Naming and Shaming GPs.
“Health Secretary Jeremy Hunt has vowed to root out doctors who cost patients’ lives by failing to send them for vital hospital tests soon enough.”
Would it not be more productive to praise those Doctors who achieve the near impossibility of looking at the outside of a patient sitting in their surgery complaining that she is ‘tired all the time’ and correctly deduce that she may well have cancer and send her to the local oncology specialist in time to save her life?
‘Tired all the time’ is the number one complaint heard in Doctor’s surgeries. True, people with one of the 200 different types of cancer do complain that they are ‘tired all the time’. So do people who stay up til 3am watching porn movies; as do people who are holding down three different jobs whilst trying to save the deposit for a house; as do women with three children under the age of four to look after; as do people with a host of other ailments nowhere near as serious as cancer.
There are a shade under 64,000 GPs in the UK, and around 300,000 new cases of cancer every year. So, on average, every Doctor is going to see 5 cases spread amongst 200 different types of cancer each year within his ‘quota’ of 1,500 patients. Is he supposed to send every single patient who complains of ‘feeling tired’ to join the queue for a scan for fear that one of them may be harbouring a cancer which will see him named and shamed as an ‘inefficient and uncaring’ Doctor? How long will the queue for the scanner be then?
The media have been quick to find grieving relatives who support the initiative to ‘name and shame’. Mrs O’ Reilly went to her GP complaining of ‘back pain’. As do thousands of patients every year. Should he have sent her, indeed, all of them, to the oncologist or the local physiotherapist? He sent her to the physiotherapist – a sensible option given the reason for most back pain. Only when the physiotherapist returned her to the Doctor saying the problem was ‘not muscular’ in his expert opinion, did he send her to the oncologist. Sadly, she was one of the ‘average five’ patients of his who did have cancer – which had spread, and she died. Her son is naturally upset at losing his Mother – and backing the call to see this Doctor labelled as ‘dangerous’. It is not only the queue for the scanner which will lengthen if this initiative is put into practice – but the queue for GPs – as thousands of patients veer away from GPs labelled ‘dangerous’.
Mr G drove me to Toulouse yesterday, to have lunch with a very special lady. She and I are unusual creatures; we both have a rare cancer in itself, and of the womb – and neither of us have a womb. In my case, for the past 40 years, in hers, for the past six years. What is a GP supposed to do with us, should either of us have presented at a UK surgery saying we were ‘tired’ – the sole symptom that either of us could lay claim to – and that only with hindsight? It was sheer chance, and exemplary diagnostic work, that led to either of us having treatment for something that could neither be seen, nor heard. Doesn’t that deserve praise to the GPs concerned, rather than condemnation of any of the thousands of other GPs, for whom cancer of the womb in a patient that they knew perfectly well didn’t have a womb, might have failed to send us to an oncologist?
She, like me, is also English, and to my surprise, for her French is superb, had decided that following surgery, she couldn’t face going through chemotherapy with the added hurdle of doing everything in a foreign language. When you are at your lowest ebb, having to check through every sentence for the correct verb declination and noun usage, does add a certain je ne sais quoi as they say in these parts, to the stress levels.
She went straight to The Royal Marsden hospital; no hold ups, no problems with a GP, the creme de la creme of cancer treatment in the UK – and you could say ‘they got it wrong’. She didn’t have the same ‘high density’ treatment I had in France, and now she is back here, hoping against hope that the French will agree to try her on the same treatment. She is 25 years younger than me, with a 12 year old son – yet the Marsden would only give her palliative treatment on the grounds that Leiomyosarcoma is ‘incurable’ and there was no point in wasting resources on staving off the inevitable. Should the Royal Marsden be labelled a ‘dangerous’ hospital for having ‘failed’ her so far? I don’t think so. Should the money be available to take the French attitude and at least try to save every life, and in the process, perhaps, perhaps, discover a course of treatment that might help others ? Yes!
There seems to be an idea afoot that cancer is like measles, you should be able to spot the signs easily and apply the correct medication. It isn’t. There are over 200 different cancers, that occur in people of both sexes and in between, in a variety of sites, in people with all sorts of different underlying conditions, and which are diagnosed at varying stages. That half of all people who develop cancer now survive for at least ten years – a figure which has doubled in the UK over the past 40 years, is nothing short of miraculous.
Of course there is room for improvement, there is always room for improvement; not spending NHS resources tracking down all the staff who worked in the Maudsley hospital 30 years ago because some idiot phoned up Operation Yewtree to say he ‘thought’ he saw Jimmy Savile walking across their car park in 1980 would be a very good start.
The NHS has become a hugely political organisation, at the forefront of political correctness – the billions that are poured into it every year could ensure sufficient scanners to allow every GP to send every patient for a scan on the off-chance that they have cancer if that is what you think they should be doing, but to ‘name and shame’ the Doctors for not having done so is not productive.
There is a school of thought that says we have a ‘right’ to life – and if we lose our life, it must be ‘someone’s fault’. More than 40% of cancers are due to ‘sub-optimal lifestyles‘. In other words – how we chose to live.
Yet the only finger we are prepared to point is at the GP? Try pointing the finger at the NHS for wasting resources.
- Moor Larkin
July 1, 2014 at 8:41 am -
Oh come on. British GP’s are being paid £200k or more a year since tha botched NHS reforms. They refuse to work weekends or evenings and are bribed by International Pharma to experiment on us all anyway. They deserve to be pilloried…. or worse.
- Peter Raite
July 1, 2014 at 10:14 am -
As Anna notes, there are 64,000 GPs. The Telegraph article below states that in 2009/10 890 (i.e. 1.3%) of them earned over £200,000. It further states:
“Data from the NHS Information centre, based on tax returns, found that on average a partner in a GP practice earned £105,700 in 2009/10.
David Cameron earns around £142,000 a year by comparison.
GP earnings peaked in 2005/6 at an average of £110,000 and have steadily fallen since then.
Doctors who earn a fixed salary and do not take part in running the business earned less. The average salaried GP earned £58,000 but they are also more likely to work part-time.
The figures include NHS work and private practice.”
http://www.telegraph.co.uk/health/healthnews/8878830/Family-doctors-earning-more-than-200000.html
- Moor Larkin
July 1, 2014 at 10:19 am -
Presumably those failing to reach £200k OTE can be named and shamed as lazy….
