Category Archives: Community Health Councils

What does the CHC offer us in Wales? They dont exist any longer in England.
Do we get an advantage from their existence? What do they cost?
Are they structured correctly – the CEO is appointed by the WG and may not feel able to speak out.

Even London and the Home Counties are feeling the squeeze… as standards and staff numbers fall re revert to the pre-NHS divide.

Just some of the pain felt in the rural shires is now feeding into London and suburbia. Standards of staffing and clinical diagnosis and speed are all falling. The blame is long term political neglect and denial from an elected elite who always felt they had access to the best – in London. No longer… it is impossible to report on all GP surgery closures as there are so many. The reality is that private services for ambulance, GP, A&E etc will follow… Bevan wanted the same high standards for the miners as the bankers – instead the standards are falling, but as before we had a health service, the bankers can afford the private option.

Owen Sheppard for MyLondon reports 7th September 2019: West London overspends by £112m!!

GP surgeries across Surrey are facing an uncertain future, with two confirmed closures and a third possibly following suit, which are set to put pressure on those nearby.

Patients say they are worried about the pressures on neighbouring services following the announcement of closures of surgeries in Staines and Guildford.

In Burpham, a petition has been launched to save the Burpham New Inn surgery which is also facing closure.

So why are surgeries closing?

The Guildford and Waverley Clinical Commissioning Group (CCG) has cited problems with leases and premises, which have led to the closures of two practices in the area.

In Staines, the Staines Thameside Medical Practice shut on Saturday (August 31) following a decision by the doctors to end their contract with the NHS to provide GP services. This was reportedly due to personal reasons.

Patients will lose the St Nicolas branch surgery in Bury Fields, Guildford, which will close at the end of October following issues with the premises and its lease.

Guildford and Waverley CCG has confirmed the surgery will close on October 24. All services will instead be provided by the main surgery at Guildford Rivers Practice in Hurst Farm, Milford.

One St Nicolas patient, who did not wish to be named, said: “I am very upset about the closure of St Nicolas Surgery, it came as a shock.

“[I believe] this was pre-planned since last year but without telling patients previously. I have not received a letter as yet about the closure.

“I think it’s been about a year that all the telephone calls to St Nicolas Surgery have been re-directed to the general practice in Milford.

“The closure of St Nicolas Surgery will put extra pressure on other GP surgeries in Guildford as patients who are ill, disabled, elderly or who don’t drive won’t be able to get to Milford.”

The CCG has said it will work with the practice to ensure that despite the changes, patients will continue to receive high quality care.

A spokesman said: “The CCG received an application from Guildford Rivers Practice that proposed the closure of its branch surgery, St Nicolas Surgery, due to issues with the premises and the lease which was proposed to have had a negative impact on the service offered to patients.

“Following a period of engagement with patients and neighbouring GP practices, the application to close the branch has now been approved by Guildford and Waverley’s Primary Care Commissioning Committee (PCCC).”

The spokesman added: “Registered patients of Guildford Rivers Practice will remain so, following the branch closure, with GPs from St Nicholas Surgery transferring to the main site and continuing to offer appointments to patients.

“Any patients who require home visits will continue to receive these in the usual way.

“The practice is committed to providing the best service for patients by operating solely from the Guildford Rivers Practice main site and the CCG will work with the practice to ensure patients continue to receive safe and high quality care moving forward.”

The news comes as patients await the decision on the future of Burpham’s New Inn surgery. A decision was set to be made on August 28 but this has been delayed.

A spokesman for Guildford and Waverley CCG said: “The PCCC has been re-arranged to ensure every option put to the CCG is fully explored, before a final decision is made.

“The committee has been rescheduled for September 13.”

In a letter to patients sent on July 31, the CCG said it was likely the New Inn Surgery in London Road would have to close later in 2019 due to problems securing a long-term home.

The letter said the surgery’s lease was expiring and no other suitable alternative sites have been found.

Patients launched a petition to save the surgery, which has been signed by 282 people to date.

Staines

Around 4,500 patients have had to re-register with another GP surgery after Staines Thameside Medical Practice closed its doors on Saturday (August 31).

