitude being "we are doing you a big favour you need to bend to out will" the exact opposite of a consumer focussed patient friendly approach
dino-nurse, the cost of a text is nothing compared with the money saved by people attending.
As a radiographer in nuclear medicine in the NHS, my wife was always telling me about no shows. In that area, it means the doses of radioactive material are wasted. It does add up to rather a lot per year, enough to pay someone to do some chasing.
When she ran a private nuclear medicine clinic, the office manager's job also involved calling patients to remind them of their appointment, and in case of problems, reallocate people. Guess what ? In 6 years there, they never had a no show.
In my experience of the NHS, I find that only a few people actually give a shit. I think it is mostly due to the system and bad management, but there is no excuse for not doing your job properly.
I agree with Jayanne. Coming from Australia where there is a mix of paid for and publicly funded health care, one would still often wait to see the GP after the booked time-period. Only those GPs that were 100% private seemed to be able to get this wait to less than 5 min on average. On the other hand, fining people for not showing appeals to my inner sense of fair-play. Unfortunately, there are no simple solutions.
It's tempting to charge late patients but as it would penalise the poor more than the rich, I'm not sure how effective it would be. Not to mention it'd create an extra layer of bureaucracy to decide who gets the refund in case of financial hardship.
But still...tempting. I was lucky to be given a lunchtime appointment for my flu shot. Turned up on time, nurse had disappeared to get a cuppa. Fair enough, I'd say because no one had turned up in the last half hour.
Anonymous - have you ever thought of treating doctors and other health professionals as people with feelings. The vast majority of them are fighting the system too. I know it doesn't always work, but a bit of empathy on both sides doesn't go amiss. It's only human nature to side with the people who appear to support you, while the serial complainers can often find themselves relegated to the back of the queue. If you're not happy wth your GP sugery try another - unless you live in the middle of the countryside, most practices have overlapping boundaries. Or have you already worn out your welcome at all of them?
Yes, I'm with Ageing Student here.
In my experience the major stressor on doctors I know is the difficulty sometimes involved in "getting the necessary done in timely fashion" for the patient. The docs often feel they are struggling to do the job right (which is what they want to be doing) in the face of a whole waggon-load of "institutional and structural constraints" - from managers and silly targets and daft "care pathways" to lack of ancillary staff to waits for tests and scans to need to bounce back to GP for re-referral etc etc.
Given this, when the patients - the people they usually feel they are doing it for - get in their face about the service, it is only human nature to occasionally feel a bit of "Well screw you too Sir/Madam, who do you think I'm wading through all this sh*te for?"
Most of them understand this impulse for what it is and work past it. But they need places to "vent" just like everyone else.
thoouth I'm not complaining about waiting to see a GP (probably the private ones have longer appointments so can more easily cope with the problem that some patients will need more time than others). Indeed, I am concerned by patients/customers/clients who don't understand that fixed-length appointments don't work unless they're made inefficiently long. (Even then, of course, something could crop up. One of my London GPs had to dash out of the surgery to tend to a man who'd had a terrible accident, and in my York GPs' practice a patient was taken seriously ill right there in the surgery.)
If you're not happy wth your GP sugery try another -
I believe, ageing student, it isn't that simple. First, GP practices have catchment areas (they overlap, of course, so -- for example -- people in my street could be registered with one of at least three practices). Second, (if what I'm told is true) practices within a catchment area (roughly speaking) may have no-poaching agreements. [I wasn't told this by a doctor, NB.] Third, a practice may not accept new patients. And *fourth*, 'try another' then go back to your original GP?!?! (But I see no one/anonymous already said that in this thread... )
(It's interesting that that's what pisses you off. What pisses me off -- admittedly I know no one doesn't think all doctors and nurses are bad, very far from it -- is the way he, no one/anonymous, goes on about old people and 'the underclass' and so on.)
phd scientist yes patients have to extend understanding to medical staff. And vice versa.