- Peter Raite
July 1, 2014 at 10:30 am -
It’s just a more complex situation that the headlines suggest, and on average I wouldn’t say that GPs are anywhere where they shouldn’t be in the league table of earners:
- Peter Raite
- Comrade Ox
July 1, 2014 at 11:37 am -
Without being trite about this, but why are you comparing the salary of the Prime Minister, the person who (allegedly) has the fate of 63 million people in his or her hands, and could lose his or her job every five years, who is scrutinized by everybody and his dog, to a GP?
Unless the remit of doctors has expanded to declaring war, I don’t see the comparison?
A £30k difference seems like a reasonable deal to me…….
- Moor Larkin
July 1, 2014 at 11:45 am -
It gets quoted a lot. The idea is that if the PM is at the tip of the pyramid of “the State” then s/he should command the highest salary. It became very fashionable when Chief Executives of the local Councils were publicised as earning more dosh than the PM.
- Peter Raite
July 1, 2014 at 12:11 pm -
That has to be tempered by the acknowledged fact that the salary of the PM is kept low precisely to minimise the risk of someone going for it just for the money. In that context, the PM should absolutely NOT “command the highest salary.”
- Moor Larkin
July 1, 2014 at 2:48 pm -
The Patrician system certainly has its advantages I must agree. I imagine they only started paying politicians to encourage the working classes to apply. The buses seemed to be better when run by the Corpy and certainly in my day living in a Corpy house was a step-up from renting rooms. The rot set in with that bloke Poulson perhaps. http://en.wikipedia.org/wiki/John_Poulson
- guthrie
July 1, 2014 at 3:20 pm -
It was more that the working/ middle classes forced them to start paying MP’s so that said classes would actually have better representation in parliament (And help avoid more obvious corruption that would arise from someone having to find the money to become an MP).
- guthrie
- Mr Wray
July 2, 2014 at 12:07 pm -
That has to be tempered by the acknowledged fact that the salary of the PM is kept low precisely to minimise the risk of someone going for it just for the money
LOL!That’s what they all do it for these days! Being PM is the stepping stone to vast wealth. Just look how rich Blair and Brown have become since their premierships. Those two did considerably more damage to the health of the Nation than any last lustre GP would be capable of.
I think you’d have to go back 50-60 years to find a PM that wasn’t much richer after leaving office than s/he was before he entered it.
- Moor Larkin
- Peter Raite
- Moor Larkin
- Moor Larkin
- Peter Raite
- Tom
July 1, 2014 at 8:52 am -
There was a culture of naming and shaming in 17th Century Salem. It’s an idea that has taken root again in our country today and is the basis for persecuting elderly celebrities for their behaviour 30 years ago, for CRB checking of all and sundry and smearing the reputations of people who dare try to minimise their tax bills by legal avoidance. I see it as a modern, politically correct, version of the intolerance that those same PC folk purport to despise.
- Moor Larkin
July 1, 2014 at 8:54 am -
There was a culture of naming & shaming in the News of the World in about 1998……….
- Comrade Ox
July 1, 2014 at 10:06 am -
“There was a culture of naming and shaming in 17th Century Salem. It’s an idea that has taken root again in our country today and is the basis for persecuting elderly celebrities for their behaviour 30 years ago, for CRB checking of all and sundry and smearing the reputations of people who dare try to minimise their tax bills by legal avoidance. I see it as a modern, politically correct, version of the intolerance that those same PC folk purport to despise.”
Indeed there was a culture of naming and shaming in Germany circa 1933-1945.
I can’t however, see how naming and shaming GP’s will reduce cancer deaths?
But this is what you get when the State runs the health system. Increasingly bizarre set of headline grabbing ‘solutions’, tractor stats and pledges, each one ‘tougher’ than the last as the political class scrambles around for votes.
For a Government supposedly seeking to reduce the compensation culture, the only outcome that I see is Injury Lawyers 4 U rubbing their hands with glee……
Here is an idea, why not actually look at our ‘beloved’ NHS, and have a real discussion on how we sensibly fund the health system, with obligatory health insurance, with private health insurance companies for short term treatment, alongside a system of long term treatment being covered by a state-controlled mandatory insurance as in the case of the Dutch or German systems?
- Peter Raite
July 1, 2014 at 10:17 am -
This is clearly NOT, “what you get when the State runs the health system,” given that this is relatively recent phenomenom in a 65 year history.
- Engineer
July 1, 2014 at 10:25 am -
The NHS – in recent decades – has always staggered from crisis to crisis, finding solutions to problems about a decade after they’re identified. That’s because it’s a huge, bureaucratic monolith with deeply entrenched vested interests, and the patient’s needs are not one of those interests.
It does need an almighty kick up the fundament, but nobody seems to have the balls to administer it.
- Peter Raite
July 1, 2014 at 10:37 am -
Having worked 22 years in the NHS, I could certainly point to areas that are over-bureaucratised, but also others that are chronically under-staffed and under-funded. Much of the “bureaucracy” is actually people doing unavoidable administrative functions on relatively modest salaries. It’s also wrong to think of it as monlithical, since it’s actually made up of lots of separate entities doing their own thing.
- Moor Larkin
July 1, 2014 at 10:47 am -
My local super-duper 4-storey local mini-GP-Hospital must be understaffed and under-funded because having built it about five years ago, so far as I can see two thirds of it have never been used to this day. The building of it was hilarious. It all began about 15 years before now. The local surgery closed before they had achieved any planning permission, so the GP-“surgeries” moved into a vacant old school. That was then re-developed after about three years as an old folks housing project, and the surgeries were decamped to pre-fabs on a vacant local car-park where they then remained for a further two or three years before finally the new-build was permitted and built, but now, whatever the ideas about local hospitals were way back when, they have evidently been abandoned since the same old doctors are sitting in rooms on the first floor, with the two aboove it empty. The new building is about twenty feet from where the building is that they originally occupied all those years ago. It appears to be a Nursery School now.
Oddly enough the local Post Office performed a very similar series of “moves” a few years ago, adding to my suspicion that this is just how State-managed industries function.
