To think GPs should do their job

[Wotnokids]

Just heard the news that £250million is to be made available to GPs to 'increase the amount of face to face appointments'. AIBU to think this is just extra cash for doing their job?

I remember about 20-15 years ago when the NHS services were way better because they were properly funded. I have a rare illness where I get occasional really bad flare-ups. About 15 years ago I had one and went to the GP. The next day the nurse visited me at home to do an assessment of my home needs. Hospital appointment a week later, followed up weekly and some nurse appointments.
I had a flare-up again about 5 years ago. Gp appointment and referred to a clinic I waited a month to attend. Then monthly follow-ups with a nurse. I mean I did get better. But the level of care was like chalk and cheese and it took longer. I was actually a bit shocked the second time to wait a month to see someone. Yes, I could have gone back to my GP but he doesn't know any more about my illness than what he can read on the internet. I needed a specialist.

I only share this to say it doesn't need to be like it is currently in the NHS. It was way better and it takes money. But if you cut the NHS constantly, GPs retire early, it gets harder to persuade people to become GPs, and care gets worse.

An insurance scheme terrifies me. I have to pay a lot for holiday insurance and cant get life insurance. I also at times have a lot of appointments, and even when things are okay, I probably have an appointment about every two months. I think I would have to quit working so any insurance costs were covered by the state.

[quote Theworldisfullofgs]I worked in the nhs when labour came in, in 1997. The sense of optimism was amazing. And we got funding, we could actually do stuff. So I'm not sure wher you got that from Awalkintime. Any facts to go with the statement? And btw I'm fairly agnostic when it comes to political parties.

Thought some might enjoy this.

twitter.com/LBC/status/1448962003989635096?t=F5L7VdwpquUFe9fsWOjFOg&s=19[/quote]
Yes that was a most bizarre comment. Funding for GPs was particularly generous during the 2000-2010 period. I think most media highlighted that UK GPs among the highest paid in the world. And that the then new GP contract was money for old rope.

Unfortunately a few GP partners did just back pocket the extra funding and even got rid of previously directly NHS funded nurses. This small number of practices aren’t good places to work, then and now. Salaried GP, nurses and trainees elect to go elsewhere. That’s why there is excellence and dross in GP provision.

And what happens when they try to get rid of the dross? People complain and scream cuts. When it is anything but.

It wasn't a bizarre comment when it happened. They are cuts when the services are no longer there. Not cuts to funding but cuts to physical services. Labour also cut beds in hospital - they had to have wards at 95% capacity under labour and they couldn't have overspill wards they previously had for pressure points in the year. Prior to that there was extra capacity but Labour changed that - as in, cut services available (beds).

@Awalkintime

It wasn't a bizarre comment when it happened. They are cuts when the services are no longer there. Not cuts to funding but cuts to physical services. Labour also cut beds in hospital - they had to have wards at 95% capacity under labour and they couldn't have overspill wards they previously had for pressure points in the year. Prior to that there was extra capacity but Labour changed that - as in, cut services available (beds).

That was a change in how funding was invested not cuts. They spent more, just in different ways. And you are injecting this comment into a debate about primary care when investment was not cut during that period. Anything but.

The continued diversion of money into hospitals when it should be spent on primary care is a long standing problem. It’s better to prevent the reasons why people are in hospital by investing in primary care. That’s not even a debate.

Unfortunately anytime this is put into action, vested (hospital) interests whip up emotional sentiment by screaming cuts. I seem to recall Andrew Langsley was part of those protests about “cuts”. He subsequently halted the strategic policies aimed at improved primary and community services and implemented a disastrous restructuring.

It’s a significant problem in the NHS that people with vested interests block all change and improvement by screaming cuts. Even when that wasn’t the case as it was under new Labour.

At no point did I say there were cuts to funding. I said cuts to services. If there services are no longer there then they have been cut. Closing 3 A n E services means they were cut. There weren't 3 others invested in and the one that all areas had to use wasn't extended. Paediatrics were cut in one town and not extended in the other town. There was no restructure as they didn't invest in improving the services elsewhere or extending it. They just cut it in one area and left the single one we could use as it was. Restructuring didn't happen.

www.lancashiretelegraph.co.uk/news/15635710.campaigners-look-back-ten-years-since-closure-burnley-general-teaching-hospitals-e-department/

@awalkintime. You might have not agreed with what was happening but in total terms there were no cuts, they changed how the resources were used. It wasn't done by the government but by the local decision makers. Apart from all that, you're right.

