Category Archives: Post Code Lottery

The cost of technology is exceeding our ability to pay.

Commissioners and Trust Board directors find themselves in an impossible position. Their political masters will not allow use of the word “rationing”, and yet they are expected to keep up with new treatments, and make them available to all. We rarely hear any “exit interviews” but the resignation of Bob Kerslake following the demoting of KGT to “special measures” should tell the politicians what the professionals already know: the health services are founded on financial sand. The edifice is falling.

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Chris Smyth reports 6th June in the Times: Discount deal opens up new cancer treatment but 

Of course there are numerous other treatments, and much money has been invested to get a return!

Hundreds of lung cancer patients will receive a cutting-edge immunotherapy drug on the NHS after health chiefs boasted of beating down prices.

The deal was the first test of a controversial policy that allows NHS England to restrict or delay medicines that will cost taxpayers more than £20 million a year, even if deemed cost-effective.

Officials said the threat of such measures had been enough to persuade the drugmaker, MSD, to agree a confidential discount. Pembrolizumab costs £84,000 per patient at full price and to get below the threshold would have to be reduced to a fraction of that. About 1,800 patients a year will now be eligible.

Pembrolizumab is one of new class of medicines that boost the body’s own natural defences against cancer. It is used in cancers of the lung, stomach, head and neck, skin and bladder and is being tested in other types such as prostate cancer.….

On the same day Kat Lay reported: Targeting cancer’s genes prolongs life

Treating cancers based on their genes, rather than where they occur in the body, increases a patient’s chance of surviving for a decade six-fold, a study has found.

Data presented at the American Society for Clinical Oncology (Asco) meeting in Chicago showed that 15 per cent of patients given drugs that targeted specific genetic mutations in their tumours survived for three years, compared with 7 per cent of patients who had standard unmatched therapy.

Six per cent of the matched group survived for ten years compared with 1 per cent of the unmatched group.

“All patients should have access to next-generation sequencing and I believe in the next few years we are going to see this approach dramatically improving outcomes,” Apostolia Tsimberidou, who led the research, said. “We need to know what is really causing these diseases so we can treat them properly.”

Researchers from the University of Texas looked at more than 3,000 patients with cancers including breast, lung, gynaecological and stomach tumours. After using a technique called next-generation sequencing, which tested between 20 and 50 genes simultaneously to determine exactly which molecular abnormalities were present in the tumours, they found that 1,307 had at least one genetic change. Some 711 of those patients received drugs matched to the biology of the tumour, for example blocking the function of the mutated or altered gene, sometimes alongside chemotherapy. A further 596 received a drug that was not matched to their tumour’s biology, usually because a matched treatment was not available to that patient at the time.

Those studied had advanced cancer that standard care had failed to halt, with some having tried 16 therapies. While overall survival in the study was small because the patients involved were very ill to start with, Professor Tsimberidou said that the results would probably be even more striking had the technique been used earlier.

In the NHS, many cancer patients receive genetic testing of some type, but next-generation sequencing has yet to be adopted widely. The cost can vary but has declined rapidly in recent years, with some versions costing about £300.

Professor Tsimberidou said that one patient in her clinic had had glioblastoma — the aggressive brain cancer that killed Tessa Jowell, the former cabinet minister, last month — diagnosed in 2011 but was still alive thanks to personalised treatments.

Catherine Diefenbach, an Asco expert, said: “We’ve just scratched the surface. Now with faster and more robust genetic tests we can help even more patients by treating the cancer based on its genetic makeup rather than solely on its location in the body.”

 

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High Tech advances hit NHS funding. A proper debate wont happen however.

The state is not able to keep up with the advance of technology. This means we HAVE to ration care. It’s just a choice of rationing covertly and differently by post code/region, or doing  it overtly. Our cowardly political masters know this, but refuse to speak out. The media thinks health is too complex for a sustained debate that their readers will appreciate. So, in a media led society,  it won’t happen.

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HI-TECH ADVANCES HIT NHS FUNDING
Nye Bevan did not foresee, and your leader neglects, the effects of medical advances on both NHS funding requirements and patient demand (“Higher tax is not the only solution to an ailing NHS”, Editorial, last week).

New investigations and treatments create “wants”, which change to “needs” as they become familiar. Such advances have been dramatic and are often expensive: if they extend life beyond what was previously possible, patients survive to require more clinical management for longer. Thus the costs are not limited to the treatments themselves, but to the longevity they facilitate.

