Today I'm angry about.....

[Prufrock]

[jimbo]

This morning I'm angry, sad and worried about the future all at the same time. I've tried to avoid banging on about the current junior doctor contract issues for a number of reasons as the idea of striking still sits very awkwardly with me. That said, things seem to have reached a critical point where a new contract will be enforced whether we agree to it or not this August.

We currently have a government with seemingly no idea about the work currently being done by junior doctors across the country. Instead, they use media spin and lies in their attempts to create a 'seven day NHS'. What even is a seven day NHS? No one from the government has actually answered this question. Currently junior doctors work between 1 in 2 and 1 in 4 weekends and regular night shifts through the week providing high quality emergency care. If you are admitted as an emergency at 2am on a Sunday morning you'll get pretty much the same care as on a Tuesday afternoon. If you need it, the doctors, nurses, radiographers, midwives, theatre staff, porters are all there to pull together and save your life 24 hours a day, 7 days a week. How different will the new 7 day NHS be? How different does it actually need to be?

One of the saddest things is how we're being misrepresented in the media. None of us begrudge working weekends. We already do it. News stories along the lines of us being a barrier to seven day working are simply lies. Nor do we want more money. I'll be honest and say that we aren't badly off compared to most our age. Unlike most our age my fiancé and I have over £100k of student debt between us. We have continuing expenses for our careers. This year I'll spend about £2000 on professional fees - insurance, gmc registration etc. I'll also have to pay another £1700 to sit an exam with a 50% pass rate later in the year. Despite that, we don't want more money. We want more doctors. Rotas are dreadfully understaffed - my fiancé last year on a rota designed for 5 people covering the shifts. 3 of the slots were empty which left her and her colleague plugging the holes for 4 months. It nearly broke them, yet nothing was done to recruit extra staff. With 'seven day working' surely the current scarce resource of junior doctors are going to be spread even more thinly?

It upsets me how the government accuse us of being strung along by the BMA, buying their lies. Junior doctors are people who have been trained for years and learned to independently analyse and critque the evidence before them. That in itself is the basis of clinical practice. The notion that we would be so gullible and easily misled is again such a gross misunderstanding.

And so to the contract imposition - the NHS are a monopoly employer. They know we can't work for anyone else without leaving the country. By imposing a contract against the wishes of a whole workforce will just damage morale further. It will stretch resources even more thinly which will lead to increased burnout, stress, and mistakes. The pressure on young doctors is greater than ever already. More support, not less, is needed. What happens to the NHS when the older generation of doctors retire and the current juniors have grown disillusioned with the profession and moved abroad or left altogether?

I apologise if this is awfully rambling or incredibly dull - I'm at the end of yet another night shift and a little worn out both physically and mentally. There's a lot more a could say about this and probably a lot I've forgotten to say. My main issue this morning is the feeling of hopelessness as I look to the future. It feels very bleak indeed.

[thebish]

[Abdoulaye's Twin]

I think you've the support of most right minded folk Jimbo. Stand up for what is right - I believe and trust doctors far more than any politician.

[BWFC_Insane]

This morning I'm angry, sad and worried about the future all at the same time. I've tried to avoid banging on about the current junior doctor contract issues for a number of reasons as the idea of striking still sits very awkwardly with me. That said, things seem to have reached a critical point where a new contract will be enforced whether we agree to it or not this August.

We currently have a government with seemingly no idea about the work currently being done by junior doctors across the country. Instead, they use media spin and lies in their attempts to create a 'seven day NHS'. What even is a seven day NHS? No one from the government has actually answered this question. Currently junior doctors work between 1 in 2 and 1 in 4 weekends and regular night shifts through the week providing high quality emergency care. If you are admitted as an emergency at 2am on a Sunday morning you'll get pretty much the same care as on a Tuesday afternoon. If you need it, the doctors, nurses, radiographers, midwives, theatre staff, porters are all there to pull together and save your life 24 hours a day, 7 days a week. How different will the new 7 day NHS be? How different does it actually need to be?