So a ward that dealt with 30 patients in one town and a ward that dealt with 30 patients in another town was how it was for example. They got rid of one ward of 30 and that just left the other ward of 30 for a wider area. I'm not sure what you would call that, it isn't a restructure or a change in resources. I would say they removed services, or cut them.

The only change in how they used resources was to not fund the wards in 1 area. They didn't extend the services in another area to compensate.

The Tories cut 17,000 hospital beds in the 10 years to 2019.

They have but so too did Labour. Labour stopped wards having excess beds for pressure points. They are both as bad as each other.

www.kingsfund.org.uk/sites/default/files/field/field_publication_file/independent-audit-nhs-under-labour-1997%E2%80%932005-sunday-times-march-2005.pdf

@Awalkintime - you must live in a different world to me. Tories have, and continue to destroy public services. You only have to read this week’s announcement about GP’s.

Well in Lancashire it usually is the case! I never disputed what Tories have done to the services, I just said Labour also made cuts to services which they did. Both are a crock of shit.

I agree that Tories have done some major damage and if you read my comments at no point did I say they haven't. However, I am saying that Labour also contributed.

@Awalkintime

Well in Lancashire it usually is the case! I never disputed what Tories have done to the services, I just said Labour also made cuts to services which they did. Both are a crock of shit.

I agree that Tories have done some major damage and if you read my comments at no point did I say they haven't. However, I am saying that Labour also contributed.

I have worked in the NHS under both Labour and Tory Governments, I saw our hospital services flourish under Labour. I have seen the NHS being systematically destroyed by the Tories.

@amymel2016

There’s a huge lack of GPs in the U.K., mainly thanks to underfunding. The Government want us to start blaming the GPs, teachers, firemen, police etc etc rather than blaming the Government for their total incompetence.

And they'll still vote Tory.

We need thousands more GPs just to deal with Stockholm Syndrome in England.

@Awalkintime

At no point did I say there were cuts to funding. I said cuts to services. If there services are no longer there then they have been cut. Closing 3 A n E services means they were cut. There weren't 3 others invested in and the one that all areas had to use wasn't extended. Paediatrics were cut in one town and not extended in the other town. There was no restructure as they didn't invest in improving the services elsewhere or extending it. They just cut it in one area and left the single one we could use as it was. Restructuring didn't happen.

I’m sorry but this is just rhetoric. Closing services is necessary for a number of reasons. One reason is that the service does not have enough specialist capacity to maintain clinical viability. This is what happened with some paediatric units where the quality of care that needed to be provided couldn’t be maintained under the configuration.

Going to the nearest hospital was not always the best solution for many people who needed expert treatment from a number of specialists.

Improving the NHS means closing services but to call that cuts is misinformation. It is what stops improvement. There will have debate based on expertise at the time of the changes you describe.

MissyB1 I saw differently - I saw money being wasted on things like entertainment systems for wards instead of nurses and vital equipment and beds being cut to ensure 95% capacity. I saw managers managing managers. So the money was there but not well spent and frontline services were shocking.

Going to the nearest hospital is helpful when you need emergency treatment - travelling for 30 minutes and waiting outside in an ambulance isn't the best course when you have a stroke or heart attack and countless people will have died as a result. It didn't improve services, it lead to services being over-stretched and queues of ambulances at A n E who couldn't hand over patients.

It is a cut if services were not improved or developed but closed and allowed the other services to get overrun.

Awalkintime- it is a little more complicated than this. Sure, it is good to have fast assessment for heart attack and stroke. However there are specific treatments that you need a larger centre for. In some cases, it may be better to expand the facilities at the larger regional treatment centre than to have more local services - because after assessment at local centre, some patients need transporting to regional centre anyway (so longer time, maybe no space at regional centre).

That said- I do think it was short sighted to close a&e depts and reduce beds - given that we have a GROWING and AGING population. My guess is that most people in nhs would think labour did a better job than tories. BUT Labour did make some bad decisions too (which tories continued). One is the PFIs - public-private finance initiatives which build hospitals fast but leave a large ongoing bill for future years. These should really be stopped.