No country, whatever its healthcare model, can provide the funding that could potentially be absorbed as technology advances. We have to recognise this and use funding wisely. A mature debate is long overdue.
Dr Vernon Needham, provost, Wessex Faculty, Royal College of General Practitioners

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Red-tape waste
Your editorial is correct. Huge sums are being wasted through the present complex system of commissioning healthcare. The internal market process has been estimated to consume 14% of the total NHS budget and has not been shown to improve outcomes.

About 200 clinical commissioning groups (CCGs), each with its own infrastructure, have to negotiate with multiple providers. Recent changes were meant to reduce bureaucracy, but my experience on the governing body of a CCG leads me to believe the opposite has happened. The system is divisive and wasteful.
Professor Robert Elkeles, Northwood, London

A bus-load of cash awaits
It shouldn’t be difficult to find more funds for the NHS. As those of us who followed the EU referendum can attest, Boris Johnson and Michael Gove know where to find an extra £350m a week.
Stephen Ball, Littleborough, Greater Manchester

Its going to get much worse. The difference in health, life expectancy and quality of life, in a two tier system. The finances are dire. Hospitals are bust.

It is now inevitable tat more and more people will vote wit their feet. Out of their health service, (private) or go abroad.  Its going to get much worse. The difference in health, life expectancy and quality of life, in a two tier system. The finances are dire. Hospitals are bust. And do you really think the minister will propose a sensible solution…..?

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The Guardian today: Two in five GPs in England intend to quit within five years – survey

Warning over standards of care as NHS falls short on targets

NHS deficit last year twice as high as expected, say sources The Guardian today

Catriona Webster May 3rd in the Times reports: Shona Robison has agreed to publish the finances of NHS boards monthly after pressure from the Scottish Conservatives.

Sky News today: NHS report reveals sharp rise in waiting times for care

BBC News today: Deficit for NHS trusts in England double the amount planned

NHS trusts in England have reported a combined financial deficit that was nearly twice the amount planned.

There was a deficit of £960m in the last financial year compared with the £496m they had planned for, the regulator NHS Improvement said.

Acute hospitals were largely responsible, mainly because of increased patient demand, it said.

All other providers, including ambulance and mental health trusts, had collectively underspent, it added.

The latest reported deficit is reached after taking account of extra financial support provided by the government.

Therefore, the Nuffield Trust think tank argued that the true underlying figure was much worse, as the finances had to be patched up with one-off savings and emergency extra cash.

Senior policy analyst Sally Gainsbury said: “Given the huge pressures on NHS providers, it is not at all surprising that the reported deficit for 2017-18 is £960m……

…Ministers have promised a new long-term financial plan for the NHS, which is expected within weeks.

In March, Prime Minister Theresa May said she wanted to get away from annual “cash top-ups” and would come up with a blueprint later this year to allow the NHS “to plan for the future”.

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Radical and simple. Why not expand this suggestion? Fundin the ealt Services..

The Times letters 28th May:

Why do we know that this suggestion will not be acceptable? Because it means that access is not free at the point of delivery. Who on earth made this a sacred cow? We have charges for eyes, dentistry, and prescriptions (in some post codes), so why not an income related co-payment? My only query is why not allow for all means, including capital, as there are many people who would be excluded without. we always want to kick the party tat suggests tax increases…

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NHS FUNDING (The Times letters 28th May 2018)

Sir, There is one way to increase NHS funding without raising the nominal tax or national insurance rates (Comment, May 25, and letters, May 26). Every time a UK citizen uses the NHS the appropriate charge should be logged with HMRC which will then alter the beneficiary’s tax code. This would mean that the beneficiary would pay not the whole amount, but a proportion equivalent to their marginal rate of taxation. Those who do not pay tax would still receive free treatment, while other users would pay a proportion of their benefits.
Christopher Buckmaster

London SW11

 

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Update wit further letters 29th May:

Sir, Paul Johnson (Comment, May 28) excellently highlights the fragmentation and funding crisis of elderly care services. May I offer some considerations for long-term solutions?

Beveridge designed the National Health Service as a “make-you-better” service, offering acute interventions that cure patients who can resume normal life. It was never intended as a “look-after-you-for-ever” service for increasing numbers. The major policy failure arises because no government has allocated pre-funding for care needs. Rising demand and costs have resulted in ever-stricter rationing of care provision, which inevitably increases NHS costs.

Reforms of health and care services in recent decades have focused on highlighting problems rather than implementing solutions as costly reorganisations addressed parts of the system, rather than the whole.

