[Fultonius]

Is it just me, or does the BBC (BBC 1 News, Radio 4 etc.) have a little bit of an anti-NHS stance these days?

Now, I'll admit that I'm very "pro" NHS. I think it's a great resource and I think that England will be a worse off place when the government inevitably chop it up and sell it off to their chums... (fortunately us hairy left-wing Scots are working harder to keep the NHS 'cos none of us can afford private anyway...) 

However, I thought the BBC was meant to be impartial, but too me the majority of the reporting recently seems to "attack" the NHS, pointing the finger, etc. 

Today's report on the morning news (BBC 1 and the Radio 4, again) seemed to have the dagger out about the review of GP practices. The slant seemed to be all about how bad things are and how poor performing GP practices should be shut down.

I found this quite in contrast with what the inspectors were saying which was more along the lines of (paraphrased) "yes, we found 9 out of 900 + with serious failings, but the majority of these have been dealt with and 2 practices have closed".

Surely the news form this is that, on the whole, the NHS is doing alright considering the pressure GPs are under, and that things are improving as a result of the inspections?


Am I misrepresenting the BBC?  Am I reading too much into the reporting?  I just have this mildly fatalistic feeling that their fully onboard with the "down with the NHS" sentiment...


I'm going to throw this out there. Is the BBC the new Daily Mail  [kiding...]

[GCW]

Far too much hype and negativity from all sides.

Yesterday I was told about a book called NHS SOS which is apparently quite good.

[rich d]

I think it's more that they're looking for a story. One of the problems with 24hr news and a constant need to generate comment/interest and interaction for phone ins etc as well as competing with other news media for market share and they believe that sensationalism sells.

Maggots found on the floor in GP surgery or Unacceptable standards found in GP surgery both make more dramatic headlines than the vast majority of GP practices are good. 

[Jaspersharpe]

I was thinking exactly the same thing myself listening to this "news" on 6 music this morning. Suppose it's worth considering that:

The BBC is under massive pressure from the government who are very anti-BBC and very pro "the free market" when it comes to broadcasting (i.e. Murdoch etc, whatever they may say).

The government are destroying the NHS bit by bit and need excuses for when everyone wakes up and realises what's going on, whatever they may say.

The BBC is reporting any information about the NHS in an extremely negative, inaccurate and sensationalist manner which seems designed to show the NHS in a bad light at any opportunity.

Hmmmmm.......

[SEDur]

You (not you personally) are a fool if you believe a word that is said in the morning news, isn't in some way vetted by the interests of specific parties; political, corporate or otherwise.

We have neither freedom of speech, or a 'free press'.

[Fultonius]

You (not you personally) are a fool if you believe a word that is said in the morning news, isn't in some way vetted by the interests of specific parties; political, corporate or otherwise.

We have neither freedom of speech, or a 'free press'.

I haven't watched the morning news much recently, but the last few weeks I've been staying at a mate's who watches it most days. It is drivel.

I know that all news has a slant, but its a shame to see the BBC changing in this way.

[Durbs]

There does seem to be a lot of negative NHS stories recently, which has coincided both with ol' Dave's plans to sell as much of it off as possible, and huge and un-sustainable cuts.

They're just setting it up for the inevitable fall, which is massively galling.

It just sets up a vicious circle - massive cuts, services dip (slightly), big news story about how terrible it all is. Bring in more management to sort it out at the expense of floor staff and so on, and so on.

I guess there's not much of a story in "NHS does huge amounts of excellent work, with very limited resources" everyday.

Probably that whole 7:2 ratio (think that's it) - have a bad experience, you'll tell 7 people, have a good one - 2. Just skews everything towards the negative

[dave]

The BBC is under massive pressure from the government who are very anti-BBC and very pro "the free market" when it comes to broadcasting (i.e. Murdoch etc, whatever they may say).

This

There does seem to be a lot of negative NHS stories recently, which has coincided both with ol' Dave's plans to sell as much of it off as possible, and huge and un-sustainable cuts.

