AIBU to not understand the english attitude towards the NHS?

[EggplantsForever]

Every time someone criticises the NHS, every time someone asks for better health service, or to have some not absolutely vital procedure (like IVF) covered, or to be referred to a specialist there is a barrage of voices here calling them "ungrateful", proclaiming that "the NHS is on it's knees", etc.

I just find it so peculiarly English and I have very hard time understanding it! Perhaps you can explain?

I mean, it is almost as if people feel that someone very nice and kind has given the English people the free health service, and they should be eternally grateful and not mention its shortcomings or it will be taken away. But the NHS is in fact paid by your own taxes! It belongs to you. And you have full right to criticise it and expect it to work just as well as other free healthcare systems in the world. Which it doesn't. It actually compares pretty badly even to the countries that spend less money per capita on health. I have a feeling it is actually badly mismanaged.

For example, look at this table en.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare
UK is at the bottom at most of them, below Portugal/Spain, Israel, and Slovenia who spend significantly less money on healthcare.

From my personal experience, having lived in a country with free healthcare, you could go to a gynaecologist without referral (and women were advised to see one for a yearly check up). Skin specialist did not require referral either. Referral to any other specialist took me on average two weeks. IVF was available to everyone for free. The list of cancer drugs included drugs that are not funded in the UK. etc And people still routinely complained about their healthcare. Which they had full right to do, because it was funded by their own taxes.

So I am just not sure why is everyone so afraid to criticise the NHS? It is actually one of UK's biggest problems. And why does everyone eternally fear that it will be "taken away"?

it might be that a gp can tray a lot. but when the first response from the gp is: take paracetamol and rest then that doesn't fly.
especially if the patient has already self treated for weeks whilst waiting for the appointment.

"but when the first response from the gp is: take paracetamol and rest then that doesn't fly."

Or worse. Come back in a few weeks when as you say, you've already waited a few weeks before asking for an appointment and then waited weeks to get the appointment.

"Many many things are managed in primary care"

Yes, but when people have been going to their GP for a year and the GP still doesn't know what the problem is, the patient knows the only reason she's seeing the GP and not a specialist is because the GP is acting in gatekeeper role and trying to block her from seeing the specialist she needs to see.

Also, you didn't answer my question about GPs no longer having an overall look at our health and some of them refusing to discuss more than one symptom, so taking away the advantage of seeing a doctor that is not just focused on one area.

Hellomumsne - that's IF you even can get a GP to agree to refer you. Often they refuse even direct requests. On (I think) another thread (may be this one) a GP claimed there were certain things GP's were expected to do first before making referrals, but I've been unable to get a response either in real life or on here or other forums as to exactly what these "things" are. Can't find anything in NICE guidelines either - even when I've given specific scenarios. Why are GP's so reluctant to explain this?

"The hidden price for NHS rationing (and gatekeeping by GPs) is patients' suffering; its just there is no monetary value for it in the decision making, even though the economic costs are still there for the families!" My argument is its NOT just additional costs/impact on the patient and their families - I'm certain (but again struggling to get official acknowledgement let alone figures) that it MUST be cheaper to refer, dx & treat patients earlier before their condition worsens and

Causes them to need time off or even quit working
Necessitates more expensive & longer term treatment
Potentially costs the nhs legal costs.

I'm pretty sure it would have been cheaper to refer me to a gynaecologist and for my endo to be Dx and treated earlier & more effectively than it cost to block my referral.

Treating the symptoms with

14 years of pill
14 years of blood flow reducing meds
14 years of pain meds
14 years of migraine meds
14 years of nausea meds
14 years of GP appointments not only for me TRYING to get a dx but to get the symptoms treated

numerous days off work including 10 days due to first mc
2 surgeries for 2nd mc/ectopic pregnancy, almost 10 weeks off work at that point...

