The government spent over £10 million of our money surveying thousands of us to find out that a rather large majority were actually very happy with our local General Practice service. I am a sceptic and believe that if there was any dirt to be found, then the government would have found it with this leading and manipulative survey. There was no dirt, on the whole people were found to be happy, unfortunately the government didn't stop there; it is always worthwhile remembering that HMG will always sink that little bit lower in its attempts to undermine genuine democracy.
The CBI have now thrown their corrupt hat into the ring, they have allied with the government on this issue because they want to make a killing, both financially and literally, by opening numerous tacky cubicles in their high street stores and supermarkets. To do this they have decided to produce yet more poorly researched propaganda to undermine the country's rather enviable General Practice system. Based on a rather small and flawed survey produced by the highly 'neutral' Alliance Boots, a large company that stands to make huge profits from privatised primary care, the CBI has naively pronounced that the UK economy is losing £1 Billion a year due to GPs not working around the clock.
The CBI's flimsy argument does not take more than a few milliseconds to robustly deconstruct. It would actually be very easy for them to allow workers more flexibility to see their GP, it would also be decent of them to provide decent occupational health services at work; some would say it should be expected of them, given that many of these businesses are rather large with thousands of employees. The CBI's argument also assumes that this small survey is representational and that people are telling the truth when they claim they have been at the GP's; one must remember that the DoH's rather bigger survey contradicts the CBI's statement. I would also bet that there are many other issues that cost the CBI's members many more billions than this so called inflexibility; how about delays on public transport, child care, bank visits, optician and dental appointments, home deliveries, getting the car serviced and on and on. In fact most GPs are open from as early as 8am and up until 6pm, hardly bad for non emergency medical care is it? I also wonder how many NHS staff lose many hours every year taking time off work doing routine things like servicing the car, sorting things at the bank or getting an electrician or plumber in? Should all these workers be on 24hr call as well? The government's propaganda machine, the BBC, is also jumping on the bandwagon; by their logic we should all be doing nothing but working, working, working- has anyone thought of the poor pillow manufacturers?
If you agree with the CBI then you are in the minority, and I would suggest that you look at the underlying motives. Alliance Boots was in fact taken over this year by none other than KKR. It is therefore a strange coincidence that Labour peer Lord Hollick is an adviser to KKR, while the Labour party has received several rather large donations from such private equity firms. These are the very same private equity firms that seem to enjoy profiting from stealing peoples pensions. I am more than a little suspicious that these people do not intend to plough money into health care to provide a better service for patients, I suspect that they want to get their greedy mits on some more easy money and that the government is only too willing to oblige.
If these corrupt profiteers get their way then it will only be bad news for patients. British General Practice is actually a remarkably high quality service that comes at a relatively low cost, one of the things that makes it so precious is the continuity of care that it provides. This will be lost if this short sighted privatising agenda is allowed to continue, catalysed by dishonest pretences at consultation by the illiterate Alan Johnson and the malignant Labour crony Ara Darzi. These big businesses do not care one jot for their workers' health or well being, they are simply intent upon fleecing the tax payer by uniting with a corrupt Labour government that has come to represent the exact opposite of what the Labour party should stand for. Depressingly the way it is going, I fear for the future of British General Practice, and it will not be possible to recreate the brilliant concept of the local doctor who actually knows you when it has been ruthlessly destroyed by this Brownite dictatorship. All we will be able to say is 'I told you so'.
Dr Rant
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55 comments:
"These big businesses do not care one jot for their workers' health or well being..."
This is not entirely true: as we see time after time from public sector organisations, unhappy staff make for huge inefficiencies (through stress-related illnesses leading to absenteeism, etc.).
And why on earth you should think that large public sector organisations care any more about their staff than large private companies, I don't know.
Your main point is valid though: however, I have no problem with private companies setting up GP-type services.
If people want them, then they will use these services; if they don't, then the companies will stop providing them.
As things are at present, I suspect that this is what would occur.
DK
People (at least in the London area) often commute an hour plus to work. If they don't manage to get an appointment first thing, they miss several hours of work which many bosses are not too happy about. The solution I see to this is to let people register near their place of work rather than near their home.
I imagine this would lead to more surgeries in city centres, and I don't quite know how you'd work OOH (more walk-in centres?), but I can't see these are insurmountable problems. Or am I missing something?
"Or am I missing something? "
This is actually not a problem. Patients can see any GP they like anywhere as a 'temporary'.