Other GP surgeries in the area are accepting new patients despite some having recently had their lists capped.

Two Staines councillors are concerned about the additional pressure on those surgeries.

Councillor Jan Doerfel, Green Party member for Staines, said: “Expecting other GP practices to absorb the additional 4,500 patients is likely to result in longer waiting times for all those affected and additional travel for those that had to enrol with those practices. This is not acceptable.”

Councillor Veena Siva, Labour member for the ward, said: “Yet another GP surgery closes. Smaller practices are closing due to underfunding and insufficient GPs which means they can no longer be run safely and sustainably.”

She added: “As it stands, it is unfortunately no surprise that there was no interest from GPs to take over the surgery when in doing so all they would face is under-resourcing, enormous pressure and stress.”

NHS North West Surrey Clinical Commissioning Group (CCG) was responsible for supporting patients as they switched to a different GP service.

St David’s Family Practice Doctor Jagit Rai works at one of the surgeries receiving patients from Staines Thameside and is a governing body member at NHS North West CCG.

Doctor Rai said: “The closure of this practice does not relate to funding or staff shortages. The CCG was disappointed to receive notification from GPs at Staines Thameside of their decision to end their contract with the NHS to run the surgery.

“They made this decision due to a change in personal circumstances that could not have been predicted or planned for. The CCG asked neighbouring practices about the option to take over the running of Staines Thameside and reviewed their capacity to take on new patients.

“The surgeries decided the best way to care for Staines Thameside patients is at their practices where they can benefit from an established team and range of services.”

It’s slightly brighter news for the residents in Chiddingfold, where a new surgery is being built after the former building was destroyed by a fire.

Chiddingfold Surgery in Ridgley Road was gutted on January 7, 2019.

Plans were submitted in March to Waverley Borough Council for the complete rebuild.

The surgery has relocated to Cedar ward at Milford Hospital, where full doctor and nurse surgeries are in place. Expanded opening hours are available for patients at Dunsfold surgery.

Update : Diane Taylor in the Guardian 8th September 2019: London GPs told to restrict specialist referrals under new NHSThe New “Rationing Plan”. Plans for new cuts sent same day Boris Johnson reinforced NHS spending commitments..

How can the NHS offer fulfilling, lifelong careers? The managers have no idea why doctors quitting in droves…. Exit interviews?

The exit interview is a rare event in the 4 health services. The BMJ opinion from Wilson and Simpkin is honest and powerful, but their drawing attention to the absent “exit interviews” now needs attention, and from a completely independent HR company. None of the staff will trust the “in house” services. Yes, its got that bad, and its going to get worse. Life expectancy has peaked already and went down this last year….

The BMJ offers some advice on workforce retention: How can the NHS offer fulfilling, lifelong careers? BMJ 2019;364:l1100

With morale and retention among UK doctors declining, The BMJ hosted a discussion at last week’s Nuffield Trust health policy summit, asking what the NHS can do to support clinicians throughout their careers. Abi Rimmer reports

“Enabling people to pursue their other interests is one key thing,” said Rakhee Shah, paediatric registrar and research associate at the Association for Young People’s Health, kicking off discussions. She highlighted the importance of giving clinicians more control over their working lives.

Ronny Cheung, consultant paediatrician at Evelina London Children’s Hospital, took this further, saying that it was also important to give clinicians control over their everyday workload. He said that his trust, Guy’s and St Thomas’ NHS Foundation Trust, had been “trying to make time and space for teams to come together.”

“It’s about regaining control,” he said, “and investing in people to allow them to do that.” This not only made staff feel more valued but also helped to remind them what they enjoyed about their work. “It has a multiplying effect,” he said.

Claire Lemer, consultant at Evelina London Children’s Hospital, highlighted the importance of food for staff. She described a successful initiative at her hospital that encouraged the executive team to provide food for clinical and administrative staff……

……The demise of the firm structure of working in hospitals had reduced support for clinicians, said Morrow….

…The panel also discussed how the intensity of clinical work affects clinicians’ ability to maintain a long term career in the NHS. Lemer said that, in some specialties, “the pressure and intensity of work is so extreme that it’s not sustainable for a whole career.”…

…Cheung also warned that the rigidity of medical training pathways was denying doctors the flexibility they needed, as they were forced to choose a specialty so early in their career.

