to think that within a few years we will be paying to visit the GP,Conservatives consider limit on GP visits

[MiniTheMinx]

The Conservatives have considered limiting the number of times patients can visit their family doctor in a year, it has emerged.

"Labour health spokesman Jamie Reed told the Independent on Sunday: "This paper, hidden away on their website, reveals the Tories' true agenda for the NHS. After throwing the NHS open to ever more privatisation with a wasteful and damaging reorganisation, it seems the Tories want to go even further.
"It's shocking that they are considering limiting the number of times patients can see their GP - changing the fundamental principle in the NHS constitution that access to the NHS is based on clinical need.
"The Tories have already wasted £3bn on a top-down reorganisation of the NHS and overseen a crisis in A&E - now they are consulting their members on opening up the NHS to even more competition, and making it harder for patients to see GPs in the evenings and at weekends."

A Conservative Party spokesman said: "This was simply a topic to provoke discussion and isn't Conservative Party policy."

Yet.

We all know where we are headed with this don't we? or am I being an unreasonable old cynic?

I had a prescription like that, married. In my case the part of the NHS that changed was the GP, who simply overrode the 28 day prescription and wrote me out 60 day ones, repeated without personal visit. They asked me to pop in a few times a year to say I was still alive, but that was it.

LazeyJaney, despite higher overall expenditure, US infant mortality rates are deteriorating and their national life expectancy rates are dropping. Believe me, that is one dysfunctional health care system.

Yes, it is not working because it is designed to enrich the financial institutions who run the insurance.

There is no way a health service can cover everyone if it is financed by private, profit-motivated financial businesses who are mainly interested in wriggling out of covering treatment wherever possible.

there is also a problem with inflated price tags on treatment as this is driven by the financial model too - to the extent that it becomes unaffordable to many.

It is deeply unethical that the profit motive can be at the heart of how health care is organised.

148478 SIGNATURES AND COUNTING!
secure.38degrees.org.uk/page/s/dont-cap-GP-visits#petition

BoffinMum, yes I read about infant mortality rates in the U.S a while back. Things like TB are on the rise.

A little while back I watched a documentary about a team opening these free walk in clinics. People came from far and wide to wait for hours. One man had a life threatening hernia and he couldn't afford the insurance or the money upfront for the surgery. He was told that he would probably die from this "treatable" condition. It was so sad.

No one would say the hernia shouldn't be treated but the vasectomy reversals, the IVF, the gastric bands, the tattoo removal. I know that sounds daily mailish but none of those things are what the NHS was designed for. It was designed to treat disease and make lives more comfortable and free where possible rom pain. It was never meant as a ppanacea for every "ill" which had not its route in disease. Alcohol binge induced stomach pumping for free really - a state brought about by choice?

"No one would say the hernia shouldn't be treated"

• how do you know? That is what they are saying in the US, maybe they will be saying it here soon.

terrifying. I have been treated for abnormalities picked up on a routine smear. I hate to think what might have happened without it.

Curry is right - asymptomatic hernias are on many commissioners "let's not do these" lists. And if we are getting in to the rationing debate, shall we charge for sports-related injuries, smoking-induced cancers (that'll be virtually all of them) and infertility brought about by leaving everything too late?

LazyJaney You are wrong that the US "do it better"

Eh? where did I say the US does it better? I said they charge, but so do a lot of other countries with much better systems. I'd be the last to advocate the US model, I lived there! I'm in favour of European systems, I've lived there too and they are better than the NHS, and they don't doom their poor to a nasty, brutish and short life.

Maybe thats I don't quite get why people on here think we only have a choice of what there is now with all it's faults, or some form of dystopian doom. There are systems out there that work very well, just over the channel.

Re. the NHS paying for gastric bands - I watched a documentary a few months ago (Weight Loss Ward?), which was looking at an obesity ward in a Sunderland Hospital. They carry out gastric band operations and other weight loss operations on very overweight patients who also have weight related conditions like diabetes.

The really interesting thing the surgeons said, was that if they give the operations to the "right" patients (i.e. ones judged physchologically ready, and likely to comply with the lifestyle changes the operation will impose on them), then within a couple of years of the operation, the weight related conditions (like diabetes) have usually either gone completely or drastically improved - so in the long run, these operations actually save the NHS money.

I know obesity is usually self inflicted, but if these operations do actually save money in the long run, it seems short sighted to refuse them to NHS patients.

The advantage of providing procedures such as gastric bands and so on via the NHS is that they are correctly performed on a non profit basis with the patients being brought into optimal health afterwards.

We do not have high street cosmetic surgeons doing it to make a fast buck and leaving NHS A and E to deal with post operative complications (as has been the case in other respects).