However, since the cities have a shortage of GPs and the payment GPs receive for seeing temporary patients is not wonderful, it can be difficult in practice for people working in a city.
The biggest hurdle for complex problems is sharing of GP information. It's one of the only sensible uses of the NHS data spine (and could be done safely by having the host practice get the patient's permission to share data with a specific other practice).
Dr Rant, I agree with you - big business will do anything to get their claws into Primary Care. However, as someone who works in Primary Care I am more pissed off with the local NHS bureaucrats and 'politician' GPs/nurses - you know, sit in more meetings than they do clinics - who are acting as willing government lick-spittles and arse - wipers! If any of these people had any idea of the value of the service they provide (or rather the clinicians and practice staff provide)they would be digging in their heels and informing the Gvmt that actually their proposals are a load of bollocks. Instead, they go to all the meetings in London (at tax payers expense) and then return to their organisations evangelising about the latest 'big idea' from the CBI arse-lickers in central government.
Still if you're an assistant director of the director of commissioningof etc..etc.. on £100K + per year with a nice position at Assura Health Care lined up if things go pear=shaped in the NHS, you're not going to care, are you? Look it's 7>30 am and now I'm ranting too.
Anonymous, you sum things up well. The twaterati are conniving in the breakup of UK general practice.
The idea that CBI care is laughable. To their members ill people are expendable, and use of GP is a means to this end. The lack of protection to subcontractors particularly in building sector is appalling. Big companies wash their hands of dangerous jobs, and leave small companies with little profit and high liabilities.
What people don't realise is a fundamental difference between business and public servies is that businesses select their customers, whereas public services have duty to treat all comers.
Hotels advertise to middle and upper classes, and don't want the hoi polloi in except as kitchen porters. Certain people just are not invited, and would not get a booking at some hotels and restaurants.
A+E and GP have to treat everyone who needs us. It's a different game. What people don't realise is how quick and accurate an experienced GP is, and how slow and inefficient nurses are in comparison. The idea that most General practice could be passed onto nurses and "nurse practitioners" gets more absurd the more you know about what GPs actually do.
Needless to say CBI knows next to bugger all about GP work. And many companies try and get free occ health work off NHS (hidden subsidy?)And if companies stopped employees getting burnout and boreout they'd have less sickness. And if personnel manangers had any courage most of the interpersonal disputes that lead to stress would be sorted before time off work was needed.
If middle managers were empowered to make decisions they and their staff would do far better, both in terms of health and of productivity.
If the GANFYD (get a note from your doctor) phenomenon was banned then many currently wasted GP appointments would be freed up. GANFYD is never about a medical need, usually it is about a jobsworth in an office somewhere needing "medical confirmation" to what bloody obviously ought to be done without wasting doctor's time.
We live in a high bureaucracy, ultra-procedural, low trust world at present. CBI wants doctors open longer to indulge this idiocy, rather than helping doctors limit demands on their time.
I'm not impressed at being told what to do by a dysfunctional and ineffective government and their lackeys in CBI.
Dr blue I agree
BUT it is true that for the ordinary person it can be very difficult to get to see a doc, and that I am afraid will force the issue one way or another, given the small remnants of a democracy we have left it may not happen in the best manner, but people ARE going to get access to docs in the evening and sat mornings one way or another
The CBI may have elements of nonsense in what they are saying, but then so does the average dr rant missive have nonsense (communist health provision works bla de bla)
Ignore the nonsense and come and see how hard it can be to get to see a dr for an ordinary person, people power will change this, if they cannot exercise this power by taking their money elsewhere as they do in most consumer industries they will exercise it via the press etc
Most patients who have experienced medical provision in another western nation think the NHS is shit, now there's a survey I would like to see...
Treatment on the basis of "want" is rightly limited by GPs. Treatment on the basis of "need" is rationed as effectively as possible.
People will get their "wants" supplied by private medicine soon enough. It'll not be what they expect, and will be very expensive, and the provision of it will destroy the "needs" provision. irreversibly.
Think of the governments attempt at running out-of-hours non-routine primary care services using private contractors. Then apply that to routine in-hours services. But it'll be much worse.
Treatment on the basis of "want" is rightly limited by GPs. Treatment on the basis of "need" is rationed as effectively as possible.
