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The end of the NHS. (Read 193062 times)

GCW

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#225 Re: The end of the NHS.
October 23, 2014, 09:50:59 pm
I want to write a column based on Catch 22.

tomtom

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#226 Re: The end of the NHS.
October 23, 2014, 10:16:46 pm

I want to write a column based on Catch 22.

Take a leaf out of Major Major Major Majors book and hop out of your window whenever a patient is due... :)

Ru

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#227 Re: The end of the NHS.
October 23, 2014, 11:16:27 pm
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.

I don't really know TBH. From the outside idiocy and conspiracy look quite similar.

GCW

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#228 Re: The end of the NHS.
October 25, 2014, 12:32:55 am
Ward 22 Episode 1

Knock. Knock. "Come in".
Dr White sits down. Regular exercise, good food and fresh air could keep him healthy. Unfortunately in general practice we all work long hours and have little time for relaxation.
"It's my heart, Doc" Dr White says. "I keep getting this crushing central chest pain radiating to my left arm whenever I think about QoF or enhanced services. The last time was just now and it lasted for 24 hours."
I thought long and hard. "It could be your heart" I said "we need a specialist opinion".
"OK" said Dr White, going a little blue.

"Med Reg".
"Err, hello. I have a 56 year old smoker, stressed to the eyeballs, strong family history with cardiac sounding chest pain."
"Yeah?  What's the ECG show?"
"I can't get one immediately. Can you not see him without?"
"Well, we need to rule out a cardiac cause."
"That's why I've called you. If the ECG is abnormal, what will you do?"
"Ah, we will see him on MAU."
"OK, and if the ECG is normal?"
"Ah, we will see him on MAU."
"Pardon?"
"Don't be so naive, a normal ECG doesn't exclude ischaemia."
"So if I get an ECG, whatever the result, you'll see him on MAU?"
"Yeah. Unless he's acutely unwell, in which case he needs a 999 ambulance to A&E."
After thirty minutes on the 'phone, I called 999 and sent him to A and E.

The next day I received a snotty A&E letter. "Serial ECGs normal, CK normal, troponin I, troponin T normal, CTPA normal. Poor GP referral with obvious musculoskeletal pain".

a dense loner

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#229 Re: The end of the NHS.
October 25, 2014, 02:09:46 pm
Shouldn't that have been in the "only joking" thread  ;)

GCW

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#230 Re: The end of the NHS.
October 25, 2014, 05:39:41 pm
It isn't a joke, Dense.   :boohoo:

tomtom

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#231 Re: The end of the NHS.
October 25, 2014, 05:55:36 pm
I now see where your catch22 thoughts come from... bonkers.

Sloper

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#232 Re: The end of the NHS.
October 29, 2014, 03:09:59 pm
http://www.bbc.co.uk/news/uk-england-hereford-worcester-29815677

It seems as if some Doctors are changing they way they practice.

Perhaps the real issue is poor management in the NHS?

webbo

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#233 Re: The end of the NHS.
October 29, 2014, 07:46:12 pm
http://www.bbc.co.uk/news/uk-england-hereford-worcester-29815677

It seems as if some Doctors are changing they way they practice.

Perhaps the real issue is poor management in the NHS?
Poor management in the NHS. Well I never, next you will be suggesting in order to meet performance targets. Clinicians should stop seeing patients so they can spend time checking figures.
Last year the local acute trust in order to meet a performance target for staff having flu jabs, offered staff an extra days leave if they had one.
So they made more money paying the staff not to be at work.

Sloper

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#234 Re: The end of the NHS.
October 29, 2014, 07:59:19 pm
NO, I do not support the idea of performance targets, performance should be about clinical outcomes, not 4 hour waits, not referral time targets, not fuckwitted 'diagnosis' targets.

Clinicians should be free to be clinicians and exercise their professional judgment.

The management of the NHS is, in my view a part of the problem not the likely source of the solution secondary cause of difficulties is the the political ineptitude and cowardice exhibited by all leading politicians.  The NHS simply cannot deliver everything, for everybody, all time time, free at the point of service.  Until politicians accept this then we're doomed to the failure of mediocre management.

PS I'm still waiting for anyone to come up with an answer as to why the cost of successful claims for clinical/medical negligence has been rising steadily since 1999/2000.

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#235 Re: The end of the NHS.
October 29, 2014, 08:16:24 pm
Shouldn't that have been in the "only joking" thread  ;)

See this every 3 hours at work... As in.. This PISS poor ability for allegedly well educatated professionals seriously fucks it up. All the fucking time... Why?? Well these people don't go to work to do a shit effort.. The whole system breeds decay, rot and failure. This is a classic example..