Why don't you take a page out of the airlines' book and double-book those you know have been no-shows? You could advise people this will happen when you make the appointments. If both turn up: take the first, and rebook the last.
No remedies will work, though, unless you keep all *your* appointments.
Re "It's only human nature to side with the people who appear to support you" agreed and understood, although a good professional should still give good service to those with whom they don't see eye to eye
Re "while the serial complainers can often find themselves relegated to the back of the queue" don't know, if it happens it shouldn't in the GP context. But you see no GP has ever considered me a "serial complainer", complaints I've informally made about my own GPs
i) A locum who couldn't understand basic English, result fuck all but the practise seemed to sympathise with my frustration, it was obvious for all to see, simple factual complaint, didn't fix the problem
ii) A GP surgery which had a camera crew in doing a documentary sticking cameras in the faces of very sick people, who wouldn't leave the sick people alone when asked, filming sick people very much against their will. Got an apology after the event.
Other major frustrations have been with GPs and my family. Long list of issues with the way my diabetic partner is mishandled by the nhs, including the GPs. Long list of issues with the way some of my elderly relatives are treated by the NHS, including GPs. etc.
I know you don't believe it but I'm not normally the complaining type.
Re "If you're not happy wth your GP surgery try another" Oh dear this is a well-worn topic. Let me give you an example. If you live in the XYZ postcode there are only 3 GPs which the PCT will allow you to register with (there are others for students only). If you ring and try and register with any other GP for a hundred miles in any direction, including just up the road, they will tell you "sorry the PCT does not allow us to register patients from your postcode". Now of the 3 GPs you are allowed to register with 1 is half decent but books are full, no spaces 2 and 3 are generally staffed by locums who cannot fucking converse in basic English and the surgeries are normally literally full of the leading members of the drug dealing and using criminal violent members of our community, to say nothing of the poor appointments provision etc. So you tell me what I should do? Move address! Which is exactly what I was forced to do, for my partner not really for me.
Re "I know no one doesn't think all doctors and nurses are bad" far from it some are great, I could list a few exceptional ones, who I have gone out of my way to thank
Re "old people" well generally I find the service my older friends get from the NHS to be fairly useless also. But I do think appointments for things like blood tests should be arranged on a "peak" and "off peak" basis to allow people who work to get seen when its best for their job. I find the current situation where if you go look at the place where all the blood tests are done which is open (I think just remembering off the top of my head here) 8.00 am to 6.00 pm that at 8.00 am there is already a long queue of OAPs to get seen, making life for any working person trying to get seen before 9.00 impossible. Of course I also believe there should be evening and Sat appointments for working folk. I actually think that OAPs would understand if they were offered special off peak access, if done well.
Re "and 'the underclass' " well what does this mean? I have a lot of sympathy for genuine decent folk born onto a shit public housing estate forced to go to crap schools who have low chances of escaping, I find the prevalent politically correct fashion to allow running such folk down, e.g. in programs such as "Little Britain" to be offensive
However I am also frustrated by, and find, the system which allows generation after generation to have kids young, get public housing, go to the worst schools, and fail to reach any potential very very sad. Large wastelands of public housing estates living almost entirely on state handouts for at least the last 3 generations I know about is not good for any of us. And many of the people in this situation have such limited horizons due to the environment around them. I think decent education is the only way to solve it, but it aint happened in my lifetime.
But worse I find a society, which fails to tackle a large number of persistent criminals and druggies, to be failing. I have no sympathy for the drug dealers, or the car thief's, or the mobile phone stealing, and I find it very annoying to be genuinely very sick in A & E behind a bunch of these folk acting very aggressively and getting treated largely for self inflicted injuries.
The UK is pretty unique in forcing honest decent folk into having to use the same GP surgeries as the dominant drug using criminals of that city
no one
But I do think appointments for things like blood tests should be arranged on a "peak" and "off peak" basis to allow people who work to get seen when its best for their job.
we've discussed this one before! I agree with you, I simply had no idea, before you mentioned it, blood tests were arranged like that, as where I live, blood's routinely taken at a GP's surgery. (The system isn't ideal as it's 'turn up when the phlebotomist's there, and wait; but I've never had to wait more than 10 minutes.)
