Wouldn't it make sense for the NHS to spend more on...

[RunBackwards]

Early detection and treatment, to save the cost of much more expensive treatments later and provide a better experience for patients?

Two examples at opposite ends of the scale.

• DS2 had an infected toe. GP diagnosed an ingrown toenail (as expected) and prescribed antibiotics but can't treat the cause becuase podiatry isn't available on the NHS unless you're diabetic. It's certain the infection will reoccur, come back for more antibiotics when it does. Thankfully I was able to get the nail treated privately, a minor procedure taking around 20mins and costing £40. If I hadn't, the NHS would have born the cost of regular GP appointments and antibiotics indefinitely....to save £40.

• DH had a cough and was sent for a scan. Long story but the lungs were fine and cough is now better but they found a large tumour on his kidney, which is apparently the way most kidney cancer is found because it has no symptoms until very late. Because of the way it had spread, this resulted in a major operation, involving both Urology and Vascular surgegons and a spell in ICU. Obviously I am incredibly grateful that the NHS was able to do it but I dread to think what the cost was and if it had been found sooner, say by a routine scan, he could have had it a abladed as an out patient.

And in a similar but different example, a fellow patient while he was in recovering from the op had a similar issue but his had been found sooner, so his op was not considered urgent. Obviously knowing you have an aggressive tumor and having to wait months for treatment is difficult to live with so the NHS had been treating him for depression and anxiety and the state had been paying him sickness benefits for months leading up to the operation. Doing it sooner would have been better and saved money all round.

Now, I know none of this can happen overnight, will need investment and major change in processes, moving resources and different/equipment and staff etc but surely saves money in the long run and has to be better than keep increasing funding to the NHS to keep doing what it's doing, the way it's doing it?

Some efficienties (the ingrown toenail) could be effected relatively easily.

I agree with you about the toenail situation.

I'm sorry to hear about your DH and hope he makes a full recovery. However the nhs does do scans for cervical cancer and breast cancer for example. If we were to routinely scan everyone for every possible cancer I would imagine that not only would it cost the nhs a fortune but we would all have to spend a significant amount of time taking time off work to have these tests.

I wonder what it would cost though? DH scan was his whole torso, although only "required" for his lungs at the time and would surely pick up most of the major cancers. Of course there's a cost and to make it widespread there'd need to be investment in additional equipment but the savings from catching things early would be huge. (Assuming they were also treated early)

A whole body scan once every 3 years? I don't know if that's often enough or if 5 years would be enough?

I have no idea why your GP didn't refer your DS to podiatry for the ingrowing toenail/
I've worked in podiatry across the country for the last 18 years and we've always done nail surgery on the NHS. I don't know a trust that doesn't do it.
I did 6 last week alone and we have a very short waiting list maximum 3 weeks.

I had very lengthy discussions with GP over it. She insisted that podiatry is and never has been available on the NHS unless you have diabetes.

Sorry to hear about your DH, and hope he recovers fully.
The problem with your suggestion is that whole body scans expose you to radiation, which if done on a regular basis have their own risk, and very unlikely to pick up a problem without symptoms. Scans often pick up incidental findings which may well have never caused any issues, so you are then exposed to treatment with its own risks that you may never have needed.
The screening programmes are well researched and only done if there is a definite benefit. You still however pick up breast lumps etc and treat when the likelihood is that they would never have spread, but once you know they are there, you can't ignore.

Some need surgery some dont but we will always assess and do one treatment. Sometimes GPs don't know what is available and just say no. You can look on the podiatry department website locally to see what we do.

As an nurse I completely agree with the ‘prevention is better than cure’ approach. The screening programs that do run such as cervical/breast/AAA etc are all very effective, minimally invasive and proven cost effective. There are multiple issues with screening for everything such as: the NHS only ever looks to the year ahead regarding what it can provide in terms of annual budget. Some screening requires more invasive procedure or scans such as xray/CT/MRI and you can’t regularly expose people to these without clinical need. The amount of equipment and staff needed to do such screening would cost ££s and that sort of initial investment in equipment and training isn’t possible. The pick up rate for things needs to be ‘acceptable’-now I would argue that picking up one cancer or serious illness early is acceptable but in the bigger picture when they do the sums the powers that be wouldn’t agree. I think a ‘private’ health model where you get a sort of annual MOT would pick up things quite well (bloods, quick physical, social history etc) however this would require huge buy in from GP/primary care and buy in from secondary care that the rate of referral for ‘incidental findings’ would increase. Fundamentally I agree with you with things like the toe nail situation-it is an easy win in terms of cost reduction and patient experience. The bigger picture is more challenging. The NHS needs overhauled in many areas as it is now funding so many things that couldn’t even have been imagined at it’s inception I’m not sure how long it can carry on with management just ‘papering over the cracks’.

I hope your DH is recovering well.

@RunBackwards

I had very lengthy discussions with GP over it. She insisted that podiatry is and never has been available on the NHS unless you have diabetes.

Our youngest was referred to a Podiatrist because of an ingrown toenail and had half removed by them the beginning of this year, all through the NHS.

He is not diabetic in the slightest.

DS had a red sore patch on his face.
Doctor prescribed a medicated face wash which didn’t work.
Doctor prescribed anti fungal cream which didn’t work.
Doctor then prescribed antibiotic cream which also didn’t work.
DS then had a course of oral antibiotics which, guess what.... didn’t work!

Doctor finally did a swab test which found quite a rare type of bacterial infection on his skin.
DS was prescribed different antibiotics which FINALLY did the trick.

This whole process took over three months. I had FIVE telephone consultations with the doctor about it and FIVE different prescriptions (all at a full cost to the NHS as DS is under 18).

If he had just done a swab in the first place (or at least after the first couple of unsuccessful prescriptions) then a lot of time, effort and money could have been saved.