WRT IVF, the involvement of the NHS also reduces costs for people, for example those who lost their fertility early in life due to other medical treatment. THe NHS could probably do more to help by negotiating harder on the costs of the necessary drugs so that these can be prescribed cheaply for those who wish to take them for other reasons. That need not mean robbing Peter to pay Paul, but instead using collective negotiating power to give the nation a healthcare system that works for patients rather than corporate providers.

Similarly we perform breast reconstructions for those who have to sacrifice their breasts as a result of cancer, or whose breasts are so huge in proportion to their slim frames that they have permanent back ache. We provide false teeth for those who have poor dental health. In the bigger scheme of things, I find it hard to object to such provision.

WRT tattoo removal, we could be doing a lot more to research cheap ways of dealing with this so that ultimately it's as difficult as removing a wart or verruca.

Ultimately we have to look forward and develop affordable way of providing what is needed by patients now, not what was felt morally appropriate in the 1980s. All this is possible if we really want to provide it. And it won't be possible if a profit motive creeps in too strongly.

Lots of posts ...so just replying to OP....
I moved to NZ in the early 90's and was shocked to discover they charged for GP visits, and also a small charge for A & E, x-rays etc.
If you were an in-patient, had a long term illness, or were on benefits, then there was no charge.

Once I was over the shock, and had been through the system once or twice with children's ailments and DD's broken elbow, I have to say I was all in favour.

Charging a small fee for seeing the GP pretty much does away with time wasters. Charging the same for an A & E visit stops people clogging the waiting room when they just have a cold and cough .... or toothache, and they should be seeing a dentist ( 6and that really does happen^ )
It brings a bit back into a heavily over-subscribed service.

Of course I thought it was brilliant coming back to the no-fee UK. But looking at the bigger picture .... the NZ approach really did work, and there was a sensible safety net in place so that genuinely sick people were not penalised.

Update from the petition

"Good news. It looks like we may have nipped it in the bud. Jeremy Hunt has been forced to respond to our 180,000-strong petition. And he?s made a public pledge to "never" introduce a limit on the number of times we?re allowed to visit our GP"

Do any of you read the blog by Roy Lilley - I can highly recommend it.

Here it is today's - Sorry can't link it is sent as an e-mail.

Too late

News and Comment from Roy Lilley
I have always thought being a GP must be fabulous. What other work could be so satisfying? Knowing, in intimate ways, you've changed a life, saved a life, been a lifeline in the labyrinth of illness. What a fabulous job.

The variety, the unparalleled sense of quiet fulfilment. How good it must be to hear the words; "Thank you doctor" and know they come from a place where only the truth resides. Being self-employed but unlike lawyers and accountants, never having to look for a customer and in the top 1% pay-bracket. Does it get any better?

Sadly, I fear the craft of general practice is in a place where doctors are no longer at ease with themselves. They are touchy, prickly. They are neither independent, nor contractors; they do what is dumped on them. They work hard - but not like road diggers. Long hours - but not like the exhaustion of a factory shift. They have the weight of responsibility - but not like the police rapid response fire-arms unit.

Local, living in a community that depends upon them but in other places, a treadmill. The undeserving treated by the unwilling. GPs are echinated... Practices swing between Ikea cool and stuffed-to-the-gunnels, car-boot-sale. General practice is eclectic...

I never thought I'd say it; I agree with LaLite; it can't go on. I fear general practitioners may be set to become lamplighters in a digital world. GPs workload is becoming unmanageable. There are around 300,000,000 GP consultations, every year... increasing. The Mystic-Megs of workforce modelling say (Page 4) if recruitment holds up we might struggle through. They don't inspire me with confidence:

"...achieving and maintaining 3,250 GP trainees per annum is necessary to address future demand, and should be the top priority... Given the rapidly changing nature of healthcare and the inherent uncertainties about future demand... we... recommend there be periodic reviews... supported by a stronger evidence base."

In other words, they don't really know. Since 2008 SHAs tried and couldn't manage 800 a year. (Page 8) Here is something else I agree with:

"On the demand side, we see some scope for GPs to improve their ways of working over the longer term... (this would)... help to ensure that any remaining demand-supply gap is closed."

GPs have to get to grips with demand management, work-flow and system-shaping. The days of; ring-up, wait, receptionist, wait, appointment, wait, see the Doc, wait... ain't gonna crack this. Look what is happening to the high street. The same forces are at play here. As a business model Primary Care needs refreshing.

Aren't we forced into a new set of assumptions?

Assumption 1; Doctors should answer the phones in the morning, not a receptionist. Who better to decide if an appointment is necessary? And, get used to the idea the first resort for consultations might be by email, Face-Time, Skype, the web and the phone. A surgery visit, when all else fails.