One of the saddest things is how we're being misrepresented in the media. None of us begrudge working weekends. We already do it. News stories along the lines of us being a barrier to seven day working are simply lies. Nor do we want more money. I'll be honest and say that we aren't badly off compared to most our age. Unlike most our age my fiancé and I have over £100k of student debt between us. We have continuing expenses for our careers. This year I'll spend about £2000 on professional fees - insurance, gmc registration etc. I'll also have to pay another £1700 to sit an exam with a 50% pass rate later in the year. Despite that, we don't want more money. We want more doctors. Rotas are dreadfully understaffed - my fiancé last year on a rota designed for 5 people covering the shifts. 3 of the slots were empty which left her and her colleague plugging the holes for 4 months. It nearly broke them, yet nothing was done to recruit extra staff. With 'seven day working' surely the current scarce resource of junior doctors are going to be spread even more thinly?

It upsets me how the government accuse us of being strung along by the BMA, buying their lies. Junior doctors are people who have been trained for years and learned to independently analyse and critque the evidence before them. That in itself is the basis of clinical practice. The notion that we would be so gullible and easily misled is again such a gross misunderstanding.

And so to the contract imposition - the NHS are a monopoly employer. They know we can't work for anyone else without leaving the country. By imposing a contract against the wishes of a whole workforce will just damage morale further. It will stretch resources even more thinly which will lead to increased burnout, stress, and mistakes. The pressure on young doctors is greater than ever already. More support, not less, is needed. What happens to the NHS when the older generation of doctors retire and the current juniors have grown disillusioned with the profession and moved abroad or left altogether?

I apologise if this is awfully rambling or incredibly dull - I'm at the end of yet another night shift and a little worn out both physically and mentally. There's a lot more a could say about this and probably a lot I've forgotten to say. My main issue this morning is the feeling of hopelessness as I look to the future. It feels very bleak indeed.

Great post and I'm sorry that you feel so hopeless. As above I'm sure most people who can engage their brain are totally behind the junior doctors and totally understand where they are coming from.

The Tories of the 80's seemed hell bent on destroying British industry. Now this latest incarnation of the Tory party seems hell bent on destroying the NHS and public services. It makes me incredibly sad, and a bit angry to see what is happening. The manipulation via the media is also particularly galling.

[Beefheart]

Recently spent a couple of days in hospital. From overhearing conversations it was obvious that staff were struggling but it certainly wasn't noticeable from the patients point of view, which is a testament to them. I was surprised to keep seeing the same faces though, they must have been putting in a lot of shifts.

[Worthy4England]

This morning I'm angry, sad and worried about the future all at the same time. I've tried to avoid banging on about the current junior doctor contract issues for a number of reasons as the idea of striking still sits very awkwardly with me. That said, things seem to have reached a critical point where a new contract will be enforced whether we agree to it or not this August.

We currently have a government with seemingly no idea about the work currently being done by junior doctors across the country. Instead, they use media spin and lies in their attempts to create a 'seven day NHS'. What even is a seven day NHS? No one from the government has actually answered this question. Currently junior doctors work between 1 in 2 and 1 in 4 weekends and regular night shifts through the week providing high quality emergency care. If you are admitted as an emergency at 2am on a Sunday morning you'll get pretty much the same care as on a Tuesday afternoon. If you need it, the doctors, nurses, radiographers, midwives, theatre staff, porters are all there to pull together and save your life 24 hours a day, 7 days a week. How different will the new 7 day NHS be? How different does it actually need to be?