Thank you for explaining your views about 'the underclass', I agree there is a problem. Having been pushed around in Starbucks today by some yummy mummy types who a) thought it was their right to stand blocking my way in a corridor and so stop me getting out of their path (!! -- I stared them down till they backed off) and b) (a different yummy mummy group) blockaded my coat and papers so I had to go around the outside of 'their' circle and lean all the way over to get them -- they didn't even apologise, not even perfunctorily -- I'd say there's a more general problem, though.
(Yes, education could do a lot, but I'm not optimistic either.)
there a difference between rude people in a coffee shop, and having to sit when you are ill and at your most vunerable in a surgery waiting room full of people who have recently been given some community service order or other for their latest round of violence and drugs offences
again if the patients were actually allowed to choose their own GP this would quickly resolve itself
on reflection i would add re "It's only human nature to side with the people who appear to support you" that the NHS is usually a "he who shouts loudest gets the best service" organisation, its usually mild mannered folk like me who get the worst service, and thousands like me
jayann education is the only answer, but despite the political promises the same public housing and inner city areas have the same crap schools which can only attract the crap teachers, and so it goes on, and the nhs is going the way of education what you get is dependant on your postcode more and more, there are attempts at social manipualtion forcing mixed developments of middle class and poor folk but these in my recent experience are largely a failure, simple understanding of human nature is missing
and yet i wish i could take some of the young kids off the worst estates and expose them to some good role models
We live in a rural area where public transport is non existant. I was sat in my surgery and overhead a conversation:
Patient: Would like to book flu jab, I pay for it.
Receptionist: Oh this year we have a different system - don;t know why - but anyone who wants one who pays goes to Dr Smith's surgery.
Dr Smith is about 5 miles away.
Then she said something about all his NHS patients who didn't pay coming to our surgery, which sounded bloody stupid, if you ask me.
So where I am, if you want a flu jab, but pay for them, you can't get one unless you drive to Dr SMith and all Dr Smith's patients who don't pay come to our surgery 5 miles away.
So much for reducing our CO2 footprint and what if you don't have transport??
£115 an hour - and you're complaining!!!!!
If you want to pay for a flu jab sainsburys pharmacy is doing them, probably cheaper than the gp, and at least you'll be able to get through on the phone
there a difference between rude people in a coffee shop,
I'm not comparing the situations, simply pointing out that there are some very crap middle class people around (I was, it happens, pondering the growth of a feeling of entitlement in British society when all this happened).
oh yes lots of crap middle class people around, lots and lots and lots and lots
look, my point is that you seem to have an aversion to sitting waiting for hours in dirty hospital clinics or (for less long) in GP surgeries, both literally full of the leading members of the drug dealing and using criminal violent members of our community, when I might have an aversion to sitting waiting for hours (etc.) hemmed in by yummy mummies (who'd get better treatment, and faster, even, probably, because of the Cult of Motherhood). I have every sympathy with your complaints about waiting, dirt, etc.. But the NHS is for everybody, or it is nothing. There can't be an opt out for people who don't like the company they keep in waiting rooms, short of their going to private GPs/hospitals. What we need to (try to) do is have decent appointment systems and far shorter waiting times.
Sorry Dr Crippen, but having a go at the middle class 'worried well' does not wash. I agree with what you say but I am middle class male and 45 and spent the last year getting indigestion, back pain and occassional very dark stools. Self treating with various indigestion remedies and pain killers kept me just about OK. I kept thinking, I do not feel well and yet how can I go to the doctor and tell him I keep getting indigestion and a bit of back ache?
Well, last weekend I spent 48 hours in agony with indigestion and back ache so bad I could not sleep. I went to my NHS the doctor and guess what? If I am lucky I will probably be diagnosed as having a peptic ulcer which may be bleeding and if I am not lucky I may be getting treatment for pancreatic cancer.
