Category Archives: Professionals

Dont ration hearing aids if you want to reduce early dementia (as well as falls and depression), and avoid Regional Disparities

Some health trusts have been reducing the number, access, and quality of hearing aids. This is particularly prevalent in Wales. The message from a large study in Michigan is that this is an important population measure: keep access to the best hearing aids available to all and avoid post code and regional discrimination. England currently offers WiFi connectivity but Wales does not. We pay the same taxes!! Hearing aid technicians often leave NHS (all 4 dispensations) to set up privately. Exit interviews would reveal why.. There is a mixture of management, resource and quality issues which drive them away after being trained at the state’s expense. Are Trusts and Commissioners suffering from selective deafness?

Image result for selective deafness cartoon

Andrew Gregory in the Sunday Times a5th September 2019 reports: Hearing aids cut risk of dementia, falls and depression

Wearing hearing aids can dramatically reduce the risk of dementia, depression and serious falls, according to the largest study of its kind.

The analysis found the risk of developing dementia within three years of being diagnosed with hearing loss fell by 18% for those who used hearing aids, compared to non users. The risk of falls fell by 13% and of depression by 11%.

In July, a study of 25,000 adults found aids improved memory and attention.

Elham Mahmoudi, a health economist at Michigan University who led the study based on 115,000 adults, said: “We already know that people with hearing loss have more adverse health events . . . but this study allows us to see the effects of an intervention and look for associations between hearing aids and health outcomes.

“Though hearing aids can’t be said to prevent these conditions, a delay in the onset of dementia, depression and the risk of serious falls, could be significant. We hope our research will help clinicians and people with hearing loss understand the potential association between getting a hearing aid and other aspects of their health.”

Beth Hartley, 29, a food manager for Sainsbury’s, said hearing aids changed her life after she was found to have hearing loss at the age of five. Hartley, of Wheathampstead, Hertfordshire, whose grandfather had hearing loss in later life and had dementia when he died, said: “I consider wearing hearing aids incredibly empowering — both in the short term for integrating socially and in the long term for my mental and physical health.”

Rebecca Dewey, a research fellow in neuroimaging at the University of Nottingham, described the new study as “compelling”, adding: “Too much of the time, hearing aids sit in a drawer to the direct cognitive disadvantage of the person.” Around 7m Britons could benefit from aids but only about 2m use them, research suggests.

Roger Wicks, of Action on Hearing Loss, said: “With the number of people with hearing loss predicted to rise to one in five by 2035, and with the link to dementia increasingly clear, more must be done to encourage greater take up of hearing aids.

“Some areas of the country already have restrictive policies on hearing aid provision — going against all clinical guidelines — in a misguided effort to make short-term savings.”

James Connell, of Alzheimer’s Research UK, said the key advice to ward off developing the disease was not smoking, drinking within recommended guidelines, staying mentally and physically active, eating a balanced diet and keeping blood pressure in check.

The Mirror: Hearing aids can reduce the risk of dementia and depression …

Rob Andrews for Stoke on Trent live reports 5th September 2019:  Will you be affected? Thousands of Stoke-on-Trent patients …

 

 

 

Don’t believe we are rationing? Do you believe in transparency and honesty? Why not use the correct word?

Just in the last few days these news items reveal the truth. Despite this the “R” word can never be acknowledged by politicians. None since Enoch Powell has embraced the truth. (Described by Richard Smith, former BMJ editor as “the best book written on the NHS”. A new look at medicine and politics: 1975 and after. Pitman Medical 1976. 2nd edition. ) 

Link to his book published by the Socialist Health Association

Why do you think we had no PET scanners until 20 years late! Why are there waiting lists longer than any other G7 country (and the results to match)? Why have the two countries that emulated the original NHS reconsidered? (NZ and Scandinavia). Why are we only appointing 1 doctor for every 10 who apply and have been encouraged to do so by their careers officers? Why are botched operations so commonplace?  Why does the NHS Ombudsman produce reports which have no notice taken? Do the politicians read these reports?

If you believe in honesty and transparency why not use the correct word? We will never win the hearts and minds of the health service staff if politicians and media and public collude in the language of denial.