There's treatment, dr yorkie, rationed by GPs, hospital doctors, nurses, and other HCPs plus NICE, etc. on the basis of need and what they perceive as feasible (and by private doctors, as the GP here who sees private patients (for 200 an hour) will be glad to affirm, i.e. he will say his patients get what his clinical judgement suggests is appropriate). And there's 'diagnosis' for want of a better term ) possibly plus 'treatment' (i.e. there's 'seeing a GP'. This thread is about 'seeing/getting an appointment with a GP'. GPs probably would like to be able to decide who needs an appointment with them without seeing them or even hearing their account of their symptoms but guess what? sometimes they can't. ('Sometimes'? I'm being polite.)
sorry. parenthesis 2 should precede 'for'.
I can easily tell you who needs to see me.
"Not everyone"
And there lies the problem.
re "Treatment on the basis of "want" is rightly limited by GPs" actually i think the rationing by GPs is done in a very variable manner, not at all fairly, and often very questionably from a "need" point of view
one of the problems with "GP as the gatekeeper of care" is that you depend on having a decent GP, for the millions of us who do not this is a bummer
as discussed recently I know in great detail of a case where a GP was refusing to refer, and he was ganged up on by a specialist nurse and another GP and TOLD to refer, now that GP left to his own devices would have stopped the patient getting access to treatment they need
now yes these are often not black and white decisions, but when its you or a loved one being denied a referral (often without even knowing it) it stinks
GPs are not gods, and the current system is in meltdown for this and other reasons
Oh and on the CBI being corrupt issue I think you will find the average nhs organisation more corrupt than most other organisations with very high proportions of jobs handed out on the "friend of a friend" principal
I agree, dr yorkie. But I see no easy way of screening out all the people who don't need to see a doctor.
I have to agree that having a good GP is paramount, and they are not always available. The question is though whether the present drive to commercialise GP will increase the availability of good GPs or lessen it.
-"friend of a friend" principal-
I don’t know what you do anon but I would place bets that it isn’t a senior role. In the (highly competitive) industry I worked in most senior jobs were filled after consultations on the old boy network. There might have been an ad in the paper but few vacancies were filled this way. Those that weren’t filled on recommendation were filled by candidates supplied by head hunters. And what do head hunters use? um the old boy network.
Having just finished my morning surgery (and paperwork)I think the real problem lies in the amount of totally unnecessary visits to the GP. If you are having difficulty seeing your GP it's likely to be due to the fact that the surgery time is clogged up with people wanting sick notes ('my boss won't accept a self-cert'), insurance papers, wanting to have 'slimming pills' and the common cold. I am fortunate to work in a prcatice where the population size means that people having to wait weeks for an appointment just doesn't happen. Most of our patients - if they need one will get an appointment on the same day - however I reiterate this is largely due to our small practice list size. I sympathise with someone who is having genuine difficulty getting a GP appointment, but if the Private sector had to deal with the numbers most GP practices deal with on a daily basis they would rapidly collapse under the strain.
I have to agree that having a good GP is paramount, and they are not always available.
thank you for saying that, dr yorkie. For quite some while now I've had really good GPs but before that I had some bad ones.
The question is though whether the present drive to commercialise GP will increase the availability of good GPs or lessen it
(a note about the 'present drive'; my little local Boots closed some months ago for 'renovations' including a 'consulting room where pharmacists could see customers', you think perhaps, just perhaps, Boots saw this coming?...) I think this further privatisation of GP-hood (GP-ness?) is likely to provide a poorer service than could be provided by the kind of registration kh suggests. I further think the government's being disingenuous when it says people will be able to see 'GPs' at Boots etc. as it knows what many of us mean by 'GP'; it should say 'a doctor'. Having said that, such arrangements would cater for e.g. people with shingles unable to see their GP quickly but unwilling to trouble A & E or with a nasty burn whose seriousness they hadn't realised, that got infected... (whinge whinge!).
But I am not at all happy about these proposals (and suspect they're, whatever else they are, a diversionary tactic to cover up the OOH wreck), pace dr whichever's belief I want to see him working in Tesco.
re "I would place bets that it isn’t a senior role" as ever the guess factor contentants are wide of the mark
and there is a difference between having someone recommended by a business associate who has seen the person in action, and the nhs version which is often just relatives and mates down the pub
re "This is actually not a problem. Patients can see any GP they like anywhere as a 'temporary'." er it is a problem, as a temp patient (if they will indeed see you), they will not refer anywhere else other than back to your own GP (miles away), will not perform simple tests etc etc
A simple step in the right direction would be to let the patients visit any GP they dam well choose and NOT the few imposed by the PCT, allow those GPs to get paid fairly for this, allow those GPs to refer etc, in this way a little competition would close the extreme crap surgeries in the worst areas, although sadly this will only make it busier for the better GPs, but then hopefully they will get more money to fund more care
thanks dr yorkie, not many docs on here prepared to admit how crap the crapper end of the GP spectrum are
I think at some stage we'll do a posting on "What a good GP does really well"
The difficulty with poor performance is proving it. On the other hand if 360 feedback comes in most good GPs have satisfied colleagues and patients, and the absence of this would show up on 360 appraisal.
