Ah so another tale from a patient
Letter from GP telling her that she cannot register with their surgery, as she is "outside their catchment area"
Which since they are the second nearest GP means that she has NO CHOICE WHATSOEVER IN WHICH GP SHE GETS
Don't you just love the NHS?
So much competition for the providers, the GPs in this case, (err none at all) and so much choice for the customers (err none)
So there you have it in Browns Britain you have no choice of GP, you just get the one the apparatchiks at the PCT and their wombling GPs impose
All the easier for the crap GPs to continue for evermore
Like the schools in this country we only have choice if we are prepared to, and can afford to, move address
Shambles
31 comments:
Agree no one. Read the post I put on the runt site as I am sure he will delete. There is a new concept in GP clinics that ill, i think, place runt and those of his persuasion in the place they belong. Working in the worst of our medical centres that are places of last resort. The current "list" system allows GP's to control patients, the new concept in London make the patient the consumer, doctors must provide good services or find a new profession. The tide is turning slowly.
The runt post:
nice side step. I won't answer you because an annon didn't answer me. Why? Because the only data out there around outcomes states that we have some of the worst outcomes in Europe.
Despite the copious amounts of ink spilled on this site ranting about Darzi, the GMC, Brown, Johnson, and just about everyone else, the only real issue is ignored with great precession. Why do we have some of the worst outcomes in Europe. our hospitals in most cases are about as good as those in Poland where they spend 4.5% on healthcare and doctors are paid far less, our doctors (you have told me this many times) are the "best" in the world even though you offer no proof of this assertion. And yet when a lowly "troll" asks a very serious question "why are our outcomes worse than most other Eurpoean nations including the new eastern block members?" You never answer the question.
If someone, given this fact, argues that maybe the doctors have just as much if not more responsibility for this situation since they actually TREAT the patient. The answer is always, must be a labour plant, intellect is inferior, off his meds, doesn't know what he is talking about.
In the final analysis the "inconsistencies" you mention are inconsequential. The fact people are dying because you want an easy life and no interference from the government, the people who pay you, and are therefore ignoring the compelling evidence that you need to reform along with the health service is.
No doubt I will now be called a troll and deleted and ignored for daring to suggest that, as the key structural enabler in healthcare that you and your intransigent, sometimes ignorant stance is killing patients, and has as much to do with the current unspeakable state of the health service as politicians, patients who want good care, and anyone else who pays your salary.
Fortunately, I attended a talk recently where a firm presented a new concept where people can pay a monthly fee to access their GP when they want and as often as they want. They have 5 clinics and have plans to open a further 10 in London. Rant will say "bring it on, more money for me". Since he and the rest of you are too busy fighting your idealistic little war here and in the NHS unfortunately GP's who want to put the patient first will be the only ones benefitting from this I suspect.
It would appear that we are now starting to see the real cracks form in the NHS where it will be pushed even farther than it is now into a two tiered system. Unfortunately the unreformed rump that adheres to the principles of this blog will be the ones left to operate in the NHS looking after those who are forced by poverty to use the unresponsive, unreformed services of the NHS.
In spectacular form, you are destroying yourselves. How long in an increasingly harsh financial climate do you think tax payers will want to fund the NHS with some of the worst outcomes in Europe? So you dwell on "inconsistencies" while Rome burns around you. I would expect nothing else.
NIKU
You really have missed the point regarding the structure of the NHS. goverment sets its own agenda and targets, managers have to monitor this. Doctors have a small part in the overall makeup of the NHS.
You are clearly a paid up member of the labour party to have such blinkered views.
Is it so hard to consider that government targets and interference from managers may make doctors/nurses/physios etc,etc jobs more awkward and thus affect patient care?!
Try "thinking outside the box"
I agree with no-one in this instance.
I don't agree with niku, who has had his questions answered on several other posts, but then has not responded to them, and reposted the same questions on new posts. People get tired of repeating themselves.
But anyway,
I agree, catchment areas are awful. When I was going to secondary school, I discovered that the only school I was in the catchment area for was a school with 16% A-C grades at GCSE, where the majority of the teachers didn't even speak english. The fact that there were two other far better schools, which were actually closer to me didn't matter, because I wasn't in the catchment area. Luckily I managed to get a scholarship to the local private school. But I suspect my life would have been very different if I'd had to go to that state school.
I can imagine it being similar with doctors.