One of the saddest things is how we're being misrepresented in the media. None of us begrudge working weekends. We already do it. News stories along the lines of us being a barrier to seven day working are simply lies. Nor do we want more money. I'll be honest and say that we aren't badly off compared to most our age. Unlike most our age my fiancé and I have over £100k of student debt between us. We have continuing expenses for our careers. This year I'll spend about £2000 on professional fees - insurance, gmc registration etc. I'll also have to pay another £1700 to sit an exam with a 50% pass rate later in the year. Despite that, we don't want more money. We want more doctors. Rotas are dreadfully understaffed - my fiancé last year on a rota designed for 5 people covering the shifts. 3 of the slots were empty which left her and her colleague plugging the holes for 4 months. It nearly broke them, yet nothing was done to recruit extra staff. With 'seven day working' surely the current scarce resource of junior doctors are going to be spread even more thinly?

It upsets me how the government accuse us of being strung along by the BMA, buying their lies. Junior doctors are people who have been trained for years and learned to independently analyse and critque the evidence before them. That in itself is the basis of clinical practice. The notion that we would be so gullible and easily misled is again such a gross misunderstanding.

And so to the contract imposition - the NHS are a monopoly employer. They know we can't work for anyone else without leaving the country. By imposing a contract against the wishes of a whole workforce will just damage morale further. It will stretch resources even more thinly which will lead to increased burnout, stress, and mistakes. The pressure on young doctors is greater than ever already. More support, not less, is needed. What happens to the NHS when the older generation of doctors retire and the current juniors have grown disillusioned with the profession and moved abroad or left altogether?

I apologise if this is awfully rambling or incredibly dull - I'm at the end of yet another night shift and a little worn out both physically and mentally. There's a lot more a could say about this and probably a lot I've forgotten to say. My main issue this morning is the feeling of hopelessness as I look to the future. It feels very bleak indeed.

I have to ask, not being that close to it - if the "new" Contracts are not going to change anything much, because there is already a 7 day NHS - what's the underlying problem? I think the notion that the working week, for many, runs Monday to Friday is one that's long past in many areas of working - certainly in my business and I generally see that reflected in NHS, like you say. Someone needs admission on Saturday or Sunday they get it.

I thought at its core, it was pretty much ALL about pay, as it relates to the working week and unsocial hours payments (that might be just good spin as you say)? If for example the offer was "here's a flat salary per hour across a 7 day week", but we'll now recruit more doctors, would that work or actually be possible?

I am much more concerned about the burnout problem as a user of the service, it's clearly not a profession where making the odd cock-ups here and there (as some of our teams do when they've been working through until 04:00 from 08:00 the previous day) - as the saying goes "nobody died". So that's a real problem for me - if I was admitted at 03:00 on a Saturday, I'd expect the same decision making to go on as if it was midday on a Wednesday. The reality is that giving extra money to people to work those timeslots doesn't help their decision making if it's come on the back of a 90 hour week.

So is the Doctor's contention here that effectively they want the same pay for less hours than currently? I know from a friend or ours who's a Nurse the shifts she has to do to make ends meet (and I know the decision making is a notch down from Doctors), but she actually works the graveyard shifts because they pay more money.

I'm genuinely a bit lost on what the problem is.

I hear what you're saying on University debt - we should scrap it IMHO - but that said there isn't only Doctors that'll come out with £50k debt a piece and still need Professional fees on top.

[Hoboh]

This morning I'm angry, sad and worried about the future all at the same time. I've tried to avoid banging on about the current junior doctor contract issues for a number of reasons as the idea of striking still sits very awkwardly with me. That said, things seem to have reached a critical point where a new contract will be enforced whether we agree to it or not this August.

We currently have a government with seemingly no idea about the work currently being done by junior doctors across the country. Instead, they use media spin and lies in their attempts to create a 'seven day NHS'. What even is a seven day NHS? No one from the government has actually answered this question. Currently junior doctors work between 1 in 2 and 1 in 4 weekends and regular night shifts through the week providing high quality emergency care. If you are admitted as an emergency at 2am on a Sunday morning you'll get pretty much the same care as on a Tuesday afternoon. If you need it, the doctors, nurses, radiographers, midwives, theatre staff, porters are all there to pull together and save your life 24 hours a day, 7 days a week. How different will the new 7 day NHS be? How different does it actually need to be?