You see, the worried well are sometime very ill - but sometimes we cannot self diagnose without the occassional visit to the NHS surgery. Sorry to be a bother but thats illness for tou. Actually my doctor was absolutely brilliant, got straight on the case and blood test results on Thursday. Wish me luck.
How are Sebastian and Harriet destroying the NHS? Prsumably they use the NHS infrequently and almost certainly have PMI, so any expensive treatment they do need will be covered by that.
Incidentally, both of the GPs in my surgery and the next nearest have '07 plated estate Audis. Being a 'girlie' I'm not sure whether a BMW is more 'middle class' than an Audi - my guess is that they're pretty similar.
I would consider my husband and I to be fairly middle class - guess what he drives a 'W' reg Ford Focus and I an 04 C Max. The GPs certainly get the 'posher' cars...
Jayann - I'm a mum of 2 young children and I most definately DO NOT get better or faster treatment!
Anon Sat @ 6:29 - Hope the bloods come back clear and that you get better soon. Good luck!
'Someone'
re "look, my point is that you seem to have an aversion to sitting waiting for hours in dirty hospital clinics or (for less long) in GP surgeries, both literally full of the leading members of the drug dealing and using criminal violent members of our community, when I might have an aversion to sitting waiting for hours (etc.) hemmed in by yummy mummies (who'd get better treatment, and faster, even, probably, because of the Cult of Motherhood). I have every sympathy with your complaints about waiting, dirt, etc.. But the NHS is for everybody, or it is nothing. There can't be an opt out for people who don't like the company they keep in waiting rooms, short of their going to private GPs/hospitals. What we need to (try to) do is have decent appointment systems and far shorter waiting times."
dont agree, we need inner city NHS facilities specialising in drugs victims
there should be zero tolerance to agressive behaviour in a normal family GP waiting room, and folk doing this really need to be seen somewhere away from vunerable members of the community
its really not fair on decent folk to be expected to put up with treatment in such surroundings
if the patients were allowed to go to any GP or clinic they choose, which should be the case, then the NHS or whoever would be forced to provide better decent specialised care for the druggie criminal element
certainly i dont like waiting or being seen in dirty clinics, again i think simple customer pressure would solve this if they could take their business anywhere
it is a lack of competition between clinics and providers within the nhs that is in large part responsible for the ongoing dropping standards, it is not good for ANY members of the community to allow this to continue
yummy mummies can be a pain in the bum but rarely attack people
re "middle class 'worried well' does not wash" agreed, bigger problem is middle class (and wroking class) males who have not been to a GP for years, who get some minor symptom which is an early indicator of something more serious who dont go to GP early enough
Is it OK to make derogative comments about someone being 'middle class', but not OK to make adverse comments about someone being 'working class' or to mention the colour of their skin? Isn't that being 'classist' and surely is as bad as being 'racist'??
Surely in the grand scheme of things there are more important injustices in the world than having 'middle class' patients who come to see you once in a while? Just been reading about women in Africa who suffer long term health problems as a of obstructed labour. These women are in labour for DAYS (Gosh no epidural!) they then manage to get to hospital have if they have the money, a C-Section, baby is usually dead and they end up leaking urine and faeces until they have the fistula repaired. The cost of the operation £170.
http://news.bbc.co.uk/1/hi/world/7050934.stm
http://www.endfistula.org/
'Someone'
On the whole the genuine working class, i.e. the decent folk doing manual jobs, are probably discriminated most against in the UK, as are their children in perpetuity no matter how successful and they become
The long term unemployed do have some politically correct supporters
The middle class who are geographically stable are in many parts of the country the best at manipulating the system and getting their kids into the better school, and GP list
The mobile workforce both working and middle class, is shafted and discriminated against all the time
I would say the ordinary working folk, and underclass on the worst estates who will never work, are the last bastion for the prejudiced comic, all of the old racist jokes have been rehashed and come out against the D's and E's on the large wasteland housing estates
I know plenty of women with long term health problems due to shit care and dirt in maternity in the NHS
no one
The maternity unit i worked on served deprived wards form the local area (itself pretty bad).