“If we squeeze people into these pathways we shouldn’t be surprised if people break free, and we shouldn’t be surprised that we’re developing a workforce that isn’t particularly happy,” he said.

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The NHS is failing to look after its staff and patients, expert warns

Abi Rimmer, The BMJ

Anne Gulland, The BMJ

Opinion from Hannah Wilson and Arabella Simpkin is honest and ends with the paragraph: (This was not available in the on-line edition)

Quitting in DrovesHannah Wilson and Arabella Simpkin P 473 of the BMJ

Surprisingly, while there is little literature that discusses both the quantity of doctors that leave the NHS and the factors that may drive them, there is no literature discussing the attributes and characteristics of doctors that leave. To understand what is driving the flight, we must first ask who are the doctors that quit? Surprisingly exit interviews are rarely held. Yet this is critical information to develop interventions and strategies to stem the leak.

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Missed appointments are a distraction. In the factory model there has to be a disincentive for poor quality (and to make a claim).

Recent news on missed appointments may be confusing the public. GPs are pleased to have a little reflective and organisational and administrative time when a patients does not attend. They may already be late, and then the time is merely used to catch up. In GP land, before GPs were excused from “emergencies”, all patients had to be seen before you went home. Not so today. In Hospital land, consultants have limited numbers, and GPs have followed suite. The least popular careers in the 4 health services are, guess what, emergency medicine. Victims of a career in A&E have to contend with long and difficult shifts, overdemand, and under capacity. The mopping up which GPs used to do has moved to A&E, and with less experienced doctors seeing the patients. Missed appointments are a distraction. In any factory  model ( mutual insurance system ) there has to be a disincentive for poor quality ( and to make a claim) .. Once we ration overtly, and probably introduce co-payments, morale in all areas will improve, recruitment will be better, and the “reality” of life will sink in to the public as a whole. Phil Collins in the Times opines that “..The factory model of healthcare is no longer appropriate in a nation made healthier by the success of the first seven decades of public healthcare.” But even he shies clear of the need for autonomy, responsibility for self, and for sticks as well as carrots to encourage good health. If missed appointments cost millions, most Drs don’t really care. It’s a distraction, a side issue. Politicians have yet to arrive for their reality appointment… (see below)

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BBC News 2nd January: Missed GP appointments ‘cost NHS England £216m’

July 2nd in the Times: Attlee ‘would be shocked by abuse of NHS’ – “The prime minister who created the NHS would be horrified that patients are abusing it by missing appointments”, his granddaughter has said.

Jo Roundell Greene, the granddaughter of Clement Attlee, said that when the health service was created people were “so grateful”, but some now took the system for granted.

We have to shut hospitals to save the nhs – Phil Collins opines in the Times 4th Jan 2019…    “…Public Health England, the government’s health agency, has been highlighting the threat from diabetes which, on current trends, could take up a fifth of the whole NHS budget by 2035.”

The Times letters to the Editor 2nd and 4th Jan 2018: Missed hospital appointments and the NHS

Sir, I challenge the supposition of the chief nursing officer for England that missed clinic appointments are so costly (“Timewasting patients are costing NHS £1bn a year”, Jan 2).

When, some years ago, we looked into the problem in my orthopaedic and fracture clinics, we found that most non-attenders had recovered, or no longer needed our treatment. Most were judged to have been given precautionary appointments by less experienced junior doctors.

In some areas patients are now sent mobile phone text reminders of their appointment, with plans to supplement this with a similar email policy. This and better supervision and training of young doctors should resolve the problem for most cases.

Reappointments need be sent only to those unable to decide for themselves, such as children, or the few deemed at serious risk should they miss their checkup.
Paul Moynagh
(Retired orthopaedic consultant surgeon)

Sir, The chief nursing officer tells us that patients who fail to attend their hospital outpatient appointments are costing the NHS nearly £1 billion annually. This is almost certainly nonsense. In almost all of my 25 years as an NHS consultant in ear, nose and throat surgery (which has a heavy outpatient workload), we would evaluate the missed appointments rate regularly and increase the planned numbers per clinic accordingly. This is standard practice across the service.
Prof Antony Narula
Wargrave, Berks

Sir, I feel we are not made sufficiently aware of the costs of NHS services we use. If the cost of each medication were printed on the package we may be persuaded to use it carefully.