One of the saddest things is how we're being misrepresented in the media. None of us begrudge working weekends. We already do it. News stories along the lines of us being a barrier to seven day working are simply lies. Nor do we want more money. I'll be honest and say that we aren't badly off compared to most our age. Unlike most our age my fiancé and I have over £100k of student debt between us. We have continuing expenses for our careers. This year I'll spend about £2000 on professional fees - insurance, gmc registration etc. I'll also have to pay another £1700 to sit an exam with a 50% pass rate later in the year. Despite that, we don't want more money. We want more doctors. Rotas are dreadfully understaffed - my fiancé last year on a rota designed for 5 people covering the shifts. 3 of the slots were empty which left her and her colleague plugging the holes for 4 months. It nearly broke them, yet nothing was done to recruit extra staff. With 'seven day working' surely the current scarce resource of junior doctors are going to be spread even more thinly?

It upsets me how the government accuse us of being strung along by the BMA, buying their lies. Junior doctors are people who have been trained for years and learned to independently analyse and critque the evidence before them. That in itself is the basis of clinical practice. The notion that we would be so gullible and easily misled is again such a gross misunderstanding.

And so to the contract imposition - the NHS are a monopoly employer. They know we can't work for anyone else without leaving the country. By imposing a contract against the wishes of a whole workforce will just damage morale further. It will stretch resources even more thinly which will lead to increased burnout, stress, and mistakes. The pressure on young doctors is greater than ever already. More support, not less, is needed. What happens to the NHS when the older generation of doctors retire and the current juniors have grown disillusioned with the profession and moved abroad or left altogether?

I apologise if this is awfully rambling or incredibly dull - I'm at the end of yet another night shift and a little worn out both physically and mentally. There's a lot more a could say about this and probably a lot I've forgotten to say. My main issue this morning is the feeling of hopelessness as I look to the future. It feels very bleak indeed.

I fully support the doctors, one thing I would like is the removal of the term 'junior doctor', it is very misleading.
Of course this is all about money, does anyone seriously think that Hunt and his crew genuinely have the patients interest at heart?
I had personal experience, this week, of one of the faults the NHS suffers from and would like these things addressed first and foremost.

[Worthy4England]

I fully support the doctors, one thing I would like is the removal of the term 'junior doctor', it is very misleading.
Of course this is all about money, does anyone seriously think that Hunt and his crew genuinely have the patients interest at heart?
I had personal experience, this week, of one of the faults the NHS suffers from and would like these things addressed first and foremost.

At last we've found something to agree on. I've been advocating an increase in the mental health budget for years.

[Hoboh]

I fully support the doctors, one thing I would like is the removal of the term 'junior doctor', it is very misleading.
Of course this is all about money, does anyone seriously think that Hunt and his crew genuinely have the patients interest at heart?
I had personal experience, this week, of one of the faults the NHS suffers from and would like these things addressed first and foremost.

At last we've found something to agree on. I've been advocating an increase in the mental health budget for years.

Cheeky!

Truth is, why would you block a bed for 4-5 hours holding up a patient discharge, on a normal weekday, because you are waiting for prescriptions to come from the pharmacy? Now this happened with four beds on that ward and when asked about the delay I was told it was 'normal'.
Hang on says I, so I can book a holiday to overseas, pick my flight, seat on the plane, room in the hotel, airport parking and any other extras or services, as well as book in certain cases a visa in less time than to get a prescription from 'downstairs'?
'Kin ell!

[Abdoulaye's Twin]

From my understanding they intend to beef up the staffing at weekends/nights but not put any extra resources in. Meaning either longer hours or thinning the weekday service. Robbing Peter to pay Paul is only going to worsen outcomes surely?

