How would you fix the NHS?

[PinkFruitbat]

The Government is asking for ideas on how to fix the NHS.

https://change.nhs.uk/en-GB/

What would you do to fix it?

Because a GP and the associated call handlers can work from home, a MIU needs a receptionist, 2 or more nurses, HCA's... radiologist.... a Doctor... security staff.....

Just to add to that...

Some of the money saved from the over-zealous medical interventions for the very old could be used for regular home-visits by a doctor or nurse to check on them and make any necessary adjustments to their medical care. I bet most very old people would vote for regular home-visits from a professional than being dragged into hospital all the time.

@Alexandra2001 that's another issue. GPs want to work from home. I've never heard anything more ridiculous.

GPs surgeries should be 7am - 9pm 7 days a week.

So many people use a&e as an out of hours doctors. I have a family member who didn’t want to miss work, so she went to a&e for her medical issue so she could have access to help for her non urgent issue. What she done is ridiculous, but so many people do this with the cost of living and not affording to miss work. I think there needs to be more access to gps, both with calling as most people are in work when the phone lines open and if you phone outside of that - you cannot gain an appointment. And as gp open times are during work hours, there needs to be slots in the evening for every surgery so people can access the care they need.

I think a lot of it relies on gp surgeries, so many people go to a&e because they cannot access appointments. And if you phone 111, most of the time they tell you to go to out of hours or a&e. More funding needs to go into gp surgeries to decrease the load of people wasting time at a&e and preventing real emergencies from getting the care they need. I almost died when I had sepsis from a mastoid infection, but a&e was so overworked I was sitting there for hours unseen. When I finally got seen, I was so close to dying and if I would have been left any longer I would have. That’s the difference between critical people in a&e being seen and people using a&e as doctors care.

We do sent text reminders 48 hours before (or Fridays if a Monday appointment) and on our highest cost/highest demand clinics a member of the admin team calls everyone on the list the day before to confirm attendance to try to reduce DNA's, which is hugely time consuming. But even when people confirm attendance they either don't turn up, or turn up really late after clinic has finished and then shout at us when say we can't see them.

One of the clinics my DD attends sends text reminders, but they operate across 3 sites within a 15 mile radius and the text never tells us which clinic the appointment is for. I've also lost count of the number of times we've had appointments booked for the same team, in two different sites, at the same time. Trying to cancel is very hit or miss, and they can never just book another appointment when you call to cancel, they have to send another letter, and another text reminder. The amount of outdated needless admin and lack of joined up thinking is astounding.

@sharpclawedkitten they are legally not allowed to do the prescribing course. They should go to prison if they are prescribing.

ANPs can prescribe. They are highly trained. PAs can have a zoology degree and then do 18 months course. So not highly trained.

The NHS needs more staff. we have trained them but we don't employ them. Which is madness.

Can you explain please why you think its ridiculous?

You want GPs, receptionists, practice nurses to do 14 hour days? and if you don't, where are the staff coming from to cover these shifts?

You ve come out with some good ideas but you don't seem to recognise the lack of HCPs in this country.

@Alexandra2001 because GPs should be seeing face to face. Not over the phone from their bed.

They can do shifts. 2 x 7 hours. As they do in hospitals.

We have unemployed GPs. Employ them. Then easier to see a GP, less people in A&E, ambulances can turn around quicker.

Stop sending appointment letters after the appointment has been

Where will you magic up GPs from and the associated staff they need to work efficiently?

GP locums don't want to work in practice... you cannot make them.

@Alexandra2001 we have millions out of work. There's your receptionists.

There are unemployed GPs. Employ them. Stop this part time, flexi working from home bollocks and get them doing the job they've been trained to do.

Perhaps we need to move away from a GP model of care? More and more surgeries are running very well with a whole host of different clinical staff meaning we all get seen quickly by people specialised in that type of care. I'm on multiple medications for a complex health issue, my medications are reviewed and managed by my practice pharmacist, and they have an in house physiotherapist. I can't remember the last time I saw or needed to see a doctor. Even when I've had an ear or chest infection I saw a very competent nurse who prescribed my antibiotics.

There are not millions unemployed at all, a GP receptionist is a stressful and skilled job, which requires training, there are approx 350k long term unemployed, most of these are unemployable, MH and substance issues, most people claiming unemployment benefits are churn, shorterm between jobs.

You want to forcibly stop GPs working PT or flexibly? how?

Practice GPs are not unemployed, the issue is locums cannot get work so easily now.

We need to move with technology, Video quality is now brilliant and ooh, there is nothing wrong with using it.

@Alexandra2001 they're told, get back in the surgery and see patients or you lose your licence and your contribution to the partnership.