Care funding should be a core element of 21st-century retirement planning. Kick-starting care funding through baby-boomers’ pensions or long-term savings could be facilitated by allowing tax-free pension withdrawals for care funding, or an inheritance-tax-free care Isa allowance.

In addition, national insurance (or tax) must encompass elderly care, not just pensions, for future generations.
Baroness Altmann

House of Lords, SW1

Sir, There is no doubt that the NHS would be helped by a tax hike or an increase in national insurance but would that solve the problem (Comment, May 25, and letters, May 26 & 28)? A modest charge on a GP appointment has been suggested and that would deter unnecessary users. What the NHS does now is far more than what was envisaged at its inception 70 years ago. Putting aside contentious matters such as gender changes and homeopathy, heroic attempts to extend life can sometimes be as costly as they are cruel. Assisted dying is to be avoided at all costs but resuscitation of the terminally ill or operating on them to extend life by a few weeks is cruel, costly and puts a load on often-elderly relatives.

Throwing taxpayers’ money at the problem is not the solution; caring about care may be.
Dr Robert J Leeming

Coventry

Sir, Christopher Buckmaster makes a good point on NHS funding (letter, May 28). When I lived in France 30 years ago a similar system existed. When visiting the doctor you handed over FF100 (about £10) and were given a receipt: the local tax office would refund the amount against the docket. If the state offered you a life-saving procedure, you were given the option of paying for it or attending a month’s residential course on improving your lifestyle.
Denis Harvey-Kelly
Sherborne, Dorset

Update 31st May Times letters

INCREASED FUNDING FOR THE NHS
Sir, As we approach the 70th birthday of the National Health Service it is welcome that we are now having a national debate on its financial sustainability. Medical royal colleges have consistently called for increased funding for the NHS, public health and social care and last week’s report from the Institute for Fiscal Studies and the Health Foundation Securing the future: funding health and social care to the 2030s makes clear that increases of about 4 per cent a year will be needed if the government wishes to improve NHS services, including meeting waiting-times targets and addressing under-provision in mental health.

We urgently need a settlement for the NHS and social care that goes beyond managing short-term crises, acknowledges the financial deficits and recognises the need to invest in transformation and recruitment.

As leaders of medical professionals, we recognise that alongside increased funding there need to be substantial changes in how health and care services operate if we are to
provide first-class, integrated care
for patients.

Professor Carrie MacEwen, chairwoman, Academy of Medical Royal Colleges on behalf of Professor Derek Alderson, president, Royal College of Surgeons of England, Professor Derek Bell, president, Royal College of Physicians of Edinburgh; Professor Alan Boyd, president, Faculty of Pharmaceutical Medicine; Dr Liam Brennan, president, Royal College of Anaesthetists; Mr Mike Burdon, president, Royal College of Ophthalmologists; Professor Wendy Burn, Royal College of Psychiatrists; Professor Jane Dacre, president, Royal College of Physicians of London; Dr Anna de Bono, president, Faculty of Occupational Medicine; Professor Michael Escudier, dean, Faculty of Dental Surgery; Professor David Galloway, president, Royal College of Physicians and Surgeons of Glasgow; Dr Tajek Hassan, president, Royal College of Emergency Medicine; Dr Paul Jackson, president, Faculty of Sports and Exercise Medicine; Dr Asha Kasilwal, president, Faculty of Sexual and Reproductive Health; Mr Mike Lavelle-Jones, president, Royal cOllege of Surgeons of Edinburgh; Professor Jo Martin, president, Royal College of Pathologists; Professor John Middleton, president, Faculty of Public Health; Professor Lesley Regan, president, Royal College of Obstetricians and Gynaecologists; Professor Helen Stokes-Lampard, chairwoman, Royal College of General Practitioners; Professor Russell Viner, president, Royal College of Paediatrics and Child; Professor Carol Seymour, president, Faculty of Forensic and Legal Medicine; Dr Nicola Strickland, president, Royal College of Radiologists; Dr Carl Waldman, dean, Faculty of Intensive Care Medicine

Britain ranked last (out of 20 rich countries) by a wide margin in the number of CT and MRI scanners per head of population. Australia has six times as many CT scanners per head, and spends roughly the same as Britain on healthcare overall as a share of GDP.