I was horrified to be told by the pharmacist that my bottle of medicine cost £300. I now make sure that I don’t waste a single drop.
Elizabeth Bass

Shepton Mallet, Somerset

and on 4th Jan:

MISSED APPOINTMENTS
Sir, I cannot understand how missed appointments are costing the NHS £216 million (report, Jan 2). The so-called cost of an appointment is a notional figure; if the appointment does not happen, it costs nothing at worst and saves money at best. If a patient fails to show, not only can an overworked GP catch their breath (or catch up, because they will almost certainly have got behind) but they won’t have to do expensive tests or prescribe expensive drugs. So this £216 million is fake accounting.

What might be interesting is why appointments are missed. The patients may have got better; their mother-in-law may have been admitted to hospital as an emergency; or there was no one to take them to the surgery.
Dr Andrew Bamji

Rye, E Sussex

Sir, In my experience missed appointments can be due (in part at least) to the NHS’s own systems. For example, my wife was called by her consultant’s secretary to ask why she had not attended an appointment; she replied that she had not been given an appointment (the letter, which had a second-class stamp, arrived the next morning).

My daughter has had a number of similar experiences: once the letter dropped through the letterbox 30 minutes before the appointment was due. After another appointment she was called by a secretary at the hospital, who asked why she had failed to attend. My daughter replied that she had, in fact, attended. She was then asked to relate, in detail, what the doctor had said to her.
Malcolm Hayes

Southam, Warwickshire

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Can the NHS be saved? Only with different local and global thinking, and changing the “rules of the game”.

All of us in the caring professions know the answer to this question, and indeed that there is no “N”HS any longer. The Guardian knows the answer….. Iain Robertson Steel, a retired medical director acknowledges the problem (But suggests no answer/solutions), but on 26th April  in the Western Telegraph I suggested a “fourth option” for people in Pembrokeshire.  This last is only for local needs, and a letter suggesting a global rethinking was in the Western Mail 25th Jan 2018 is at the bottom of this post. What can save the 4 health services is not clever reorganisations, but an honest debate on overt rationing, and making it clear to everyone what is not available free, for them. ( Changing the rules of the game )

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Can the NHS be saved? The Guardian – Dennis Campbell – 

…the Guardian’s health policy editor Denis Campbell spent a day in King’s College hospital in London. He found staff and patients who are devoted to the NHS but who can also clearly see what is needed in order to sustain the service for future generations.

A long-term plan designed to secure the future of NHS England has been delayed once again by Brexit. But as Britain’s health service heads into its annual winter beds crisis, the Guardian’s Denis Campbell visits King’s College hospital in London to find out what staff and patients need for the future – and how much it will cost. 

“The Welsh NHS and social care is a shambles and no longer sustainable or fit for purpose.” Dr Iain Robertson Steel in the Western Telegraph 7th December.

Health service needs to be remodelled Western Mail 25th January 2018

From the perspective of west Wales there is no British health service.

I do not have access or choice to anywhere outside my own rural trust (Hywel Dda) unless the service needed is not available here. Even a second opinion has to be within the same trust.

There are four, and possibly five health services if Manchester is included. The WHO has said it will no longer report on an “NHS”.

The lack of choice, the covert rationing, and the unequal access to tertiary centres, primary care, and palliative care threaten to bring on civil unrest.

A Welsh mutual of three million people cannot offer the same quality of healthcare as one of 60 million. Even if the Welsh Government has tax-raising powers, there are not enough taxable earners to rise above the decline.

We seem to have forgotten the power and improved health outcomes in large mutuals. Since the UK’s health service has to be refashioned, now seems a good time to unify again, and re-establish the same rights across the country.

Increasing taxation to pour more into a holed bucket should not appeal to most taxpayers.

We need a new health insurance system (the original NHS was insurance based) and the caring professions will remain cynical until what replaces “in place of fear”, avoids bringing it back.