In Canada they do 360 appraisal (sample includes patients, fellow GPs, attached staff/DN/HV etc, consultants) and visit the top and bottom 2.5% of scorers for learning from good example, and to tidy up the dire warnings.
"as a temp patient (if they will indeed see you), they will not refer anywhere else other than back to your own GP (miles away), will not perform simple tests etc etc"
Actually, they can and we do. In fact, we have dozens of temps on our books who are 'regulars' because they have holiday homes in the area.
"A simple step in the right direction would be to let the patients visit any GP they dam well choose and NOT the few imposed by the PCT"
You can already see any GP you damn well please, so long as the GP is willing to see you.
The problem in some areas is a shortage of GPs, so the GP may not be willing to see you.
The PCT can only 'force' a GP to see you if you live within their practice area and they have an open list.
As I tried to demonstrate with the 'bloody builders' posts, have a capitalist supply and demand system is no guarantee of being able to get a speedy service.
The CBI annoy the hell out of me. They complain about the billions that they "lose" every year due to staff sickness when it's a fraction of what they gain from unpaid overtime.
Years ago, companies used to provide apprenticeships and training but now the lack of trained staff is the fault of the education system and the taxpayer needs to fix it. Companies are enforcing more and more draconian "absence management" policies which create more GP visits (for sick notes and because if you didn't see a GP, then your illnees isn't "proper") and the CBI members, again, want the taxpayer to foot the bill. Fuckers.
Oh, and the conspiracy theorist in me looks back to the change of GP contracts, and the OOH opt-out followed by the carefully coordinated press smear campaign and wonders. The general public is being persuaded that GPs are crap and therefore something needs to change. Of course, GPs are already private companies, but they aren't large political donor type private companies.
BTW: yes, I sometimes find it difficult to get to see a GP, but that seems to have more to do with parameters set by the government than anything else.
Alliance Boots is owned by KKR which also owns Hospital Corporation of America.
http://www.kkr.com/
http://www.kkr.com/investments/current-invest.html
Business: The largest and most diversified investor-owned health care services provider in the U.S. with hospitals and freestanding surgery centers in 20 states, England, and Switzerland.
Website: www.hcahealthcare.com
Business: Provides cardiology and cardiovascular services through the development, operation, and management of heart hospitals and other specialized cardiac care facilities, and provides consulting services to physicians.
Website: www.medcath.com
The buyout of Alliance Boots was predicated on getting downstream in the NHS and owning GP surgeries to push branded pharmaceuticals and to push for removal of restrictions on direct advertising in return for the NHS accepting patient co-payment for prescriptions across the board
herring and voyager make interesting points,
the CBI are indeed very happy to make huge profits while expecting the tax payer to foot the bill for work that it really should be doing itself
workers are often treated with utter contempt by their employers in big business, as regards 'absence management' for example; if they treated their employees with more dignity and respect in a cooperative way, instead of their typical bullying way, then they may find that this would work better
KKR et al need to be stopped from getting so much power that they control the whole supply and demand chain, there is no way in the world that drug manufacturers should be allowed to advertise directly to patients; this would be a step too far in favour of big business, and against the interests of the public's health
As ever some balance from the real world of patients, which is obviously so very different to the perspective of Dr Rant.
Re "Actually, they can and we do" good, you are at the better end of the Spectrum, many are at the other end of the spectrum. I have been refused a GP appointment as a temp patient, in New Malden Surrey as it happens as an example, and a thousand curses on that evil witch of a receptionist.
I have been referred back to my GP many a time by GPs in other parts of the country. I think at the heart of it the PCTs are trying to push the costs of referrals back on the "home" PCT. As you know I've largely given up on this and have tended to go private more recently, but I have been with relatives when similar stuff has been said.
Re "You can already see any GP you damn well please" NO YOU CANNOT!
