[Ru]

It seems to happen cyclicly. I thought that the infamous 'botched' contract negotiation in 2004 or whenever it was that removed out of hours and increased pay was done on purpose to entice people to join or stay in the profession. The difference between then and now is that theres no money to do that again. Ultimately however some sort of sweetner might be needed, hopfully before systemic collapse. The general public however currently prefer the "whippings will continue until morale improves" approach which makes it difficult for politicians to engage brain.

[GCW]

2004 cut pay, but there was an option to do out of hours in addition. The income for out of hours was relatively tiny, so predictably nobody opted in!!

[GCW]

NHS chief suggests GPs should 'reflect' on damage caused by raising alarm over state of profession.

Drum? I's a bangin'.

[Sloper]

What's the score with the MDU & etc? I'm going to be doing some due diligence on the acquisition of a book of clinical negligence work and an early indication is that if the claim is against Dr Death etc then the chances of success are very real, does in your view the NHS actually manage out dysfunctional practitioners or just try and keep it quiet.

The costs of claims against the NHS is going up and going up steeply, this may be the equivalent of a serious internal bleed but there seems to be no proper response, perhaps this is the only real threat to the existence of the NHS.

PS I fucking hate doing due diligence, so as from next Monday please expect a bellicose Sloper.

[Jaspersharpe]

It's try to keep it quiet not try and. FFS.

[fatdoc]

I kinda just understood that...

2penneth....

Post Francis, game changer. Not just in consolidating validation... But on the  shop floor change of attitude. Remember staffs was not dr lead, but dr accepted. This no longer happens.

There is no ongoing bleed. I suspect you are dealing with the non healing scabs from such in times gone past.

Foundation trusts get rid of of the failing ( in the eyes of the waiting list exec)  permanent member of medical staff like a shot.. Like you should...??  Worryingly perhaps just coz they don't tow the line..

There is not cohorts of hospital consultants being cuckholded by their peers, nor known poor performance being covered up..

Yes, the dysfunctional, in terms of corporation, are moved out. Yes in terms of revalidation, the poor performers are also pushed.

[Jaspersharpe]

Jon.

Could you please write that in English so I can actually get your view on this.

I'm not being a cunt, I have no idea what you just said.

[GCW]

The MDU et al are just insurance companies, like any other insurance company. If it will cost more to defend a claim than to settle, then they will settle even if it's a stupid claim as it'll cost them less.

As for bullying, protecting incompetence, in my opinion it goes on a lot less than it potentially did.   There's no way of collecting actual data on it so we don't really know.

Reading Pulse this week, it seems that in the last 3-4 years over 500 GP surgeries have had to close. No new practices have been opened.

[Sloper]

That's not true, the MDU will defend cases which they will clearly lose, often to the door of the Court when costs are eye watering and most categorically they do not settle cases based on economics. 

As for the bullying of staff, particularly whistleblowers this seems to be a fairly common themein The Eye

Jon, good to know that the known dysfunctional clinicians are pushed out the door, to become locums one expects which is an even greater concern no?

[GCW]

I didn't say they wouldn't defend cases them may lose. That's a different matter.

[Sloper]

My experience is that they don't settle cases for say £10k when it will cost £100k to defend, there's a point in defending cases when there's a defence, but the MDU & etc defend cases when there's no realistic prospect of a successful defence keeping the claimant out of their damages for longer and massively increasing the costs.

Good insurers admit liability when there's no defence and deny when there is a good defence, the MDU does neither.

[tomtom]

[Sloper]

The NHS will always be 'failing' as demand is in essence infinite and resources finite, the world in which the NHS operates has changed beyond recognition since the NHS was incepted, and I would be surprised if the pace of change does not increase.

The NHS will change radicall over the next 10 years as it has changed over the last 60 years, but to decry the change is like harking back to a golden age that never was, old maids cycling to evensong, toasted crumpets with honey and the Dr as god.