Sloper

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#236 Re: The end of the NHS.
October 29, 2014, 08:25:48 pm
Think of your BP, and relax.

On a more serious note, how would it improve your practice if you were able to tell people to fuck off, lose some weight, stop smoking, do some exercise and so on without the fear of 100s of complaints and so on?

fatdoc

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#237 Re: The end of the NHS.
October 29, 2014, 09:17:55 pm
Im currently in a personal BP management programe. You are right, this sort of out of work reflection is not good for my health.

If I could tell people that is costs £10 per visit to ED, and that I could tell them, to f3ck off even so... My life would be much less stressful.

GCW

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#238 Re: The end of the NHS.
October 29, 2014, 10:35:58 pm
Try getting £55 per head per annum for unlimited access. That'll get your BP up......

a dense loner

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#239 Re: The end of the NHS.
October 30, 2014, 02:09:03 am
What was that the other day about some gp's getting 6 figures for only working wknds? How not true is that?

chris j

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#240 Re: The end of the NHS.
October 30, 2014, 05:29:44 am

PS I'm still waiting for anyone to come up with an answer as to why the cost of successful claims for clinical/medical negligence has been rising steadily since 1999/2000.

Because punters are more litigious than they used to be and less likely to accept an error as 'mistakes happen sometimes' and rapacious lawyers are demanding higher pay-outs?

drdeath

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#241 Re: The end of the NHS.
October 30, 2014, 07:58:31 am

PS I'm still waiting for anyone to come up with an answer as to why the cost of successful claims for clinical/medical negligence has been rising steadily since 1999/2000.

Because punters are more litigious than they used to be and less likely to accept an error as 'mistakes happen sometimes' and rapacious lawyers are demanding higher pay-outs?

The legal system implicated?! The very idea...

Seeing as we usually quote to the Guardian around here, I might as well redress the balance...and I know Sloper likes cherry-picked examples as indicative of broad practice (as shown by earlier posts to this thread...)


http://www.telegraph.co.uk/health/healthnews/9352397/Lawyers-seizing-lions-share-of-payouts-in-NHS-negligence-cases.html

There have been reforms to the legal-aid/no win no fee arrangements since this was written, but a bulk of the claims still being processed date from before that time...

Declaration of interest - I work for solicitors writing reports on various clinical/medico-legal issues...it's paid pretty well so far and I say yes to every offer that comes across my desk...money for old rope.
« Last Edit: October 30, 2014, 08:04:04 am by drdeath »

GCW

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#242 Re: The end of the NHS.
October 30, 2014, 08:10:12 am
What was that the other day about some gp's getting 6 figures for only working wknds? How not true is that?

Average partner earnings are consistently dropping and are around £103,000 Gross. Knock off 24% pension, high rate tax, £10,000 compulsory fees etc and the take home ain't a lot for the job.

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#243 Re: The end of the NHS.
October 30, 2014, 09:56:49 am
I have to agree with that. It's sounds a lot of cash... But these days with the accrued debts of educatin in what is a high school achieving cohort... Well, I'm sure moat student drs are a lot brighter than me... And could earn a truck load more cash doing something else.

I lecture / inform 6th form students about the career paths medicine offers. Every time I get directly questioned on income. Ive done this for about 8 years, the income drop is now very clear in that time frame.

I realise, all to well, medicine is a vocation. But to attract the bright, motivated and eager I'm afraid the income isn't worth it these days. Don't get me wrong, real time salaries have fallen for decades, and in past generations the income from th state was preposterously high.... But now.... Put it this way..... I've made it very clear to my kids not to consider medicine...

There are easier ways to bring home a good wage.

Personally, despite rants and BP surges... I love my job. As I age I have learnt to let the ridiculous in house and national political meddling pass me by a whole lot more.... Well, to a degree. Best decision I ever made was to leave medical management. I feel for this in primary care, they cannot do that.

The stats say it all, no one wants to be a GP!!!!

This will give us a different point of access to free medical cre very soon.

Super sized impersonal primary care health factories with a huge onus on desperate to achieve ever changing national targets are inevitable.