The outcomes were damn good.
Long term outcomes for women delivering in the NHS are very good from the stats we were given in lectures. What sort of "long term health problems" are we talking about? Most of the long term problems i know of are known compications of delievery, not due to "shit care". Week in and about i was in theatre seeing the repair work for urinary incontinence (cause varied but multiple delivery was the main). This was not due to bad care just known complications which were repaired on the NHS.
Oh and as for the working class.. where is this class, is it money based? if so then many of the people who live i nthe "posher" areas near me are tradesmen.
Do my parents (who left school at 13 and 15 as they were told to work by their folks) not count as working class because they saved and worked harder than many to live in a a good area and have the 2 cars etc.
Funny pseudonym - I would say that 'class' is pretty much money-based, but I guess a certain amount of 'breeding' comes into it....
Tradesmen do pretty well these days. Plumbers earn around £250 a day, builders around £150. All about supply and demand.
My point is that there's much more to get upset about in the world than whether someone drives a BMW or not.... if I had the gift of being able to treat people I wouldn't waste my energy getting uptight about what kind of car they drive.
'someone'
funny fucker
well i know of a few women who have been stitched up after birth with swabs still inside them, subsequently developed problems due to those dressings being inside them, infections, long term complications, and even the eventual op to remove the swabs have not left them 100% afterwards
do you really want me to list all the examples? you been to a shit nhs hospital recently, you seem to live in a fantasy land or maybe the only fucking decent nhs hospital in the country - if so id love to know where it is?
no one
Not having logged on over the weekend, I note the discussion is STILL going on. Anonymous, you have my sympathy re your problems with finding a GP surgery. The one we go to is on the edge of a large council estate and I have never had to share the waiting room with the sort of people you describe. There are large notices in the entrance and in the waiting room stating that the practice does not tolerate aggresive behaviour to any of its staff and that any paptients who do not comply will be removed from the list. Either they have all accepted the terms and do behave or the worst offenders have all been asked to leave (and presumably are now registered with your previous doctor).
Anon how long ago was this?
God damn i would be going mad and taking people to court for these problems.
In theatre all the scrub nurses i have worked with have done more counts than nessesary in instruments and swabs. They go ape when a count is wrong and whe nthe offending item is found (usually 2 swabs stuck together) they do it again to make sure.
Actually anon i have now worked in 4 hospitals in ths country during medical school, 2 abroad and worked in 2 hospitals in the North before medical school (i was in one during the military but not in a medical capcity).
re "God damn i would be going mad and taking people to court for these problems." ah the beauty of the nhs complaints procedures, how fair they are, and how the nhs reacts when you issue a summons against it, throwing tens of thousands of pounds worth of lawyers against a poor hard working person who can only afford the most basic legal advice
DONT BE FUCKING STUPID, OF COURSE THEY HAVE COMPLAINED AND TRIED THE LEGAL ROUTE
the courts will only work for millionaires in most cases against a fucked up NHS which can throw infinite amounts of tax payers money at defending itself, and then delights in ruining the injured party by insisting on costs being awarded
the complaints process is a fucking sham, with lots of staff per hospital having a full time job of manipulating and responding to the complaints process
YOU REALLY HAVE NO FUCKING CLUE
if the nhs actually owned up and admitted its fuck ups and improved then maybe people like me wouldnt get so fucking worked up
the NHS should be like the police, if you need in extreme to make a complaint against the police the first stage is an inspector comes and listens to you, often they offer to go back and bang heads together and that resolves matters, otherwise at least the local leadership understand why the public are so pissed off while the formal complaint is progressed
in the NHS complaints process you will get fobbed off with PALS (dont waste your time) and the admin wallahs whos job it is to do their best to mitigate the affect of the complaint, by lying and covering up if necessary
as far as I am concerned if a complaint is made against the nhs the most senior doctor in that speciality should be forced to sit down with the patient for a few hours to listen to how bad things are from a patients perspective, I am convinced from this blogg that many docs dont even realise whats going on around them
No you have no clue.