Ring around ALL the GPs in Coventry, say you have a CV1 postcode, and see how many GPs will see you. Go on do it I dare you. The staff will happily tell you i) they have lots of free spaces on their lists ii) they are prevented from registering you as the PCT only allows folk from that postcode to register with other surgeries. ALL OF THE SURGERIES WILL TELL YOU THIS SAME STORY. There are only 3 surgeries you can register with if you live in that postcode. (To be precise there are another few if you are a student, but normal non-student residents cannot use them). Go look at the surgeries, go and chat to the locum docs typically on duty, report back if you think the folk in CV1 are getting reasonable health care.
It is nothing to do with "a shortage of GPs, so the GP may not be willing to see you." and it's a separate issue to how PCTs sometimes force GPs to take on some patients. Rather it's about which GPs in a given city a patient living at a given address is allowed to register with AND SEE... BY THE PCT, not the choice of patients or docs.
If the system worked the way you think it works I would know residents of CV1 registered with surgeries outside the assigned 3, I don't because they don't exist. Patients have so little choice of which doc they see they may as well have no choice at all.
Unfair to pick on Coventry, as it's not the only example, I can list others... I know my parents were recently kicked off their GP list of about 40 years standing and forced to use one of 3 surgeries nearest their home. Again not the GP or the patients choice. WE KNOW THE GP, WE KNOW ITS THE PCT DOING THIS. And thousands of people in their home city forced to move also. It is the NHS which is dictating to patients AND docs who can see who.
Dr Rant you need to understand this stuff to understand why people feel the way they do about NHS underperformance! These are just small examples, the real world is so very different to the imaginary model in your brain.........
no-one, the last word I would think of with respect to you is balance!
thanks matt
yet another hilarious letter arrived from the nhs for a close relative today, hilarious in the sense its a total disgrace they are allowed to get away with this crap, given this constant bombardment of crap service from the nhs i think i am fairly balanced
happy to recognise when the nhs does well also
more balanced than many on here
""You can already see any GP you damn well please" NO YOU CANNOT!"
Yes you can.
You can't register with any GP, but you can see any GP.
The only reasons they would say 'no' would be lack of capacity or the payment they recieve is too low.
You see the GP can choose too. So if you are a mouthy arsehole then they can say 'no, fuck off'.
I thought that was the kind of market supply/demand thing you would like, No-One.
a resident of CV1 sure cannot see any GP in Coventry they choose
yes they can try and see a GP as a visitor when in another part of the country, but they sure as hell cannot see any GP elsewhere in their own city
nothing to do with capacity or being a mouthy arsehole, lots to do with a piss poor nhs
supply/demand i would like includes a GP being paid to see me, and being keen to get that revenue, and not taking bollocks from PCT telling them who they can and cannot see
If people are allowed two GP surgeries won't that just put more pressure on GPs?
If the CBI are so concerned why don't they just pay for private healthcare for their workers?
re
"If people are allowed two GP surgeries won't that just put more pressure on GPs?" in simple terms it shouldnt, there will still be the same number of genuine patients, with genuine reasons to see a GP, an individual GP should see things balance out, there will be areas with peaks, such as central london and other cities but the money should be put in place to resolve this
really we should be able to register with as many GPs as we like
re "If the CBI are so concerned why don't they just pay for private healthcare for their workers?" private healthcare is very common for secondary healthcare (ie needs a GP referal), and is becomming more common for primary care as big companies give up and hire their own GPs etc
why the fuck should people (or CBI members) pay twice for the same healthcare though?
Re. the PCTs/seeing other GPs: the management consultants who have fucked up this country convinced the government (and many businesses) that if you divide an organisation up into many separate profit centres they will suddenly focus on giving the best service at the lowest cost. Rather than try their utmost to pass off any costs to other "profit centres".
In private companies you see it: arguments over whether IT or Facilities pay for the photocopier toner. Now you're seeing it in the NHS: the hospital will only give you 2 days worth of pills and send you to the GP - despite the fact that they can get them cheaper. Instead of fighting the Romans (illness) the Judean People's Front et al are fighting each other.
"dishonest pretences at consultation by the illiterate Alan Johnson and the malignant Labour crony Ara Darzi"
I came across an example of this yesterday regarding a "consultation" about Darzi's NHS review. I have documented it on my blog at dr rays focal spot.
The long and short of it was that the consulted public were actually an invited, paid, rent-a-crowd chosen by Nulabour to vote through the reforms. So when you read that the public supports so-and-so reform just read between the lines
.
Yes, you are dealing with known, proven crooks.
.
You can find out all about Lord Hollick here:
http://rigorousintuition.ca/board/viewtopic.php?t=876&sid=67d60d4c4e3a7bd0ad9197d61d52fbff
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