- Engineer
July 1, 2014 at 10:52 am -
I don’t buy the ‘underfunded’ line. The Health budget is about £120 billion, so that’s about £2000 a year for every man, woman and child in the country. We should be able to provide some pretty decent service for that, bearing in mind that most of us don’t use anywhere near our £2000-worth most years of our lives.
I’ve worked in large organisations, and seen the waste, the petty politics and empire protecting and the union intransigence that tends to happen in them. I’m inclined to the view that a lot of this could be reduced significantly by breaking the NHS into smaller, leaner and more nimble units. That said, I’m not sure exactly how it could be done. I just know that what we have now is no longer ‘the envy of the world’, because there are other countries that do it better.
That’s not to denegrate individuals working in the NHS; I’m quite sure that most are trying to do their best (though one does wonder at what goes through the minds of some of the staff of – for example – the Mid Staffs hospital as patients starved to death), but as a patient of the NHS – because I’ve no other choice – I do feel that the service I get is not always what it should be.
- Peter Raite
July 1, 2014 at 12:27 pm -
Resources aren’t evenly spread, and I’ll give you a concrete example. When I worked in primary care commissioning, it was well known that some of the most over-worked and under-paid staff were clinical coders. These are the people who convert individual patients’ notes into ICD and OPCS codes so that what they are in for and what has been done to them can be correctly recorded on the Patient Administration System. PAS data is what determines what the hospital gets paid, as well as any performance measures they are subject to. It is literally the case that virtually everything a hospital does effectively funnels through the clinical coding department, making it possible the most important adminstrative function in the entire organisation. And yet even a accredited senior clinical coder would only get a salary of £18,838 – £22,016 now. When I was working in primary care commissioning, I was aware of one very large teaching hospital, the clinical coding department of which consisted of three people in a basement office without any natural light (think the ‘IT Crowd’!).
- English Pensioner
July 1, 2014 at 12:47 pm -
But is it really necessary? Do private hospitals do this? Do French or German Hospitals do it? Could there be a simpler solution to record keeping and payment?
I suspect far too much administration in the NHS is from habit, not necessity.- Peter Raite
July 1, 2014 at 1:37 pm -
There is more to it than just payment, although that is the most direct importance to the hospital itself. Without the system, a whole raft of healthcare-related statistics would simply not be available, including the ones Anna linked to in this article. Without the detail we have on inpatient admissions, nobody would be able to say how many people suffer whatever condition or injury that it is, nor how many of whatever type of operation or intervention is carried out.
- guthrie
July 1, 2014 at 3:22 pm -
Look at the internal market gubbins- disliked by many because it increased the amount of statistics and suchlike so that each hospital could get paid for whatever work it did at whatever the rate was at the time. A non-marketised system is cheaper, that’s one of the reasons the NHS could get away with being massively underfunded compared with many other countries healthcare systems.
- Peter Raite
- English Pensioner
- Peter Raite
- Moor Larkin
- Peter Raite
- Comrade Ox
July 1, 2014 at 11:03 am -
“given that this is relatively recent phenomenom in a 65 year history.”
Seeing I’ve been alive for the last 40 odd years of this ‘golden age’ of healthcare, I can’t remember a time when the health system WASN’T in some sort of crisis.
Remember the 1970’s,. NALGO on the picket-line? Bodies stacking up in the mortuary? ‘Non essential’ services cancelled because of strike action?
Remember the 1980’s, NALGO on the picket line? Waiting lists increasing, hospital beds Modest attempts of reform blocked?
Remember the 1990’s, A&E departments ‘close to breaking point’, waiting lists at an all time high, Beverley Allett? Harold Shipman?
Remember the 2000’s Tony and Gordon pleading for more money? MRSA rates sky rocketting, Strategic Health Authorities Bankrupt? Mid Staff’s? Maidstone and Tunbridge Wells NHS Trust and C Dif?Thankfully I was in the Netherlands for some of this, enjoying food you could eat, safe in the knowledge that I was in a clean hospital, or that I could ring my GP, and see him that morning.
No, the clue Peter is when the State runs the show, politicians run the show. Seeing that we have such illustrious leaders of the NHS as Edwina Currie, Andy Burnham, Frank Dobson, Patricia Hewitt and Kenneth Clarke, you kind of get the gist of where I think the problems may stem from………
But I guess you must be delighted to be spending £108.9 to have the 15th best health service in Europe.
- Moor Larkin
July 1, 2014 at 11:12 am -
Convenient to blame politicians because we can actually hire and fire them I suppose but “we” will also not allow them to relinquish control. Perhaps the English just like moaning far more than living.
- Comrade Ox
July 1, 2014 at 11:22 am -
No……….maybe its the way we fund the NHS that’s the problem.
- Moor Larkin
July 1, 2014 at 11:30 am -
“maybe” doesn’t fill me with confidence…
- Moor Larkin
- Ruxley OAP
July 1, 2014 at 5:25 pm -
… but we don’t actually hire and fire the politicians in charge of the NHS – they are appointed from among the cronies of the prime minister of the day, on criteria that have nothing to do with executive capability or knowledge of public health governance and everything to do with short-term internal political manoeuvring.
- Comrade Ox
- Moor Larkin
- Engineer
- Peter Raite
- Moor Larkin
- GildasTheMonk
July 1, 2014 at 8:53 am -
I have had both positive and negative experiences with GP’s. A couple who have been very sensitive and supportive despite clearly being under pressure of time and appointments, and one who behaved like an arrogant and insensitive t**t, telling an elderly relative rather dismissively not to worry, it would be unlikely she would be here long anyway…
I suppose like any profession there are all sorts.
My best wishes to your friend. Let’s hope for some more superb French care. Disappointing to her that the Royal Marsden has been so dismissive. - Joe Public
July 1, 2014 at 9:08 am -
Solution:
Free NHS issue to fortify all over-forties – https://farm3.staticflickr.com/2766/4199799327_fb119cb6f6.jpg
In other news “Prime Minister David Cameron has vowed to root out politicians who cost soldiers’ lives by sending them prematurely to Iraq & Afghanistan.”
