A way to streamline NHS

[FairytalesAreBullshit]

With most of us having access to the internet, I know this does exist privately, but maybe surgeries use the internet more to help patients.

Like the patient with a UTI, reflux, skin complaint emails in and the Dr goes ah yes, they need this. Or even a nurse practitioner.

The child with an irritating cough is triaged further with questions, then the typical linctus is suggested. Or the child with D&V is triaged further, if necessary, they're bought in when the surgery isn't full of unsuspecting victims to avoid transmission.

The patients with more complex symptoms get booked into surgery.

A lot of the time if you have several health issues, you fear the GP will have a nervous breakdown if you mention everything you want to ask. Plus a lot of us forget, so emailing ahead, the Dr has the full picture and can deal appropriately.

Or the patients with other chronic diseases, who pretty much know what is needed, say what it wrong and suggest this has worked in the past. GP decides if they need a face to face consult.

For a few patients, it's quite ironic but doing the littlest of things is a big deal, so being able to email the GP with 'ok this is happening,' they might be able to prescribe there and then, or want to see the patient.

Say blood tests have come back, a nurse practitioner could get the results, if we focus on TSH, low or high, patient is told that bloods have shown hyperthyroidism, prescription has been send to your chemist for meds you need to take at a certain time, plus a new bloods form will be posted, so they get retested in so many weeks.

Or the person with a borderline fasting blood sugar, nothing imminently wrong, please book in to have a GTT.

It could streamline how services work, it could make it easier for patients who work and commute. Say John went in and was found to have slightly high BP, they gave him a BP monitor for morning and night, email or write down results and bring back machine. GP / NP takes it from there.

I know some surgeries may use it, I think I read of a woman who ordered meds online for her husband, there was the example he said he had something he didn't to get anti biotics. You'd have to trust that it wouldn't happen often.

For those who love being at the Dr's Surgery, it could really transform things. So say you started a new med, all seems ok, there's no further in person checks required, all sorted quickly.

Leaving appointments open for those who really need to see a Dr ASAP.

They do have the telephone triage system, but with an email triage system, you can get it all on email, instead of losing your nerve as some do and getting cross as the triage Dr/NP is dismissive.

It could work well in hospitals too, with patients checking in with consultants / specialist nurses. Asking any questions they may have forgot or cropped up.

Maybe it's not as simple from an insurance point of view. But last example, Ellie is waiting for ENT surgery, has another bloody infection, Mum knows the signs well. Sorted quick.

Would you use it if it was available?

[FairytalesAreBullshit]

I'm really sorry to hear that, you are right. I guess it's not always as straightforward as it seems.

[wickerlampshade]

I'm a GP. answering an email takes almost as log as seeing a patient so every email or two I answer would mean one less appointment available.plus they are medicolegally high risk.

[FormerlyFrikadela01]

One of the GPS at my practice experimented with Skype appointment's but doesn't do them anymore so it mustn't have been a success.
I think there are a lot of people that insist on seeing a doctor so would feel fobbed off by an internet/email triage system.

[BoomBoomsCousin]

Some of the stuff about a NP directing you straight to a specialist service for some things has been happening at my surgery in London for at least 7 years. Telemedicine (Dr diagnosing remotely) can be a real boon if it's really hard to get to a doctor, but an examination takes longer and is less effective. I suspect we could make much better use of nurses if we could hire enough of them, I suspect we'd have to raise wages significantly to do that and keep up the quality though.

[wickerlampshade]

getting cross as the triage Dr/NP is dismissive.

and they'll be less dismissive on the phone knowing that they have 150 emails lined up to answer? I know you mean well, but you clearly have no idea of the stresses on GP and the fact that we can't just magic up time in our day to deal with a load of emails without a knock on effect on appointments provided.

[Oliversmumsarmy]

But this would have to rely on doctors actually listening and treating all the symptoms in one go rather than treating one symptom at a time.

Whenever I have self diagnosed I have been told not to and spent some times years going through needless appointments with umpteen consultants or psychiatrists when they think the symptoms are all in my head (nearly died in that instance) before coming to the diagnosis I had said in the first place.

