[Offwidth]

...and on Cameron's 7 day NHS promises with an almost 'irresistible force meets immovable object' situation developing:

http://myemail.constantcontact.com/No-he-can-t.html?soid=1102665899193&aid=xFzNLxB_h8c

[slackline]

Not about the end of the NHS, rather the beginning, from 1948...



Read it all here.

[GCW]

.......and the future of the NHS.....

[GCW]

Two Hunt announcements within the past eight hours mean I am now extremely concerned this will precipitate an exodus. Oh dear.

[tomtom]

Two Hunt announcements within the past eight hours mean I am now extremely concerned this will precipitate an exodus. Oh dear.

They really havnt got a clue have they! 5000 new GP's - when there are... erm lets see.. erm.. none? waiting to become one..

Wonder if they'll now start 'devaluing' the reputation of GP's work in the same way they have with Teachers over the last 5 years...

[GCW]

£10m more to open 7 days. That's an average increase in funding of under 0.2% for a 20% increase in opening hours. Hmmmm.

Oh, and Mr Hunt- at 7pm I've been working for 12 hours already, so how exactly do I change my mentality that I can go home and it's not my responsibility?

People were holding off going to hear today's announcement. Not any more.

[tomtom]

Do you recon I could become a 'physician associate'? I've a biology O level...

All sounds a bit like pcso's for Gp's...

[Oldmanmatt]

The "Physicians Apprentice"...

Visions of marching Syringes, dancing aspirin capsules and bubbling cauldrons of Piriton; conducted by a White Coated Mickey Mouse,  a'la Fantasia.


Sent from my iPad using Tapatalk

[bigtuboflard]

Do you recon I could become a 'physician associate'? I've a biology O level...

Don't think you even need that, I walked in to Homerton hospital in East London hospital this week to visit a dying relative to be asked "which patient are you here to see Doctor?" by the nurse at the ward desk. Given that I was just wearing my smart work suit (London meetings) and carrying a brief case I could have made anything up at that point.

[Offwidth]

5000 new GP's

Its not 5000, its 5000 extra over the demographic loss which is higher than normal due to more than average being close to retirement. GPs can also retire early, do something else or maybe even emigrate (again increasing numbers are) The real gap is reported to be a good bit over 10000. The only real solution is to buy in doctors from other countries.

[lagerstarfish]

how many doctors are just about to not get paid in Greece?

[GCW]

5000 new GP's

Its not 5000, its 5000 extra over the demographic loss which is higher than normal due to more than average being close to retirement. GPs can also retire early, do something else or maybe even emigrate (again increasing numbers are) The real gap is reported to be a good bit over 10000. The only real solution is to buy in doctors from other countries.

Official figures:

Unfilled GP posts quadrupled in last three years (now 7.9%).  Lack of recruitment to training posts.
32,075 GPs in 2015; 32,110 in 2009.  RCGP estimate 40,100 are needed.
Increasing demand on appointments:  13% rise in numbers between 2008 and 2013.  370m appointments per annum, 60m up from 2010.
Increasing workload:  37% of GPs feel workload unmanageable, 93% say workload negatively impacts patient care.  543 practices are said to be at risk of closure imminently.

[Offwidth]

Another depressing nail:

http://www.theguardian.com/global/2015/sep/28/nhs-junior-doctors-forced-out-contract-department-of-health

[mrjonathanr]

To a non-medic the thinking seems clear: degrade the system till -by degrees of course- a privately-run option will be acceptable to the voting public.

[slackline]

To a non-medic the thinking seems clear: degrade the system till -by degrees of course- a privately-run option will be acceptable to the voting public.

You are Noam Chomsky...

[mrjonathanr]

Not quite so illustrious I'm afraid.

[Wood FT]

To a non-medic the thinking seems clear: degrade the system till -by degrees of course- a privately-run option will be acceptable to the voting public.

Depressingly clear, we'll also see the villification of the medical profession (see: Gove Teachers model 1.0)

5 more years of this shit.

"'The creatures outside looked from pig to man, and from man to pig, and from pig to man again; but already it was impossible to say which was which"

[fatdoc]

Nice Guy. Deal is ive left this thread alone, as I've said before its all fucked, can't be stopped and the end is nigh. Sorry all... The foundation trusts last year were approx 5% in debt... Now it's predicted 85% by financial year end..

[petejh]

Is there any merit in the idea of nurses, doctors and surgeons being contractually obliged to work solely for one employer (or otherwise a tight limit on hours worked elsewhere), i.e. either the NHS or a private medical provider?

If not why not?

[drdeath]

Contractually? Not really sure about that....

At the minute in Scotland Consultant Medic Job Planning (yearly process of laying out your role and responsibilities, working pattern etc) includes a declaration that the NHS will have first bite at any extra time you have in your week - i.e. you can go work privately one day a week, but only if the health board doesn't want you that day...

In practice it's a bit redundant as the vast vast majority of doctors work solely in the NHS and any who do private work, as I do myself, do it in their spare time - i.e. Saturday Mornings, week nights etc...