Dr Roger Burns

Haverfordwest

Pembrokeshire GP urges a “fourth option”. Western Telegraph 26th April 2018

The finances are in such a mess, that local post code and unexpected rationing is everywhere… The “Rules of the game” need to be changed…..

Changing the rules of the game

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Social Care is means tested, so why not health? More funds for cancer care is appropriate, but in Wales it could go on free prescriptions.

Kat Lay in the Times reports 15th June 2018: NHS (England) must use extra funds to fight cancer

Social Care is means tested, so why not health? More funds for cancer care is appropriate, but in Wales it could go on free prescriptions. If the people have a choice they will choose local, ahead of improved outcomes and travelling. As the population ages, and more people survive cancer, we will need more radiotherapy and oncology services. The shortage of Radiologists and Oncologists is so severe that the potential for improvement is threatened.

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The NHS will be expected to improve cancer survival rates and put a greater focus on maternity safety under a multimillion-pound funding package due to be announced within days.

Theresa May appeared poised to set plans to boost the NHS budget by more than 3 per cent after intensive meetings yesterday between No 10, the Treasury and the health team.

At a conference of health service managers in Manchester, Jeremy Hunt, the health secretary, said: “We need to make sure we unite the NHS and British people with a small set of bold ambitions as to how we want to transform our system. To get our cancer survival rate to the best in Europe; to transform our maternity safety so it is as good as Sweden; to truly integrate health and social care; to make sure we have waiting time standards for mental health that are as strong and powerful as the standard for physical health.”

He was still having “difficult” discussions with Mrs May and the Treasury over the precise details of a long-term funding plan, but an announcement is expected soon. NHS leaders say they need funding increases of 4 per cent a year, in line with assessments by think tanks. The Treasury is thought to be reluctant to provide that much.

Brexiteers want rises in health service spending to be funded by the so-called Brexit dividend — money available after Brexit that would have gone to the EU. They worry, however, that Philip Hammond, the chancellor, will suggest funding it through tax rises.

NHS sources fear that a “big picture” announcement could amount to a fudge because it will not spell out the exact funding increases on offer. That would mean health chiefs including Simon Stevens, chief executive of NHS England, waiting until November for the details.

There is also likely to be disappointment at a decision to keep social care funding, which is delivered through councils and is the subject of a forthcoming green paper, separate.

A report from the Institute for Public Policy Research, a left-wing think tank, has called for social care to be free of charge for people with substantial needs as part of a new long-term health funding settlement. Social care is currently means tested. Making it free would bring the care system into line with the NHS, where healthcare is free at the point of need.

Cancer patients given new drugs that won’t help them. GPs needed in oncology clinics…

Advanced directives needed. Choice in death and dying. Lord Darzi warns of “draconian rationing”. GPs need to be involved at the interface of oncology and palliative care.

Rationed – Start of cheaper technique for breast cancer is delayed in UK despite adoption elsewhere. GP commissioners should be demanding intra-operative radiotherapy.

Cancer drugs fund is illogical. More money should be spent on radiology and radiotherapy.

Cancer chief quits amid radiotherapy shortfall

Artifical Intelligence is no threat to doctors, but it’s potential needs to be managed. A shortage of Radiologists is more bad news for the future.

 

So, you did not think there was post code rationing of cancer care?

Kat Lay reports 12th March 2018 in the Times: “UK behind on cancer guidelines” (she means treatments)

It may be very sensible to refuse treatments for which there is a poor return, and serious side effects. The spending of state money has to be rationed, but NHSreality maintains that this should be overt, and universal for the low volume high cost treatments. Aneurin Bevan talked about In Place of Fear ( A Free Health Service 1952 Chapter 5 In Place of Fear ) but we are doing our best to bring back fear. There are four British health café systems, each rationing differently. In each we pay up under the same tax rules. The UK is also behind on introduction of new drugs – for good reason. Mark Littlewood doesn’t believe is deserves the taxpayer funding it gets! The Times also explains why and how more people are having to pay for cancer treatments which are excluded. Sarah Kate-Templeton reports on the current private income from treating cancers privately in 2017: £360m

British cancer guidance is less likely to recommend innovative drug treatments for patients than versions used in other parts of Europe, a study has found.