Once I had a dx (accidental pretty much - and not in U.K. But by a European dr though technically I was still an nhs patient) I had 2 surgeries for surgical removal (as much as poss) of the endo, which happened in one week and if that was all I was dealing with I'd have only needed about 10 days off work + Medical treatment to "shrink" the endo which meant for about 15 years it was pretty much held at bay, aside from a blip after dd was born. Then I had another treatment which has worked well for about 8/9 years, I'm now being put on a new medication that will hopefully keep it at bay till I'm through meno.

I've said before I'd LOVE to know how much all that cost vs the cost of me being referred, dx, correctly treated!

Theredjellybean - I DARE you to go on my thread and defend the Drs there who ignored, dismissed, denied even LAUGHED at patients who almost or even actually died (their loved ones reporting their stories of course) as a result of their prejudices & (in many cases repeated) incompetence!

Many times patients DO know what's wrong with them and are prevented from getting the correct treatment by arrogant, sexist, prejudiced GP's.

"No one knows it all and sometimes it is good to listen to patients and not treat them as complete idiots." Exactly - though it's also quite disturbing that GP's even when presented with a patient with clear textbook symptoms of a condition can try and WRONGLY tell that patient that:

They're imagining it
They're exaggerating symptoms
They're not really ill they're anxious/depressed/"hysterical"/"neurotic"
That X is the only treatment available anyway - often a lie!
That having had X y z test means they don't have X (numerous examples on mn alone of endo sufferers being told they don't have endo as ultrasounds were "clear" when endo doesn't fucking show on ultrasounds!) (ditto hypothyroidism sufferers because the levels accepted as "normal" in nhs really aren't! - I believe this to be the case with anaemia, b12 deficiency, vit d deficiency too - among others)

"Clearly if my patient believes they need to see a specialist then it is arrogant of me to take the time to take the history, exam them, discuss what I think is going on, discuss and explain the treatment or investigation plan and then organise that for them, it's arrogant of me to presume that I might know how to do my job..." Many examples on mn of GP's who DON'T take a full history, don't perform exams when they're clearly indicated, barely even look at patients in fact - there's too many GP's DON'T know how to do their job or who don't care but it's virtually impossible to get rid of them! Hell its virtually impossible to even complain about them without risking ending up without access to primary care!

"Do you believe that my training and years of experience count for nothing?" Depends on how they're executed.

My GP surgery here is set up that patients can "direct refer" to podiatry, opthalmology, audiology, physio, maternity services, dietitian services. Absolutely no reason that can't happen uk wide. Works very well for patients needing those services. We still have a shortage of GP's though (deprived area, not attractive place to non locals to be honest) but it would be even harder to get a GP appointment if people needing those services also needed to book a GP appointment first just to get a referral when they KNOW eg (as referenced upthread)
they have an ingrown toenail!

I've yet to hear a decent argument why women with clear gynae problems can't self refer to gynae.

"There is a huge problem in this country with increasing numbers of people who suffer from health anxiety. I see at least 2-3 a week, they would be booking appointments constantly. As it is they can be managed in primary care." And I've read many experiences by patients who were dismissed as "anxious" when they actually had a physical, diagnosable and treatable condition - and that includes several conditions which have a physical cause with anxiety as a symptom or where symptoms can be misdx as anxiety (hyperthyroidism, diabetes & other metabolic disorders, heart conditions, asthma), plus some medications can cause anxiety/anxiety like symptoms.

Oh and if they really do have health anxiety I assume you've referred them to the appropriate mh specialists?

Mind you as someone who also suffers from MI, and has been involved with mh services for several years I've also heard from many mh hcps that they're dealing with patients being referred to them with supposed mh issues - only for it to turn out they actually have a physical illness that's causing their mh symptoms. To the point my Cmht now ROUTINELY for new referrals test for various vitamin deficiencies, metabolic disorders etc to rule them out. Apparently they're finding a significant number of patients referred to them aren't actually MI but suffering from thyroid issues, vitamin deficiencies etc. Conditions that are easy & quick to test for, dx & treat.