Would I come in and work for the NHS during those times?

It's not very practical for them to ask, as it would be overtime and paid as such...therefore more economical to hire someone else, more junior.

And if push came to shove, my private work pays £150 an hour: the NHS?.....does not.

Although Locum Consultant rates start at £100 and hour and go up rapidly from there...and there will be more of that coming as the shortage of doctors worsens...before all of these contract shenanigans we were in trouble...now its looking grim.

I gave a lecture to our local FY2 group last week, 30-40 doctors just out of training...I asked the question 'who here has plans to go abroad to work next year?' and out of that group I would say >50% raised their hand.

Cynical as I am, even I was shocked...they were determined, had plans, and a good many won't ever come back.



As for nursing staff etc. I wouldn't want to comment, due to complete ignorance.


D

[psychomansam]

I now work for an NHS trust. Recent numbers had the trust at a shortfall of ~200 nurses. That is being at least halved with the next intake but, despite sending recruitment agents abroad to vet and import nurses, we will still be going into the winter with a shortfall.

I'm still trying to work out how this government plans on driving the economy with a chronic shortage of professionals. Engineers, web developers, doctors, nurses, teachers, who needs them? We've got bankers and consultants baby.

[petejh]

I gave a lecture to our local FY2 group last week, 30-40 doctors just out of training...I asked the question 'who here has plans to go abroad to work next year?' and out of that group I would say >50% raised their hand.

Cynical as I am, even I was shocked...they were determined, had plans, and a good many won't ever come back.

Who pays for the medical training institutes and the lecturers/training staff in this country? Are they 100% privately funded, a mix of private/public, or 100% publicly funded?

Is there a case to be made for providing 100% publicly-funded (or heavily subsidised) medical training open to all students of all means, dependant on recipients being bound to a contractual obligation for full-time work in the nations public health service for x-years? I would have thought there would be an appetite among less priviliged students for this?

I think what I'm digging at, without any real knowledge or strong viewpoint either way, is what would an NHS look like if you could create a system geared toward providing expensive medical training to the great pool of people who - I get the impression - come from less privileged circumstances than has been the average for medical students over previous decades. And then impossed on them some kind of reciprocal obligations to the state.
I come from a military background btw where working hours/locations wasn't a choice open to me. So I'm perhaps less sympathetic than some and still see some roles that might be able to be best served with a dollop of 'duty' rather than choice.

And if push came to shove, my private work pays £150 an hour: the NHS?.....does not.

There's supply/demand at play. By which I mean demand for private treatment is increasing in this very unequal country.

It's inevitable that supply of willing medical people will increase to meet any increase in demand.

[GCW]

Nice Guy. Deal is ive left this thread alone, as I've said before its all fucked, can't be stopped and the end is nigh. Sorry all...

Me too. Our local trust is under scrutiny from Monitor and has a £30 odd million deficit this year.

We will all be paying soon..

[drdeath]

Who pays for the medical training institutes and the lecturers/training staff in this country? Are they 100% privately funded, a mix of private/public, or 100% publicly funded?

Is there a case to be made for providing 100% publicly-funded (or heavily subsidised) medical training open to all students of all means, dependant on recipients being bound to a contractual obligation for full-time work in the nations public health service for x-years? I would have thought there would be an appetite among less priviliged students for this?

AFAIK - Its a mix of public and private...the fees for English students is about £9000 a year for five years, but the actual cost is somewhat higher.

So, you are talking about letting them off the hook for £45000, at a maximum...

And the question then is what you expect in return?

It would have to be something likely to be seen as a fair exchange - and holding them for say 10yrs under the contract changes that are about to come in would never work...nobody would go for it, being aware of what they are giving up. Particularly as student debt is deferred and recovered over extended periods...

Also it may build a two tier system of training - the indentured drones who can't leave under pain of financial clawbacks and those able to leave for the sunlit financial uplands of the free world.

And could it be enforced? Would it run against European law (no idea...just wondering, although that may not be an issue after next year)...

For all the comments bandied about when this topic comes up in the media, the essential paradox never seems to be spoken...

Why, if the money is so great, the workload so manageable and the profession simply not aware of how good they have it, do we have a recruitment and retention crisis that leaves us shipping in doctors from all over the world, and still failing to fill posts?

Surely we should be bursting at the seams with doctors?

D

[Offwidth]

When you look at this sort of thing as a bright kid from a poor background it's pretty scary:

http://www.westernmorningnews.co.uk/Newly-qualified-doctors-82-000-debts/story-26364020-detail/story.html

There are lots of routes to extra financial help but grants are now are moving to loan based support as well.

One of the biggest problems with the latest contract changes are they will very likley further hinder the numbers of women progressing to the best paid posts as balancing family and the much less favourable out of hours working arrangements, and the added disadvantages for those taking parental leave or working on fractional contracts.

On Pete's point the current supply economics is UK trained staff moving out to other nations and outside trained staff moving in alongside a big increase in expensive locums... not very healthy in the current political and financial climate.