They're just setting it up for the inevitable fall, which is massively galling.

It just sets up a vicious circle - massive cuts, services dip (slightly), big news story about how terrible it all is. Bring in more management to sort it out at the expense of floor staff and so on, and so on.

The tories are doing exactly the same with education/teachers/schools too.

[shurt]

And they claim its purely driven by cost cutting and isn't ideological... All with a straight face. Nice to see Nick Clegg reigning them in.
I can't watch the news anymore as I'd end up putting my head through the screen.
The biggest tragedy is that as with the Thatcher years, a lot of it cant be put back very easily. There's not exactly been much re nationalisation happening

[webbo]

However the BBC have managed to gain information about how the goverment are actually cutting funding ( 2% ) to Mental Health services despite they are saying there are no cuts to NHS funding. This despite a 16% increase in referrals to Mental Health Crisis Services and Community Mental Teams.

[tregiffian]

Try ITV. More factual  and less driven by PC agendas

[Falling Down]

It could also be due to the fact that there are lots of issues with the NHS that should be brought to the attention of the public (Staffordshire trust etc) that the mandarins in charge would rather not see the light of day.  Just a thought....

[fatkid2000]

CQC is a joke - its been forced on practices. Steve Field who's in charge has no respect from the profession.

We reckon its cost us £10 K plus huge amounts of time. There's been no funding help for this. Diverting time away from patient care. To check we have the correct colour mop or that the child protection info is in the correct colour folder.

The NHS is creaking primary care budget slice has dropped from 11% to 8.5% of the NHS budget.
Whilst doing 90 % of the NHS work.

We all know where the shit practices are - its all recorded in data on prescribing, referrals, admissions.

Time for somebody to admit we are going to have to charge people to see a doctor.

[fatkid2000]

Oh yeah and no cuts to the NHS budget - that's a load of SH1T.

The so called efficiency savings - that's actually a cut in funding.

If you want to find out more - look at AQP - this will see virgin etc bidding for health care that a profit can be made from - the quality of which will be questionable. You could walk into your GPs in a few years time & told sorry we don't manage blood pressure or do flu jabs - we do your chronic chest disease and you impossible to manage psycho-somatic disease because we can't make any money out of it.
GPs are having to set up federations and business provider arms to protect their work and hence the rounded service they provide.

[GCW]

There is plenty of evidence that practice income is dropping. There are practices in this area close to collapse- there are some that have not paid themselves or staff for at least a month as the money isn't there.

Clare Gerada and others are still talking about a new model in which practices should run a list of around 30,000 patients and only employ salaried GPs. So how will that work exactly?  Oh yeah, it'll need a well organised large business to run it, preferably one that knows about healthcare. Hmmmmmm, any ideas?   

[GCW]

Time for somebody to admit we are going to have to charge people to see a doctor.

Great, I'll be able to afford to laminate all the stuff CQC ask me to.

[psychomansam]

The BBC has been basically fucked ever since the coalition came in and threatened their funding, among other things.
It's virtually impossible to get anything out of them via a FOI, e.g. correspondence with the cabinet,  because they just claim they hold it for 'journalistic purposes' and refuse the request. (The FOI law needs strengthening here perhaps)

They failed to give proper coverage to NHS privatisation and to the vested interests of ministers. They certainly don't present a great lot of counter-government balance at the moment. These days I just tend to think of them as a government office.

Assange gets great later on in this: (By the way, if you don't know the details about the 'sexual allegations' against him and how they've been used, you really should. I doubt you'll find out on the BBC)

[Fultonius]

Time for somebody to admit we are going to have to charge people to see a doctor.

This point interests me. Can anyone point me in the direction of some studies on how effective this is?

On the one hand, I can see that a fairly small (nominal) charge would probably make people think twice about going to the GP for minor ailments. However, well-off people would barely blink and probably just go as and when required.

Is there a risk that the poorest in society may think twice about going when they have a genuine need? How do you deal with that?