- Ian Reid
July 1, 2014 at 9:21 am -
Anna got to pull you up on attributing 40% of all cancers to lifestyle choices. By far the biggest risk factor for cancer is age, it dwarfes all others. The 40% figure is based on the abuse of statistics, otherwise known as epidemiology. Are you saying that those people who get a cancer which is attributed to their lifestyle should not be treated, or should receive lower priority?
- English Pensioner
July 1, 2014 at 9:31 am -
A young friend of mine died, not of cancer, but of a heart attack.
He had registered with a local GP some three or four years previously when he moved into the area but had otherwise never been to the surgery. When he started to get some chest pains, he went to the GP who diagnosed indigestion. He went back about a week later and was effectively accused of being a hypochondriac.
Now, I’m not a doctor, but surely when someone comes to see you with a problem, someone who has been registered with the surgery for some years but has never needed to see a doctor, he is the very last person you should be calling a hypochondriac. I have sympathy with doctors who try, but fail to diagnose a problem, but in this case the GP didn’t even suggest some routine tests such as an ECG.- Jonathan Mason
July 1, 2014 at 1:49 pm -
That is bad. ANY complaint of chest pains at all should be followed up with an ECG, a simple and cheap diagnostic procedure that can be done in a doctor’s surgery. Hell even I can do one. The modern machines also have computerized readings of the results built into the machine and will tell you if the electrodes are misplaced, so even a person without training could use one to good effect, not that you would want a person without training doing it.
- Mr Wray
July 2, 2014 at 12:48 pm -
Same thing happened to my father although it was the other way around – he died of a heart attack after stopping his heart pills because he could no longer take the pain of his cancer, despite morphine. The GP had accused him of being a malingerer which upset him so much he refused to see the doctor again until it was too late.
Fortunately not all doctors are poor but the law of averages states enough are for it to be an issue. Anecdotally I’d say at least a third of the GPs I have had misdiagnosed my ailments, one of which; appendicitis nearly killed me. Fortunately his colleague was able to diagnose peritonitis, so there is hope.
- Jonathan Mason
- Moor Larkin
July 1, 2014 at 9:48 am -
Presumably, the commercial solution would be to fire those deemed to be bad/incompetent doctors and let them get on with their lives elsewhere, while their patients do the same. It’s all hopelessly Byzantine and designed to bend everyone to the will of the Management.
- Jonathan Mason
July 1, 2014 at 3:19 pm -
No the commercial solution (i.e. what a for-profit company would do) would be to show doctors the data on their referrals time turnaround and offer them further education or training if necessary, then set new targets for them to aim for, and then monitor their performance and only fire them if they continued to underperform and fail to follow written guidelines, policies, and procedures after adequate warnings.
- Moor Larkin
July 1, 2014 at 3:29 pm -
What sort of time-scale?
http://clinicds.co.uk/?page_id=79- Jonathan Mason
July 1, 2014 at 3:53 pm -
Yes but it looks like you are referring to her activities as an expert witness, not her outcomes with patients she treated.
- Jonathan Mason
- Moor Larkin
- Jonathan Mason
- Duncan Disorderly
July 1, 2014 at 10:01 am -
The problem with sending marginal cases to a specialist is that you will clog up the system with people who are mostly healthy, whilst people who are in dire straights won’t be seen quickly enough. You might save some marginal cases who really were sick, whilst killing more people who were really sick, and costing more besides. Given that a GP can only get punished for not sending through everyone for a test, this state of affairs will come about. There will, of course, be GP’s who miss clear cases that should be sent to a specialist as a matter of routine, and these will be cases where the GP should be censured.
- Jonathan Mason
July 1, 2014 at 1:42 pm -
Well, you really have to set measurable parameter for something like this, for example setting a range of basic blood test or chemical results that must be referred to a specialist for evaluation within a certain time frame.
When politicians make pronouncements, what comes out is inevitably dumbed down, because a) politicians don’t really understand the issues themselves, b) they just say what they are told to say by their senior civil servants, c) the population is too dumb to understand the real issues so it is simplified, d) the red top newspapers and increasingly TV media are just looking for a catchy headlines, so they will further distort the real issues.
It may well be the case that some cancer patients are coming late into treatment because of avoidable GP snafus or oversights and referrals are not made in a timely fashion in spite of clear evidence that they are needed. Perhaps this does need to be addressed.
- Jonathan Mason
- Michael
July 1, 2014 at 10:03 am -
My mechanic has far better diagnostic skills then my GP.
- Engineer
July 1, 2014 at 10:13 am -
Vets are pretty sharp too – most of their patients can’t tell them what the symptoms are, and are often not that keen on being ‘done good to’.
- Mudplugger
July 1, 2014 at 11:59 am -
But your highly-rated vet has the fall-back option to recommend putting the patient down – it’s called burying your mistakes.
- Engineer
July 1, 2014 at 1:07 pm -
Interestingly – so do mechanics!
It’s a fair point, though.
- Michael
July 1, 2014 at 2:29 pm -
My mechanic used to say (cue Yorkshire accent ) – “if that were horse a’d shoot it”. I think he was in the wrong game.
- Michael
- Robert the Biker
July 2, 2014 at 6:03 am -
“But your highly-rated vet has the fall-back option to recommend putting the patient down – it’s called burying your mistakes.”
“Cooks cover their mistakes with sauces, Architects with creepers, Doctors with earth”
- Mr Wray
July 2, 2014 at 12:55 pm -
Give them time. The BBC have been agitating for euthanasia on the NHS and Andy Burnham pushed many OAPs down the pathway at Mid-Staffs.
How long before there is a Usefulness Index along with a Body Mass Index to determine our fate?
- Engineer
- Mudplugger
- Jonathan Mason
July 1, 2014 at 1:35 pm -
My mechanic has far better diagnostic skills then my GP.
Well, great, you can go to your mechanic and pay him or her for diagnosis, and then ask your GP to prescribe free treatment on the NHS based on your mechanic’s diagnosis. Can’t you?
- Michael
July 1, 2014 at 2:32 pm -
Ha! The NHS docs won’t even acknowledge the validity of tests performed privately by qualified doctors which are standard practice in other European countries.
- Michael
- Don Cox
July 1, 2014 at 3:01 pm -
Presumably you mean your car mechanic ?
