Can some of the moaning twats who drone on and on and on and on about not being able to see their GP because they are only open until 6pm please explain to me why they don't just:
1. Get some time off work to see their GP.
2. Pay to see a private GP.
3. See the GP at some time during the 8am to 6pm Mon-Fri period when they are not at work?
To pre-empt any fuckwit responses, I should point out from the start that:
i. No employee is so important that they can't take an hour off work from time to time to see to their own health.
ii. Anyone who never has any time off during the working week either (a) does not work at 8pm themselves so can't talk, the selfish fucks, (b) are earning far too much money and can afford a private GP, or (c) work for Ebenezer Scrooge and need to find a better fucking job/kill their employers and stage a revolution.
And finally, those cunts at the CBI who think that the NHS should pay £200 per hour to have GPs open at 8pm just so tight-fisted money-grabbing employers can save 20p by not having to unchain their sick, miserable, overworked slave workforce from the sweatshops that they call businesses can just fuck right off. Bastards.
And to the teacher that thinks taking time off to see a GP means children not getting taught: you're school needs to get more teachers so you can cross cover each other. Supply teachers? Headmaster taking a class for an hour? For fuck's sake, wake the fuck up.
Anyway, the solution is simple. Take out the clause in the new GP contract that bans GPs from offering evening and weekend appointments to their patients if they are willing to pay for them. Dr Rant has been saying this since the new contract was first being discussed. The government put this clause in to stop GPs 'doing a dentist'. Without it, patients could choose to pay to be seen in the evenings and the weekends by their GP without taking NHS resources away from the vast majority of people who are actually, you know, sick.
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28 comments:
Nay Nay and thrice Nay!
Or as Billy Connolly remarks (on women, tho equally can be applied to the values of some other individuals herein represented)
"I want some of that, all of this, a whole load of that, plenty of that and fuck all of that, and I want it today, and I want it now and hurry the fuck up because tomorrow it'll all fucking change"
"Testify!" Waves arms and claps. "Testify!"
I'm off to do my GP 'Medicine in the community placement' this week and if this longer hours nonsense comes into force 1000s of poor med students would be forced into gaining valuable clinical experience instead of watching Channel 4 news with a cuppa.
In all seriousness it is or should be easy to get time off work - you say to your employer - 'I need some time off work to see my GP.' Even junior doctors (bless their overworked, underpaid souls) manage to get time off to see their GP using such various cunning strategies such as telling their boss, booking the last appointment of the day or getting a colleague to cover for them.
It's not hard people. Even poor students in the vast Welsh medical school who work nine to five every day and are dragged to Bangor, Aberystwyth and Rhyl every five bloody minutes manage to see their GPs through a combination of common sense and a little forethought.
I know who is moaning by the way, it's the bloody dentists. They can't bear to take any time of work for fear of the money they wouldn't be making. Be careful folks or GPs will do the same.
Don't you realise what a genius service GPs are? I speak with a wide experience of pretty much every major NHS specialty - they are a godsend who if I ask nicely prescribe me the keratolytics that make day to day survival possible. I shudder to think what I'd pay in charges and fees if I had to get this privately from a dermatologist.
Ingrates and idiots the lot of you. Especially you Gordon.
Ahmed Stewdent
Ahmed....what do you mean C4 with a cuppa...you have a very soft GP.
Mine made me stay till the bitter end of about 7.30 the 4 days a week i was there as "you need to see what a Go really does"...didn't mind though just got extra teaching :)
You are preaching to the converted. If people were very ill, they wouldn't be at work and would therefore be able to attend any of the available appointments. Those whose work is too valuable to leave can afford private care at a time that suits them. I think you are mistaking the government for a body that represents the views of the people that elected them.
OK, I'll answer partly as myself and partly as some close friends and family would
why they don't just:
1. Get some time off work to see their GP.
Done this many times, sometimes its been a fairly painless experience although these are largely distant memories of many years ago, more recently there are always problems.