Henry Bodkin in the Telegraph 14th September 2019: NHS bosses tried to “gag” father of boy whose life was ruined in botched operation

In The Guardian 30th August 2019 Dennis Campbell: ‘Crumbling’ hospitals putting lives at risk, say NHS chiefs  –  Four in five NHS trust bosses in England fear Tory squeeze on capital funding poses safety threat

Why cannot Cheshire recruit enough GPs? Pulse reported by Lea Legraien 14th September

Why do we still get fraudulent managers promoted (The Independent 19th December 2018)

Why are half of the 4 health services’ trusts using out of date radiotherapy equipment? ( Andrew Gregory in The Sunday times 15th September 2019 )

This is particularly important for Pembrokeshire and West Wales as we have a long distance over difficult roads to travel to Swansea at present. Our planned new Hospital, wherever it is, needs Radiotherapy, Radio Isotope Investigations, and STENT treatment for Coronary Heart Disease if our options are to be the same as those in more favoured areas. I reproduce the article at the bottom of this post.

Adam Shaw for the Harrow Times reports 13th September 2019: North-West London CCGs dismiss claims of “rationing” services.

Kat Hopps September 13th in the Express reports: IVF: How NHS IVF treatment is unfair postcode lottery and keeps couples childless

A disgrace and a shame on politicians: “Surge in patients raising own cash for amputations”. Rationig by waiting and by incompetence.

Pembrokeshire Oncology cancer services in crisis

There is a “need to put doctors in charge and force them to take account of patients’ views. Cancer survival rates are (just) one of the prime examples of NHS mediocrity.”

Desperate NHS needs a desperate remedy – care is already rationed

The 3 myths of the NHS…..& …No learning from other countries – no co-payments, and more scandals..

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.

Why are half of the 4 health services’ trusts using out of date radiotherapy equipment? ( Andrew Gregory in The Sunday times 15th September 2019 )

Almost half of NHS trusts are using outdated radiotherapy machines that are far less effective at killing cancer cells to treat patients.

The revelation comes days after the UK came bottom of an international league for cancer survival rates in The Lancet Oncology journal.

In 2016 the NHS said it was investing £130m in upgrading radiotherapy equipment but the figures, revealed via freedom of information requests, found 46% of trusts are still using outdated linear accelerator (Linac) machines beyond their recommended 10-year lifespan.

Dr Jeanette Dickson, president of the Royal College of Radiologists, said more advanced radiotherapy techniques enable “greater precision when targeting specific tumours and have been shown to be less harmful to surrounding tissue than older types of radiotherapy, depending on the complexities of the cancer being treated”.

Rose Gray, policy manager of Cancer Research UK, said it was “deeply concerning” to hear outdated radiotherapy machines were being used.

She said: “The NHS has grappled with the question of how best to replace outdated equipment for many years, and the government has repeatedly been urged to put a long-term plan in place.

“But . . . that still hasn’t happened. These investigation findings prove the urgent need for a solution to this persistent problem.”

In total, 57 of the 272 Linac machines used this year are 10 or more years old. One of them that is still in operation has been used for 17 years.

Dr Peter Kirkbride, the former chairman of the government’s radiotherapy clinical reference group and spokesman for the Radiotherapy4Life campaign, said: “That radiotherapy has been put on a lower footing than other cancer treatments — such as chemotherapy — by successive governments is an open secret within the NHS.”

The Liberal Democrat MP Tim Farron, chairman of the all-party parliamentary group on radiotherapy, described the figures as “shocking”.

He said they proved the investment in 2016 had been a “drop in the ocean” when compared with what is required to meet soaring demand.

Saffron Cordery, deputy chief executive of NHS Providers, which represents hospitals, added: “What we do know is that for year after year, money earmarked for capital investment has been siphoned off just to keep services running.”

An NHS spokeswoman said 80 radiotherapy machines had been upgraded since 2016 and patients were benefiting from “a range of improvements” to cancer services.

Enoch Powell 4 Supply and Demand – Rationing

 

A&E waiting times – are a dangerous disgrace. Casualty should be manned by more rather than less experienced doctors.

A recent admission to my local DGH A&E was an eye opener. It was as if nobody cared when a retired GP arrived at 00.30 to say he had a painful infected hand and needed an operation. The time taken to be seen was appalling, with 30 mins to see the triage nurse, 4 hours later to see the SHO and 1 hour later to see an F2 covering orthopaedics from another speciality. (Surgery). The result of a sleepless and painful night without adequate analgesia was my walking away at 06.00 (after being advised that there would be no way to see anyone before 10.00 am!) with a compartment syndrome not yet diagnosed or seen by somebody able to take action. This was a wait of 5 and a half hours, but then I got access to the specialist via my GP by barging in first thing. (GPs are not meant to be an emergency service!). She rang the consultant and arranged for me to be seen mid morning, and an operation ensued at 19.30 which was some 18 hours later than it might have been. The result, even for a doctor who presented himself, was delayed decompression of my dominant R hand, and a long recovery on antibiotics. I suspect that the pain could have been less, the operation sooner and the recovery quicker if the right person had been in A&E. 

