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?

No, it uses many contractors.

Thanks @Kendodd . It was the polar opposite of DMIL, whose departure took the path you describe. Dementia, on top of multiple chronic conditions, must be the cruellest way to go.

We ve been here before.... the US Govt uses contractors, the NHS out sources services previously provided inhouse, now done by private companies, using previously employed NHS staff.

I know this is going to go down like a lead balloon,but at this stage of my life (edging 70) I am starting to think that I would prefer to buy any care I need or want privately, so that the provider answers to me, solely. Take a skid on NHS provision? I probably would not ..

And yes, it will mean I have less money to spend on other consumables. I can cope with that.l

Yes, we have been here before. I was right then and I’m right now.

Clearly you’ve not worked in the NHS then. If you can tell me why GP surgeries aren’t mandated to provide services within the NHS/GDS service standard with systems and services that fully integrate with the backbone…

GP surgeries can drop dead. They are what hold
us back.

I ve worked in a roll out of IT within GP surgeries and our company provided IT services to several large district hospitals nationwide, some of the stuff they use is ancient, eg i ve seen (pre CV) XP used in Hospitals.

NHS IT is awful, back bone? what backbone? there isn't one but spending billions on improving this, wont, initially, get one extra patient an operation & by the time it was rolled out nationwide, it would be out of support!

You expect a small private business like a healthcentre to integrate IT with local trusts?? so my HC would need to integrate with 3 trusts... what about the rest of the country?
who pays for this?

You want GP surgeries to "drop dead" so what would you replace them with?

😂

No I don’t expect a small private business to integrate. They have been give the opportunity and they refused. The fact that they have systems that don’t comply with the NHS / GDS service standard is literally a crime that kills people.

I would entirely disband private GP practices full stop. They are an anachronism that holds back patient care. End them now.

It should be the responsibility of the GP practice to procure software systems that integrate fully with the rest of the NHS in their area at least.

Here in accountancy, we are forced to use "compliant" software that integrates with HMRC's nationwide system for submitting tax returns, VAT returns and payroll, and which can read certain data from the HMRC. Likewise the software must integrate with Companies house for submitting company accounts and returns to Companies House. WE HAVE NO CHOICE. If we don't buy such software, we simply can't operate our businesses as we'd be unable to submit client tax returns as legally required to HMRC! Coming shortly is "MTD" for sole traders and self employed which will require quarterly returns to HMRC of accounting transactions, again by law required to be submitted by software which integrates fully with HMRC's system.

We can't just decide to write our own systems or choose a system that isn't compliant and fully integrated. We'd not be able to operate our business. Not sure why GP practices think they're so special that they can decide to choose their own software that isn't fully integrated. The GP contract that practices work under for providing services for the NHS should have been written to specify the exact tech specs of software they could use to provide a proper and full two way exchange of data between the GP surgery and other NHS systems.

& you can pass on the considerable costs of this to your clients, a GP practice cannot...

Area systems is where we go wrong, a GP practice IT system should be able to talk to any NHS system anywhere, otherwise its pointless, people move and can nominate ooa treatment.

Anyway, there is a program of IT works to integrate nhs into GP practice, funded by the NHS Digital, as it should be.

Disband, sure and as i asked earlier, replace with what?

GP surgeries owned and run by the NHS with GPs as salaried staff.

How would that work? Many GPs own the bricks and mortar and have sunk considerable sums into their businesses. What's the buy out cost?

I know of a woman who worked for the NHS. She went off on the sick for one year, during which time she started up her own business, so was pulling in two incomes.
I'd crack down on this kind of thing, as they make it too easy.
Obviously that's only a tiny part of the problem though.

Who cares. -people die because GP want to have their little fiefdoms. Fuck em.

Well I care, I'm a tax payer. If you're proposing a multi-million pound (or more) expense id like to know how it works.

But what are you actually talking about

I was thinking about this some more today and one thing I'd like to get rid of is the postcode lottery. Everyone entitled to the same services across the country (ideally across the UK, but certainly across each home nation). For example, my mum lives on a county boundary and friends over the boundary find it much easier to access their GPs and also get some nursing care at home after they've had an operation. In her area there is nothing and I even needed to get shirty with her surgery to get them to send a nurse out to her to check a dressing.

Post-operative care like that should be standard, not depend on where you live or how stroppy your daughter is!

My mum also had a friend who had an accident in Germany and a nurse was sent to their caravan park every day to check their wound dressing! I can't see that happening in the UK!

Also, MIL had a fall but she was bed-bound afterwards. They wouldn't give her physio because she had dementia and wouldn't remember to do it. I feel like in other countries, someone would come round to the house every day to make sure she did it. Obviously family could as well, but physio needs to be done properly.

It's that sort of care that should be standard and might actually save money in the long run.

I think the biggest issue for the NHS is that it is too short-term-ist.

Like most things, to be fair.

Yu sound like you ve had a bad experience and want to "throw the baby out with the bath water..." to quote my dear granny.

NHS run and salaried GPs wont get rid of the bad ones, in fact would make it harder, there has to be a gatekeeper for NHS services, the vast majority of GPs do that exceptionally well.

Not my GP, but a local GP has just announced that they are no longer going to chase referrals for patients, and patients have to contact PALS. Not sure what they are meant to do if they don't have the wherewithall to chase referrals.

GP surgeries are private businesses who do not want to comply with NHS data interchange and standards. Which holds the entire NHS back a huge amount. Take away that power by bringing GP services entirely inside rather than entirely outside the NHS.

i said it quite clearly about ten times now.

I’ve worked directly on the research design and implementation of several key NHS services and the problem always comes back to GPs.
you tell me why GPs should be able to not meet the standard everyone else has to? https://service-manual.nhs.uk/standards-and-technology/service-standard

You may or may not be right. But you’d never get that past the GPs.

However much Labour might cosy up to doctors, they will have to contend with a workforce more protective of their rights and income than any other.

Medicine in the UK is not a selfless vocation and it never has been. And, frankly, why should it be?