[Worthy4England]

I fully support the doctors, one thing I would like is the removal of the term 'junior doctor', it is very misleading.
Of course this is all about money, does anyone seriously think that Hunt and his crew genuinely have the patients interest at heart?
I had personal experience, this week, of one of the faults the NHS suffers from and would like these things addressed first and foremost.

At last we've found something to agree on. I've been advocating an increase in the mental health budget for years.

Cheeky!

Truth is, why would you block a bed for 4-5 hours holding up a patient discharge, on a normal weekday, because you are waiting for prescriptions to come from the pharmacy? Now this happened with four beds on that ward and when asked about the delay I was told it was 'normal'.
Hang on says I, so I can book a holiday to overseas, pick my flight, seat on the plane, room in the hotel, airport parking and any other extras or services, as well as book in certain cases a visa in less time than to get a prescription from 'downstairs'?
'Kin ell!

Aye that's one of the big mysteries - hospital discharge day. Wake up 06:00 - get out 18:00...(even if you can go get the prescription yourself from the pharmacy).
I got that bored once, I removed my cannula's - that went well and I was soundly applauded as they mopped up the blood.

[Worthy4England]

From my understanding they intend to beef up the staffing at weekends/nights but not put any extra resources in. Meaning either longer hours or thinning the weekday service. Robbing Peter to pay Paul is only going to worsen outcomes surely?

I'd agree absolutely. I'm not against the Dr's striking - they usually know when it's not working. I just hadn't followed it closely enough to know what it was about.

I think there's a lot that's fcked to be honest. When you look at it outside of hospital too. The GP service isn't anything like as comprehensive as when I was a kid in terms of hours they cover etc, so stuff that would have been handled by a GP during the wee hours now necessitates a hospital visit and or ambulance to boot - putting more pressure on. NHS direct generally come to the same conclusions you could find yourself on the internet. People who don't need a hospital bed - but still need some sort of "supervised bed" can't get one as that's now down to councils, so they're stuck in a hospital bed they don't need clogging it up. It just seems to be that the frontline staff are providing a sterling service in spite of everything rather than because of it.

[Abdoulaye's Twin]

I'd agree absolutely. I'm not against the Dr's striking - they usually know when it's not working. I just hadn't followed it closely enough to know what it was about.

I think there's a lot that's fcked to be honest. When you look at it outside of hospital too. The GP service isn't anything like as comprehensive as when I was a kid in terms of hours they cover etc, so stuff that would have been handled by a GP during the wee hours now necessitates a hospital visit and or ambulance to boot - putting more pressure on. NHS direct generally come to the same conclusions you could find yourself on the internet. People who don't need a hospital bed - but still need some sort of "supervised bed" can't get one as that's now down to councils, so they're stuck in a hospital bed they don't need clogging it up. It just seems to be that the frontline staff are providing a sterling service in spite of everything rather than because of it.

I think the concept of GPs is a bit antiquated now. Patient records should be instantly available to any GP from a central system (with appropriate security etc), allowing me to go to any NHS hospital, GP, minor injuries or walk in centre to suit my ailment and location. As it stands many can't get an appointment with their GP either for weeks, or they do that no appointments and phone on the morning. This must be pushing lots of people to A&E. I also think the targets etc have turned patients in to customers and in turn given a sense of entitlement. The fragmented nature of mental health, social care and hospitals doesn't help as you say. I think it's time to look at the NHS again and work out a new structure that finds a better balance between provision and cost - it'll never happen though. Too many politicians with short term thinking to either stay in power or get into power.

[Hoboh]

http://bakingjames.co.uk/7-day-nhs-a-hu ... e-doctors/" onclick="window.open(this.href);return false;

Hope this helps.

[Worthy4England]

I'd agree absolutely. I'm not against the Dr's striking - they usually know when it's not working. I just hadn't followed it closely enough to know what it was about.