This type of story is commonplace. Retired colleagues all tell me “dreadful” stories of their own experiences. It would have been better for me if I had travelled to a properly staffed tertiary centre than my local DGH, even though it is 90 mins away. We need honesty and transparency in all areas of health, and I suspect increased death and complication rates are already a fact if you happen to live in the wrong post-code.

Rosie Taylor in  the Times 13th September reports: Alarm grows over A&E waiting times

The number of patients kept waiting at A&E departments in England reached its highest level in a decade last year, prompting warnings that pressure on the NHS would rise this winter if it faced the “perfect storm” of high demand and a no-deal Brexit.

Patients kept waiting at least four hours more than trebled in the past five years. Last year only 88 per cent of patients were seen within four hours compared with 98.3 per cent ten years ago, according to the NHS’s Hospital Accident & Emergency Activity 2018-19 report.

Separate NHS figures show that last month was the busiest August ever.

Tim Gardner, senior policy fellow at the Health Foundation charity, said: “A no-deal Brexit would only exacerbate these pressures, intensifying staffing shortages, driving up demand for hard-pressed services, disrupting supplies of medicines and other necessities, and stretching the public finances which pay for healthcare.”

Helen Fidler, deputy chairwoman of the British Medical Association’s consultants’ committee, said: “This summer emergency departments had their busiest August on record. As we move into what will undoubtedly be a difficult winter the situation will get worse . . . A no-deal Brexit threatens to pile even more pressure on overworked staff.”

A&E attendances last month were up 6.4 per cent on the same month last year. Although doctors treated an extra 1,200 patients within four hours, the percentage of people seen within that time dropped from 89.8 per cent to 86.3 per cent.

About 24.8 million people attended emergency departments in 2018-19, a 21 per cent increase on the 20.5 million who visited in 2009-10. However, while attendances rose 2 per cent year-on-year, the population has grown by only 1 per cent a year over the same period.

Miriam Deakin, director of policy and strategy at NHS Providers, which represents hospitals, said the sheer dedication of staff was stabilising A&E performance despite a record number of patients. However, she added: “This winter will be a very testing time for trusts. We anticipate that performance will slip even further, with patients waiting longer for treatment across various services.”

Rising demand has also increased the time patients are left on trolleys. Last month 362 patients waited for more than 12 hours in A&E after it had been decided to admit them, more than double the figure for August last year.

An NHS spokesman said that in July a record number of patients were seen within two weeks of referral for urgent cancer checks, routine tests or treatment for serious mental health problems. He added: “Every part of the health service is playing its part in meeting the rising demand for care.”

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..

A view from Switzerland: “I would’nt put up with it for 2 seconds”… What the NHS needs is the “right sort of bureaucrat”.

The “devotion” to a non existent National Health Service is evident in every meeting where any change is proposed. Until we change the “rules of the game” our health services are set to decline compared to the private alternatives. However much money we put in we will never have equality and fairness given the current 4/5 dispensations, post code differences in quality, waiting, life expectancy, etc. If only we could “see ourselves as others see us”: devoted to a mythical concept rather than the reality of today. (Robbie Burns in Ode to a Louse.)

Janice Davis opines on September 7th 2019 in “The conservative woman”; What the NHS needs is the right sort of bureaucrat”.

HEALTH spending in England during the financial year 2018/19 was approximately £129billion, and is expected to rise to nearly £134billion by 2020. Of that, £115billion was spent on the NHS England budget, while the rest was spent by the Department of Health on initiatives, training, education and infrastructure, which includes IT and new hospitals.

In spite of that massive budget, the NHS operates under severe financial pressures. Trusts across England collectively ended up in 2018/2019 with a deficit of £571million – not a huge percentage of the total perhaps, but still an enormous amount over-spent. There is political pressure for savings, at the same time as demand is rising and the population is ageing. Some claim that treatments are being rationed, while patient care is often found to be inadequate.

It’s all looking a bit of a mess. Why? It seems to me to be the result of a gap between the political scope of the health care system and how the government is managing to finance it. Techniques and medication have developed greatly in the 71 years since the NHS was initiated. But so has the range of ‘health’ issues which the national service sees the need to treat at taxpayers’ expense. Cosmetic procedures, sex transitioning even for infants, fertility for ageing would-be parents as well as the growing costs of obesity: all would have William Beveridge turning in his grave. Then there’s ‘mental health’ – the whole nation appears to be suffering a serious nervous breakdown.