Catchment areas are an out dated historical legacy from 2 generations ago. GPs are able to apply to change their practice area but very rarely do.
Boulndaries between different Primary Care Organisations often make this process difficult however. Dealing with more then one PCO can be a nightmare regarding funding of services.
Helen, love your moderate views, keep 'em coming.
"GPs are able to apply to change their practice area but very rarely do."
It's probably a good thing they don't change their catchment areas. Last year all the schools in my area changed their catchment areas (again!) so that now the two good ones are only taking from the good end of town, and leaving the worse school with the council estates and areas with high levels of immigrants (and so low levels of "english as first language"). So of course, that school is going to get worse and worse, and when it's shut (as it inevitably will be with the latest threats) it will spill into the two better schools which won't be able to cope with the pressure.
Errm, yes, I think I went off on a tangent there. Apologies.
Surely it wouldn't be so difficult for someone to draw the GP surgery catchment areas on a map and then arrange the PCO catchment areas so that they don't have half of one GP surgery? It could be the work of an afternoon, and save a lot of time and effort and paperwork for everyone. Or have I got the wrong end of the stick here?
"Helen, love your moderate views, keep 'em coming."
Thanks :D
I'll try not to go off on tangents like this time again!
All practices have to demonstrate their practice catchment area on their practice leaflet, readily available in all practices.
Though compartmentalising practices in such a way would reduce choice for patients exactly what NIKU was suggesting as being a problem.
Rural areas are the main problem when it comes to lack of choice over practice as practices are often far apart.
Most people have a reasonable choice of different practices.
Issues raised by NIKU such as recording ethnic origin and requiring proof of ID are recent requirements brought in by the Labour Govornment, not just frivilous delaying tactics by practices.
Nope both GPs are in same PCT
Catchment areas as far as I am concerned are a recent development
In my childhood the extended family from all over a big city all had the same GP, that GP had a very wide catchment area, and I know he enjoyed it cos he had the full picture of the whole family issues, he knew us very well, we knew him very well, all was good, yep he probably had quite long journeys when doing home visits, but they were rare and only in very severe need would he be disturbed
My parents in the last year or two were kicked off the GP list on the orders of the PCT as they were "too far away from the GP" and forced to reregister with a closer doctor, in fact the whole city were forced to move GPs (those that were not already registered with a close GP). This is a new innovation of the NHS, the patients sure did not request it, and those patients who resisted were worn down by all sorts of means. I know of several other cities where this has happened.
So patients no longer really have choice of GP
In fact we should all be able to register with a GP near our place of work, as is routine elsewhere in the world, why the fuck they expect us to travel home to see a GP when we spend most of out lifes miles away is beyond me
And of course the words on the medical card "any GP will see you in an emergency" were consigned to history long ago, and like the inside page of the passport which is equally nonsensical and reflects ancient not modern realities
Me personally I would have GPs who refuse to see a patient who walks in off the street in agony shot and fucking thrown off a pier, agony takes priority over a room full of pensioners there for routine appointments in my book, but nope not in the modern NHS
If only the average GP receptionist had some basic training instead of being a useless arrogant £"$"£! on average
The sooner we have some commercial reality and patients paying to see GPs, and GPs actually needing the money from the patients to service the better
Normal commercial reality as soon as possible please
Fuck the failed NHS
re "All practices have to demonstrate their practice catchment area on their practice leaflet, readily available in all practices. " er bollocks I afraid, if this is a requirement it is clearly not enforced as I have leaflets from serveral practises in front of me
Oh and all the cases here are none rural, normal surburban England
Its fucked the nhs
Helen my question has never been answered. So here it is again, why does the NHS have some of the worst outcomes in Europe? Can you give me a short one para answer to that? Should be easy to cut and paste the answer from the runt site. However, I don't want any anecdotal bullshit that has been shit out of the runt sausage grinder, baseless and free of fact. Give me data that is recognized by a reputable organization since the data that says we have some of the worst outcomes in Europe is from the WHO.
Shouldn't take more than 2 minutes to cut and paste off the runtletts site. I will sit here and wait since it will take so little time. I have a prediction, you can't do it.
Niku, just take a look at "The NHS is a failed experiment - Discuss". You remember the thread? It was the one where you accused me of being "a 49 year old male sexual predator" and saying that I had "ilielikeshititis" You stopped posting there once people had actually answered all of your questions.
