The NHS Way:
1 Get Ill
2 Wait a few days to see if it will go away on its own
3 Make an appointment to see a GP, get given an appointment 3 days away minimum
4 Wait 3 days, during which it gets worse, you are in pain, unable to sleep, life in tatters, unable to work due to lack of sleep etc
5 See GP in a rush who says it's viral come back if it gets any worse
6 Go away give it a few days to get better
7 It doesn't, it's getting REALLY bad, ring for GP appointment, 3 days away again
8 See GP, get given antibiotics
9 First day or two of antibiotics it's fixed, miracle of modern antibiotics, and fuck all to do with the GP
10 Time from initial symptom to appropriate drugs 10 days
The Private/Routine elsewhere on the planet way
1 Get Ill
2 Wait a few days to see if it will go away on its own
3 It doesn't, so walk in off the street and see a GP there and then who gives appropriate antibiotics immediately
4 Time from initial symptom to appropriate drugs 3 days
NHS leaves you in pain and bad symptoms for 10 - 3 = 7 days longer than the rest of the world on average minimum (excludes weekends etc)
Of course its even worse if you have moved to a new area and have not been round the houses to register with a GP, or you are away from home
It is no wonder folk try to see an NHS GP speculatively at the 1st sign of an illness cos they know how long the cycle is
Now
Presenting with the same symptoms at one of the private GPs in London will routinely lead to antibiotics versus crap nhs GPs will delay antibiotics until you have been around the loop a few times and their pet viral theories have been well and truly disproven, now where is the proper scientific evidence supporting either practise?
Given the difficulty actually getting to see anyone in the NHS about chest infection (yes I mean INFECTION) or severe ear ache, to name but two of the most common complaints ordinary folk have to deal with occasionally, it is hardly surprising that folk demand antibiotics of NHS GPs cos they know it will be so hard to get to see a GP the next time
Really we need private fee paying access everywhere, and proper minors clinics fronted by docs in all towns and cities for 24/7 cover where A & E is clearly not appropriate but simple pain relief or antibiotics or advice is needed
You think this is bad, try being diabetic, many only kept alive by advice they get from consultants in Belgium as access to consultant in UK is fucking impossible
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Of course, if you were my patient the system would run like this:
1 Get Ill
2 Wait a few days to see if it will go away on its own
3 It doesn't, so call nice Rant Surgery and make an appointment to see the doctor that day.
4. Turn up at fabulous rant surgery, read up-to-date subscription copy of Top Gear and Empire for 5 minutes on the leather sofa having a freshly brewed coffee from the machine in the waiting room.
6. Dr Rant comes to the waiting room and you have a quick chat about your new car and the weather before going to the consulting room for a thorough history and examination.
7. Dr Rant's prescription is electronically transmitted to the pharmacy in the same building, ir prepared for you before you even leave the surgery, and you collect it on your way out.
Time from initial symptom to appropriate drugs: 3 days
Cost at the point of care: free.
Level of service: fucking amazing.
Sadly of course, Dr Rant's surgery is likely to close with the recent changes to the way the NHS is run. So in future you'll need to take two buses and the underground to queue at the polyclinic.
not many dr rant surgeries in the nhs then
So wait a minute, you want doctors to prescribe antibiotics for every cough and ear ache that comes in the door?
Hey, that's a great idea! Oh, hang on, didn't we used to do that? Oh yes, and that's what caused MRSA...
Idiot.
NIKU
FUCKING IDIOT!
I think this post confirms the sheer ignorance of you pseudobloggers.
Re "So wait a minute, you want doctors to prescribe antibiotics for every cough and ear ache that comes in the door?
Hey, that's a great idea! Oh, hang on, didn't we used to do that? Oh yes, and that's what caused MRSA...
Idiot."
Er NO not at all
I want poor people (using the NHS), folk too far away from a private GP etc, to be able to see a GP THE VERY SAME DAY when they are in agony as for instance the most extreme cases of ear ache can be
I do not think it is appropriate to wait 3 days to see a GP if you are in so much pain that you cannot sleep, and you therefore struggle to do your job
This is basic humanity as per the entire rest of the Western world
AND
I want some consistency so that similar conditions get similar response whether you see an NHS GP or a private one
Now extreme ear ache from private GP you get Clarithomycin and Gentisone (hope I've spelt that right I'm not a medic and don't pretend to be) where as similar presentation to an NHS GP tends to be come back next week if it still hurts (normally in the cases I know about it does)
Now I do not want to be the arbiter of what the best response from the doctor should be in these cases, I just observe that on a fairly large sample of friends and family the average response from the medic is along those lines
A cynic would imagine its just cos the NHS is penny pinching
I just want some fucking consistency, so the poor people get what the folk seeing the private medics get, and both get the best advice - whatever that is?