The Times leader may 13th 2018: Cancer Catch-up

There is a mismatch between great British research and less impressive careSee the source image

In Baroness Jowell’s final speech to the House of Lords she drew attention to the fact that just 2 per cent of British cancer research funding is spent on brain tumours. She would no doubt be pleased that the government is increasing that amount by £65 million in her name. Her accomplishments on many fronts are themselves a memorial to a life well lived and the extra money will be a capstone on that memorial. It is not, however, a strategy for bearing down on the most stubbornly lethal cancers and driving up survival rates, and a strategy is what the country needs.

There is a stark divergence between the quality of cancer research in Britain, which is genuinely world-class, and the quality of treatment and outcomes, which continue to lag behind those in other developed countries. One of only two top-rated cancer research centres in Europe is in Cambridge. Cancer Research UK works with 13 centres in all and they are among the world’s most prolific publishers of peer-reviewed papers. By contrast a recent study ranked Britain on average 17th out of the 28 EU countries by five-year survival rates for nine common types of cancer.

This underachievement on cancer treatment is not new. Nor is it simply a result of limits on resources available to the NHS. It is largely a result of delays in diagnosis and treatment, and all-too-frequent failures to make new therapies available to those who need them. These failures may be explained by the need to save money, only to cost more in the long run.

With no operational proton beam therapy machines of its own, for example, the health service now pays for patients to have the treatment abroad or privately. Or leaves them to go without. A systematic effort to speed up diagnosis and treatment might not have saved Lady Jowell, but it would save thousands of others.

Part of the challenge is to boost uptake of screening programmes already available on the NHS. There are well-known risks attached to excessive cancer screening, including false positive results and unnecessary but debilitating treatment. These risks have been taken into account in setting current screening guidelines for breast, prostate and cervical cancer. Despite this, the number of women attending recommended breast cancer screenings fell last year to its lowest level in a decade, while 25 per cent of those booked to attend a cervical cancer screening did not.

When diagnosis is late the best treatment in the world may not be enough. Even when it is not, a simple lack of specialist staff and equipment may delay treatment. Of 20 rich countries in a recent King’s Fund study, Britain ranked last by a wide margin in the number of CT and MRI scanners per head of population. Australia has six times as many CT scanners per head, and spends roughly the same as Britain on healthcare overall as a share of GDP.

Prevailing in the battle against cancer requires choices. It will be galling for some if the government now allows brain cancer patients to take part in more than one clinical trial at a time, at Lady Jowell’s suggestion, while denying other cancer patients, such as those with leukaemia, access to drugs approved as clinically and cost-effective on the false basis that they are still experimental. Surviving cancer patients deserve a coherent strategy to bring British care up to standards taken for granted elsewhere in the developed world.

The English Health Services have finally been shamed into action by Ashya Prague’s parents. Proton beam centres ‘to treat 1,500 patients a year’….

Proton beam therapy arrives in the UK.

It was rational rationing: but it revealed the lack of Proton Beam therapy in the UK: a shame on the Health Services

Proton Beam Therapy – it’s covert rationing in all UK regional health services since 1990!

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

Sir Hughes-Hallet proposes “Healthforce” – an army of volunteers to “stop NHS sinking”. It might work in Wales, but rationing overtly still has to be part of the package.

See the source imageUpdate 16th May: Disparity between cancer care and research, and the post code lottery.

Sir, The problems identified in your leading article (May 15) on cancer survival rates in Britain are very real. We are a persistently poor performer relative to countries that we would like to see as our peers. But this is a complicated problem, and simple solutions will not work. Studies suggest that British patients are more reluctant than their counterparts on the Continent to go to their GP with symptoms, and GPs in turn are less likely to refer people for testing.

Although there would be advantages to spending more on cutting-edge drugs, the high cost could come only from other NHS treatments, and the evidence suggests that the overall effect would be relatively small compared with improving other aspects of prevention and care. This is not a problem unique to cancer: the NHS needs to improve outcomes across a wide range of conditions. It is very seductive to focus on particular diseases but experience in other countries suggests that strengthening the overall system will be more effective.
Nigel Edwards

CEO, Nuffield Trust

Sir, Your leading article succinctly describes how the UK lags behind most of Europe in terms of cancer survival rates. But it (perhaps inadvertently) creates the impression that the solution lies in narrowly focusing on improving cancer care.

This is doubtful. The NHS is a laggard in terms of health outcomes in general, not just cancer survival. It is also a laggard in terms of stroke survival, measures of avoidable premature deaths, mortality rates for respiratory diseases, and almost any indicator for which we have comparable data. It would be odd if cancer were the exception.