I don't have one short easy paragraph to answer your questions, because it's spread out over that entire thread, and several others. The general gist is that Britain has the worst combined drinking, smoking, drugs, obesity, under-age pregnancy problems in Europe.
* Britons drink 11.37 litres of pure alcohol per person compared with an EU average of 10.95 litres.
* The number of women aged 35 to 54 dying of alcohol abuse has almost doubled in the last 15 years.
* There are 288 deaths per 100,000 people from smoking-related causes in the UK, compared with an EU average of 263.
* People in the Britain eat an average of 25kg less fruit and vegetables each per year compared with EU countries.
* Diabetes sufferers have risen to 4.8 per cent of men and 3.6 per cent of women in 2003.
* Despite declining teenage pregnancy rates, the UK still has the highest proportion of births to under-20s compared to other western European countries. There are also new highs in separate figures for self harm, and the sexually transmitted disease Chlamydia.
These all take time and money from the nhs, and add to the death toll. That's why we are the sick man of Europe.
No one
"My parents in the last year or two were kicked off the GP list on the orders of the PCT as they were "too far away from the GP" and forced to reregister with a closer doctor, in fact the whole city were forced to move GPs (those that were not already registered with a close GP). This is a new innovation of the NHS"
This situation was brought on by the local Primary Care Organisations for financial reasons, they were unhappy to be funding care for people who lived outside their area but who were registered with a GP in their area. thus not a decision made by the doctors in the practice.
Practices have always had specified practice areas but historically often had people registered from much further away, due to patient choice.
Another example of the labour government's contradition in thinking it is improving patient choice when clearly it is doing the exact opposite!
Why is it so difficult to see political influence reducing the quality of care in the NHS?
Helen - The other countries we are compared against have significantly lower per capita incomes that lead to just as many health related issues as the ones you see in the UK. France has a much higher rate of smokers and yet MUCH better outcomes. As usual these are anecdotal points that don't answer the question of why do we have such shit outcomes? Medics always tell us it is because we don't spend enough money. Is the reason now the fact we eat too much, or is it they are an unreformed group of individuals who are far more concerned about what is best for them to the detriment of the patient. If they really cared, and there was competition in the system they would have fixed this access issue. Or is it a result of too little veg, too much fat, and not enough exercise, oh, and don't forget, WE NEED MORE MONEY!
"Britons drink 11.37 litres of pure alcohol per person compared with an EU average of 10.95 litres."
How is that anecdotal?
And yes, France is worse than us at smoking, but they're better than us with diet, exercise and drinking.
This debate has been had, you can continue it on the other thread if you like, but I see no use in going over points we have already gone over. And I'm not the person to have this debate with, I'm not an insider of the nhs, I don't know enough about it. Hawkeye pierce countered all of your points in the other thread far better than I can (Admittedly he used the words fuck and shit far more than I did, but his points still stand.)
And as far as I can work out, it's not that the nhs needs more money, it just needs the money it's got to be distributed properly.
That's the problem with runtlettes. You NEVER have a debate. You throw out what amounts to trivia and expect that everyone will just say, "oh okay, wow didn't know we had a shit health service because people drink 11.37 L of alcohol! Should have seen that, explains everything, long waits, crap doctors, no access, 70's style treatment plans, unreformed workforce, worst outcomes in Europe."
Thanks Helen. Never would have guessed it was that simple. I don't know what you profess to do, I only know you as a runt groupie. What you need to understand is that people are getting tired of all the excuses around our third world health system.
The people on the runt site are hypocrites. They are the descendants of people who voted by 89% in 1948 NEVER to have anything to do with the newly formed NHS. Now that they are creaming it, they love the thing even though it is third rate. Why is this Helen? Because, just as voting not to join the NHS in 1948 insured in their tiny little minds that they would be okay, now in 2008 they fight change once again so that they will be okay. Only difference this time is that they mugged the government first and made sure they would be the highest paid docs in the world and that includes the yanks. So, once again, why do the highest paid docs on the planet produce the shitiest outcomes? Oh sorry, silly me, that's been answered, it's because we drink 11.37 liters of alcohol a year. Shit, simple really!
Niku, I agree with the 70's style treatment plans, but you cannot disregard the impact that lifestyle has on mortality figures. Our lifestyle is one of the worst in Europe. That's all I'm saying.
What I profess to do? Is it relevant? Not a lot - I'm having to take a year out of education after my gcse's due to illness. In this time I'm doing stuff like Open University courses to keep occupied. I'm housebound most of the time, and bedbound or in hospital the rest. But I don't see how that is in any way relevant.