Here are JUST SOME of the conditions that people's Drs put down to "anxiety" on my thread:

SEVERAL cancers (even when the patient had previous dx of the SAME cancer and knew the symptoms), heart disease, asthma, gall stones/gall bladder disease (very commonly dismissed), ectopic pregnancy, pleurisy, pneumonia, UTI, herniated disc, viral meningitis, pernicious anaemia, eds, DVT, sepsis, ovarian torsion...

It's ABSOLUTELY UNACCEPTABLE!!

Oh and btw "managed" seems to me to be a euphemism for "treating the most troublesome symptoms rather than establishing an actual dx and effective treatment in hopes the patient will shut up and go away"

"The hidden price for NHS rationing (and gatekeeping by GPs) is patients' suffering; its just there is no monetary value for it in the decision making,

maybe the nhs should compensate for loss of income due to waiting times or people being off sick unnecessarily because of long waits for treatment...

A badly infected ingrown toe nail is absolutely obvious. When I had one decades ago, my GP took one look at it and sent me straight away to have the toe nail removed.

When my son had one last year, it took several GP/Practice nurse appointments with them faffing around suggesting salt baths, antiseptic cream, off the shelf ingrown toe nail treatment, etc. As the weeks past, it was getting worse and my son couldn't do his sports/PE etc. We had to INSIST on a referral to get it removed - the GP/practice nurses didn't seem to have a clue what to do. When we finally got the referral, it was removed very quickly - the podiatry dept could give appointments within the week - they had no backlog.

That's a classic case where the "gatekeeping" failed miserably.

People "self refer" themselves everyday for other health aspects such as dentistry and eyecare (and more and more audiology via Specsavers!). If it works for dentistry, eyes and ears, why isn't it available for podiatry, physiotherapy, etc??

Certainly, as the Guardian reported this year that the average time to diagnosis for endometriosis is 7 - 8 years, it shows that GPs are on the whole failing to manage it in primary care; because they would refer it much more quickly if they were? Then they wonder why those patients, their families and friends don't see them as capable?

IMO, women should be able to self refer to gynaecologists.

You cannot self refer to a specialist maxfax or orthodontist though.. You go to your dentist who can manage many dental issues and if you then need specialist dental treatment they refer you. So in fact dentists are like GPs...oh except you pay again for them above your taxes.
Ditto audiology at spec savers.. They can do hearing test but cannot provide specialist ENT services.. So they act as filter, simple age related hearing loss they can sell you a hearing aid... Complex or not obvious hearing loss.. They send you to your gp... And then ask gp to refer to specialist. So effectively no it's not the same as saying we don't need GPS we can all book ourselves straight in with a specialist just because we can book a dentist appointment ourselves.
With issues like infected toenails to use Pp example.. Most get better with antibiotics, and advice on cutting technique and salt water bathing. If it doesn't or it continues to recur then a gp should refer. The fact is MOST will get better, you don't need a specialist, and in fact many simple things like that, you'd be told by a specialist to try xyz first...
In this utopia you all think would work better.. A huge number of specialist appointments would be taken up by people booking to see them too early only to be told take xyz or let's try this that or another.. Most of which are things the gp could do for the patient first.
Specialist appointments are hugely expensive, and people would not necessarily get problems sorted any quicker.

people would not necessarily get problems sorted any quicker.

But you would at least avoid having to wait weeks to even start the process by waiting for the gp appt (or more likely several gp appts before they take you seriously). Anyway, I don't think anyone has suggested self-referral to consultants - what is being requested is self-referral to the department. Ie for audiology, it's not to see the consultant, it's to be "triaged" by reception or audiology front line staff. For podiatry, not to see the top consultant, but to see a podiatry nurse, etc. There's still gatekeeping to protect the consultant and avoid expensive tests etc., but it's done within the dept, not the GP. Just like dental surgeries, opticians, etc - you don't walk in unannounced and see the optician/dentist - you have to go through reception etc to make appointments, check eligibility, discuss needs etc.

