Anyone else feel like the NHS almost doesn't exist for them any more?

[brogdale]

But moaning that GPs just 'sit about' and give phone appointments and sending people to A&E unnecessarily is so fucking clueless it's a fucking joke.

Really informative post; thanks.

Regarding your last point; I can appreciate how annoying it must be to read hear such ill-informed comments but isn't there an inevitability about push-back when changes to PHC access have been made so rapidly? Most patients remember when they were able to see a GP, and those of us that are older will even remember having our own 'family' GP who gave us continuity of care. The practice with which I'm registered will now no longer take phone calls or make appointments beyond 1 day and it is very difficult to make progress through the gate-keepers to get a GP appointment. On the rare occasions that I have to visit the Health Centre (to drop off repeat requests) the place is always empty. These are big cultural changes for patients and I do worry about the reality of PHC for those less able to access IT etc. I suppose what I'm saying is, I completely understand why staff like yourself might be considering other other career opportunities, because less reflective/informed patients must be lashing out at what has become of our NHS PHC.

 

[LDC]

Really informative post; thanks.

Regarding your last point; I can appreciate how annoying it must be to read hear such ill-informed comments but isn't there an inevitability about push-back when changes to PHC access have been made so rapidly? Most patients remember when they were able to see a GP, and those of us that are older will even remember having our own 'family' GP who gave us continuity of care. The practice with which I'm registered will now no longer take phone calls or make appointments beyond 1 day and it is very difficult to make progress through the gate-keepers to get a GP appointment. On the rare occasions that I have to visit the Health Centre (to drop off repeat requests) the place is always empty. These are big cultural changes for patients and I do worry about the reality of PHC for those less able to access IT etc. I suppose what I'm saying is, I completely understand why staff like yourself might be considering other other career opportunities, because less reflective/informed patients must be lashing out at what has become of our NHS PHC.

Yeah, I think it's a mess/unfit for purpose/whatever description you want to use, for sure. But I'd look at why has there been the massive expansion in this need for primary care (among other services) leaving it in such a frustrating, annoying and dangerous state. Blaming staff etc. is an easy way out, and one the goverments (of all shades) are quite happy to see and sometimes throw their opinions in with too.

But we need to look at why has there been this need expand? Austerity, funding, poor mental and physical health due to work/stress/poverty, less open spaces, closure of libraries, fragmentation of family life and the related isolation of individuals from social support that previous generations might have had, lack of basic health and cooking education in schools, etc. etc.

Where I work there's also really complicated issues around language and wider communication problems, patriarchy, lack of understanding how the NHS works (related to immigration from places with very different healthcare models), poor and overcrowded housing, unemployment, how the benefits/UC/PiP/sick note stuff works, etc.

Those answers can be a bit useless and demoralising for patients though, like, "Do I have to wait for the revolution for better heathcare then?" So I do think we need to have some serious re-structuring now under the current system, but it isn't going to be easy - if I'm honest I'm far from sure is even possible.

What's also complicated is the way GP practices are run which leads to a huge variation in access and quality of service etc. I would bring them fully under the NHS as a start and impose a common model of working alongside increased funding. The problems that is going to be faced by any government doing that (and prioritising prevention over acute care) is that the seat of medical power is largely in hospitals, and there will be a period of time where possibly outcomes for patients might get worse in terms of mortality before the benefits of prevention kick in which will be a complete vote loser. That and it will be a battle with some GPs bringing them under the NHS umbrella fully.

If I could wave a magic wand I'd establish a cross-party, area specialist, NHS worker and 'citizen' (urgh) involved NHS improvement working group that has the power to impose fast and sweeping changes with some agreed common statements as a guide (eg. free at point of care, universal access, best care possible, etc.) and with a timescale to work to. It would also need to power to enforce changes in other areas like education.

 

[purenarcotic]

Yeah, I think it's a mess/unfit for purpose/whatever description you want to use, for sure. But I'd look at why has there been the massive expansion in this need for primary care (among other services) leaving it in such a frustrating, annoying and dangerous state. Blaming staff etc. is an easy way out, and one the goverments (of all shades) are quite happy to see and sometimes throw their opinions in with too.

But we need to look at why has there been this need expand? Austerity, funding, poor mental and physical health due to work/stress/poverty, less open spaces, closure of libraries, fragmentation of family life and the related isolation of individuals from social support that previous generations might have had, lack of basic health and cooking education in schools, etc. etc.

Where I work there's also really complicated issues around language and wider communication problems, patriarchy, lack of understanding how the NHS works (related to immigration from places with very different healthcare models), poor and overcrowded housing, unemployment, how the benefits/UC/PiP/sick note stuff works, etc.

Those answers can be a bit useless and demoralising for patients though, like, "Do I have to wait for the revolution for better heathcare then?" So I do think we need to have some serious re-structuring now under the current system, but it isn't going to be easy - if I'm honest I'm far from sure is even possible.

What's also complicated is the way GP practices are run which leads to a huge variation in access and quality of service etc. I would bring them fully under the NHS as a start and impose a common model of working alongside increased funding. The problems that is going to be faced by any government doing that (and prioritising prevention over acute care) is that the seat of medical power is largely in hospitals, and there will be a period of time where possibly outcomes for patients might get worse in terms of mortality before the benefits of prevention kick in which will be a complete vote loser. That and it will be a battle with some GPs bringing them under the NHS umbrella fully.

If I could wave a magic wand I'd establish a cross-party, area specialist, NHS worker and 'citizen' (urgh) involved NHS improvement working group that has the power to impose fast and sweeping changes with some agreed common statements as a guide (eg. free at point of care, universal access, best care possible, etc.) and with a timescale to work to. It would also need to power to enforce changes in other areas like education.

We also need proper action in relation to the social issues which we know impact health. Good quality housing, proper access to good food, access to interesting things to do in your community which keep you connected to others, proper investment in drug and alcohol services… as you’ve said the prevention takes time though. And I worry that with competing budgets, money gets shoved into prevention and not into treating. But sick people still exist, we can’t prevent all sickness / illness / disease anyway. It isn’t an either or, but I can see it ending up like that.

 

[LDC]

But sick people still exist, we can’t prevent all sickness / illness / disease anyway.

I mean that's a complication and difficult society wide 'discussion' that needs to happen around quality and length of life and where we prioritise, as I think unavoidably some things need to take precedence over others even if money and staff were unlimited. Might be more forthcoming with the recent stuff on assisted dying...