Assumption 2; Every practice should have a self-care nurse-practitioner, training and coaching patients away from being a cost centre and looking after themselves.

Assumption 3; Where ever possible long-term conditions should not be clogging up waiting rooms. They will be tele-maintained on the web, self-managed and supervised by regional health and wellness call-centres, funded and run by GP federations.

Assumption4; The millions needed to bring the primary care estate up to scratch and absorb secondary care services is unfundable. Forty percent of practices with no more than 4 GPs is a not a goer. (Page 10) Federating to get to 30+ might make the skills of general practice future-proof? Bigger is better but with case-holding community nurses working in community centres, Mother-Care and Church Halls. Satellite GP surgeries in Sainsbury's.

Assumption 5; Bigger surgeries that redefine the GPs role in the community. Practices becoming become community centres, drop-in places, child-care schools for young Mums, places where people can go and learn to turn ingredients into healthy meals. IT teach-ins, health and wellbeing workouts. Workshops for the new generation of retirees to potter, repair, make and meet without having to play Bingo and sing the songs that made Vera Lyn famous. Coffee shops, book exchanges. Social services, CAB, job-centres, physio's and rehab, just down the corridor.

If GPs stand still they are in danger of becoming inundated by the same forces that are destroying the high street. We need GPs to be where we are now, where our lives are nowadays, in the places we inhabit. This is not an 8-6 world, this is not a closed at the weekend existence. This is increasingly an on-line, on-the-phone, on-the-go, converged lifestyle. New technologies have to be used to create head-room for the practice to see the people they really need to see.

I want GP practice to survive, not by clinging to the wreckage of the past but by building a new future.

Assumption 6; they may have left it too late.

Kevin - the cancer patient I saw yesterday was in the process of trying to borrow money to get to the hospital for his appointment.

His DLA has been stopped (he doesn't know why). He is too weak and ill to cope with getting 2 different buses and doing the same thing to get home after his chemo.

He showed me the letter from the hospital telling him that if he missed the appointment he would be discharged and referred back to his GP.

He had been ringing the surgery and the hospital on and off all day. The phones are either not answered, or, when he did get through, he had to leave a message on the machine. By 5pm no-one had called him back.

I know from experience that he is not unique in this experience.

3littlefrogs i'm sorry to hear that, support services at that hospital seem very lacking and it's not surprising patients can't turn up or get through to staff. Our hospital is a little different: well staffed and trained specialist cancer advice and bookings line with instant response; patient portal for email correspondance; key worker immediate access for urgent queries; welfare rights drop in service; hospital transport which is used by many unwell patients and which can be booked directly by the patients themselves or their key worker; consultants secretaries sat by their phones all day. Despite this 25% of patients did not turn up to their appointments last week, none of whom rang up / emailed, etc before or after. All will be booked back quickly and will overfill clinics, and none will be discharged from the service. None will receive any penalty or even be questioned. This is however a huge unnecessary cost to the NHS.

I read Roy Lilley, Stayaway. Unfortunately, he too is stuck fast in the medical model. We don't need nurse practitioners to teach people to stay fit, we need society to embrace healthy living as a way of life. And not run to the doctor with every little thing and demand a pill, test, op, miracle.

Argy I quite agree, but then he was fairly high up in a FT in the past, but he does have a great way of summarising the facts and is a fantastic speaker.

I suppose the real issue is that the current model is unsustainable, patients will run to A&E the GP while the option is available and will not take responsibility for their own health while others do it for them - I am generalising somewhat, but then I work in a town where the life expectancy between the rich and the poor is 13 years, and despite a variety of PCT (now LA / CCG / National) programmes it isn't getting smaller.

I think this is where the NHS is heading...

en.wikipedia.org/wiki/Healthcare_in_the_Netherlands

Apologies for the Wiki link.

www.conservativehome.com/thetorydiary/2018/07/howard-flight-this-conservative-government-has-slipped-towards-socialism-the-rot-must-be-stopped.html

"The Government needs to face up to the fact that the NHS cannot be wholly funded from general taxation. There are several areas where it makes sense to render charges. Some, such as visits to the GP, could be a modest charge, e.g. no more than £20, and so can be universal. Others, which could be significantly larger, should be levied on a means-tested basis – for example the cost of board and lodging in hospital. The arrangements for NHS dentists’ charges work reasonably well and sensibly, and without citizen complaint. There is a lesson to be learned here for the rest of the NHS."

The fucking cheek of a Labour Party MP complaining about Conservatives making it harder to see GPs at weekends and in the evenings when it was Labour who negotiated GPs contracts so they stopped opening in the evenings and weekends. 😡

Also I believe the system in France has people pay to see their GP most of which is refunded once they've attended the appointment. If they don't attend they don't get a refund. Which sounds like a sensible system to me.