No one is seriously suggesting people rock up randomly asking for a MRI scan or skeletal x-ray - and if they do, then the receptionist for that dept needs to refer them elsewhere. The vast majority of "normal" people wouldn't do stupid things like that, but I think it's very condescending and arrogant to think average Joe Public isn't capable of self referring for basic stuff. Especially when there is little or no waiting list in the relevant departments, i.e. I can walk in to audiology and ask for my hearing aids to be adjusted - no appointments etc and if I need something the front line staff can't deal with, they arrange an appointment with someone who can, usually just a week or two after. Now that my son has an open podiatry record, he can quickly and easily make new appointments, likewise with my OH and his physiotherapy - once you've got past the GP roadblock and have a direct line and open record, it makes things so much easier - and if, say, my son or OH starts to take the mickey, I'm pretty sure the dept concerned would have something to say.

But I would point out your talking about hearing aids not ENT specialist services.
And physio not orthopedic spinal specialist services.
I see many people who would be booking specialists and Mri scan etc... Very freely
Yesterday in evening clinic I had three patients demand referral for.. An Mri because they had a headache for two days, a neurologist because they had tingling fingers (easily diagnosed as carpal tunnel and advice as per nice to try nsaids and wrist splints first) and the third wanted to see gastro for her ibs.. This had been fully investigated multiple times, she had been seen before by specialist who found nothing... That is an average clinic... Non of those were unintelligent people, all had jobs, qualifications etc...
I think there is a difference between having direct access to simple therapeutic measures such as physio, podiatry, hearing tests. But the origin of this thread was suggesting open access to all specialists.
So patient A has a headache.. Books herself an appointment with the leading professor of neurosurgery at Queens hospital... Or she could see the GP or practice nurse who might find she is anemic, or needs an eye test, or just needs reassurance or some migraine treatment etc.
I am honestly not arrogant, I just think that the posters on here vastly over estimate the ability of many of the public to interpret what constitutes a complex health issue needing specialist intervention and what their gp is well qualified to deal with.

@redjellybean, why don't GPs tell patients that both medication and the more serious tests have side-effects, and so - for the sake of the patient's own health - should be avoided unless strictly necessary?

For example, radiation from X-rays, and worse still, CT scans, will cause some damage. Fine if you've been smashed up in a car crash; not great if you've got a bit of a backache and want a scan to check for tumours every two minutes. MRI scans similarly have harmful effects, I believe - so why not tell patients that?

I do... Most often people are reassured by a good explanation but some will insist because they read it in the paper or they are waving a printout from the Internet... Or they know someone who knows someone who had the same headache and they had a tumour.

And as you can see on this thread there are people who seem to believe that all GPS are rubbish and are wilfully thwarting the public from getting the right treatment.
Why doctors would do that I don't know but on mn there is a strongly held belief by some that this is the case

I think it's because the case is not made that all medical intervention carries risk and often some harm.

Medical intervention is portrayed as a luxury good that patients have to fight GPs for, as if in the January Sales. People are often told they should "fight for" or "insist on" a scan. Personally I fight not to have one. Ditto medication.

"So patient A has a headache.. Books herself an appointment with the leading professor of neurosurgery at Queens hospital..."

That's obviously an extreme example. Why would anyone do that after one headache?
They might want to do it after 6 months of going to the GP and getting no relief.

I see many people who would be booking specialists and Mri scan etc... Very freely

I can related the experience in the US with these two issues. Any type of diagnostic testing like an MRI requires a doctors order, using written as a prescription. So we do gatekeep for this.

When private insurance here transitioned from indemnity insurance to managed care, one of the new requirements was that GP's had to refer patients to specialists or the insurance wouldn't cover the cost of the specialist visit. Within a few years they all dropped this requirement as they found it wasn't reducing the number of specialist visits and wasn't worth the administrative cost. Now when you make a first appointment with a specialist the physician's assistant will ask you if you've been referred and by whom. It's then up to them if they want to see you directly or ask you to see your GP first. That helps them manage unnecessary visits.

"IMO, women should be able to self refer to gynaecologists."