You see often I'm only going to be in the same town as my GP one or two days in the next few weeks, trying to get an appointment on those days can be a pain in the arse if they don't fit in with the demands from the surgery. And I mean demands cos they have completely forgotten any customer centric values.
Other times I've been held waiting more than 4 hours past the allotted appointment slot, and led to major issues on complex project at work.
Other times I really am maxed out at work and cannot afford to travel the miles to the surgery near my home imposed by the PCT when I would rather have one near where I'm more likely to be working
2. Pay to see a private GP.
Done this many times, fine if you're in a large affluent area with some private GPs, doesn't work in many other parts of the country where there are in fact no private GPs. Also for people with long term conditions needing expensive drugs and entitled to significant discounts on price of drugs via nhs prescriptions getting a private prescription which a private GP would have to issue is no good at all cos you'll end up significantly out of pocket, much bigger financial impact than the cost of the GP appointment itself, and indeed the private GP cannot refer to an NHS consultant either, so the usefulness of private GP is limited by the nhs. Such restricted practises should stop and private GPs should be only issuing prescriptions on the same notepads as nhs GPs and which doctor issued them should have no bearing on what you pay at the chemist, in the same way any doctor should be able to refer to nhs consultant.
3. See the GP at some time during the 8am to 6pm Mon-Fri period when they are not at work?
As above sometimes done this
Re "No employee is so important that they can't take an hour off work from time to time to see to their own health." yes but sometimes at the critical part of a large expensive project even humble employees can be worth more to the country that a GPs time
Re "Anyone who never has any time off during the working week either (a) does not work at 8pm themselves so can't talk, the selfish fucks, (b) are earning far too much money and can afford a private GP, or (c) work for Ebenezer Scrooge and need to find a better fucking job/kill their employers and stage a revolution." I think you should spend sometime with my diabetic friend who works her heart and soul off trying to contribute to society and pay her taxes, and watch in amazement the ridiculous amount of time off work the nhs forces her to take - which we could compare and contrast with say diabetics in Belgium who are actively helped to lead a normal life by their health system and that means minimising disruption to their working life, to say nothing of the problems keeping an employer happy or taking a decision to go freelance or whatever when faced with the nhs bossing your diary around all the time, same for other long term conditions
Re "And to the teacher that thinks taking time off to see a GP means children not getting taught: you're school needs to get more teachers so you can cross cover each other. Supply teachers? Headmaster taking a class for an hour? For fuck's sake, wake the fuck up." no no no, the health system should be offering appointments when its convenient for the end customers like every other fucking business in the country apart from this soviet style fuckup called the nhs, schools need a shake up too but thats another issue
Re "Anyway, the solution is simple. Take out the clause in the new GP contract that bans GPs from offering evening and weekend appointments to their patients if they are willing to pay for them. " agreed, although for some workers on low pay I think they too should be helped to try and work and build a career or whatever without having to take lots of time off work for GP appointments etc
The standard of GP practises varies widely, and in some parts of the country the piss poor access is worse than you probably imagine in your internal world view, you are comparing how your surgery handles things, i am comparing how some of the bottom 10 % of surgeries do things
And patients should be able to go to any GP at all, not a few imposed by the PCT, only by patients voting with their feet will the worst surgeries be forced to change
no one
How does one go about seeing a Private GP? Are there actually any outside of big cities? The only private GPs I am aware of seem to specialise in Xenical, Reductil and Controlled Drugs.
Yes, a lot of Private prescriptions will end up costing a lot more than £6.85 but a majority of the off-patent generics should only cost £3 or £4 a month.
My pharmacy opens the same hours as the adjacent surgery. So, if I need to see a GP (and I do not decide to self-medicate) then I need to get a locum in. Okay, that's fine if I am seriously ill but seeing a GP privately would be far easier.
Would my normal GP possibly see me privately if I asked, or is this not allowed?