Researchers at King’s College London evaluated clinical practice guidelines issued by different national bodies, finding that UK examples were more likely to focus on surgery, and slower to pick up on new research.

Their study comes after several high-profile cases where patients have had to travel abroad for treatment.

The Home Office is considering allowing a medical cannabis trial to treat Alfie Dingley, a six-year-old boy with epilepsy, who travelled to the Netherlands to take a cannabis-based medication last September. Jessica Rich, one of two sisters with Batten disease, a genetic disorder that kills sufferers before they reach their teens, has to fly to Germany for treatment with a drug that Nice will not fund and Ashya King, now eight, was taken to the Czech Republic by his parents for proton therapy on a brain tumour, against the recommendation of doctors in Southampton in 2014. Earlier this month his family announced that scans showed he was free of cancer.

The study, published in Esmo Open BMJ, found recommendations in continental Europe tended to focus on the use of new chemotherapy agents or targeted treatment, while UK guidelines tended to focus on surgery, screening or radiotherapy.

Mark Baker, director of the centre for guidelines at Nice, insisted the research was “poorly undertaken” and misrepresented its guidance .

 

Imposter? Many of our own go abroad. With so many Drs from overseas, how many of them have “fake” degrees?

Without overseas staff, doctors midwives and nurses, the Health Services would collapse. Many of our own fo overseas. The majority of doctors from the Indian subcontinent have been trained at private medical schools, and although the state does train many, they are a minority. With the media exposing false and illicit degrees, the 4 health services in the UK need a healthy scepticism when examining the CVs of desperately needed staff. This includes midwives and nurses. As the Health Services implode further, Trusts may be so desperate that they really don’t mind imposter degrees servicing their citizens. The perverse incentive to appoint and examine the evidence later may be too great..

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Duncan Geddes in the Times 17th Jan 2018 reports: Fake degrees from Pakistan sold to doctors

A “diploma mill” in Pakistan has sold fake degrees to thousands of British workers and companies, including NHS doctors and a defence contractor, according to leaked documents.

Axact sold more than 3,000 qualifications in Britain over two years, including PhDs and medical doctorates, an investigation by BBC Radio 4’s File on Four found. The company has invented hundreds of universities online and uses fake news stories in an attempt to fool employers who check fake references on CVs.

Buyers of fake post-degree qualifications between 2013 and 2014 included NHS nurses, consultants and an ophthalmologist, according to the BBC. A British engineer based in Saudi Arabia spent almost half a million pounds on fake documents, it was claimed.

Dozens of websites selling fake degrees have been closed in recent years but the authorities struggle to keep up because they are usually based abroad. Pakistan opened an investigation into Axact nearly three years ago but the company continues to operate a global network from a call centre in Karachi.

In Britain the crackdown on bogus degree sellers is led by Higher Education Degree Datacheck. Its chief executive, Jane Rowley, said that only a fifth of British employers properly checked qualifications when hiring staff.

The BBC investigation claimed that the defence contractor FB Heliservices bought fake degrees for seven employees, including two helicopter pilots, between 2013 and 2015. Its parent company, Cobham, said disciplinary action had been taken.

The purchases were a “historic issue” and had no impact on safety or training, Cobham said.

Axact denies all wrongdoing.

Not enough doctors – just keep lowering the bar & reducing the funding

Making doctors stay….. in a neglected NHS. Letters in the Telegraph. Altruism destroyed early..

Thousands of fake degrees sold in UK – BBC – 4 days ago

Pakistan-based IT firm sold thousands of fake degrees to UK citizens … The Times of India 3 days ago

‘Diploma mill’ in Pakistan sells fake degrees to Brits | Daily Mail Online 3 days ago

London GP services crisis pending… Overseas doctors will probably fill the vacancies. Watch for private GPs and Private A&E departments in the capital…

A day on the frontline. Numbers of NHS doctors registering to work overseas could reach unprecedented record

10% increase in vacancies. “Industrial scale” recruitment from overseas is a clear admission of recurrent cross party political failure.

Declining training standards prompt rescue action

 

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