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Are we really going to sit by while they destroy the NHS?

SpookyFrank said:
unlike the DIY machines no ticket clerk ever got Falmouth and Falkirk mixed
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I want ticket offices to be staffed, but I doubt this. Long before the internet and DIY machines, I tried to buy a ticket from London to Yeoford in Devon.

I had to struggle. I was initially told there was no such place, and I meant Yeovil in Somerset. I prevailed, eventually.

When I got there, I discovered that people less determined had been sold tickets to the wrong place.
 
Lorca said:
My partner, a Nurse was chatting to a very experienced Doctor the other day who was speculating, hypothesising? that she thinks NHS primary GP practice as we know it is not going to exist soon, possibly within a decade. She was saying that loads of GP's are quietly looking in to setting up private practices because they see the writing on the wall. Dentistry was the test run, seen as successful. Apparently the initial set-up costs are high, but long term they see it as the way things are going whether they like it or not (and many DO like it). She said that unsurprisingly there's been a massive shift in numbers of people now buying private healthcare which has recently caused some problems due to over-subscription but they will be solved by expanding the private sector.
Eventually anyone wanting a GP will have to pay or if they can't, will have to queue up in a rump NHS setting to most likely be seen by a 'Noctor' - that is an Advanced Nurse Practitioner or a Physicians Associate. Problem with that is, she said in many cases, not to denigrate them but they just don't have the diagnostic skills and experience that GP's have, which I can well believe tbh. It's also probably why they are moving to pharmacists doing some lower level diagnostic and prescribing work (albeit, pharmacists can be extremely skilled knowledgable.) Three GP's were laid off from the same surgery recently, doubtless replaced by cheaper 'Noctors.'This will all be painted as inevitable and for the best by the usual scumbags.
Just feels so helpless at the moment, it's massively dispiriting and depressing, my partner is constantly exhausted from understaffing and morale is just at rock bottom, at least in her setting. I don't even know why i'm writing this, I can't do fuck-all about it and hardly anyone seems to even care, including the very people who need the NHS the most. Is there any hope?
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Feels like I want to come up with something positive in response to this but I can't. It's just the kind of trend that a starmer government will end up pushing.
 
Lorca said:
My partner, a Nurse was chatting to a very experienced Doctor the other day who was speculating, hypothesising? that she thinks NHS primary GP practice as we know it is not going to exist soon, possibly within a decade. She was saying that loads of GP's are quietly looking in to setting up private practices because they see the writing on the wall. Dentistry was the test run, seen as successful. Apparently the initial set-up costs are high, but long term they see it as the way things are going whether they like it or not (and many DO like it). She said that unsurprisingly there's been a massive shift in numbers of people now buying private healthcare which has recently caused some problems due to over-subscription but they will be solved by expanding the private sector.
Eventually anyone wanting a GP will have to pay or if they can't, will have to queue up in a rump NHS setting to most likely be seen by a 'Noctor' - that is an Advanced Nurse Practitioner or a Physicians Associate. Problem with that is, she said in many cases, not to denigrate them but they just don't have the diagnostic skills and experience that GP's have, which I can well believe tbh. It's also probably why they are moving to pharmacists doing some lower level diagnostic and prescribing work (albeit, pharmacists can be extremely skilled knowledgable.) Three GP's were laid off from the same surgery recently, doubtless replaced by cheaper 'Noctors.'This will all be painted as inevitable and for the best by the usual scumbags.
Just feels so helpless at the moment, it's massively dispiriting and depressing, my partner is constantly exhausted from understaffing and morale is just at rock bottom, at least in her setting. I don't even know why i'm writing this, I can't do fuck-all about it and hardly anyone seems to even care, including the very people who need the NHS the most. Is there any hope?
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Is this necessarily a bad thing? It would effectively nationalise primary care, which is the one part of the NHS which was always in private hands, GPs still being essentially entrepreneurs. It would also force acute trusts to develop centres of diagnostic excellence, staffed with generalist doctors, to manage complex cases which were beyond the ken of referring noctors - who could nevertheless be trusted for most referrals.