A car is a thousand times simpler than the human body, and you can just lift the bonnet to take a look. It is designed to be repaired while the human body is designed for limited self-repair.
Compare a textbook for medical students with a car repair manual.
- Engineer
- Moor Larkin
July 1, 2014 at 10:13 am -
Just remembered the biggest serial murderer in the history of the UK was a GP. You have been warned.
- Serengwalia
July 1, 2014 at 10:27 am -
Perhaps that should be
“the biggest serial murderer [yet discovered ] in the history of the UK……” etc.
No doubt some deceased or ageing individual can be found to shoulder the blame….
- Moor Larkin
July 1, 2014 at 10:31 am -
I think he was deceased before the Judge-led Inquiry found him guilty to the power of 400-ish
- Moor Larkin
- Jonathan Mason
July 1, 2014 at 1:32 pm -
The biggest serial murderer other than Jimmy Savile, that is.
- Moor Larkin
July 1, 2014 at 1:46 pm -
Unfortunately for Scotland Yard, DNA-testing put paid to that revelation……..
Sometimes technological progress can be a block to the approved policing methods.
- Moor Larkin
- Serengwalia
- Engineer
July 1, 2014 at 10:20 am -
If GPs are grossly overworked, do we perhaps need to appoint a few more? I’m sure it could be cost neutral, too. Let’s say 10% more GPs, with the pay for each GP about 10% less than at present (not such an imposition, given that they had something like a 50% pay rise not that long ago). It doesn’t necessarily need more facilities, either – use the extra GP time for out-of-hours appointments and cover.
Too simple? Of course it is – too many vested interests prodded, too.
- English Pensioner
July 1, 2014 at 10:46 am -
A major problem is the shortage of doctors.
No more are being trained, in spite of the increasing demand for their services. Additionally, over 50% of new doctors are now female, a majority of which don’t work full time. Our surgery has three female doctors who replaced two retired male doctors. The men did a five day week, the ladies do a three day week, so we have effectively lost one “doctor-day” every week.
Its a recognised problem, the only solution so far seems to be to bring in more foreign doctors.- Engineer
July 1, 2014 at 12:25 pm -
Agree entirely. It seems immoral to me to solve our own shortage of doctors by taking scarce and expensively-trained staff from countries who’s needs of trained medical staff are agruably greater than ours.
Perhaps we should train more doctors than we think we’ll need. Those that don’t fill the available medical posts would make excellent medical administrators, since they’d have a full understanding of what they’re managing. The additional short-term cost would be repaid with interest by the improved effectiveness of the healthcare system.
- English Pensioner
July 1, 2014 at 12:41 pm -
I fully agree with you. It is totally immoral to recruit foreign doctors, especially when they have been trained at another country’s expense and are badly needed there. The same applies to nurses, we need to train more of our own.
But no doubt to accountants, it is far cheaper simply to allow someone else to pay for the training and then offer doctors and nurses a bit more pay to come here. - Jonathan Mason
July 1, 2014 at 1:29 pm -
The same situation exists in the US, but there is little or no angst about recruiting doctors from foreign countries, including the UK. It doesn’t seem to be possible to train sufficient doctors to meet the demand, never mind to create a surplus, probably because the training is long and hard and there are insufficient quality applicants. The University of Bombay, on the other hand, churns about about 2000 medical graduates annually off its doctor production lines and the amount of money they can earn in their own countries is much less than they can make in the UK or the US.
The view on foreign recruitment in the US is that individuals should be free to apply for employment opportunities and not be told where to work by governments. Of course this is self-seeking as far as the US is concerned, but would the UK like a ban on British medical graduates leaving the country, or make them pay back for their education if they want an exit visa?
- Peter Raite
July 1, 2014 at 1:44 pm -
At the turn of the century I had a brief sojurn in NHS workforce development. It was somewhat depressing that we were doing our best to enabale the training of more nurses here, despite the fact that when many graduated they would promptly leave the country to earn more money in Australasia, the United States, and the Middle East. This was at the same time certain sections of the press were complaining that the NHS was having to recruit so many Phillipino nurses, who of course were originally geographically a lot closer to both the United States and Australasia…
- Jonathan Mason
July 1, 2014 at 1:57 pm -
There are lots of Filipino and Filipina nurses in Florida. And a lot in Australasia too. Excellent employees for the most part who have few lifestyle-related absences from work (i.e. not obese smokers and alcoholics) and get the job done in a very efficient manner.
- Peter Raite
July 1, 2014 at 2:36 pm -
Of course, but it was still something of a paradox at the time that we were losing nurses we had partly paid to train, at the same time as the press was complaining about importing non-British nurses. I don’t recall the (the press) ever picking up on that particular detail.
- Peter Raite
- Engineer
July 1, 2014 at 1:58 pm -
It takes a lot of ‘get-up-and-go’ to emigrate. You don’t do it lightly, especially if there’s an attractive job with a good pension right on your doorstep. What is it about the NHS that makes people want to get out of it?
- Peter Raite
July 1, 2014 at 2:37 pm -
Simply the opportunity to earn more money elsewhere.
- Moor Larkin
July 1, 2014 at 2:49 pm -
Perhaps a better quality of customer too.
- Cascadian
July 1, 2014 at 7:41 pm -
I disagree Peter, money is a motivator (and should be, if the NHS is competing in a global market then they need to pay globally competitive compensation). However better working conditions, better hospital equipment, better training, better housing, all -round better lifestyle and the ability for promotion all enter into it. Which makes me believe that NHS personnel departments are poorly informed and believe that (particularly nurses ) should be satisfied and sacrifice for the great socialist experiment.
- Peter Raite
July 1, 2014 at 11:51 pm -
I wouldn’t know, having never worked in a “personnel department.” I am aware, however, that payscales are nationally set, and not therefore not the remit of such departments, anyway.
- Cascadian
July 2, 2014 at 7:21 am -
Well “nationally set” seems to confirm the great socialist experiment comment then. I think you may have identified the crux of the problem.
As to the personnel department tag, I believe everybody can understand the remit of such a group unlike the crazy grandiose names the NHS now use for underperforming groups.
- Moor Larkin
July 2, 2014 at 8:07 am -
Things at the NHS have to be “nationally set” in order to avoid the “Postcode Lottery” effect so beloved of the UK media.