I really do not see how you can defend lack of access to a medic when you are in extreme agony especially when you are in another part of the country to your home GP
Earache maybe minor to the average GP, when it's dominating your existence, and stopping you sleeping it sure feels more important than that
As a simple example of a common condition where the NHS is way behind the private and rest of the world in its response
No I do not want over prescribing, and no I do not want to define what best practise prescriptions should be, I simply want fair access to good quality care, especially in parts of the country where there is no competition to the NHS
Playing devil's advocate:
'Viral theories' aren't usually pet projects of individual GPs; for evidence base regarding chest infections, the British Thoracic Society has an extensive evidence base. And ear infections have been fairly well studied... there is evidence that they are overwhelmingly viral in origin; BUT making the diagnosis between viral and bacterial is virtually impossible.
Fortunately, my GP is on the DrRant model.
Slainte
Glad that I prompted some debate - note you ignored the point I was making about productivity, but at least having a ding-dong about sore ears allows actual evidence to be brought into play. My own practice is much like the good Dr Rant's (though the good coffee is reserved for the staff) in that if you need to be seen that day you will be and the receptionists do not make any judgement about whether you are or aren't - an experienced nurse triages all such requests. The OOH service I work for also sees people pretty much on a walk-in basis as far as I can tell. The cost is not an issue for me - if the case needs antibiotics it gets 'em - but I wonder if you are confusing "giving the patient what they want" with "giving the patient what the examination and available evidence says they need"? NOt many GPs would be surprised that the private GP doles out the antibiotics (and expensive ones, if you've got the name right), because frankly people don't like to be told that they don't "need" antibiotics, and that if they continue to use painkillers etc it will get better on its own. It takes LONGER to have that conversation than reach for the prescription pad so in fact you should be grateful we are taking the trouble to prevent you taking medicines that you don't need, might harm you and contribute (as someone else mentioned) to MRSA etc.
However, the patient always knows someone who had somehting that only got better when they had antibiotics, or themselves believe that their sore throat miraculously healed under the influene of penicillin when it was going to get better anyway...
I am aware that my surgery's system works because there is an understanding, an unwritten contract if you like, that patients will give things a sensible chance to heal on their own and call us when they have failed to do so - that reduces the numbers so that we CAN see them immediately. But it's taken a fair while educating the patients to reach that point, and there are still some who don't want to hear it.
The problem as I see it is the rampant consumerisation the Government is engaging in to buy votes is undoing this work as fast as we are doing it, and pandering further to the public without any actual evidence that polyclinics, walk-in centres, pharmacist prescribing et al will improve outcomes clinically. They make people feel they have had a "better" service, but have they really?
It comes down to the productivity argument that you ignored in my original post - the "productivity" the politicians have chosen to measure is actually pretty tangentially connectd to "effectiveness" of GPs, but it can be measured so it is being, and Gps are being beaten up because they can't acheive it.
I can promise you that standing in front desk in tears of agony of the nearest GP surgery and begging for an appointment that day (this is first thing in the morning) led to the classic NHS response "sorry the earliest they can see you is in 3 days time"
Now if you dont get this kind of response where you go thats probably why our views of the NHS are so radically different
I went private, lots of folk cannot afford that option, its a fucking national disgrace
You think this is bad, try being diabetic, many only kept alive by advice they get from consultants in Belgium as access to consultant in UK is fucking impossible
**********************
Ummmmm I am a diabetic (Type 2 Diabetes - insulin and tablet treated, as is my wife) and I have never heard of anyone getting advice from Belgian consultants and have no problem seeing the diabetic consultant at the local hospital clinic. Admittedly we mostly see one of his minions for the routine stuff, but when I had need for the cosultant for one of the complications of Diabetes an appointment was made (quite soon too) and then a follow up 2 weeks later, again with the consultant himself. so not impossible at all - with or without the expletive
Steve
Steveg
Well access to consultants for diabetics is very variable in this country now, so it depends where you live
Big nhs push to have diabetics looked after more by GPs (and nurses)
Some complex cases that really need access to consultant now often have that blocked by nhs
And if you move address frequently you will find there is a big lag from first seeing new GP, convinving them you are a complex case needing consultant advice, to seeing consultant, to being one of the small group of patients the consultants know they need to see regularly
the nhs is fucked
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