"£579.3 million was paid out in connection with clinical negligence claims in 2006-07"
"96% of the NHSLA's cases are settled out of court. Fewer than 50 clinical negligence cases a year are contested in court."
So get legal advice from the local authority or council and take them to court. Complain as a means of showing you have taken nessesary steps and then when nothing happens stat legal proccedings.
But then i have no clue...
PALS actually seem to be the people in the hospital who can get things done asap. We have often told people to talk to PALS when things are not going along (i.e. when we have requested but not heard anything) they seem to get things sorted pretty quickly in most cases.
The doctors know exactly whats going on in most cases but are powerless to act.
I was on a ward where there were 4 patients who were medically fit but thier families "wanted to make alterations to the house before they could come home".
Some of the reasons were terrible..we need a new toilet seat and it will take a week or two to get it. The consultant has no power to remove the patients from hospital, i see consultants regularly fustrated they cannot order certain tests or reffer to a specialist center (it need to go to the PCT via the GP fora funding decision).
No one, i do wonder what happened to you or a person close to you to thnk the NHS is so bad. I see people all day who get what they need in a timely manner and seem to be doing well (follow up clinics are great when the med/ op/ scans have worked/come back normal).
You don't have a monopoly on insight into the NHS or it's failings.
re "i do wonder what happened to you or a person close to you to thnk the NHS is so bad" so many things all the time as a constant drip drip drip over the last years, plus the regular extreme fuck up, and failure to provide treatment, i have outlined a number of them on here
PALS probably helps the worried well and middle class dross Dr C worries so much about, serious stuff they are out of their depth
compared with some great service abroad
funnily enuf ive chatted at length with the lawyers who go against the nhs regularly, and sometimes defend it, their off the record view is rather different to yours
Ah the 'worried well', educated people who are proactive about their help, research it first and then visit the doctor - presumably for some confirmation or to argue the toss about seeing a consultant. Don't ya just love em? or Don't ya just hate em? They arn't easy to manipulate, usually have fancy notions and take away doctor/patient control. Better those working class or timid middle classes who show respect for the superior mind of the doctor, who blindly trust them to look after their health.
I don't do bashing, most doctors provide a diligent, professional approach. However flu jabs are here to stay, there will always be a portion who never turn up, and there will always be moans about it.
To those who complain about holiday jabs the reply is - the NHS is free at the point of entry and isn't there to provide treatment for those with lavish lifestyles.
Don't most consultants working within the NHS hospitals work also in private hospitals? So it must be for patients. This has to cut both ways.
And another thing....
Those who participate in dangerous pastimes or who play contact sports such as rugby playing, football, etc., should be charged if they recieve an injury directly related....
Anonie1 - couldn't agree more - well said!
...re sports injuries - should that list include DIY injuries? Lots of those! ££££
'someone'
Kudos! Very informative article, keep up the good work!
This blog will be one of the many that I visit everyday.
Best of luck,
nursereview.org
I have always thought that appointments should cost, and prescriptions should be free.
Whilst it is true that many who regularly and genuinely use the NHS are not working, that is not the case for everyone. I am 40 have many health problems e.g. bronchiecstatisis a type of lung damage and neurological problems. I work full time and always have done. I am lucky that my current employer is happy for me to take time off during the day to visit the Dr and the hospital.
However, not all employers are so understanding and this does make it harder for those who genuinely have ongoing health problems and need to visit health services regularly.
My GP is also sympathetic and gave me the flu jab during a visit for other health reasons rather than making me come in a separate day for another appointment.
I do think the health service has to consider the needs of the elderly who use the health service most, but don't forget about people like me either.
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