I think there's a lot that's fcked to be honest. When you look at it outside of hospital too. The GP service isn't anything like as comprehensive as when I was a kid in terms of hours they cover etc, so stuff that would have been handled by a GP during the wee hours now necessitates a hospital visit and or ambulance to boot - putting more pressure on. NHS direct generally come to the same conclusions you could find yourself on the internet. People who don't need a hospital bed - but still need some sort of "supervised bed" can't get one as that's now down to councils, so they're stuck in a hospital bed they don't need clogging it up. It just seems to be that the frontline staff are providing a sterling service in spite of everything rather than because of it.

I think the concept of GPs is a bit antiquated now. Patient records should be instantly available to any GP from a central system (with appropriate security etc), allowing me to go to any NHS hospital, GP, minor injuries or walk in centre to suit my ailment and location. As it stands many can't get an appointment with their GP either for weeks, or they do that no appointments and phone on the morning. This must be pushing lots of people to A&E. I also think the targets etc have turned patients in to customers and in turn given a sense of entitlement. The fragmented nature of mental health, social care and hospitals doesn't help as you say. I think it's time to look at the NHS again and work out a new structure that finds a better balance between provision and cost - it'll never happen though. Too many politicians with short term thinking to either stay in power or get into power.

Agree other than the bit about GP's being antiquated. And agree about the centralisation of records - although we've all seen what a failure that's been. I guess the point I was making about the GP Service is that it used to act as a triage point for most of the stuff that clearly isn't an accident or an emergency, but nonetheless worrying for the individual. I suppose I'm thinking things like my baby's running a temperature type stuff. Dr used to pop out, dispense calpol or whatever - really important bit reassure the mum/dad that it's not meningitis etc. - no visit to A&E needed. Surely that type of service has to be run a) better than NHS direct - whose natural default has to be cautious as they can't actually see the patient they're dealing with so they flirt them off to A&E and b) more cost efficient than having all those folks using it clogging up ambulances and/or A&E? The out of hours services outside of A&E are akin to zero.

[Prufrock]

I'd agree absolutely. I'm not against the Dr's striking - they usually know when it's not working. I just hadn't followed it closely enough to know what it was about.

I think there's a lot that's fcked to be honest. When you look at it outside of hospital too. The GP service isn't anything like as comprehensive as when I was a kid in terms of hours they cover etc, so stuff that would have been handled by a GP during the wee hours now necessitates a hospital visit and or ambulance to boot - putting more pressure on. NHS direct generally come to the same conclusions you could find yourself on the internet. People who don't need a hospital bed - but still need some sort of "supervised bed" can't get one as that's now down to councils, so they're stuck in a hospital bed they don't need clogging it up. It just seems to be that the frontline staff are providing a sterling service in spite of everything rather than because of it.

I think the concept of GPs is a bit antiquated now. Patient records should be instantly available to any GP from a central system (with appropriate security etc), allowing me to go to any NHS hospital, GP, minor injuries or walk in centre to suit my ailment and location. As it stands many can't get an appointment with their GP either for weeks, or they do that no appointments and phone on the morning. This must be pushing lots of people to A&E. I also think the targets etc have turned patients in to customers and in turn given a sense of entitlement. The fragmented nature of mental health, social care and hospitals doesn't help as you say. I think it's time to look at the NHS again and work out a new structure that finds a better balance between provision and cost - it'll never happen though. Too many politicians with short term thinking to either stay in power or get into power.

Agree other than the bit about GP's being antiquated. And agree about the centralisation of records - although we've all seen what a failure that's been. I guess the point I was making about the GP Service is that it used to act as a triage point for most of the stuff that clearly isn't an accident or an emergency, but nonetheless worrying for the individual. I suppose I'm thinking things like my baby's running a temperature type stuff. Dr used to pop out, dispense calpol or whatever - really important bit reassure the mum/dad that it's not meningitis etc. - no visit to A&E needed. Surely that type of service has to be run a) better than NHS direct - whose natural default has to be cautious as they can't actually see the patient they're dealing with so they flirt them off to A&E and b) more cost efficient than having all those folks using it clogging up ambulances and/or A&E? The out of hours services outside of A&E are akin to zero.