It’s a bit like when they prescribe the lowest dose of bog standard antibiotics (usually Amoxicillin) for DM’s reoccurring chest infections. They never work but the doctor insists on them as a starting point before increasing the dosage or changing antibiotics to different ones that actually do work.

My GP’s practice isn’t even doing smear tests at the moment, they are concentrating on flu jabs and until those are done there won’t be any smear tests.

@RunBackwards Podiatry have always seen kids with ingrowing nails.

Can I just get this out about podiatry services? It’s not just diabetics we see, it’s tablet steroid patients, rheumatoid arthritics, people with poor peripheral circulation, people with active foot ulceration, pregnant women & orthopaedic foot problems. They don’t mind seeing patients as I’ve heard off some Drs 🙄 because you only get paid for seeing patients . If they refused all referrals they’d have no money.

We save the nhs a lot of money annually by healing foot ulcers that would otherwise result in a below the knee amputation which has a 85% mortality rate within 5 years, and a lot of those didn’t make it out of hospital they died in HDU.

I’m private now but I refer high risk patients to NHS care if I think/know their going to get ulceration.

As an aside, I had my smear test recently. I would keep ringing about that until I got one. Can family planning do them?.

Im a nurse. This is the entire reason ive come out of A+E and got a job in General Practice. The answer to a failing NHS is comprehensive community based care (community services, GPs etc). Hospital based care should be the last resort - but it isnt.

Funding should be redirected to the community imo.

My mother’s GP tried to stop her having a vitamin B12 injection because blood tests showed her levels were ok. Yes, they were okay due to 3 monthly injections! She has no stomach so has to have injections for the rest of her life. This has taken several phone calls to sort out after they did blood tests that weren’t even needed.

Also, the public need to do their bit and not live an unhealthy lifestyle.

Liver disease is HUGE in the UK but receives little publicity but I read threads on here going “is a bottle of wine a night too much?” And I just think can’t you look up maximum units of alcohol units per week yourself and their genuinely hoping lots of mumsnetters will come along and go “it’s fine hun, the guidelines are all bollocks”.

@Fluffycloudland77 completely agree I’m in gastro and liver disease is the only cause of mortality that is rapidly rising. It’s not just alcohol the scary thing is the number of referrals I see with fatty liver disease. Non alcoholic fatty liver disease will soon become the leading cause of cirrhosis and need for liver transplant but got forbid I tell someone they NEED to lose weight.

Yes, I do agree people need to take more responsibility too and I can't for the life of me understand why it's so taboo to suggest someone should lose weight.

I also agree that the public need to take up the reigns a bit too

@RunBackwards

I had very lengthy discussions with GP over it. She insisted that podiatry is and never has been available on the NHS unless you have diabetes.

It must depend on the area, my son has had treatment via podiatry as has my partner. Neither have diabetes.

It doesn’t, we’ve always seen non-diabetic patients. GP’s saying this are wrong.

This is why I had such lengthy discussions about the foot, because it didn't "sound" right but she was very firm and she's the senior partner who's been at the practice 30+ years, so when she assured me that it's never been available, who was I to argue? (much). Still I suppose she did save the NHS £40

They do try. Smears, routine mammograms 40 health checks in some areas.

It’s a finely balanced sum though between:

How much early detection actually helps
Cost of screening
Whether an early treatment is available
False positives causing distress and needing further screening

I don’t think they’re too bad on early detection actually. I’m currently working on a massive project to identify people who are ‘nearly in a certain health situation’ for example.

I think where they’re not so active is in the prevention. So, working with broader agencies to tackle obesity etc.

Perhaps it varies from area to area. DD had an in growing toenail. GP prescribed antibiotics and advised to get it sorted privately because the NHS was unlikely to deal with it. Podiatrist did a bit of trimming but dd needed a bigger procedure to take part of the nail away. I was told such services were not available locally on the NHS when an annual flare up or two could be managed (by a/bs and trimming). Dd's procedure could be carried out at only one private hospital where they had access to paediatric theatre nurses.

I don't know what the answer is to the NHS but I do think we need a little more honesty of what the NHS can provide and there needs to be full disclosure of what comprises a basic service free for all. People need to be aware so their expectations are correct.

There’s nothing to stop you ringing the local podiatry services yourself and asking for guidance, we're helpful!.

It does occur to me that if they refer to nhs podiatry they pay a referral fee, if they do the op themselves there’s no ref fee. I would always request podiatry for nail surgery.

@Itsalwayssunnyupnorth, it’s a huge problem. Early morning I saw two secondary school girls walking on our estate (nice area, posh cars everywhere and well maintained houses etc so you have to earn to buy here) one eating crisps, one with a big tube of Pringles. You only have to watch Eat well for less on iplayer to see how the public view diet “I’m a devil for chocolate 🤦🏻‍♀️, it’s not going to help with their high cholesterol though is it?.

@Fluffycloudland77

There’s nothing to stop you ringing the local podiatry services yourself and asking for guidance, we're helpful!.

It does occur to me that if they refer to nhs podiatry they pay a referral fee, if they do the op themselves there’s no ref fee. I would always request podiatry for nail surgery.

@Itsalwayssunnyupnorth, it’s a huge problem. Early morning I saw two secondary school girls walking on our estate (nice area, posh cars everywhere and well maintained houses etc so you have to earn to buy here) one eating crisps, one with a big tube of Pringles. You only have to watch Eat well for less on iplayer to see how the public view diet “I’m a devil for chocolate 🤦🏻‍♀️, it’s not going to help with their high cholesterol though is it?.

Except that the GP, the expert we're directed to told me categorically they wouldn't be able to help!

Actually though, that is another inefficiency. If you could self refer for these kinds of things, it would save a lot of GP appointments.