In many countries (I'd imagine most actually, but can't verify it) gynaecologists are considered primary care and people can go to them directly, often going for annual checkups whether there's anything wrong or not.

"here are people who seem to believe that all GPS are rubbish and are wilfully thwarting the public from getting the right treatment."

Who has said that ALL GPs are rubbish?
You seem to be saying that all GPs are always right though!

In many countries (I'd imagine most actually, but can't verify it) gynaecologists are considered primary care

This is true in the US. Most insurance policies have allowed this for ages, but they're required to now under the affordable care act.

There's something MN could campaign for. Wouldn't that be amazing - gynaecologists as primary care?

I said "there are people.."
I did not say all people think that but read back over this thread and see what people have been saying about GPs

Why do women believe they need to see a gynaecologist for gynae primary care? Genuinely puzzled by this.. What is it about a gynaecologist that makes the better at doing smears than the nurse at your gp surgery?
Or prescribing the pill
Or inserting a coil?

Plus why do women need a yearly check up with a gynaecologist?

As for the headache example.. yes lots and lots of people would be booking appointments and Mri scans etc..

"it shows that GPs are on the whole failing to manage it in primary care;"

Because usually it's not even dx in primary care let alone properly treated! Mainly because it CAN'T be, many endo sufferers NEED surgery, particularly if it's in certain areas which are messing up body systems including reproduction.

As I think a pp said, and I've certainly had gynaes say it to me - by the time they see sufferers often damage has been done by the condition that can't be truly undone!

"So in fact dentists are like GPs...oh except you pay again for them above your taxes." There's another BIG exception ime - dentists LISTEN to patients, they don't arrogantly dismiss them as clueless with regard to their own bodies! My dentist was the one that motivated me to insist on a referral to an ent specialist for the recurrent very painful sinusitis I was experiencing, after again YEARS of dismissiveness from GP's. Turns out I had some scarring believed to have been caused when I'd had an ng tube years before for another issue. A minor procedure to remove the scarring and no more sinusitis!

Ingrown toenails - my "aunt" (uncles long term gf) is a podiatrist. She despairs at how long GP's are leaving patients in pain with these. In her opinion (and she's in her 50's hardly a newbie!) salt baths etc are a bloody waste of time! She even thinks it's pointless repeatedly treating the infected ones as while the CAUSE (repeated invasion by the nail) goes untreated they'll just recur. And that was my personal experience too. Both my big toes were buggered, due to injuries. Overall took 5 YEARS until as a result of moving to a different area where I was able to self refer to podiatry and they took them off and treated them so they don't grow back. The previous area I was under had me doing the salt baths, taking repeated antibiotics (where is the wisdom in THIS when we're meant to be REDUCING antibiotic use?!), having the nail "pruned" by a practice nurse, EVENTUALLY had them removed but they wouldn't agree to the treatment to stop them growing back. They grew back and the whole palava started all over again! While I was trying to get them to agree to just take the damn things off I moved (for other reasons) and as I say at this GP surgery patients self refer for such issues. Podiatrist took one look and said "well let's get rid eh they're doing you no good whatsoever" booked in for the following week, whipped them off, treated so they don't grow back - pain & infection free ever since!

And at the end of that long patronising post we get the REAL reason:

Specialist appointments are hugely expensive

And even IF that's a consideration (which it bloody well shouldn't be! The primary consideration should be what's best for patients and frankly if as an hcp you don't agree with that you shouldn't be doing the job!) SURELY as I said before its ACTUALLY CHEAPER to NOT fob off patients with ineffective treatments, leaving them in pain and suffering and REPEATEDLY treating the SYMPTOMS rather than actually doing your job and establishing the cause and treating that!

Theredjellybean - I'm guessing you must have some idea of the costs involved so:

How much did 14 years of treating symptoms of endo (pill, tranexamic acid, mefenamic acid, co-codamol, 8 a&e admissions including ultrasounds, migraine meds, anti-emetics, 2 mc inc one partly ectopic) cost the nhs? And how much would a referral to a gynae, lap & endo removal surgery, pro-stap once every 8-9 years have cost?