- Cascadian
- Peter Raite
- Moor Larkin
- Graeme
July 1, 2014 at 4:26 pm -
Having spent 13 years on front-line (999) ambulances, I can tell you why most want to leave:
1. Dealing with unpleasant, often repeat callers, usually for drink/drug related issues.
2. Dealing with people (frequently between 19:01 and 07:59) when the on-call service isn’t coping, for a minor ailment that the caller DEMANDS a 999 response, when the on-call service quotes a 4 hour wait to be seen.
3. Appalling, incompetent NHS “management”, either promoted from within (mates of mates quite often) or moved to get them out of some other department. That, or shipped-in, no previous experience, rapid promotion types that come in, cock stuff up, swoop on and generally f***up over and over again.
4. A lack of career path – where the only options are (a) management – see 3 above or (b) admin, followed by management.My only joy was watching my former Chief Exec go (albeit with a big Golden Handshake), just after I had a very public spat with him. I left a few months later and got f*** all. I am a happier person now and would never go back.
- Mr Wray
July 2, 2014 at 1:08 pm -
I’m sure you are right but you missed out the wonderful NHS Direct service. I have had to use this twice recently and both cases resulted in ambulances. The first time 3, yes 3 ambulances were sent and the second time 2 paramedics, in separate cars, followed by an ambulance. The first time there were so many NHS personnel in the bedroom that it was difficult to move … In neither case was an ambulance requested by us, only information.
This was explained to me the last time as NHS Direct having trigger words and a policy of ‘better safe than sorry’ so ambulances are sent irrespective of need. That surely needs addressing and is actually in the control of the NHS itself. I imagine it will take a death and a well publicised case to make that happen though.
- Mr Wray
- Peter Raite
- Jonathan Mason
- Moor Larkin
July 1, 2014 at 1:51 pm -
I recall my dentist, who my mum said was, “the best dentist in the world”, leaving to go to work in California. That would have been in about 1967.
- Engineer
July 1, 2014 at 1:54 pm -
If India can manage to train so many doctors, surely the UK and the US can find a way?
A small surplus is better than a shortage. It would be immoral to dictate to the surplus what it could or could not do. (In the nature of things, it would probably never work out neatly that a small surplus occurred every year, but things could be made to balance up a bit better over time.)
- Moor Larkin
July 1, 2014 at 1:58 pm -
coz they pay them £10k a year and we pay them £60k plus pension rights, would be one reason I imagine. All of ours end up on the NHS payroll and the manpower budget is the biggest budget and endlessly ongoing.
- Jonathan Mason
July 1, 2014 at 2:01 pm -
Interesting article here on the subject.
http://www.foreignpolicy.com/articles/2010/06/11/countries_without_doctors
- Jonathan Mason
July 1, 2014 at 2:13 pm -
One of the problems in the US is that the medical schools only have so many residency positions in training hospitals. This would equate to “house officer” and “registrar” positions in the UK system. These are necessary to become fully qualified as doctors. I am not sure how this works in the medical graduate diploma mills in India or the Caribbean.
Why does the English Premier League not train more young English footballers? Are English youth not interested in these highly paid positions with early retirement and opportunities for travel?
- Moor Larkin
July 1, 2014 at 2:18 pm -
Most “Filipino’s” are female nurses rather than doctors. Our girls are too busy looking after their cheeldren. Lord knows who’s looking after the Filipino kiddies. Certainly not Gary Glitter these days.
- Jonathan Mason
July 1, 2014 at 2:34 pm -
Filipinos are male nurses, Filipinas are female nurses. Unless they have had sex-change operations, in which case it gets complicated. Often the grandmother takes care of the kiddies while the mother is at work.
- Jonathan Mason
- Moor Larkin
- Moor Larkin
- Peter Raite
- English Pensioner
- Engineer
- English Pensioner
- The Blocked Dwarf
July 1, 2014 at 11:07 am -
I looked a mate’s grave stone the other day- the things you can find on google. He was born a year to the day after me and died screaming, his body a Roquefort of metastasis in 1998.
He never smoked, barely drank, living an optimal lifestyle….a 5 A Day man as opposed to me a 60 A Day man (and, at my fighting weight a 1 1/2 litre of scotch a day man with a penchant for McDonalds). He awoke one morning aged 20ish with a lump in his leg and the rest you can guess….’it’s a sprain, take blah blah’. Bear in mind that he was in Germany and saw some of the finest doctors in the world under a Health system that makes the NHS look like a front for Big Leeches.
I learnt several important lessons watching him seep away . The most important being that the first words out of my mouth when visiting the Doc should always be “I smoke 5 packs of filterless a day-the sort that leaves tar dripping down my hand”. Even though my GP could see the broken minor blood vessel in my throat that was causing me to cough up blood, he still booked me in for an Xray that day. CT scan cos I have stomach pains? Go to the front of the queue. Headache? Better book you in for an MRI. Back pain? I’ll book you in with the Heart Guy.
The Bestes Frau In The World, a life long anti-smoker, gets patted on the head and told ‘it’s probably that time of life -have you considered Relaxation Techniques?’
- backofanenvelope
July 1, 2014 at 11:14 am -
My 50 year-old daughter-in-law has cancer of the bladder. For two months her GP stone-walled her, even though she had some rather nasty effects to report and her father had died of cancer in his mid-sixties. It was only when she asked for another GP did her doctor refer her to a specialist. Within a week they had operated on her and given her a precautionary chem shot.
I would like to see a system where someone pops round and has a chat with her GP.
- Robert the Biker
July 2, 2014 at 6:11 am -
Perhaps a horses head in the bed is called for
“the Don is VERY UPSET”
- Robert the Biker
- Jonathan Mason
July 1, 2014 at 1:16 pm -
Medicine these days relies much more on computerized blood tests than it ever did back in the day. I think the first time I ever had a blood test in my life was when I was 45 years old, and yet my daughter who is not yet two years old has them done every time she goes to the doctor. The most common tests are the complete blood count and the chemical panel, though other tests like liver function tests and thyroid function tests may also be added in.These tests are the fundamental diagnostic tools of modern medicine.