@Awalkintime

They have but so too did Labour. Labour stopped wards having excess beds for pressure points. They are both as bad as each other.

As a teacher, I can categorically state that there is a huge difference in Education under both governments. It's the Tories who have systematically destroyed state Education and made the working conditions of teachers horrendous and school a pressure driven and joyless environment for kids. This was not happening under Labour- who in fact had just brought in a wonderful new evidence based and appropriate curriculum that had been developed from real evidence and consultation with schools. The coalition came into power and literally told us to throw it out- not because it wasn't good- but purely because it was a Labour policy. They then brought in their own curriculum- the worst ever which was purely based on Gove's idealism and is totally not fit for purpose. Couple this with a punitive inspection system which does nothing to support schools or improve standards. There is a good reason most teachers hate the Tories- and it isn't because we are liberal lefties- it's because we see first hand the damage they cause. The pattern is to chronically underfund so the system fails, blame those workers in the system and then offer privatisation as the magic solution.

LyndaLaHughes You're talking to a teacher here. I know what Tories have done, I am not saying they haven't at all.

Beds and services in individual hospitals have been cut has they can’t recruit staff. A doctor who wants to progress in their career is going to want to work in a larger unit with more opportunities to see a larger number of cases in their specialty.

@LemonTT I read the research at the time. Travelling longer to a specialist hospital is better for heart and stroke patients. It is worse for respiratory patients and they are more likely to die.

@Awalkintime

MissyB1 I saw differently - I saw money being wasted on things like entertainment systems for wards instead of nurses and vital equipment and beds being cut to ensure 95% capacity. I saw managers managing managers. So the money was there but not well spent and frontline services were shocking.

Going to the nearest hospital is helpful when you need emergency treatment - travelling for 30 minutes and waiting outside in an ambulance isn't the best course when you have a stroke or heart attack and countless people will have died as a result. It didn't improve services, it lead to services being over-stretched and queues of ambulances at A n E who couldn't hand over patients.

It is a cut if services were not improved or developed but closed and allowed the other services to get overrun.

Well I saw equipment being updated which allowed progress in diagnosis and treatments. I saw investment in training and an increase in staffing, and most importantly I saw a huge decrease in waiting lists. In our cancer diagnostic unit we were able to slash our waiting times - which undoubtedly saved lives.

@Awalkintime

LyndaLaHughes You're talking to a teacher here. I know what Tories have done, I am not saying they haven't at all.

The pp referenced paediatric care and the decisions to consolidate activity were based on evidence. The need to have access to wider range of specialisms and a critical mass of workload to maintain quality of care.

Plus I also said one of the reasons not all of the reasons. But fundamentally there reason was not cuts.

Today our GP has closed its online econsult, is not answering the phones and we are not allowed in the buildings - good job I can attempt to self treat a UTI and its not yet too painful. It is verging on needed antibiotics as the OTC remedy is not really shifting it just dulling it for a while! Who knows if I will get through tomorrow - the econsult takes so long I struggle to complete in my spare time at work, did one last week and it deleted it as I didn't complete it in my break time. This was for a seperate issue I have tried to treat for 6 months already!

@Noodledoodledoo it sounds like your surgery is on the verge of closure. Does it have any GPs still employed there? Surgeries like any service actually need staff. If people have left, and you have someone off sick, there may not be actually anyone there to do anything, or just one person perhaps trying to do everything.

But it is like midwives. Everyone complains about midwives being too busy to give proper care. And they are. Because there are not enough of them. And as it gets harder and harder, more and more midwives leave.

You can't run a service without staff. In Nottingham, they privatised a specialist eye service. The consultants left as a direct result, and the service went from being internationally renowned to struggling to offer a very basic service. Privatisation makes zero difference. The issue is attracting and retaining decent staff. And the kind of people who become consultants or GPs tend to have choices about where they work.

LemonTT
There are no specialisms though - they just closed one paediatric ward and overloaded the other. They closed one A n E and overloaded the other. It would make sense in that situation but there is no difference to specialism here, it was just that the provision was cut.