I'm a med student on a community placement in a GP at the moment, on Friday my GP was telling me all about the war that is brewing because the governement are invoking a clause in the GP contract (which was supposed to only be allowed in a national emergency), it seems its easier to take on the countries GPs than it is to suggest that people take an hour off work
Just joining in with no one
-- surgeries open at 8.0?
-- what about patients whose doctors' consulting hours, 4.5 days a week, are 8.30-11, 2.10 (at earliest, variable...)-17.50? (real case)
-- 'headmaster taking class for an hour'
a. *an hour*? patients should be so lucky
b. all heads teach Catullus/calculus/Moliere/the Crimean War?
c. don't you mean heads taking over for 2 sets of hours, one set to make the appointment, the other, to keep it (many many GPs having failed to work out that 'see patients who wish it, within 48 hours' didn't mean 'force all patients to give up advance booking' and also didn't mean 'make them all ring up at 8.30 a.m and spend half an hour trying to get through')?
Anyway, the solution is simple. Take out the clause in the new GP contract that bans GPs from offering evening and weekend appointments to their patients if they are willing to pay for them.
(and can afford it -- I'm partly here agreeing with no one) oh yes, forget about making employers show some sympathy/behave decently/allow employees their contractual rights. That would be a step too far.
no one,
And patients should be able to go to any GP at all
I certainly think that first, patients should be able to register with a GP near their work as well as near their home, second, it should be far easier to choose and change GP, third, yes, competition between GPs might well help but it can only work up to a point and rather slowly (because the good GPs won't have the 'slack' that would enable them to expand to take new patients).
mr hunnybun (I sympathise)
So, if I need to see a GP (and I do not decide to self-medicate) then I need to get a locum in.
You know dr rant's reply: hire extra staff to cover...
Yes, a lot of Private prescriptions will end up costing a lot more than £6.85
the consultation will probably cost you £70 -- that's in standard office hours, so, add something for evening/Saturday -- a private prescription, normally extra, costs £15 even before the cost of the drug.
(Figures from the private GPs 'fully approved by the National Assembly of Wales'.)
Would my normal GP possibly see me privately if I asked,
No. Your GP can take you on as a private patient but not on an ad hoc basis.
re "because the good GPs won't have the 'slack' that would enable them to expand to take new patients" if the money really did follow the patients youd find this commercial dynamic iteratively fixes many nhs problems, places that attract patients get more money so they expand or get copied and the places loosing patients react and improve or shut
the solution is not to keep the worst places open just because you think the other places dont have the capacity, this is nonsense, crap places should shut, and if the patient either has the money or carries the money allocation in a real sense competitors will emerge to comepete for their money
it works as a force for improvement much more than gordon telling everywhere to do a deep clean ever will
As I have said before, I think GPs are on a loser here and the government has maneuvered them into looking like they are acting against the interests of their patients.
Obviously trying to coerce people into working for nothing was abolished a couple of centuries back and the GPs have a valid grievance but I agree with "no one" on many of his points. Many people work well away from home and its not a matter of taking an hour off work to pop round to the GP. And it is unfair to take it out on teachers who have been treated more shabbily than doctors by this government; I believe that it is not possible for some schools to spare a teacher during the day without pupils having their learning disrupted.
The last point Dr Rant makes is the most valid. How on earth did they agree to a clause which restricts what you can do with your spare time? I use my spare time to see private patients or I go and work in a neighboring Trust. If I, or Dr Rant, wanted to wash cars or cut grass for money we should be allowed to do so. Anything else is a restriction of our right to gainful employment. I think the government are probably acting illegally by denying GPs the right to see private patients and Dr Rant is correct- this would solve the problem because, if GPs were not to act greedily (big if) pps could be seen at marginal cost and the fee could be quite low - say £30-50 for a consultation.
It is unfair to take it out on teachers who have been treated more shabbily than doctors by this government
(and by the previous government)Hear Hear! (I'm not a teacher.)