The health systems that achieve the best outcomes tend to be competitive, pluralistic systems with a mix of municipal, regional, private for-profit and private non-profit providers. Not wholly unlike the one sub-sector in which, as your leading article notes, the UK excels: medical research.
Dr Kristian Niemietz

Institute of Economic Affairs

Sir, Chronic lymphocytic leukaemia (CLL) is one of more than 130 types of blood cancer (reports, May 12, and letter, May 15). A recent report by the all-party parliamentary group on blood cancer found that unlike the treatment of solid tumour cancers, blood cancer is often not treatable using surgery or radiotherapy. This means that it is even more dependent on drugs being available.

People affected by CLL will often be monitored under “watch and wait” until their cancer reaches a certain stage, when they will undergo chemotherapy with all of its associated side-effects. Even then, many people will relapse. Approximately 200 people a year, whose CLL has relapsed, will be denied the drug — ibrutinib — that offers them a lifeline.

It is not acceptable that guidance by the National Institute for Health and Care Excellence (Nice) on the use of ibrutinib is being reinterpreted by NHS England, particularly if this is for anything other than what is in the best interests of people with CLL.
Henry Smith, MP

Chairman, all-party parliamentary group on blood cancer

Sir, Ibrutinib is an innovative treatment and alternative to conventional chemotherapy and can improve quality of life for patients. On January 25, 2017, Nice approved the use of ibrutinib for previously treated CLL patients. We are dismayed that ibrutinib will not be offered to these patients if they have relapsed more than three years after treatment. It is unclear how NHS England could implement such an arbitrary restriction without evidence or guidance from Nice.

NHS Wales and NHS Scotland have made no further restrictions to Nice’s guidance. This is creating a health equity issue. It is a cross-border postcode lottery, unfairly penalising English patients and their families.
Zack Pemberton-Whiteley

Leukaemia Care

 

Cancer patients denied effective drug ‘to cut costs’ – most policies from politicians are short term.

Cancer drugs are rationed both covertly and overtly. The idea that we might “qualify” for different treatments, ad different exclusions in different post codes and regions is anathema in a “universal” health care system. The research into cancers is world wide. Any investment by government will be appreciated by citizens of the whole world. The Guardian: – Brain cancer to get more funding in tribute to Tessa Jowell, says No 10 14th May 2018 – but any citizen must realise that this was an emotional rather  than a scientific decision, and without the “research targets” there is a good chance that this money will be considered a failure in the retro scope in 10 years’ time, but at least this aspect is long term.. However, allowing desperate patients to transfer from one trial to another may not help the quality of research… that will once again be short termism.

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Chris Smyth reports in the Times 12th May 2018: Cancer patients denied effective drug ‘to cut costs’

Cancer patients are being denied a life-extending drug by the NHS in an “arbitrary” restriction that experts fear could set an unacceptable precedent.

NHS England has been accused of defying a legal duty to make approved drugs available to hundreds of patients in an attempt to cut costs.

Campaigners say that if the restrictions stand, health chiefs will have a green light to impose tough restrictions on a wide range of medicines, with patients given little recourse.

The £17 billion fund for complex care has repeatedly run over budget, putting health chiefs under pressure. Simon Stevens, the chief executive of NHS England, says that his harder line on drugs has forced companies to reduce prices.

The latest row centres on a medicine to treat chronic lymphocytic leukaemia (CLL), a blood cancer that affects 3,700 people each year and kills 1,000.

A drug called ibrutinib, which inhibits abnormal white blood cells, has rapidly become the standard treatment. The National Institute for Health and Care Excellence (Nice) approved the medicine last year for routine NHS use for people who had relapsed after chemotherapy, giving the patients a legal right to the treatment.

NHS England has ruled, however, that it will pay for ibrutinib only to treat patients who have relapsed within three years, denying it to an estimated 200 patients a year who have been in remission longer.

Peter Hillmen, professor of experimental haematology at the University of Leeds, an expert on CCL, said: “I was under the impression that if you live in England you had a right to get Nice-approved treatments. We are now told that isn’t the case.”

Professor Hillmen said that it was a “false economy” to make patients undergo further chemotherapy that would have only a temporary effect. David Innes, chairman of the CLL Support Association, condemned the “lack of transparency”. He said: “This situation is intolerable for CLL patients. To impose arbitrary rules to deny this access is unacceptable.”

NHS England said that the three-year criterion had been imposed because the key trial of ibrutinib looked only at patients who had relapsed within this time, arguing that this was “in the spirit of the Nice recommendations”.

The agency hinted at a climbdown if evidence built that it was effective.