A robust generalist capability in acute trusts might also be useful for managing comorbidities and elderly care, with an assigned clinician overseeing multiple treatment pathways for single individuals.

I quite like this brave new world, and I would be happy if Starmer did.
 
Silas Loom said:
Is this necessarily a bad thing? It would effectively nationalise primary care, which is the one part of the NHS which was always in private hands, GPs still being essentially entrepreneurs. It would also force acute trusts to develop centres of diagnostic excellence, staffed with generalist doctors, to manage complex cases which were beyond the ken of referring noctors - who could nevertheless be trusted for most referrals.

A robust generalist capability in acute trusts might also be useful for managing comorbidities and elderly care, with an assigned clinician overseeing multiple treatment pathways for single individuals.

I quite like this brave new world, and I would be happy if Starmer did.
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Yeah, abandoning effective universal primary health care looks like such a winning idea.
 
brogdale said:
Yeah, abandoning effective universal primary health care looks like such a winning idea.
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We haven’t got anything like effective universal primary health care at the moment, though. And secondary care is hideously broken.

Nationalising GPs might be a way to improve both. A few would escape to the private sector and tend to the worried well, but most would be driven into new cross-specialism roles within trusts, which should be a more efficient way of joining up complex, acute and elderly care than leaving it to private sector GPs whose main concern is making a return on the massive capital investments tied up in neighbourhood surgeries.
 
Silas Loom said:
We haven’t got anything like effective universal primary health care at the moment, though. And secondary care is hideously broken.
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My daughter's feeling terrible today, called in sick which she never does. She phoned the GP this morning, and reception told her that anyone 18-65 with non-life-threatening problems has to go to the minor injuries unit instead. She went there, and they were turning away anyone except for ear/nose/throat related problems. So you're basically left with calling 111, who can't prescribe anything.
 
Buddy Bradley said:
My daughter's feeling terrible today, called in sick which she never does. She phoned the GP this morning, and reception told her that anyone 18-65 with non-life-threatening problems has to go to the minor injuries unit instead. She went there, and they were turning away anyone except for ear/nose/throat related problems. So you're basically left with calling 111, who can't prescribe anything.
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That sucks. Bucketloads of cash should be shovelled to minor injuries units and urgent treatment centres. That’s the best way to facilitate what people want, which is to rock up and get either pills, treatment, reassurance, or any combination thereof.
 
Lorca said:
My partner, a Nurse was chatting to a very experienced Doctor the other day who was speculating, hypothesising? that she thinks NHS primary GP practice as we know it is not going to exist soon, possibly within a decade. She was saying that loads of GP's are quietly looking in to setting up private practices because they see the writing on the wall. Dentistry was the test run, seen as successful. Apparently the initial set-up costs are high, but long term they see it as the way things are going whether they like it or not (and many DO like it). She said that unsurprisingly there's been a massive shift in numbers of people now buying private healthcare which has recently caused some problems due to over-subscription but they will be solved by expanding the private sector.
Eventually anyone wanting a GP will have to pay or if they can't, will have to queue up in a rump NHS setting to most likely be seen by a 'Noctor' - that is an Advanced Nurse Practitioner or a Physicians Associate. Problem with that is, she said in many cases, not to denigrate them but they just don't have the diagnostic skills and experience that GP's have, which I can well believe tbh. It's also probably why they are moving to pharmacists doing some lower level diagnostic and prescribing work (albeit, pharmacists can be extremely skilled knowledgable.) Three GP's were laid off from the same surgery recently, doubtless replaced by cheaper 'Noctors.'This will all be painted as inevitable and for the best by the usual scumbags.
Just feels so helpless at the moment, it's massively dispiriting and depressing, my partner is constantly exhausted from understaffing and morale is just at rock bottom, at least in her setting. I don't even know why i'm writing this, I can't do fuck-all about it and hardly anyone seems to even care, including the very people who need the NHS the most. Is there any hope?
Click to expand...
Only just seen this message.