How on earth did they agree to a clause which restricts what you can do with your spare time? I use my spare time to see private patients or I go and work in a neighboring Trust.
That's different. The GP contract stops GPs offering private services for their own patients -- under certain circumstances -- and if they were to open on Saturday morning or in the early evening but only for those of their patients who'd agree to pay, they'd be in breach of contract:
"Practices that opt out of the provision of additional, enhanced or out-of-hour services, cannot charge any of their registered patients for supplying a similar service privately."
I agree the difference between that and your contract may seem small, but it is not, IMO, insignificant.
Sorry but this just goes to show how GPs just don't understand how their patients think. Since when did going to the doctors take an hour? What with booking an appointment on the same day by calling an engaged phone line for half an hour, then having to do a reverse commute to get to the surgery near your home, wait to be seen, then commute back in to going to work, it's never less than a half day.
And I'd like to see the GP who's prepared to take half a day off work to see another GP - no professional courtesy queue-jumping - just so he can get a prescription for something he could have prescribed himself anyway.
There's a storm coming...
No one your example dosnt work.
Do the best resturants just keep expanding and taking more and more diners?
No they get to a comfortable level and stabilise.
What would be your driver for choosing a practice? The length of waiting for an appointment?
So they have shorter appointments with limits on number of problems and who you can see for what.
Disagree with something or need a loger slot then you will have to rebook..you cant have higher capacity and the same lenght slots unless you take on more GP's and with the way QOF points are what practice is going to have enough GP's that people don't have to wait but loose money?
Is it based on how much you like your GP? then they will quickly fill thier list and waiting times become a problem.
I'm glad you dno't have a responsible job as unless your run a tesco store your model falls down.
To be honest if the government pushes this through then GPs deserve it. How any highly educated respectable profession allows themselves to be as abused as doctors in both the UK and Ireland have been recently boggles the mind. For the love of God, stand up for yourselves! I left and came to Australia, and here docs laugh at management when they request them to work unreasonable hours on top of their normal ones. And the health system is second to none here, sure there are problems, but not like the NHS! Doctors need to realise that they have to stand up for themselves and fight for themselves, they're ok at doing that for patients, but will take any kind of crap themselves. Wake the fuck up. Other employees, when they don't like something, they STRIKE or work to rule. Hell, docs are so necessary that striking would be catastrophic. So stop undervaluing yourselves and fucking stop taking crap. lots of people would support you and the ones that don't are more than likely stupid and ill-informed anyway.
Trouble is, if recent history, is anything to go by, stikes don't do very well. Over two million, (representative of at least twenty million), people took to the streets against the war. Moreover, G.P.s would have to have the whole of the popular and incredibly powerful, press on their side and that won't happen.
People marching against a cause are very different than people who are refusing to perform a service, however. And the press be damned. If people just plain refuse point blank to do something, and make it known why they are refusing, then it's hard to force them to back down. GPs as the first point of contact with medical services are in a prime position to make their demands and have their voices heard. If they stopped even for one day hospital A&Es would instantly shut down from sheer volume overload.
". . .GPs the right to see private patients and Dr Rant is correct- this would solve the problem because, if GPs were not to act greedily . . . say £30-50
That's the crunch.
Dr Rant accurately says that many people can't access a GP 'cause they prioritise work over their health.
That could change.
Many people access their GP for matters that could be addressed elsewhere (family planning clinic, local pharmacist, practice nurse, health visitor, district nurse, 'phone advice) meaning they're in the wrong place so it's bad for them and they're consuming GP time so it's bad for everyone else.
This could change.
GP's have more work to do than time to do it in. They could either do less work (which I'd vote for, cutting out unnecessary work from their week so they can do what they do best) or work more hours. Adding more hours will, surely, reach saturation pretty sharpish too since the hours and GPs are finite and already stretched. So in truth there is no way to get more capacity for GPs to meet demand as GPs are running around like lunatics already, not swanning off playing golf all afternoon. With no realistic option of oodles more GP time, it has to be GP activity that's managed to make the job more viable and match capacity and demand better. At present capacity and demand are grossly mismatched.