Not that I'm advocating the American system generally, but I read an article the other day about how they let pharmacies do all that sort of stuff^. The article claimed that most pharmacists are more than qualified to do it and so advocated us moving towards just having walk-in clinics. I have a GP near home, but it's impossible to get an appointment that fits around work. Instead I went to a drop-in clinic. Walked in first thing, they said come back at 12. Took an early lunch, in and out in 15 mins. Appreciate it's unlikely to be that simple overall, but worth looking at IMO.

As for the junior doctors, they have my full support. All those who work in Legal Aid are well-versed in the bullshit this govt is capable of when it comes to pushing through its cuts. If they haven't already they'll soon be dropping hints about how much time consultants spend on the golf course.

Another interesting side to it is that I read the other day that Canada and Australia are desperate for doctors, and the salaries and quality of life on offer are staggering. Wouldn't surprise me if many of the junior doctors are casting glances in those directions.

[Worthy4England]

http://bakingjames.co.uk/7-day-nhs-a-hu ... e-doctors/

Hope this helps.

Yeah it does thanks. So it is about pay - that's fine - I get it now.

I would take issue with a point that's raised in the article. Our grads (in my bit of the tech industry) aren't getting £34k per annum. Nor are they working less than 48 hours per week generally including working outside a 7 till 7 timeslot and weekends. They don't get an option of overtime/increased salaries for working unsocial hours, they get what they get. I wouldn't want to bring everything down to its lowest common denominator, but that bit's not correct. If anyone in our industry thinks they're going to work under 48 hours a week, then they're smoking shit - not advocating that this should happen, just observing that it does.

[BWFC_Insane]

I'm not entirely sure what the notion of a 24 hour NHS means. We have emergency care available 24 hours. What more do we actually want? The evidence that outcomes are worse at evenings and weekends may well be true but I'd suggest that there could be a large multitude of factors behind that. Is the idea that the NHS is an equivalent service 24 hours of the time? Because whilst that may be a nice to have, you have to pay for it. And what does it mean? Operations running 24 hours a day?

The problem as I see it is that there is 24 hour walk in centres (not everywhere of course but most have fairly reasonable access) but people tend to go to A&E (which is more expensive) rather than use them. This puts pressures on hospitals, pressure on wider budgets (since A&E is astronomically more expensive) and pressure on the whole system. That was the initial idea behind the NHS Direct thing, have a triage phone call that can get people to the right place. The problem was it just increased demand as more people rang up, described symptoms that could not be ignored and then were (as you would do if unsure) directed to a walk in centre, A&E or even a GP call out arranged. In principle this should have alleviated some pressures by a first point triage system but instead just increased demand on the system. Joe Bloggs might have felt dreadful at 1 in the morning, and like he was dying but before he was faced with the choice of a) taking himself to A&E or similar, b) calling an ambulance, c) waiting it out and seeing how he felt the next day then going to GP etc....

Many would have chosen c) and that was the end of it. But now he has a number to ring and as he describes or exaggerates his symptoms somewhat the nurse or healthcare practitioner on the other end has to make a call. Would you risk it if you had doubt?

In some ways we are our own worst enemy. Years ago it was generally frowned upon for folk to go to their GP's with minor ailments and the like. You were expected to tough it out and not bother the healthservice until things got bad. Then the focus shifted to early intervention and prevention. Folk are constantly being invited in for healthchecks and shown leaflets that tell them to seek immediate advice if they have certain symptoms. Whilst the idea of this is prevention and ultimately reducing cost, what these things also do is create demand and expectation. Panicked parents take their new offspring in at the drop of a hat now. But can you blame them when they are given education that warns about every little sign of a problem?