I think this is right on the money (emphasis on money).

GP services have been diluted and pushed aside for years, and turning the first point of call into a paid for service seems to be the direction of travel. Urgent Care at our hospital is provided by a private company, they just wear NHS uniforms. Prescription charges in England have got us all accustomed to paying for medicine. Dentistry and ophthalmology are paid for (no "NHS glasses" these days!).

I don't support any of this, of course. God knows how much I'd have been charged for the last 3 months of being signed off work!. I'm not naive, either, I realised the other month as I tried to find Covid tests that there are very few genuinely free healthcare options left and there's few ways to resolve this at the ballot box.
 
Silas Loom said:
Is this necessarily a bad thing? It would effectively nationalise primary care, which is the one part of the NHS which was always in private hands, GPs still being essentially entrepreneurs. It would also force acute trusts to develop centres of diagnostic excellence, staffed with generalist doctors, to manage complex cases which were beyond the ken of referring noctors - who could nevertheless be trusted for most referrals.

A robust generalist capability in acute trusts might also be useful for managing comorbidities and elderly care, with an assigned clinician overseeing multiple treatment pathways for single individuals.

I quite like this brave new world, and I would be happy if Starmer did.
Click to expand...
I'm trying, but failing, to see how you interpret the situation Lorca describes as 'nationalising primary care'.

Or how it isn't a bad thing. Healthcare is effectively going the way of dentistry, with a two tier system of care, one for those who can afford healthcare and, frankly, fuck the rest. Look how bad the situation with dentistry has got - good care and cosmetic dentistry for those who can afford it, pliers and rotten teeth for those who can't.

One thing that has been increasingly noticeable for the last decade or so is the normalisation of private healthcare (its provision by some employers being one of the reasons).

We are potentially sleepwalking, pretty quickly, into a US style healthcare system, if we're not careful.
 
oryx said:
I'm trying, but failing, to see how you interpret the situation Lorca describes as 'nationalising primary care'.

Or how it isn't a bad thing. Healthcare is effectively going the way of dentistry, with a two tier system of care, one for those who can afford healthcare and, frankly, fuck the rest. Look how bad the situation with dentistry has got - good care and cosmetic dentistry for those who can afford it, pliers and rotten teeth for those who can't.

One thing that has been increasingly noticeable for the last decade or so is the normalisation of private healthcare (its provision by some employers being one of the reasons).

We are potentially sleepwalking, pretty quickly, into a US style healthcare system, if we're not careful.
Click to expand...

I agree that the normalisation of private healthcare is a sign of things not working, and it’s bad for the NHS.

The point that I was building from in @Lorca’s post was that GPs (who are self-employed entrepreneurs) are looking to exploit this trend, in the way that dentists have. What I was considering was how primary healthcare might be reconfigured to be delivered by salaried HCPs, cutting out the entrepreneurs, while also addressing some of the problems in acute care, which is delivered though clinical silos that are bad at addressing comorbidities.

The Lansley reforms said “let’s have hospital services commissioned by GPs, so as to keep them honest. Hospitals are nasty unwieldy bureaucracies, while GPs are our sort of people”. Obviously this didn’t work, and eventually CCGs became ICSs because that was more efficient, but the spirit of the plan remains intact.

I’m suggesting instead “let’s have the day-to-day preventative care, and first-line triage consultations, managed out of the big acute trusts because they at least know how to employ a large blended HCP workforce and operate according to risk, with a middle management tier that doesn’t need a discrete financial incentive for every job they do, and which isn’t constantly thinking up side-hustles”.

That leaves loads of questions open, and it doesn’t do anything about the way consultants have their NHS cake and eat it privately, but it cuts out a potential avenue of increased marketisation. I also think it makes more sense clinically, from my perspective as a frequent flier over the last couple of years across cardiac, endocrine and urology. I may have a bee in my bonnet about comorbidities, but it’s generally acknowledged that they are an increasing issue in the boomer demographic whose healthcare use is about to explode.
 