How much did 5 years of NOT properly treating the ingrown toenails (GP appointments, nurse appointments, antibiotics, dressings changed every other day for several weeks at one point - done by a practice nurse) cost the nhs? And how much did the final successful treatment of removal & chemical treatment to prevent regrowth cost?

How much did not properly dx & treating the cause of the sinusitis for 4 years cost the nhs? (repeated GP and dentist visits, antibiotics, inhalants, painkillers) and how much did the minor procedure that solved this cost?

How much did my dds disability going undx (I don't usually say but I will for this - hms but possibly eds or even marfan - still being investigated) (8 years of me being at the point I thought something was wrong - not being familiar with the condition. When she was v young I just thought she was "clumsy" plus she was born with a lazy eye, slightly wonky ankle - which were noted but never followed up by hcps - I now know these should have alerted hcps to the possibility along with other physical indicators - but even aside from that 8 years of sprained, swollen joints, repeated visits to a&e including X-Ray's, strapped up joints and even at points her being on crutches, digestive issues, horrendous issues with infection of mucous membranes resulting in lots of antibiotics and anti-inflammatories) cost the nhs? How much did referral to specialist, dx (tentatively) and treatment including orthotics and physio, just having the dx on her records (therefore meaning when she starts with an infection in a mucous membrane she's taken seriously rather than it being ignored until she ends up in hospital for up to 3 weeks on drips) cost?

How much did my mum going repeatedly to GP for 3 years with gall stones symptoms and being fobbed off with antacids, pain killers and bloody antidepressants, ending up an emergency admittance and having her gall bladder removed via open surgery as it became a far more complex issue cost the nhs? Vs referral and probable keyhole surgery instead?

How much did it cost the nhs to treat my aunts cervical cancer symptoms (I'm afraid I'm unsure of exactly how long she was having symptoms for as she doesn't like to discuss this - but I know it was several years) (bleeding, pain, constipation, Incontinence, repeated visits to GP & nurse, antibiotics despite no other infection indicators, and again - anti-depressants! Then FINALLY when it was discovered thanks to locums referral - full on cancer treatment - full hysterectomy inc ovaries, Chemo & radiotherapy, mh therapy to help her come to terms with the fact at 29 she'd not have her own DC? Vs if she'd been referred at first sign of the clear symptoms? (She was told she'd probably have needed far less radical surgery, perhaps not have needed chemo or even radiotherapy, maintained her fertility)

so tell me again how VERY expensive it is to see a specialist and how we're ignorant and selfish for wanting this

"Anyway, I don't think anyone has suggested self-referral to consultants - what is being requested is self-referral to the department." Exactly!

Something I've noticed on this thread, my thread and other similar discussions here and elsewhere - is that patients who've repeatedly gone to GP's about the SAME issue FINALLY get the referral/treatment they need when they see a locum GP.

This has certainly happened to myself and my family too.

Mums gall stones symptoms finally taken seriously by a locum.

Dds disability - referral done by a locum after again several YEARS of GP visits - now know that dd has visible physical characteristics AS WELL as the symptoms being clear indicators of the condition - ignored by "regular" GP's. Again specialist stated lack of GP referral a real issue in this area.

Aunts CANCER - clear symptoms ignored - referred by locum. Just in time in terms of her life, too late to save her fertility though.

Anyone else found this?

"Yesterday in evening clinic I had three patients demand referral for.. An Mri because they had a headache for two days, a neurologist because they had tingling fingers (easily diagnosed as carpal tunnel and advice as per nice to try nsaids and wrist splints first) and the third wanted to see gastro for her ibs."

And I've read and heard examples where the reality was (speaking hypothetically but you'll get my point):

The patient with the headache was having repeated, long lasting, severe unexplained headaches.

The patient with carpal tunnel turned out to actually have an undx injury or arthritis or something.

