Today I'm angry about.....

[Prufrock]

I've never once gone through the NHS online thingy and it say anything other than "go see your GP" or "go to A&E".

[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.

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."

Yeah, I don't think the suggestion was just do that straight away, there'd have to be changes to how pharmacies are run, but it seemed an interesting idea. The people there have the knowledge to do the job, the drugs are already there. Why not have it all in the same place.

[Worthy4England]

I think it's part of a decent enough idea and regardless of whether it's a Dr or Pharmacist or Practice Nurse etc. is the one that's most clearly gone AWOL. Unless there's something fairly clear in the nature of an illness (like "oh look my head's dropped off" - diagnosis "decapitated") then I reckon most stuff is around re-assurance and maybe some none controversial treatments like "get yerself two anadin and tuck up for 48 hours".

[Prufrock]

And a spot of Charlie snorted off the end of your AK47.

[Enoch]

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)

[Abdoulaye's Twin]

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)

[Enoch]

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)

Very brave.

[Abdoulaye's Twin]

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)

Very brave.

You've lost me. Why brave?

[jimbo]

So many responses. Where to start...?

Worthy - pay is certainly an issue. The main thing to realise is we are not asking for more money than we currently get. What we are wanting is the governments contract to distribute it slightly differently. Doctors contracts are hugely complex as you'd imagine - there's tens of thousands of us across the country working in different departments in different hospitals yet all bound by one contract. The rota will vary from job to job, department to department, hospital to hospital. That means that unsocial hours work will vary hugely between jobs. Currently we are paid a relatively low base rate for work within the hours of 7-7, mon-fri. Our wage is then supplemented up to 50% higher based on the number of shifts done outside of those times. The current offer appears to reduce the difference in pay between those working in 9-5 jobs and those working in specialities with a heavy burden of on calls. If doctor X is working a job where his hours are predominantly 4-12 through the week and working 12-12 every other weekend like my last job was, surely they deserve a premium over doctor Y who is working only in office hours and has his weekends and evenings free to enjoy family and social life? The incentive needs to be there for people to take up jobs in specialities like emergency medicine, otherwise we'd all become dermatologists.

Interesting points re GP/111/pharmacy and people attending A&E for trivial ailments. It's a bit of a pain, but in truth these people are triaged as low priority, will wait 4hrs to be seen if it's busy and take 10 minutes to sort out without causing too much stress for the clinician. The real problem is the number of frail elderly people with chronic disease coming in by ambulance. An old lady who falls and breaks her hip likely does so due to other medical conditions which need sorting as well and will take up a lot of time. She will then be admitted, operated on and then sit on a ward for weeks while social care is sorted out for her as her mobility is not what it was pre fall. Previously she could have gone to a community hospital while this happened, but these have all been closed down, and the cuts to social care make finding her extra support is near impossible. She has become what the government and media call a 'bed blocker'. She's nothing of the sort. She'd love to go home, but she is frail and elderly and needs the social care in place before it can happen. Until it's in place, she is indeed taking up a medical bed without having any acute medical needs, but has nowhere else safe to go. There are dozens of patients like this in every hospital.

My main problem with the way the last few months have played out is how badly the government have handled it. By using inflammatory language the doctors have responded and it's brought up all of the other underlying concerns that we were just getting along with. The relationship between a generation of doctors and the government is ruined, and people will move overseas. Already around 50% disappear off to do other things after FY2. Surely the government should be engaging with us more to try to prevent this rather than highlighting the growing disillusion in the profession.

Personally, I'm not sure what I'll do. In 18 months I'll hopefully be a fully qualified GP, my fiancé will in 2 1/2 yrs. We may as well see it through, but then there's nothing stopping us heading to the Southern Hemisphere and having the pick of jobs out there.

[jimbo]

http://www.independent.co.uk/voices/new ... 66946.html" onclick="window.open(this.href);return false;

Written by someone I trained with. Summarises the feelings among me and my colleagues pretty accurately.

[Worthy4England]

I'm with you that people doing all the unsociable hours should get the rewards. No question about it. The question is - should that be from a baseline that the Dr working 9-5 Monday to Friday is correctly remunerated or that they're "over remunerated" in comparison with the hours they do. I'm fairly sure the Govt would argue that the pot remains the same and that to fund more cash for the unsociable hours, they'd need to cut the pay of the folks doing 9-5. Then it starts to get personal between two Dr's that are actually on the same side of the argument...

The bit about bed blocking - clearly it's all fcked up.

I doubt you will get much change out of any Government that has set a financial target and is determined to meet it. The rights and wrongs of it are all to do with money - not whether or not you're skint and burnt out...You can have a constructive dialogue, but only if it's on the basis they want. The minute you challenge that premise - you're the baddies (allegedly)

[clapton is god]

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

This is the best explanation I've found:

Imagine you and your friends are all sat around a table eating chips.
Suddenly Jeremy Hunt comes along….
JH: Oooh, those chips looks nice, mind if I have a taste?
You: Er, okay I guess.
JH: Hmm, I’m not sure about these chips. I think I had better piss on them.
*unzips flies*
You: WTF?! NO! GET LOST.
JH: No really - I’m in the government, you can’t stop me.
You: If you come near these chips 98% of us are going to stab you with these forks.
JH: Okay, okay, fine. Let’s talk about this.
You: What’s there to talk about? Pissing on my chips is bloody stupid.
JH: I’ve read a paper that says that 11,000 people will die if you don’t let me piss on your chips. Chips taste 20% better with piss all over them. Come on, please let me piss on all of your chips?
You: What paper? That sounds like you just made it up!
JH: This paper here.
*produces paper, you read it*
You: No it doesn’t come to that conclusion; in fact the author in the paper specifically states that interpretation is misleading.
JH: What about the rest of you on this table, don’t listen to this guy, he is clearly a deranged militant and he is lying to you. So come on, don’t listen to him, you can trust me, pass me your plates so that I can piss on your chips.
Everyone: NO - GET LOST YOU LUNATIC!
*brandish fork at him*
JH: Those forks are completely unnecessary, my door is always open for negotiation:- How about I go to the chippy counter and get some more chips. You can each have 11% more chips, and in return I get to piss on them.
You: No, we already told you to get lost! Stop trying to piss on our chips!
JH: You drive a hard bargain, how about I only piss on half of the chips on your plate? The other half will be piss-free.
You: You’re still pissing on my chips, this is NOT a workable solution.
JH: Hold on I’ve got an idea How about I just piss on your plate. We’ll define chips that were there before the piss as being protected for up to three years.
You: But even if you define my chips as protected, will they still be sitting on my plate… in a pool of piss?
JH: Yes, you see isn’t that the best solution for all concerned?
You: No, because however you look at it I’m still getting piss-covered chips.
*the chip shop owner comes over*
Owner: Jeremy, how about you go to these customer toilets and use those while these nice people eat their chips in peace.
You: Finally someone who talks sense. Let's all agree to do that shall we?
JH: NO! I AM THE LAW!!!! I VETO THIS AGREEMENT! I must stick to my manifesto commitment for crispier cod in all chip shops by 2020.
Everyone else: WTF has crispy cod got to do with pissing on our chips?!
JH: 11,000 of 20% of 11% crispy cod piss-chips. That are a facts from serious robust research science!
(you notice a little bit of froth bubbling from Hunt's mouth as his eyes diverge somewhat)
You: That sentence doesn’t make the slightest bit of sense. And (sigh) what "research"?
JH: It hasn’t been published, but my mate told me about it so it must be the truth. Now that you’ve heard this overwhelming evidence you must understand why I need to piss on everyone’s chips.
Everyone: NO - GET LOST!
*Jeremy turns to the public*
JH: SEE? SEE! THEY ARE BEING TOTALLY UNREASONABLE! THEY JUST WON’T NEGOTIATE PROPERLY ON THIS. Time is running out, I need to impose piss on these chips before they go cold...

[jimbo]

The government wa curve their contract as offering 75% of us a pay rise while reducing our weekly hours. Sounds marvelous. The problem is they say this is to provide full 7 day care and will be cost neutral.

We're spread too thinly already. The new contract will just create more holes and will affect patient care. The thing about the money just makes no sense. Andrew Marr questioned Hunt on it last weekend and was just ignored.

[Worthy4England]

The government wa curve their contract as offering 75% of us a pay rise while reducing our weekly hours. Sounds marvelous. The problem is they say this is to provide full 7 day care and will be cost neutral.

We're spread too thinly already. The new contract will just create more holes and will affect patient care. The thing about the money just makes no sense. Andrew Marr questioned Hunt on it last weekend and was just ignored.

Aye just watched the Andrew Marr thing. Hunt didn't convince me - not for one minute.

[Prufrock]

The government wa curve their contract as offering 75% of us a pay rise while reducing our weekly hours. Sounds marvelous. The problem is they say this is to provide full 7 day care and will be cost neutral.

We're spread too thinly already. The new contract will just create more holes and will affect patient care. The thing about the money just makes no sense. Andrew Marr questioned Hunt on it last weekend and was just ignored.

Aye just watched the Andrew Marr thing. Hunt didn't convince me - not for one minute.

I thought this was interesting, Worthy: https://youtu.be/StTqXEQ2l-Y" onclick="window.open(this.href);return false;

[Worthy4England]

BAS%@☆D

[LeverEnd]

I've never once gone through the NHS online thingy and it say anything other than "go see your GP" or "go to A&E".

Or the GUM clinic, after scrubbing it with bleach.

[Harry Genshaw]

Furious may be a better word. I've been dealing with an elderly, vulnerable chap through work who was moved to supported accommodation after a couple of local scrotes were duping him out of his money to pay for their drugs. He's been in his new home for a few weeks and has settled in well. This morning I was alerted to a report of someone unsavoury hanging around the entrance to this scheme and when I get there it turns out it's one of these scumbags who've found out where he's moved to. Wednesday is the day this chap gets his pension. The sheer brass neck of this chap who was initially refusing to leave because he "needed to speak to his 'mate'"

[Lord Kangana]

I'm sorry to say this jimbo, but I'm afraid you are up against an immovable ideology. You and your colleagues leaving is something they'll either not give a shit about, or frankly be happy about.

We are in the early death throes of the NHS. Of course, no government wants it on their CV, so they'll make it look like it's f*cked itself. And they're doing a pretty good stitch up job.

[Hoboh]

I'm sorry to say this jimbo, but I'm afraid you are up against an immovable ideology. You and your colleagues leaving is something they'll either not give a shit about, or frankly be happy about.

We are in the early death throes of the NHS. Of course, no government wants it on their CV, so they'll make it look like it's f*cked itself. And they're doing a pretty good stitch up job.

I disagree, neither Hunt nor bacon dick will ever convince the majority of the public Doctors are bad!
One serious illness and most private shit goes out the door, example, the Beaumont, you will be hard pressed to find any GP who would recommend any mild let alone serious procedures there due to lack of emergency care facilities.