Once the doctor gets the results, next day or sooner, the next stage is to account for any abnormal values. If they are suggestive of cancer or of some kind of major organ failure, then the next step would probably be referral for a major diagnostic scan such as a computerised tomography scan (CT scan) of the body or brain, kidneys, etc. These are very expensive, or at least the equipment is expensive, and it is possible that in the UK they can only be ordered by specialists like oncologists, not by GPs, I am not sure. There may be waiting lists for such scans in some parts of the UK.
But not following up in a timely fashion on abnormal results on the basic GP tests or on complaints of undiagnosed pain with further referrals IS inexcusable
- Oi you
July 1, 2014 at 4:49 pm -
A friend of mine has recently left the NHS, after 10 years working as a nurse. She would sympathise with Graeme above. The biggest pain for her was the stress of dealing with the general public and constantly being on the phone trying to rouse the attentions of a consultant. She is now working as a nanny with better pay and three nice children to look after. Okay, it’s not a fantastic career change and won’t last forever, but she is less stressed and happier as a result.
I’ve had good GPs and bad GPs like everyone else on here, so I won’t regale you with similar stories. But what pisses me off enormously is that the socialists always trot out the same mantra – that the NHS is the envy of the world. I don’t think it is, they are exaggerating as usual, but it is free at point of use, which is why the whole world comes here to use it.
- Jonathan Mason
July 1, 2014 at 5:02 pm -
… the NHS is the envy of the world
It probably IS the envy of the world among those populations who have to pay for health care or suffer and possibly die if they can’t afford to payy for things like antibiotics or anticonvulsants or childbirth with medical attendants. There is also a considerable advantage over countries like the US, that you know you can change your job any time, or even quit working, and not have to worry at all about getting health care. So, yes, that could create envy.
On the other hand if you can walk into a primary care practice as a new patient (i.e. medical history unknown to the care giver) complain of chest pain, and not get an ECG then and there, then, no it isn’t up to world standards. Not only would it not get out of its group in the World Cup of health care systems, it wouldn’t even qualify to get into a group in the first place.
- Jonathan Mason
- binao
July 1, 2014 at 5:45 pm -
About the only thing we can say about the nhs is that at least it’s there.
We can all come up with horror stories and unfavourable comparisons, but for most, there’s no alternative.
About 1,5 million employees, which means 1 in 20 of the uk workforce is employed by the nhs, plus who knows how many contractors. Which suggests that one of your neighbours may be on the payroll.
Having worked for a large company, the signs are sometimes there of what happens when you don’t have the drive & vigour of dedicated individuals making sure standards are met; making it firmly clear ‘how things are done here’. Ticking boxes it isn’t. And it’s not about money either.
Even so, it’s a very brave person that will propose a plan to make it perform better overall.
I suspect that’s always going to be a politician. - Cascadian
July 1, 2014 at 6:16 pm -
Jeremy Hunt is doing what politicians do best, playing to the uninformed crowd-“something must be done” he says “he will root out doctors that do not request timely diagnostic tests”. To both comments I say NOTHING will be done, and for good reason. First, there is a great shortage of the necessary expensive diagnostic tools and more importantly a dire shortage of qualified staff to operate the tools and then provide diagnosis, therefore refferals for tests will only create further problems. Second there is a dire shortage of even mediocre GP’s so nobody will be rooted out. In short Hunt is being disingenuous-surprise, surprise.
Thinking back on the landlady’s situation I believe I am correct in saying that her regular doctor was “guilty” of not finding her disease, the diagnosis didn’t occur until a young locum was seen-my point being that what doctors do, relies on great skill across a wide variety of diseases and ailments. Some are more skilled in various areas than others, your chances of matching up with the correct GP having the correct training for your specific disease may be purely a matter of luck. The landlady got lucky when her regular GP was absent.
As to the young woman who consulted the Royal Marsden, nothing could be clearer to me that the NHS is in the business of health rationing rather than a best outcome for the patient. (Perhaps that is understandable to a degree, though when one hears of tremendous waste providing boob-jobs and other lifestyle treatments, I despair). I hope she obtains the treatment that the landlady did from the French system.
An interesting discussion, improved by the comments of Peter Raite bringing his experience of working for the NHS to our attention.
- Peter Raite
July 2, 2014 at 12:27 am -
The truth about boob jobs et al on the NHS:
http://www.huffingtonpost.co.uk/dr-louise-irvine/jeremy-hunt-nhs_b_5504979.html?utm_hp_ref=tw
Finding that was a bit of a surprise, but only in as much as my path did cross with Dr Irvine occasionally through work.
The reality really is – like the press-beloved cliché of “benefits mansions” – that you only hear about the extreme exceptions precisely because they are extreme exceptions.
- Cascadian
July 2, 2014 at 7:14 am -
A survey of one, does not a trend make.
- Peter Raite
July 2, 2014 at 10:57 am -
No, but it establishes that there are already criteria for who should and who shouldn’t get plastic surgery on the NHS, and they rule out the exact sort of extreme exceptions that do occasionally slip through and because cause célèbre. Why else is it that it’s the same very small number of named individuals that get publicised over and over again?
- Cascadian
July 2, 2014 at 6:57 pm -
Lazy journalists probably.
Plenty of examples of pneumatically-assisted females with not much in the way of financial equity on council estates leads me to believe that the much vaunted screening process is pliable.
- Cascadian
- Peter Raite
- Cascadian
- Peter Raite
- Mudplugger
July 1, 2014 at 8:47 pm -
It is perhaps unfair to focus on the GP level, when this is only the entry-point to a vast and complex system. However, GPs do not help themselves, or us, by continuing quietly to ‘trade’ as private contractors to the NHS: even the salaried GPs don’t actually work for the NHS, they work for the private organisation (usually a ‘partnership’) which employs and pays them. Same goes for all the receptionists, nurses, phlebotomists etc. you may see at the local GP Surgery. The hysteria about the NHS becoming privatised always forgets that this key GP level has always been in the private sector since 1948 when it all began, indeed that was the vital carrot which had to be offered to persuade/bribe the then GPs to join in.
In one GP practice of my close knowledge, the ‘partners’ recently decided to employ an extra ‘salaried’ GP – great, you may think, more appointments for patients, less waiting, better attention, less pressure……. What actually happened was that the extra ‘salaried GP’ worked 5 days a week, meaning that the existing 5 ‘partners’, or the business owners to be accurate, could then all have a day off each week. Result, no more service provided, but apparently a greater number of GPs ‘in service’.