Ibs isn't even a dx - it's a description of a set of symptoms - and it's often a misdx of any number of conditions including endo (happened to me - despite me being clear I was only having symptoms just before/during period), coeliac & other food intolerances/allergies, crohns, diverticulitis, ulcerative colitis, colon cancer, bowel cancer, ovarian cancer... It's a bullshit dx that means nothing.

"or just needs reassurance" reassurance that well known cure for a headache that's lasted 2 days! 🤔

"but some will insist because they read it in the paper or they are waving a printout from the Internet... Or they know someone who knows someone who had the same headache and they had a tumour." People who are worried enough to go looking.up their symptoms to try and find what's causing them are usually doing so because it's a continuing issue and they don't want to keep suffering.

Not all GP's no - but too many yes. I've had a few good GP's who've been very supportive, excellent advocates and thorough practitioners. But they shouldn't be in the minority which has been my experience.

"Within a few years they all dropped this requirement as they found it wasn't reducing the number of specialist visits and wasn't worth the administrative cost." That shows to me that it's a false economy. The USA healthcare system seems to err too much towards keeping costs down for whoever is paying that's not the patient be that private insurers or govt - many problems with that BUT on this issue it shows that the nhs way of short sighted cost saving really isn't saving money!

Many claim that one of the main reasons nhs not providing best care is lack of funds - well I think there's a strong argument for not wasting money fobbing patients off & only treating symptoms when I'm sure it's cheaper to dx properly & treat!

Gwen - I believe it is the case in many countries. I have friends and family all over the world, including in supposedly less developed countries, who can see a gynae whenever they feel the need and in many cases it's standard to see them annually for a "check up" even if asymptomatic. I believe rates for outcomes for female cancers in these countries are significantly better than in uk.

"Most insurance policies have allowed this for ages" again (shocked I'm agreeing with USA healthcare practices to be honest) this shows to me that those insurers have likely assessed it's CHEAPER to facilitate early dx & treatment than dismiss patients. I'm fairly sure they're not doing this altruistically.

"Why do women believe they need to see a gynaecologist for gynae primary care? Genuinely puzzled by this.. What is it about a gynaecologist that makes the better at doing smears than the nurse at your gp surgery?
Or prescribing the pill
Or inserting a coil?" Are you serious?! Go and read the NUMEROUS threads on gynae issues on mn alone and you will find MANY MULTIPLE examples of

Mners who've had shitty, painful, uncaring experiences of smear tests- myself included. I'm sick of inexperienced and uninterested practice nurses who don't listen when I request a smaller speculum and inform them that due to the endo and a weird shaped cervix smears are at best uncomfortable for me.

Prescribing the pill - I am fundamentally opposed to the coil for several reasons, the pill worked better for me for a number of reasons but particularly in recent years the hard sell of the mirena coil in particularly WHENEVER I try and discuss contraception or hormonal prescription for the endo is EXTREMELY tiresome.

Inserting the coil - again! Go read the numerous accounts of mners who've had problems with practice nurses or GP's wrongly inserting coils AND Then read the even more horrific accounts by in some cases suicidal mners and other women online who, upon finding for whatever reason (and this includes serious pain, bleeding and other side effects) the coil doesn't work for them, then face a ridiculous battle to get the damn thing removed! It's a scandal this isn't a scandal to be honest.

"Plus why do women need a yearly check up with a gynaecologist?" Again - given my own personal experience, that of friends and family and the experiences I've come across elsewhere - the answer would be - because generally GP's are pretty shit at taking gynae issues seriously! And gynaes - the specialists - generally agree!

My goodness Graphista you are angry and fail to see the more rational debates.

Why can’t you self refer to a gynaecologist? Because in so doing all the neurotics and health anxious would block appointments for those who were seriously at risk of significant disease. I had referral and hysteroscopy from a phone call with my (fantastic) GP within a day. There aren’t enough gynaecologist post funded or doctors trained to see everyone with occasional spotting.

Why not scan everyone - CT scans on demand? Because of the high risk involved. One off the key triggers for my moderately aggressive breast cancer was a number of chest CTts within a short period for a rare lung condition. Nobody’s fault as the lungs needed a diagnosis an risk of CTs were less than risk of biopsy but certainly not something you’d want to risk because people simply felt they ought to test everything fully.