This can change.
Charging for GP time can't generate much more capacity than there is at present and certainly opens the doors to some having no interest in having an accessible free NHS service when they can coin it in otherwise. Realistically though it just pisses folk off, no? Patients will hear, "If I had it all sorted I could see you for free on the NHS but as I'm busy if you want to see me in a timely fashion you'll have to pay."
£30, losing 40% to tax, then with the oncosts and expenses and supporting staff costs, it's not going to generate decent income at all.
Charging will make GPs look avaricious and self serving, won't massively increase capacity and surely won't generate massive income.
Is it really that attractive an option?
It would be interesting to know how many people would have taken to the streets in support of the generals, had they refused to invade Iraq.
A strike, or even a quiet refusal to apply a particular policy would require organisers. Again, if history is anything to go by, these organisers, or a lone voice such as Dr Kelly, would risk being singled out for direct or indirect ruin, either immediate or later, on some other trumped up charge.
A strike could easily become counter-productive, indeed, it could be used as a reason to impose even more control and advance the agenda of market-place
dictat's.
Sadly, governments seem to feel that listening to the service provider, is a weakness and that openly reviewing an unhelpful policy, a humiliation rather than a demonstration of courage and the strength of a mature democracy.
As a democracy, this one still seems infantile in practice, and more a control freak, self serving, bully than a wise guardian.
Given that stiking is probably a non starter, it may be that in the long term, our really brilliant, skillfull, compassionate and overworked doctors, have greater testicular circumference in their ingenious capacity to treat, rather than attempt to cut off, the clunking balls of an insecure bully.
Moreover, any successful castration, could 'freak out' any potential replacement to the degree that you end up with an even bigger, or more cunning bully. After all, it's the marketforce calling all the shots and it has all thoes competeing for power, well and truly, by the privates.
Don't worry everyone is going to look after their own health frmo now on so we don't need doctors.
http://www.timesonline.co.uk/tol/news/uk/health/article3146349.ece
Funny how folk will take time off to see a lawyer when they want to buy a house or the headmaster if their brat is playing up...
Many people access their GP for matters that could be addressed elsewhere... This could change.
It has changed in part of Scotland (where certain patients can register with a pharmacist for diagnosis and treatment of minor conditions) but GPs don't seem ecstatic about that (or at least, about the thought it might spread) any more than they're ecstatic about nurse-led WICs.
Has anyone seen Dr Grumble lately?! ... :-(
"no no no, the health system should be offering appointments when its convenient for the end customers like every other fucking business in the country"
But that's just it. The NHS is not a 'business'. It's part of a gift economy.
If you want the NHS to be a business then you will need to pay a LOT more money. Really.
Dr Rant has relatives that are teachers.
Teachers have been systematically victimised and abused by successive governments that undervalue anyone who cares more about their work than they do about money.
I would advise all teachers to leave the profession. Every time a teacher comes to see me, I immediately reach for the Med 3 (sick note) forms because they are all depressed and stressed to the max.
So the answer I was looking for was, 'yes Dr Rant, you are right - it's not the NHS's fault that I can't see a GP, it's the fucking bastards who have made schools the shit hole slave traps that they are today'.
anonymous, dr grumble is fine.
see the comments here
http://ferretfancier.blogspot.com/2008/01/2008-bloggies-awards.html
"Dr Rant has relatives that are teachers."
Write out 100 times: Dr Rant has relatives who are teachers"
Spooky how we are both getting involved in education campaigning. I wrote something on our local school last night. (no not graffiti - on my blog)
Keep up the good work Dr Rant. You are the last remaining regular medical blogger.
"Write out 100 times: Dr Rant has relatives who are teachers"
Damn my expensive education!
I demand my money back.....
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