This is from the Guardian today:
GP surgeries should be set up at hospitals to ease the growing pressure on accident and emergency units, which are struggling to cope with an "unsustainable" increase in patients, a report from the UK's emergencydoctors warns.
Family doctors, as well as nurses and specialists in looking after frail elderly people, need to assess and treat as many as 30% of the patients arriving at hospital and keep them away from the casualty departments, according to the College of Emergency Medicine (CEM), which represents the NHS's 4,000 A&E doctors.
There are three themes implicit in this. First, our demography is guaranteeing an increase in NHS demand.
Second, changes in lifestyle mean people cannot or will not present to GP surgeries. The will not is as important as the cannot: waiting is no longer an option some people will choose when in the past they did.
Third, funding is undermining the credibility of a service on which we all rely, even if we'd rather (of course) never call on it by choice.
The reality is that reorganisation can only deal with so much of this increasing demand. Society has to decide if it will fund this service or not. It does not have to. But people will suffer and die if it does not. That's an economic reality.
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Second, changes in lifestyle mean people cannot or will not present to GP surgeries
Richard,
I realise that I’m on slightly dodgy ground – after all, your wife being a GP – so please read this with IN MY EXPERIENCE in large letters at the beginning:
It’s not lifestyle. It’s people who have been put off trying to see a GP by having to negotiate the reception staff to even get an appointment, or being subjected to the TTPAFO* school of medicine.
(And yes, I know why this is: the GPs are overstretched, a lot of those presenting can’t actually be treated other than with bed rest and paracetamol, but the measures they necessarily take hurt and/or deter those with real needs)
At least you don’t have what we have in Jersey – yet. We pay for doctor’s appointments (usually about £35 an initial visit). You can understand why we have lots of people turning up at A and E – many can’t afford any other form of medical care.
James
*short for “Take two paracetamol and go away”.
Isn’t the question not “if it will fund this service…” but “at what point will it draw the line in funding the service”?
There’s an ever-increasing demand for healthcare which in the end can’t be met however much funding is increased (the reality is the exact opposite, in fact, of Bevan’s assumption that demand would wither away).
If one accepts that premiss, then the conclusion is that society has a very uncomfortable choice to make — but the politicians (of whatever stripe) won’t say this clearly because they perceive it’s a vote-loser.
So when are you going to let people die on the steps of A&E Tom?
Perhaps if we looked at the underlying causes of so much poor and physical health it would help: young people smoking/taking drugs in large numbers and getting pissed in order to cope with unsatisfying jobs/pressure to ‘get on’/ suffocating celebrity culture/ no sense of a future. prescriptions for anti depressants up to about 39 million a year and growing. of course, even without these issues, demand would be there- but the health time bomb has already exploded.
Of course not. But that doesn’t answer the underlying point, does it? The logic of your position is that the state has to find an everincreasing proportion of the national income for healthcare.
The reality is that if proper A&E care is to be maintained (which of course it must be) then less money will have to be spent in other areas of the service — if not now, then at some point in the future (assuming you accept the premiss of ever-increasing demand).
The point I was trying to make (not clearly enough, no doubt) was that this reality needs to be put before the electorate in a clear manner.
No, the logic may be that the state needs more
Because that is what people want and need
There is no logic to your argument at all
Tom, your logic seems to be that the state can’t afford more healthcare so, by default, the sick individual has to fund it him/herself, either directly or via insurance.
The problem is that the coalition wants it both ways; A we can’t afford it so you have to pay B we’re going to promote poverty wage jobs so people won’t be able to pay.
Either we have a fully functioning NHS, my great preference, or we have insurance, God forbid. But surely we can’t continue down a road that eventually leaves a huge proportion of the population with zero access to healthcare in whatever “other areas of the service” are cut?
The point I am trying to make is that the reality of continuing with this witless government and its devotion to neo-liberalism needs to be put before the electorate in a clear manner.
The demand for good quality health care is surely there for all to see – even in the US where they are prepared to pay out so much more for a poorer service. The state must correct the market failure.
If we pay half as much as a % of GDP for healthcare that produces better outcomes as the US, then we should in theory be able to double capacity for the same price. Obviously healthcare provision is extremely complex, but at the crux of it is that as a country we have to decide to pay the going rate for a good service. If wards are too short-staffed and nurses too overworked to have time to care properly, then it doesn’t need re-organisation, it just needs more money to pay for more nurses.
Not rocket science (but may be brain surgery in some cases…)
Indeed
The state, all parties, has already abrogated responsibility for healthcare. With the passing of the health and social care act the state, in the form of the health department, has the duty of paying the money but little say in how it is spent. that is the job of the gp commissioning groups (of which most will be run by private companies such as virgin health).
Locally, small practices are frantically trying to amalgamate to avoid funding problems.
With the future arrival of patients being allocated a set fund for dispersal on their heath, we shall see patients with chronic health problems devoid of healthcare as the funds run-out.
If you are ill at night there is no chance of seeing a doctor, other than at A&E, Locally it takes several hours for the flying-doctor service to find you. According to the papers this week, some private out-of-hours services employ only nurses !
The gp service provides an in-hospital service for out-of-hours care…for a while….
Since persons not resident in the uk for over a year get no nhs care, it is not surprising that A&E is over-worked. Note also that the population is growing all the time, and getting older. With all the will in the world people suffer ill health and injury. With the coming removal of large amounts of health and safety at work requirements we can expect accidents, injuries and deaths to rocket.
You also need to view education. If a school gets a lower ofsted report than it previously had, the councils can sell them to academies now. Given that the ofsted requirements are getting ever harder….