This is of course a fairly small problem relative to the swathing cuts within social care and the impacts that has on the service, aligned to the fact we mostly live longer and expect to do so in better health.

[Worthy4England]

I'd agree absolutely. I'm not against the Dr's striking - they usually know when it's not working. I just hadn't followed it closely enough to know what it was about.

I think there's a lot that's fcked to be honest. When you look at it outside of hospital too. The GP service isn't anything like as comprehensive as when I was a kid in terms of hours they cover etc, so stuff that would have been handled by a GP during the wee hours now necessitates a hospital visit and or ambulance to boot - putting more pressure on. NHS direct generally come to the same conclusions you could find yourself on the internet. People who don't need a hospital bed - but still need some sort of "supervised bed" can't get one as that's now down to councils, so they're stuck in a hospital bed they don't need clogging it up. It just seems to be that the frontline staff are providing a sterling service in spite of everything rather than because of it.

I think the concept of GPs is a bit antiquated now. Patient records should be instantly available to any GP from a central system (with appropriate security etc), allowing me to go to any NHS hospital, GP, minor injuries or walk in centre to suit my ailment and location. As it stands many can't get an appointment with their GP either for weeks, or they do that no appointments and phone on the morning. This must be pushing lots of people to A&E. I also think the targets etc have turned patients in to customers and in turn given a sense of entitlement. The fragmented nature of mental health, social care and hospitals doesn't help as you say. I think it's time to look at the NHS again and work out a new structure that finds a better balance between provision and cost - it'll never happen though. Too many politicians with short term thinking to either stay in power or get into power.

Agree other than the bit about GP's being antiquated. And agree about the centralisation of records - although we've all seen what a failure that's been. I guess the point I was making about the GP Service is that it used to act as a triage point for most of the stuff that clearly isn't an accident or an emergency, but nonetheless worrying for the individual. I suppose I'm thinking things like my baby's running a temperature type stuff. Dr used to pop out, dispense calpol or whatever - really important bit reassure the mum/dad that it's not meningitis etc. - no visit to A&E needed. Surely that type of service has to be run a) better than NHS direct - whose natural default has to be cautious as they can't actually see the patient they're dealing with so they flirt them off to A&E and b) more cost efficient than having all those folks using it clogging up ambulances and/or A&E? The out of hours services outside of A&E are akin to zero.

Not that I'm advocating the American system generally, but I read an article the other day about how they let pharmacies do all that sort of stuff^. The article claimed that most pharmacists are more than qualified to do it and so advocated us moving towards just having walk-in clinics. I have a GP near home, but it's impossible to get an appointment that fits around work. Instead I went to a drop-in clinic. Walked in first thing, they said come back at 12. Took an early lunch, in and out in 15 mins. Appreciate it's unlikely to be that simple overall, but worth looking at IMO.

As for the junior doctors, they have my full support. All those who work in Legal Aid are well-versed in the bullshit this govt is capable of when it comes to pushing through its cuts. If they haven't already they'll soon be dropping hints about how much time consultants spend on the golf course.

Another interesting side to it is that I read the other day that Canada and Australia are desperate for doctors, and the salaries and quality of life on offer are staggering. Wouldn't surprise me if many of the junior doctors are casting glances in those directions.

Problem with the pharmacy approach as I see it is their "don't sue me" defensive nature in the UK. Last year I tried to buy two - we're heading into the realms of hard drugs here - packets of Lemsip. No bugger actually had a cold/flu but we were heading into the Christmas break and you can bet your ass at least one of the people round at our gaff would get some sorta heavy cold. I got 20 questions on the nature of the illness that was being treated. To which I replied "none yet". The fcuking rigmarole was unbelievable. Pharmacist was called - to talk to me (as someone twice his fcking age) and eventually they decided that I could buy two packets of Lemsip. US pharma worked different when I was there last year - generally more along the lines of "Would Sir like some Charlie and an AK47 with that? Have a nice day."