Andrew Kaye, the head of policy at Macmillan Cancer Support, said: “Any rationale for adding extra conditions for how a cancer patient accesses treatment beyond what Nice recommend must be fully explained and backed by clinical evidence.”

Sunil Iyengar, consultant haematologist at the Royal Marsden, in west London, said: “We are denying patients with relapsed CLL a more effective, less toxic treatment with potential reductions in admissions to hospital. The worry is it sets a precedent.”

Richard Torbett, of the Association of the British Pharmaceutical Industry, questioned the legality of the decision. “If a medicine is recommended for use by Nice for patients who would benefit from it, then it’s not appropriate for that medicine to be arbitrarily rationed or restricted by NHS England,” he said.

A spokesman for Nice said: “If a patient has chronic lymphocytic leukaemia and the doctor responsible for their care thinks that ibrutinib is the right treatment, it should be available.”

An NHS England spokeswoman said that ibrutinib was funded “in line with Nice guidance”, which outlined the clinical evidence on which patients were most likely to benefit.

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A Private GP or a paramedic? Paramedics to replace north Wales’ GP home visits

Do you want a Private GP or a Paramedic? Are you aware of the differences in their training and the emphasis on differential diagnosis with a doctor? Would you pay extra to have a GP visit? This is an experiment that may not work! Since Trusts are not insured, but covered by the state compensation fund, (and in Wales the reserved amount is greater than one year’s budget) this could be short termism at it’s worst, as either the beds are still filled, or the litigation bill rises. The post code lottery has dug itself in to N Wales.

BBC News reports 30th April 2018: Paramedics to replace north Wales’ GP home visits

The difference in training time, costs, and then in risk in the two professions is reflected in undercapacity in diagnostic doctors. How did manpower planning get it so wrong? What planning is there for either litigation because of missed diagnoses, or for extra work in the local hospitals as the paramedics fail to reduce attendance? This is an experiment forced upon a government by the rationing of places and the poor manpower planning over decades and successive administrations. Graduate entry to medical school would help – in 10 year’s time.

We have 10 years of undercapacity of doctors in primary care, and in hospitals, particularly A&E, ahead of us. What better advertisement for private GPs to start in N Wales, and what a shame that Aneurin Bevan’s dream of an equal health mutual should be threatened this way.

Blaming the : Doctor shortage ‘fault of immigration rules’ does not fool observers of the 4 health services over a lifetime. Since 9 out of 11 applicants have been rejected, for decades, this is the real reason there is a shortage of doctors.

BBC news:

Traditional GP home visits could soon be performed by rapid response paramedics in a bid to reduce hospital admissions in north Wales.

A team of advanced practice paramedics would be available 24 hours a day 365 days a year.

It is one idea proposed by Betsi Cadwaladr health board (BCUHB) in a bid to transform primary care services.

The Welsh Ambulance Service said paramedics would complement – not replace – some GP practices.

It is hoped it will help stop people ending up in A&E.

A report by BCUHB assistant area director for primary care Wyn Thomas said the scheme would “address the immediate health needs of patients that, if not seen promptly, will end up being an unscheduled care hospital admission”.

The proposal, which aims to free up GPs for daily appointments and reduce A&E admissions, is just one idea to sustain primary care services to be put before the board at its meeting on Wednesday.

Another idea is to set up a “social prescribing service” to improve health and well being and “enable patients to be pro-active in managing their own conditions and well-being”.

Primary care services in north Wales have been under intense pressure in recent years, with one leading medic warning last year that a “crisis” in GP recruitment was “escalating”.

Since 2015, Betsi Cadwaladr University Health Board (BCUHB) has taken over the running of a number of GP practices across north Wales after they terminated their NHS contracts.

Now the board also plans to bring in a “flying squad” of professionals – doctors, nurses and practice managers – to help GP practices struggling with workloads and considering handing back their keys.

From 2015, the Welsh Government gave additional funding to health boards to improve the planning and delivery of primary care services and the BCUHB has already introduced changes.

These include having pharmacists, physiotherapists and other special services embedded in GP practices.

A Welsh Ambulance Service spokesman said it was working with the health board on the initiative to use paramedics for home visits, saying it was “currently in its early stages and contingent on funding”.

“If approved, a group of advanced paramedic practitioners will help to support primary care providers in some areas of north Wales where practices require assistance,” he added.

“We are committed to widening our clinical offer and will continue to work with BCUHB and other partners on system solutions that ultimately support patients.”

“According to the computer, you should be feeling better by now.”