Hawkeye Pierce (I repeat) answered these other questions on the other thread. You never answered him. I don't see any reason for me to repeat it.
ugh - I don't agree with the 70's style treatment plans - I agree with you that they're rubbish. Sorry, that was unclear.
fair enough. Also, I agree that there is a real lifestyle issue here even more than in other parts of Europe, but the WHO was measuring what happened to patients after they had received treatment which makes the reason why people needed it irrelevant.
I did indeed fall into a runt trap on the other blog, but the questions were, again, irrelevant, the fact remains we have some of the worst outcomes in Europe, and the they will never offer a answer to that because they are as much the problem as all the people they try to deflect blame onto. It is despicable behavior. We as a society have allowed them to get away with it for years and also have to accept blame.
Some more interesting facts by the way from the National Audit Office:
GP average pay up by 58%
In each of the first 2 years of the contract GP's were 2.5% less productive
Put in 7 fewer hours a week than in 1992
No wonder the BMA now loves the NHS!
MURDEROUS THIEVES!
Has inflation been taken into account for the pay statistic? If not, then that's going to make a big difference. I couldn't find figures on inflation, so house prices will have to do (I know that house prices won't give a hugely accurate picture, but it's the best I could find, and it gives the general idea).
"East Midlands 194.6 percent increase.
East Anglia 219.4 percent increase.
North 184.7 percent increase.
Greater London 263.3 percent increase."
So unless the 58% increase is after inflation, it sounds pretty reasonable.
I agree that maybe GPs are sometimes overpaid, but hospital doctors and nurses and other members of the nhs are grossly underpaid.
I still don't think it's the staff's fault for the mortality figures. You don't become a nurse for the money, afterall, you do it because you want to make a difference and do a worthwhile job. There has been something like a 5x increase in managerial positions in the nhs, and it is they, along with crackpot sticking-plaster government schemes that are taking all the money that's being thrown at the nhs. What's really needed, instead of the pointless extra managers, is more staff on the floor, more equipment, more hospitals/beds in existing hospitals and more cleaners (hospitals desperately need more cleaners!). That's what I think, anyway.
house prices are not a basis to measure pay on. The rest of the country has had to live with sub 2.5% for some years now. The fact? It was a crap deal done by the government and a bad situation taken advantage of by a bunch of greedy doctors. It is indefensible Helen.
So how come the coward rant has stopped anonymous posting?
Oh thats it, he's a coward!
No, I agree with you that house prices aren't a perfect measure, but the fact is that almost everyone has to buy a house, so how much people can afford to pay for a house will be some (if not a precise) reflection of inflation.
But my point is irrelevant - dr pink just explained the increase on dr rant.
"So how come the coward rant has stopped anonymous posting?
Oh thats it, he's a coward!"
But he's not moderating - anyone can post as long as they're identifiable. Fair enough.
you are so random
me? random? how?
dr pink explained nothing. He put some explanations on his post that may or may not SLIGHTLY moderate the figure. The FACT is they have had a 58% increase, work fewer hours and are less productive, end of story.
not you the other guy
but i like him/her. Keep posting!
There are three kinds of lies - lies, damned lies and statistics.
I think it was pretty clear after what dr pink said that those statistics are pretty selective.
actually what pink put up were excuses. the nao figures are "clean" therefore real. Yet another runt smoke screen.
But you just admitted they were unsubstantiated! And had questionable relevance!
Or did I misunderstand you?
ah multiple personalities! just the facts
58% increase
2.5% less productivity
7 fewer hours a week
The icing on the cake?!? Third world outcomes and shit access! You just kill me! Or probably will at some point..........
NIKU,
1)58% is a bollocks "massaged" figure, but even if it were accurate it happened 4 years ago and 3 years of 0% increase and this year's joyous 15% DROP in income (and all the while my staff have had above inflation awards) put us back to square one.
7 hours a week less - well we had Out of hours responsibility removed, so kind of inevitable that hours might fall a little would you not think?
2.5%less productivity?? How the FUCK do you measure productivity in General Practice. Is it less productive for me to spend 30 minutes with a chap who's just lost his wife of 40 years to cancer than to spend the same time seeing 3 self-indulgent numb-nuts who want antibiotics for their viral cold because they are "99% sure" they "need an antibitoic"?
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