Just to add to all this: house prices are implicated here, as in so many other wicked public policy conundrums. A typical GP practice is based in a property which could easily be converted to residential use. The increase in value of such properties, and the cost of servicing mortgages, mean that buying into a practice is a far greater financial commitment than it was a decade or two ago. Which is part of what drives GPs these days to balance their personal books with everything from hosting and advertising private woo clinics, to bidding for tranches of AQP work.
 
Silas Loom said:
I agree that the normalisation of private healthcare is a sign of things not working, and it’s bad for the NHS.

The point that I was building from in @Lorca’s post was that GPs (who are self-employed entrepreneurs) are looking to exploit this trend, in the way that dentists have. What I was considering was how primary healthcare might be reconfigured to be delivered by salaried HCPs, cutting out the entrepreneurs, while also addressing some of the problems in acute care, which is delivered though clinical silos that are bad at addressing comorbidities.

The Lansley reforms said “let’s have hospital services commissioned by GPs, so as to keep them honest. Hospitals are nasty unwieldy bureaucracies, while GPs are our sort of people”. Obviously this didn’t work, and eventually CCGs became ICSs because that was more efficient, but the spirit of the plan remains intact.

I’m suggesting instead “let’s have the day-to-day preventative care, and first-line triage consultations, managed out of the big acute trusts because they at least know how to employ a large blended HCP workforce and operate according to risk, with a middle management tier that doesn’t need a discrete financial incentive for every job they do, and which isn’t constantly thinking up side-hustles”.

That leaves loads of questions open, and it doesn’t do anything about the way consultants have their NHS cake and eat it privately, but it cuts out a potential avenue of increased marketisation. I also think it makes more sense clinically, from my perspective as a frequent flier over the last couple of years across cardiac, endocrine and urology. I may have a bee in my bonnet about comorbidities, but it’s generally acknowledged that they are an increasing issue in the boomer demographic whose healthcare use is about to explode.
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Thanks. So have I understood you correctly if I say you'd like to see first-line health care, i.e. triaging something like an ear infection or a minor skin complaint then referring to a pharmacist for drops or cortisol cream, while referring more serious symptoms or conditions to a GP, to be managed by the hospital trusts?

(I'll be the first to say I don't fully understand the concept of GPs being private within the NHS, although I'm vaguely aware that when the NHS was originally set up this kind of arrangement was the only one the GPs would collectively accept.)
 
oryx said:
Thanks. So have I understood you correctly if I say you'd like to see first-line health care, i.e. triaging something like an ear infection or a minor skin complaint then referring to a pharmacist for drops or cortisol cream, while referring more serious symptoms or conditions to a GP, to be managed by the hospital trusts?

(I'll be the first to say I don't fully understand the concept of GPs being private within the NHS, although I'm vaguely aware that when the NHS was originally set up this kind of arrangement was the only one the GPs would collectively accept.)
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Kind of, although I’m assuming that anything serious would be referred to the appropriate specialism within the trust, as it is these days, while GPs would find new roles in the trust both as second-line triage in the clinics, and as complex patient care clinical leads.
 
oryx said:
Thanks. So have I understood you correctly if I say you'd like to see first-line health care, i.e. triaging something like an ear infection or a minor skin complaint then referring to a pharmacist for drops or cortisol cream, while referring more serious symptoms or conditions to a GP, to be managed by the hospital trusts?
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Already happening.
 
Elpenor said:
Middle class lefties ffs
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Indeed.

I mean, look, lord knows urban has its fair share of disdain for people that such a term could refer to, but a) Streeting isn't using it that way and b) the fact he, a Labour MP, is using it basically as a dog-whistle is just one more demonstration of how far Labour has gone.

Fuck's sake...
 
I have a feeling "middle class lefties" will be the lightning rod of Labour's kinder culture war, if they ever get to government, replacing woke. All whilst the right, in opposition, tries to dominate the news grid with dog whistle "woke" stories.

What a time to be alive.
 
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