[GCW]

Prediction: in five or so years GPs will be employees and work shift patterns. Although, that will cause a huge exodus from the profession. You'll never get to see the same doctor twice, referrals to secondary care will increase and the cost of the NHS will rocket.

[a dense loner]

I agree with that gcw. To be fair I've not seen the same doctor twice since I was about 17. Not that I go to the docs much after they botched my penis reduction

[GCW]

Microsurgery can be pretty tricky.

[GCW]

NHS reforms our worst mistake.

.....charges to see a GP......

Get that seed firmly planted.....

[tomtom]

.....charges to see a GP......

Get that seed firmly planted.....

I think that'll be a nightmare...

Hey - I've paid my £10 to see you - I want some pills!!!

[GCW]

Oh, it would be awful. But is it avoidable now?

[Sloper]

I see that there are a number of problems with this,

1. An increase in entitlement culture, as Jasper says, I've paid my money and want to see a quack (even when there's no clinical need)

2. Dissuading people who need to see a Dr but don't want to spend the £££ resulting in later diagnosis, increased exposure to transmission and so on, my view is that there needs to be a presumtpion that if the attendance was reasonable / necessary the charge be waived.

3. It's not enough to dissaude the middle class worried well from attending with stained urine (conveniently forgetting the borscht at the country supper the day before)

[fatdoc]

I wrote that sober ( in on the wagon health kick mode..) , but in rapid short hand mode I'd use in preparing to write a paper... As in flight of ideas, sorry.. If Japser can't follow it.. No one can!!


I kinda just understood that...

2penneth....

Post Francis, game changer. Not just in consolidating validation... But on the  shop floor change of attitude. Remember staffs was not dr lead, but dr accepted. This no longer happens. 

=POST Francis the duty of candour is a very real daily presence in the shop flower

There is no ongoing bleed. I suspect you are dealing with the non healing scabs from such in times gone past.

= the failing service is not left to potentially harm patients. But the services are now failing for ressons what GCW has expelained in primary care and my concerns re centralisation in secondary care..



Foundation trusts get rid of of the failing ( in the eyes of the waiting list exec)  permanent member of medical staff like a shot.. Like you should...??  Worryingly perhaps just coz they don't tow the line..

= the if your face doesn't fit you are out culture is as stowing as its ever been, at senior nurse, senior manager and consultant level



There is not cohorts of hospital consultants being cuckholded by their peers, nor known poor performance being covered up..

= I'm convinced of this, in my organisation at least

Yes, the dysfunctional, in terms of corporation, are moved out. Yes in terms of revalidation, the poor performers are also pushed.

= you have to way below the bar that foundation hospitals set for annual appraisal to not get revalidated..

In the next 2 years... So all drs revalidated by then... They won't get Locums work if not revalidated. That is a real improvement... But by no means a perfect solution...

[Sloper]

The reaction in the Guardian to the announcement that malpractice and negligence is the biggest threat to the NHS shows how just how polarised (politically) and removed from rationale debate discussion of the NHS has become.

I actually see this knee jerk reaction and blind, Pavlovian response to proposed reform is the biggest threat to the NHS.

[Ru]

NHS reforms our worst mistake.

Interesting that they see the reforms as their worst mistake. In fact their mistake is ongoing and involves entrusting broad sweeping changes to ministers that have no idea what they're doing while simultaneously plugging their ears when the professions involved point out what stupid ideas they are.

It's not one bad decision it's a broken decision making process.

[Sloper]

Don't worry it will all be so much better after the election 

I see you're back on line or are you working from home.

[mrjonathanr]

Interesting that they see the reforms as their worst mistake. In fact their mistake is ongoing and involves entrusting broad sweeping changes to ministers that have no idea what they're doing while simultaneously plugging their ears when the professions involved point out what stupid ideas they are.

It's not one bad decision it's a broken decision making process.

Interesting that you see these ("no top down reform of the NHS") politicians as speaking in good faith here. I saw it as politics as usual, dealing with the fall-out, objectives unchanged.