Dd spent 5 days in hospital. I recognised the symptoms and said gastritis. Doctor said not to believe everything you read on the Internet (FWIW I had gastritis when I was younger so it was from experience) she was tested for ectopic pregnancy (she was 15 and never had a bf) gall stones (only usually found in older people or obese teens. Dd is 7.5 stones and 5ft 10")

Finally on the 5th morning she was given a scan and diagnosed with gastritis and was discharged a couple of hours later.

Dd took that bed up for 5 days plus 5 days of unnecessary tests. If I was listened to in the first place then how much money would have been saved.

Dp was diagnosed with bowel cancer last year unfortunately the umpteen appointments where different doctors diagnosed constipation and sent him in his way with laxatives. And the ones who tried to wrestle the increasing bulge in the side of his stomach back into place and told him he had a hernia and if it hadn't gone down in a few weeks then he might need surgery to repair the hernia. All added to the time before diagnosis in which it gave the cancer time to spread.

So if I was to.recommend anything it would be too listen to the patient.

Saw one consultant every 6 weeks for 5 years. At no.point during those consultations did he ever look at me.

If he had glanced in my direction he might have been able to diagnose slipped discs and not that I needed a hip replacement

[Gran22]

Perhaps the NHS should cut out free treatment for anything that isn't life threatening. No more free prescriptions for paracetamol or Calpol or anything that's freely, and cheaply available OTC. Put a moratorium on free IVF, on cosmetic surgery (except in severe cases of need), and make those who miss appointments pay a deposit when they next book, refundable only on attendance.

Police drunk tanks could reduce the pressure on A&E. Not pleasant for children or really ill people to be waiting for treatment in the company of lairy drunks! Impose these rules for five years and see if they make a difference. Oh, and lift the cap on nurses' pay. That might encourage them to stay, rather than paying for agency workers.

[allegretto]

I think a problem is that not everyone is articulate in emails. It is far easier to ask for clarificiation face to face - I think most email descriptions would leave the doctors doing more work than face to face.

[Guavaf1sh]

With the massive advances in technology that occur so often now it is undoubtedly the case that e-medicine will be a big part of our future health system. Through triage algorithms, to decide which tests to order or perhaps much more but mark my words computers will be the doctors and nurse practitioners of the future

[MrEBear]

I'm somebody else who would worry that email wouldn't get across how seriously ill a person is.
Being tired and a bit out of breath is normal at 8 months pregnant, right? It turns out that actually it was pumonia and a week on oxygen was needed.

I do agree that something needs to be done, maybe more use of nurses. It's easier at my practice to see the nurse, she will grab a doctor if she thinks it's necessary, every time I've or my kid has been Doc was called in.

[Jenny70]

I think it seems straightforward, but in reality people don't send in the relevant details.
Someone with diabetes might complain of sore toe, but not mention whether it's swollen, discoloured etc... so Dr tried to email/call back, can't get hold of them, has to follow it up later.
Someone needs repeat script, but Dr wants to check blood pressure/mood and side effects with patient, so they have to come in anyway.

People are very bad at describing their own symptoms, either including too much details (4 page email?) or very little, which isn't enough to diagnose.

[IDismyname]

I am staggered how little technology plays in the NHS, especially at the 'GP surgery ' end of things!

I imagine it's different in different parts of the UK, but why can't I book an appointment online? Or get a renewal on a prescription? I have to physically attend the surgery to fill out a paper form to do the latter!

A hospital in Wales sent (via their intranet, I gather) the X-ray of DSs shoulder to our local hospital. It 'got lost' in transit.

[Crisscrosscranky]

Get rid of appointments and if you need to see a Dr you sit and wait. Nearly impossible to get an appointment with my GP as appt are book on the day (call after 8.15 and no chance) or 3 weeks in advance (people book it then don't turn up).

No prescriptions for OTC meds

No treatment for overseas visitors unless life threatening without insurance/means to pay.

Stop allowing U.K. Trained doctors to work overseas within X years of their training without financial penalty

Centralise 'back office' functions (and I say this as a back office function manager) and pay salaries for non-clinical staff at the local market rate.