As long as this type of behaviour persists, the focus of the GP level will remain only on the comfort and personal revenues of the partners, configuring their ‘business’ for maximum ‘profit’ for annual distribution to the partners. The only hope on the horizon is if major corporate operators, such as Virgin, Tesco etc., could really get their act together and launch a nationwide, professional, GP Service, using only salaried ’employee’ GPs, who can then be properly developed and managed to deliver measured and monitored services to their registered patients. That approach is no more ‘private’ than the current partnership method but would at least offer a consistent base on which to compare, contrast and improve.
- Carol42
July 1, 2014 at 11:21 pm -
My old school GP thought my unexplained iron deficiency anaemia was worth further investigation, most would have prescribed iron and that would have been that. Thanks to him a early stage lung was found after a CT scan, surgery 4 years ago and fine so far but cancer presents in mainly strange diverse ways and it is just not possible to refer everyone . As with Anna it can be just a matter of luck that one Dr. notices something that most will not. I had no symptoms at all except tiredness due to the anaemia.
- Jonathan Mason
July 2, 2014 at 5:01 am -
That worked out well for you, but GPs should not “just prescribe iron and that would have been that”, because GPs should all have access to computerized diagnostic databases telling them what to rule out. If a post menopausal woman has iron deficiency anaemia and he has ruled out menstruation, or internal bleeding, or a deficient diet, or a problem absorbing iron, then he jolly well ought to rule out cancer, since it is known that cancer can lower iron levels, and not just prescribe iron. Yes, prescribing iron tablets might be necessary to bring up iron levels, though giving intravenous iron would probably be more effective, but not following up on the underlying cause would amount to medical negligence. Perhaps this is what the Minister was getting at.
It is not rocket science, just sound medicine.
- Carol42
July 2, 2014 at 12:27 pm -
That’s very interesting, about a year after the surgery they finally found the cause after a capsule endoscopy. There is possible laser treatment but as my iron levels are maintained with iron tablets I am alright for now. I don’t know whether the anaemia was related to the cancer but glad they found it.
- Cascadian
July 2, 2014 at 6:28 pm -
Glad to hear you are well Carol, but perhaps it is also time for a second opinion.
- Carol42
July 2, 2014 at 7:07 pm -
Not sure what you mean? Second opinion for what? It seems the laser surgery is potentially risky and, as long as my iron levels are ok it is best to stick to the tablets for now, I get regular blood tests. I am coming up to my 4 year CT scan and hopefully that is still clear. Please let me know if there is something I should seek a second opinion for? I would have no hesitation in seeking one if necessary.
- Carol42
- Cascadian
- Carol42
- Jonathan Mason
- suffolkgirl
July 1, 2014 at 11:28 pm -
In fact the exact opposite to Mudplugger’s analysis seems to be true. There is a shortage of GPS generally, but in particular there is a shortage of applicants to be partners. There is a real reluctance among doctors to take on management responsibilities, and I don’t See that privatising the lot will change this unless there is a better respect for senior. GPS and/or a big pay uplift for agreeing to be where the buck stops. Anyway, kudos to Anna for a very fair opinion piece.
- Ho Hum
July 1, 2014 at 11:48 pm -
Look, unless the people of this country are prepared to fund the real cost of the practise of defensive medicine, most of what is written here will remain the sort of wonderfully aspirational, and idealistic, fond hopes which are likely to remain amongst the last, unachievable, items on our bucket lists when we die
Even then, anyone pinning their hopes on their GP for a ticket for everlasting life is definitely going to be disappointed. As will whoever it was thought that you could maybe just hope to use any surplus of qualified medical staff, in the absence of their having any proper doctoring to do, as those both capable and competent to be managers of massive multi disciplinary, multi million pound organisations, by default. Laugh? I could have cried. Sure, some, yes, just as in any walk of life. But in real life you don’t appoint a sweetie shop owner to run BP, do you? Prime Minister. possibly, but not anything really important, surely?
And hence, looking at the original issue that engendered all this is concerned, as far as any, or maybe all, of our politicians’ involvement in that is to be considered, whoever (apologies for the failure to give proper credit) wrote the following just about sums it up in a nutshell, albeit I’m not certain if he or she really understood that when they wrote it
‘Pointing the finger of blame at someone else and playing the victim effectively upholds the ‘Nanny State’ by abolving the individual of all responsibility for his or her actions and reverting to an infantile mindset’
- Engineer
July 2, 2014 at 9:00 am -
“…capable and competent to be managers of massive multi disciplinary, multi million pound organisations…”
By definition, you don’t need many people like that. About one per NHS trust. You do however, need many hundreds of GP practice managers, local hospital managers and departmental managers, etc. – and people who can do what they’re managing generally make better managers. Would you, for example, appoint an arts graduate to manage the National Grid – or an engineer? Why should health provision be different?
- Moor Larkin
July 2, 2014 at 9:03 am -
Having seen the bloke who ran BP close up recently, I’m not sure I’d have trusted him in a sweetie-shop…..
Organisations are very peculiar things and it’s very hard to grasp what makes them fail. One of the biggest problems for the NHS remains it’s size however, if only in terms of it’s PR. If one bit is seen to fail, then the only edifice is criminalised in the newspapers. BP’s failure only ever threatened the existence of BP; the oil industry was never in any danger or disrepute.
- Engineer
- Engineer
July 3, 2014 at 8:11 am -
It’s maybe a tad late, given that the thread’s been up for a couple of days, but here’s a very concrete example of a medical provider – in this case an American hospital – learning from other areas of human endeavor to improve what it does.
Such methods have been commonplace in engineering organisations for a couple of decades. Very similar ideas have been in use in one area I know a bit about – the nuclear industry – for about thirty years, with very positive results. There’s a British Standard (BS ISO 9001) which sets out how to go about it. My solicitor has adopted it – with very positive results; their services are of a very high standard, and not excessively expensive.
People are more important than nuclear reprocessing plant, cars or engineering products. Don’t they deserve equally attentive improvements in the way they are dealt with?
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