It’s sad you’ve had endometriosis. My SIL has a hysterectomy at 28 for the same condition having delayed this for several years because she hoped for a child and wanted to try IVF. It was sad to watch from beside her but it was her right to defer and to choose. Nobody surely suggests hysterectomy should be done lightly in such a young woman without trying all other options first - and that takes some time.

No, you’re not about to get a consultant gynaecologist do your smear. Practice nurses on the whole are much more experienced at this and very competent at what is a simple procedure. There is not capacity to waste a consultants time on a routine, everyday procedure. If they’re such a problem, get a prescription to take beforehand to make it easier or determine your degree of risk in consultation with your gynaecologist/GP and make a decision not to have them (certainly not advocating for everyone but we overscreen and some women have a very low risk).

Rates for outcomes of cancer are not simply down to early diagnosis. There’s obesity and alcohol to be factored in - making U.K. higher risk for poor outcomes than many poorer and a European country. The incidence in the UK is about 12th globally. Some of that is about having such good healthcare we have an increasingly aged population but a lot is about lifestyle choices. Many people inadvertently or knowingly choose to develop cancer. Radical idea but sadly true. Smoking, obesity, alcohol, promiscuous behaviour and lack of exercise are all known causes. Drinking green tea doesn’t overcome those risks.

People need to start taking responsibility for their own cancer prevention and not simply expecting the NHS to cure them.

Cancer death rates were 125/10k nationally in 2016. That puts us quite high up in terms of survival but it’s raw data and doesn’t account for diagnosis rates, general population mortality and morbidity and lifestyle. Globally female cancer rates have remained fairly static for a decade except breast cancer where there has been a significant improvement globally.

"Why do women believe they need to see a gynaecologist for gynae primary care? Genuinely puzzled by this.. What is it about a gynaecologist that makes the better at doing smears than the nurse at your gp surgery?
Or prescribing the pill
Or inserting a coil?"

They get a proper discussion about the right contraception for them. From reading on here and other places, GPs here don't have time for that. They also get a breast check and a general gynae health check, not just the 5 minutes with the nurse for the smear test.

And sometimes people have more complex issues. I had to go to my GP for about a year until she admitted she didn't know what was wrong and sent me to a specialist. Turned out it was the wrong specialist, but it was only the gynae who figured out what it was.

In those countries that do have direct access to a gynaecologist, women can still choose to go to their GP for the more routine things.

I had a discussion with my orthopaedic friend some years back about referrals and long waits for appointments. I was curious was when the 6 weeks referrals target came out, it was set at 6 weeks.

He explained that he would definitely not want a system when patients could refer directly because it would mean seeing the vast majority of patients who didn't require expert care. He said the 6 weeks was set as such because that is often the time it takes a large number of ailments to heal naturally.

He said that one of the current problems nowadays is that people want miracle cure immediately when very often the best medicine is to do nothing and let time be the best medicine.

He also says that more and more complaints are due to poor self-care, including mental care with an assumption that surgery will solve all the problems.

He is very involved in supporting self management courses. He says that the team really struggles to get people to sign up to them because they are totally convinced their issues will only be resolved by medical intervention but those who do join and fully engage despite their belief do extremely well to their surprise. Evidence is showing that such interventions are more successful than surgery for certain conditions but when you deal with a patient who think they know it all and are oy interested in an easy quick fix, he is just wasting his time trying to convince them otherwise.

People need to start taking responsibility for their own cancer prevention and not simply expecting the NHS to cure them.

Pretty sure I saw statistics saying 60% of cancers weren't caused by lifestyle choices!!

We appreciate that the NHS can't "cure" everything, but it's a basic expectation for a GP to actually notice very obvious symptoms that may indicate cancer - unfortunately, it seems in lots of cases, they don't realise what is staring them in the face - maybe because of the arrogance and distain of some of them!