[HollaHolla]

The 'sit and wait' approach is all fine and well for one-off/urgent appointments, but I have a chronic condition which needs monthly/6 weekly checks. I can't take a day off to 'sit and wait' every time. There are thousands of people in my situation. I have a 5.15pm appointment every time, so leave work early to attend. I work elsewhere in health education - is it fair to my load to remove a day's appointments to allow me to attend a 10 min with my GP every time?

[hettie]

Any large corporation or state run organisation has flaws or inefficiency (see the banking sector circa 2008 etc).
We could tinker with all sorts of efficiency savings but the bottom line ix we pay much less (relative to GDP) than most European countries into the NHS, so we get what we pay for. We want Scandinavian public services on a USA tax system and we simply can't have our cake and eat it.....

[FabulouslyGlamorousFerret]

Good idea in theory but like the GP posted above, to decipher an email, reply, check notes etc would take longer than an actual 5 minute appointment.

[MadisonAvenue]

Recently I took my son for a hospital appointment at a different hospital to the one he's been attending for the last (almost) 17 years.

Initially I was impressed. Rather than going to a receptionist there were touchscreens to check in on in the lobby, but when we reaches the paediatric clinic there were two receptionists seated at the desk. We were in the waiting room for around an hour on and off, waiting to see various people, and all the were doing was moving a file from one pile to another and taking forms from patients after their appointments were over. Absolutely no need for two people.

Blood tests at his old hospital were done by one nurse. At this one there was a nurse taking the blood, another holding his arm and a third putting his name sticker on the envelope. Absolutely no need for that and they're staff who could've been used elsewhere in the hospital.

[MadisonAvenue]

*reached

[Oblomov17]

I too don't see why it can't be used alongside all other methods. It would fit for some cases.
I think quite a few pp have been dismissive, whilst not acknowledging that it has its place.

[OhTheRoses]

Customer service training would help. It isn't free and we shouldn't be grateful. No NHS employee does the public favours they do what they are paid for and relatively speaking the terms and conditions are very good.

The entire culture needs to change.

[PurpleWithRed]

Our surgery lets you book appointments for tomorrow online after 6:30pm; order repeat prescriptions by app; and both GPS and Nurse practitioners do telephone consultations. As a repeat sufferer of UTIs I can drop in a sample in the morning, call for the result in a few hours and pick up a filled prescription from my local pharmacy an hour or two after that. I think they're doing pretty well.

They don't accept emails but I can see why - it tends to result in a flood of trivial communication and to-and-fro stuff that's quicker to deal with by phone.

[icy121]

@Gran22 if you want patients to pay for their IVF then I presume you're also in favour of obesity related treatment (metformin, blood test strips, knee/hip replacements, heart care etc) as well, as this is a lifestyle choice? Obesity costing NHS £16bn a year, vs fertility treatment £400m a year.

Also, if children are a lifestyle choice, and should only be available for those who can afford it, you'll be in agreeement of cutting all child benefit? Child benefit costs £11bn a year vs again, ivf costing £400m.

[MackerelOfFact]

It does exist though - telehealth is an emerging area, especially for older people and those with long-term conditions who need regular monitoring without necessarily having an examination. Making better use of practice nurses is something that NHS chief executive Simon Stevens has tried to make a priority, and is a good idea - however patients want to see 'a doctor' and often feel fobbed off with a nurse. Takeup of these sorts of schemes will vary by CCG though, as they are responsible for deciding what services are needed/provided in each area.

I also think it's important for the Dr to get a full picture of symptoms and to be able to ask questions, as details that you might not consider relevant might make a massive difference to a diagnosis.

[OhTheRoses]

An enormous amount of money is wasted on fixing things. CAMHS where we live was dysfunctional. Young people not being seen, inflexible, referrals lost, generally poor ad more poor than relativity to funds would suggest, so what did they do?

They spent a year setting up focus groups taking the time of two full time managers and countless others to produce a report detailing it in 100s of pages. This was then presented to all the CCGs, six or seven Drs at a time, the LA and it's committees etc.

On the back of it they got an extra £2.3 million of funding to introduce a new layer of bureacracy to better monitor their performance failings and to formalise partnerships which Jo Public were having to use anyway because the service wasn't fit for purpose.

Guess what. The service underneath all this is still as rubbish as it was before except now the young people can't go directly to the partners.

That is absolutely what is wrong with the NHS.