To think the NHS could/should trust us to make our own referrals in some circumstances

[Normalisavariantofcrazy]

In the same manner that I can phone the school nurse and say 'can you do a hearing test for my dc' and she toddles off to the school and does one, why should I as an adult not be able to do that for myself but instead need to make a GP appointment before seeing a nurse to check my ears to then be referred to audiology?

Same thing for continence services, one PCT I lived in it was a self referral service, this PCT it's a GP referral service. Again with this one why is it not also automatically linked into gynae? So you have your baby, they then put you on a list to get a letter 12-18 months later inviting you to a check up and advice service if you want to take them up you do if not no harm no foul. With that I wonder if a lot of things can be nipped in the bud with early physio intervention and also means again no embarrassing chat with the GP so possibly a higher uptake on the service.

There are other areas where this could be implemented too such as running clinics in the same manner as sexual health clinics - so diabetes, asthma and blood pressure checks could be run as self referral drop in services.

I realise a lot of this is probably finding restricted but you know when you have a thought and you want to mull it over?

AIBU with this?

[Heebiejeebie]

Thank you for explaining (and for providing your credentials - I see that I definitely picked the wrong person to have an economics debate with). In my slight defence I am aware of per capita spending (and did quote some figures earlier). Whilst I have you to myself, do either per capita or adjusted for GDP spends tell us much about healthcare system efficiency?

[CoteDAzur]

As I said, you obviously don't know that such government expenditures are compared between countries in terms of spending per capita.

Comparing countries' healthcare spending per capita makes sense because a person's healthcare needs throughout his life does not change enormously according to the country he lives in, whereas GDPs vary significantly between countries.

Looking at spending as % of GDP figures will show you a country's priorities in allocating its spending - invading countries vs education or healthcare, for example. Spending per capita figures will give a better indication of the relative quality of healthcare in each country.

I do know what "per capita" means, by the way, having studied economics and then gone on to writing country & industry reports for institutional investors for a living.

[Heebiejeebie]

I don't think you realise that per capita means per person, or if you do then your post contradicts itself.

You said
I think the better comparison is spending per capita, not proportion of GDP. Many countries' GDPs are much lower than the UK's but they choose to spend more of it on healthcare. And less on invading other countries, for example. It's about priorities.

'The GDP is lower but they spend more of it' - implies a larger proportion (spend as a percentage of GDP) rather than a larger amount per person?.

Bangladesh spend per head is less than US - most likely because they're much poorer or because their priority is invading other countries ?

[CoteDAzur]

That's not a point.

I don't think you realise that per capita spending is generally how countries' expenditures are compared to each other, whether you are talking about healthcare, defence, or whatever.

[Heebiejeebie]

Côte, that was rather my point. You said that spending per head on healthcare was a 'better comparison'. Of what? The USA spends $8000 per capita, Canada $5000, Burma $4. I'm struggling to understand how that helps this discussion.

[Theodorous]

I know this will out me but I actually have a Theodorous. Names after a relation. How has he managed to get through years of school without this being detected? He quite likes it, I just checked.

[Gripneededfast]

Insulted by autocorrect

[Theodorous]

I stand corrected! I may just go shower now

[Gripneededfast]

Ha no offence intended!
You can phone a private hospital actually and arrange the appt via the secretary just like that. Google it or look on LinkedIn

[CoteDAzur]

All hail The Odorous!

[Theodorous]

I like The Odorous, it's like I am an important smelly person, maybe even their leader! On the beach sweating profusely at the moment so you may well be correct!

[Theodorous]

Yes but it is hard without a gp referral and they are very snotty about giving it. Also then have to waste an appointment to get it. In fairness haven't had to do this for 8 years and in those days at least one could get an appointment without waiting a month or seeing a nurse

[Gripneededfast]

The odorous, you can see a specialist privately .£190 per visit not including tests.

[Theodorous]

They being the NHS not the person

[Theodorous]

I had a mammogram yesterday. I just walked into the private lab and paid £70 for the test and the radiologist. What I am saying is the NHS is shit because it doesn't allow people to choose and pay for things they can't afford. Healthcare is expensive and the NHS makes people think it is a frivolous little thing that is free. If someone can afford to see a doctor rather than a nurse with a degree and wants to, they should have that right. Then maybe people wouldn't die unnecessarily all the time.

[CoteDAzur]

That's a gross generalisation and tells us nothing at all.

[Heebiejeebie]

Cote, Rich countries, on the whole, spend more on health than poor countries. What does that tell us about the nhs?

[meandcoffeeequalhappy]

Because some people like to visit their GP or emergency department on a super-regular basis, and they would abuse the system even more. Bad enough to rock on up to A&E dozens of times a week with nothing wrong with you, and apparently that really does happen. I am sure many people are competent to self-refer but there are many others who are also not, and are either neurotic or lonely or just plain odd. So for that reason YABU, it would stress the system and staff even more. Unless we make people pay for services which are overstretched and underfunded, and in fact you could do that go private and help yourself to all the specialists you want!

[CoteDAzur]

I think the better comparison is spending per capita, not proportion of GDP.

Many countries' GDPs are much lower than the UK's but they choose to spend more of it on healthcare. And less on invading other countries, for example. It's about priorities.

[candycoatedwaterdrops]

YABU, not all bowel conditions need a refer to a gastroenterologist. Lay people don't know the red flags, the reason why a referral might be urgent or routine or even if it's something that can be solved with medication given by the GP.

[Heebiejeebie]

Old Farticus - I'm sorry to hear about your bowel cancer.
Which countries provide better universal healthcare for a smaller proportion of GDP (including insurance costs)?

[Heebiejeebie]

OP - to answer your first question - if your ears are full of wax then a hearing test is useless. So the nurse sees you first, you clear the wax, hearing probably improves, if not then you see audiology (cheap)

OR you go to audiology, clear the wax, go back (expensive)

[AdoraBell]

Because most specialists working in the NHS are probably too busy to listen to my MIL demanding a hip replacement, having marched straight past any reception area and into their office to tell them why she needs new joints.

[OldFarticus]

When I could not afford comprehensive health insurance, I used to have a basic policy that would pay for a specialist referral but not much else. That just made sure that the GP could not refuse to refer me when I wanted to see a specialist. (It is still a totally inefficient system though).

Ironically for those struggling to access mental health services, I was offered a referral to a shrink for health anxiety when staggering repeatedly into the offices of various GP's clutching a hot water bottle to my guts and crying. The referral (to a "nurse consultant") came through the day I returned home after having a large malignancy removed from my bowel.

I agree with the posters up thread - you don't miss the NHS after moving abroad, you just realise how bad it is. I hope that people eventually realise that there are far better ways to deliver universal healthcare, as demonstrated by almost every other country in the developed world.

[Sallystyle]

Maybe Wobbly but when I see my GP he also helps me with the actual issue of my anxiety so I don't feel it is a total time waste as I do get some support with my anxiety as well.


Like I said, I like the idea a lot now I have read more and a better system in general would probably help people like me get access to a psychiatrists because god knows no one wants to give me one. Not even my husband has one and he has bi-polar. It has changed in our area and he no longer gets one to see regularly, he gets referred to one once he is at crisis point and the damage has already been done, which disgusts me.

Anyway.. that's a different subject but the more I think about it the more I think it would actually work very well.