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#244 Re: The end of the NHS.
October 30, 2014, 10:18:16 am
Glad you do. I'm sick of all the crap, constant negative portrayal and blame by the media, and to be honest listening to the problems of 120 people each week is mostly pretty boring and mentally not stimulating. 

lagerstarfish

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#245 Re: The end of the NHS.
October 30, 2014, 01:15:54 pm
PS I'm still waiting for anyone to come up with an answer as to why the cost of successful claims for clinical/medical negligence has been rising steadily since 1999/2000.

the cost of everything has been rising steadily since 1999/2000

also; the population has increased

also; as new types of case go through the courts, the gates are opened for easier claims for similar cases innit? as time increases, total cost of claims must increase

lagerstarfish

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#246 Re: The end of the NHS.
October 30, 2014, 01:22:58 pm
as an aside; if any of you GPs fancy setting up a private alcohol rehab/detox facility, I'd be up for helping you print money

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#247 Re: The end of the NHS.
October 30, 2014, 01:33:16 pm
The richest colleague I ever had was contracted to one of those places...

I should have learned from him...

D

Sloper

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#248 Re: The end of the NHS.
October 30, 2014, 01:49:00 pm

PS I'm still waiting for anyone to come up with an answer as to why the cost of successful claims for clinical/medical negligence has been rising steadily since 1999/2000.

Because punters are more litigious than they used to be and less likely to accept an error as 'mistakes happen sometimes' and rapacious lawyers are demanding higher pay-outs?

Not true.

Payouts in terms of the damages to the injured party a. only occur when there's negligence and b. have not kept pace with inflation.

Costs for claimant's are higher because of the 100% uplift which was introduced in 1997 by yes, you know who, to allow 'no win no fee'.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123761/

1999

Year           Damages             Defence Costs Claimant costs    Total
1999          £386,000,000      u/k                   £62,000,000 (legal aid)
2005-2006 £412,245,050     £53,894,083    £91,252,864       £557,391,997
2006-2007  £332,786,934    £49,808,394    £83,830,905       £466,426,233
2007-2008 £384,841,737     £56,848,517    £108,921,201     £550,611,455

This graph shows the numbers of claims going up c.40%

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/246509/0527.pdf

I understand that payments for 2013 qill be about £1.25Bn

Yes, patients may be more willing to bring proceedings now than say in 1950, but I would suggest that this social change has not been a factor certainly in the last 4 years, so what cause could there be for an increasing number of claims, succesful claims and value of the claims?

Sloper

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#249 Re: The end of the NHS.
October 30, 2014, 02:03:45 pm

PS I'm still waiting for anyone to come up with an answer as to why the cost of successful claims for clinical/medical negligence has been rising steadily since 1999/2000.

Because punters are more litigious than they used to be and less likely to accept an error as 'mistakes happen sometimes' and rapacious lawyers are demanding higher pay-outs?

The legal system implicated?! The very idea...

Seeing as we usually quote to the Guardian around here, I might as well redress the balance...and I know Sloper likes cherry-picked examples as indicative of broad practice (as shown by earlier posts to this thread...)


http://www.telegraph.co.uk/health/healthnews/9352397/Lawyers-seizing-lions-share-of-payouts-in-NHS-negligence-cases.html

There have been reforms to the legal-aid/no win no fee arrangements since this was written, but a bulk of the claims still being processed date from before that time...

Declaration of interest - I work for solicitors writing reports on various clinical/medico-legal issues...it's paid pretty well so far and I say yes to every offer that comes across my desk...money for old rope.

I can't connect to the Torygraph, but will asssume that they don't realise that the costs claimants earn are a. generally limited by the Courts, b. assessed for reasonableness and c. are paid by the compensating party only if the claimant wins.

Legal Aid was withdrawn by Labour and to maintain 'access to justice' firms were allowed to act on no win no fee and chagre a 'success fee' of up to 100% of base costs to the defendant provided there was a settlement.  The rate of successful clin neg claims is actually quite low and such you need to 'win big' to subsidise the cases which don't settle.

That said most cases are kicked out by claimant lawyers before the letter of claim is sent, so there's not a lot of defence costs incurred on those matters.

Lagers, the point is the claims vs the NHS were steady until about 2008 and then there's been significant and unexpected growth, so there's been something that underpins that, in respect of inflation generally, yes, I'm aware that it's been going up (as has the population) but I don't think we've seen a 40% inflation in population or a 300% rise in general inflation since 2008, so the natural rise theory doesn't look too attractive.

The most logical suggestion I've heard is that the underlying case is the WTD and the changes to hospital doctors' training, i.e. Drs are now less experienced than before and consequently make more and more serious errors.

 

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