[slackline]

Time for somebody to admit we are going to have to charge people to see a doctor.

This point interests me. Can anyone point me in the direction of some studies on how effective this is?

On the one hand, I can see that a fairly small (nominal) charge would probably make people think twice about going to the GP for minor ailments. However, well-off people would barely blink and probably just go as and when required.

Is there a risk that the poorest in society may think twice about going when they have a genuine need? How do you deal with that?

How are you defining "effective"?

Wasted GP time could be seen as one criteria...

User charges in health care: Evidence of effect on service utilization & equity from north India

(usual caveats e.g. of it being a different country & findings and conclusions may not be generalisable etc. etc.).

In the UK they changed access to free healthcare for immigrants which might be considered a case-study of the effects of doing so.  The authors seem to conclude that it may not make economic sense as well as leading to poorer health outcomes (higher burden of disease & mortality rates)...

Rights and the reality of healthcare charging in the United Kingdom

Probably lots more articles on it (search using http://scholar.google.co.uk/), most will unfortunately be pay-walled.  High quality journals to keep an eye on are BMJ, Lancet, New England Journal of Medicine, but there are literally hundreds of journals dedicated to health economics.

[GCW]

That's actually a difficult question to discuss.

One aspect of the comment is that we as GPs in England are being expected to do more, but the budgets have been cut. And we still await full details of the new contract.

How much does the NHS spend on drugs you can buy over the counter?  A lot I suspect, yet appointmenrrs are taken up for things like that. Sick notes?  Total waste of our time.

An entirely free system ain't that common if you look at other countries around the globe. Has dental health got worse since you have to pay?  I don't know.

Primary Care is actually amazing value for money. But the way it is being squeezed and devalued is going to reduce recruitment (shown in recent surveys) and the senior guys are going to jump ship. Why carry in working when your pension is "full" and your taking a big pay cut now seniority is gone.

There is going to be a massive workforce crisis, and nobody seems to have taken that into account.

[rich d]

Question for the GPs/healthcare bods
Has the number of people per GP surgery gone up? Has this changed massively since the 70's and 80's when I was a kid? As I can't remember ever having to wait a long time for appointments, or is it due to the additional work/services that GPs do?

[GCW]

Workload has massively increased, things like chronic disease management. As a ballpark one full time parrner counts for roughly 2000 patients.

[Fultonius]

Question for the GPs/healthcare bods

Another quesiton for the above:

Is there any reason why GP surgeries can't operate a split appointment/on the day appointment service.

I.e. allow ~30%/40%/50% of appointments to be booked in advance (for those who find this benefical) and the rest can be allocated to "phone in the morning, get an appointment that day" service? (or phone the day before)

My (admittedly terrible and overstretched) local practise almost never manage to give me a slot withn 10 days and even then, it's with any one of their pool of GPs and they'll inevitably be running late. The last time the GP was 45 minutes late. I was the first appointment of the day and he didn't even apologise!

That's my experience of a NHS run GP practice, in the Glasgow Royal Infirmary. The catchment area incorporates a lot of economically depressed areas, so I'm sure they have a hard time but it could definitely be improved. The GP surgery used to go to at my parents was so, so much better.

[GCW]

That's pretty much what we do. Pre book up to a month in advance, plus roughly ten on the day appointments per GP. It doesn't allow for someone to book an appointment for tomorrow but no system pleases everyone.

We tried all pre-book able, all on the day. The patients hated both.

[slackline]

Question for the GPs/healthcare bods
Has the number of people per GP surgery gone up? Has this changed massively since the 70's and 80's when I was a kid? As I can't remember ever having to wait a long time for appointments, or is it due to the additional work/services that GPs do?

Quick search led to this going back to 2004 and this abstract, which usefully is available in full from the authors institute  Where did all the GPs go? Increasing supply and geographical equity in England and Scotland.

Quite why they felt there was any value to commenting on the relationship between GP per capita and air quality is beyond me as they looked at deprivation, the only thing I can think air quality would serve as a proxy for, directly.