I kind of think the cruelty of extending the lives of the very elderly in very poor health for as long as possible will solve itself in the next generation. The generation below have seen it and I've never heard anyone say they want every treatment going, so they can stay bedbound in pain and distress for years themselves. I don't think people will allow such treatment to happen to us with life extending medication.

Lol, i'll stop replying to you, as your clearly living under a bridge now.... and i'm not going to try and walk over it anymore.....

My last GP surgery the doctors only ever did mornings or afternoons. They even closed for lunch for 1.25 hours

Most of the time the GPs were only at work 1.5-2 days per week

14 hour days!! I don’t think a lot of GPs at large practices work even 8 hour days for more than 2 days in any one week

Stop thinking we’re special eg there are 60 people in s Scotland with ingrown toenails . There is a clinic in Lockerbie all day on X day. So you all sort yourselves out get there arrange lifts (you can phone the taxi/ relative etc on your phone or get someone to do it for you at home time .job done
Next day clinic invites any one with tinnitus in the region to come if they think it might help.

Etc

Except I think if it was going to apply, it should apply to everyone, or I think it should. A line of credit needs to be available for those who just don't have the money there and then though.

@Yalta my GPs surgery apparently has 14 GPs but they each only work one day a week!!

@Alexandra2001

46m is such a tiny amount in terms of NHS spend that it is trivial

And there in a nutshell is why the NHS is in such a state and soaking up so much money.

That's the attitude of the majority of NHS staff. When they waste, they don't care because it's just a "drop in the ocean". If every NHS employee saved a few pounds per day, it would save billions in a year.

I remember having an ECG. Nurse opened a new packet of those self adhesive clips that stick to your chest and then the wires are clipped on. From memory, there were 8 clips in the pack, she used 4 and threw the other 4 in the bin! Half way through the ECG, a couple of the clips fell off and wouldn't stick on again. So she opened another new packet, used 2 and threw the other 6 in the bin! That packet may "only" have cost a few pounds, but if she's doing that for every ECG patient that day, it will come to maybe a hundred quid. If other nurses in different surgeries/hospitals do the same, then it soon adds up to thousands a day! I fail to understand why she didn't just keep the unused ones for the next patient, or if that's not allowed for H&S, then at least keep them until the ECG is finished in case some don't stick and replacements are needed.

@Alexandra2001

GP locums don't want to work in practice... you cannot make them.

You remove their "comfy" and high earning locum jobs elsewhere. They're only locums and choosing the "easier" and more convenient work because the work is there and they're just cherry picking the jobs they want to do, paying the highest daily rate. It's a bit like the bank and agency work for nurses. Get it sorted, remove the "need" for so many short term locums/temps, so the people having a lucrative easy life would need to find a proper/permanent job instead.

There's only the need for so many temps/locums/bank/agency staff because of poor organisation and management. Of course, there'll always be a need for short term cover, but a lot of the locums/temps etc base their entire career on cherry picking the highly paid, low hassle, roles. It shouldn't be a permanent career choice to not actually have a "proper" long term job and end up earning more, for working fewer hours, by cherry picking the short term roles.

Go back two or three decades, and the "locums" were typically retired GPs who went back to their old surgery to cover holidays, the odd Saturday morning, etc. For some reason, that doesn't happen anymore. Probably because of the pension tax problem and them getting a large pension anyway, they don't need to work.

Now that so many GPs are only working part time (some as little as one day per week), we need to examine why that is, and what we can do to "incentivise" them to work more and cover sickness/holidays of their colleagues. That makes far more sense as they know the practice, know their colleagues, know the patients, rather than bringing in an expensive locum from an hour or two's drive away, who probably doesn't even know the IT system, doesn't know the local Trust procedures for referrals etc (Yes, I've experienced that far too many times - they've not got a clue and basically just fob you off and tell you to make another appointment!).

Part time GPs will often work 40+ hours a week. Doctors often work 78+ hours a week full time. Not through choice, but because that's what the rota tells them to do.

As an example :

4x13 hour night shift
One day off
2 days 13 hour on calls

Unlikely to get away on time every day as things happen. All for the princely sum of £17 an hour.

We need more doctors and nurses. We have trained more doctors and nurses. Employ them.

Yes I'm a boring stuck record, but it's so simple.

Definitely not like the US.

France is the model to aim for. Those on the lowest incomes including people who are out of work or disabled etc, have their insurance covered - so nobody is left unable to afford healthcare. And French healthcare is better than the UK. Quicker access and more efficient (eg. prompt diagnostic tests).

Re this Turn the heating down. It’s making the patients and the staff sicker, especially on warm sunny days. Yes! It's always too hot in GP surgeries and in hospitals.