This is happening everywhere in the developed world, but one of the solvable issues in the UK is that even when the authorities have decided what the service ought to be treating, there is no consideration of either its affordability, access or even rationing. The holy cow of ‘free at the point of access’ means ‘very expensive at the point of taxation’.

It’s not for nothing that the design of the NHS is not replicated anywhere else in the world. Health care is the greediest money-eating aspect of western societies. The amount the UK spends on it should have the world salivating with envy. Instead they see an example of poor value for money.

Let me tell you about health care where I live in Eastern Switzerland. Everybody moans – the insurance premiums keep going up, and you always seem to get less cover. But health care here is superb. And everybody knows exactly what it costs, because they receive itemised statements from their insurance company. The cost of your blood pressure meds, the cost of 15 minutes with your GP, and if you’re really unlucky the cost of calling an emergency ambulance (which will turn up in five minutes, superbly equipped and manned, and will probably cost you over £1,000, because your insurance doesn’t cover it). It all makes people think, and even take care.

National Insurance taxation was supposed to pay for universal health care in the UK. But it’s not ring-fenced, and all costs now come out of general taxation, which is paid by only about 50 per cent of the UK population. All of this half of the population have the legal right of access, but far more worrying is the fact that the NHS has no mechanism for restricting access to its enormously expensive care system to those who are absolutely not entitled to it, namely health tourists who have left £150million of unpaid bills. Nigel Farage was vilified for saying that non-contributors came to the UK to get free HIV treatment. The Sun retells here the story of a Nigerian woman who came to the UK to deliver her IVF quads, two of whom died, and she left an unpaid bill of nearly half a million pounds.  Why would any taxpayer-funded organisation even contemplate this?

The Left will tell you that it’s because we are a rich country and we can afford it. The country I live in is also relatively rich, but wouldn’t put up with this for two seconds. When we moved here, we applied for the right to reside. No problem at all – except we would need personal medical insurance. Without that, the young man at the Rathaus said ‘we could become a burden on the community’. So we sorted it out. Amazingly, just a few months before, the UK and Switzerland had made a bilateral agreement whereby retired UK citizens in Switzerland and Swiss citizens in the UK would be afforded reciprocal health insurance.

This means that we can access Swiss-quality health care, paid for in part by the NHS. Everyone here has to pay upfront the first CHF 400 (£328) of health care costs per annum, and thereafter approximately 10 per cent of charges. I believe this discourages unnecessary calls on GPs and demands for medication. But what the NHS partly pays for here is very different from what it pays for in the UK. I have personal experience of both. The London hospital which sorted out my broken leg was superb until it came to the after-care. The ward was not well cleaned, the food was inedible. The woman in the bed opposite had a faithful spouse who brought her three meals a day from McDonald’s. She wouldn’t touch the slimy porridge they were serving up.

Compare that with my hip replacement operation here. The Swiss system is organised largely through subsidiarity, with cantons having financial discretion, and are not pinned down to the outrage of PFI in the UK. You can choose your GP, your surgeon, even the clinic where they treat you. The wards are immaculate, and the food is worthy of a five-star hotel, because the health professionals here know that proper nutrition is a key element in patient recovery.

It doesn’t end there. After a week of care in the clinic, you get a further three weeks of rehabilitation, with physiotherapists, a swimming pool, a fully equipped gym, and all that healthy in-house cooked food. Even visitors, hikers and families came daily to the canteen to eat the same healthy food provided for us. (They pay, of course.) And on being sent back home, three weeks of extra physio, just to make sure.

So why can’t the NHS follow the same rules and procedures in England? It’s not up to doctors or nurses – they are health professionals and care-givers. What the entire system lacks is the right sort of bureaucrats – ordinary secretaries, like the ones here who check my health card and make sure I’m paid into the system before I am treated. It’s not judgmental – it’s a case of knowing the rules and understanding how to enforce them. They are the necessary gatekeepers to control a very expensive system.

So what’s so difficult in the UK? It’s a routine job, especially if you are Swiss, and accept the importance of rules and enforcement. If UK politicians can’t or won’t work that out, I’ll happily volunteer to do it for them. Dead easy.

 

NHS needs 5,000 trainee doctors a year

The NHS’s lack of GPs is so acute that ministers must boost the number of medics who train to be family doctors to a record 5,000 a year, the head of the profession is demanding.

The unprecedented rise in the number of GP trainees is needed urgently because the workforce has shrunk so sharply and waiting times for appointments have become so long, said Prof Helen Stokes-Lampard.

The chair of the Royal College of GPs urged the government to increase the number of trainees in England from 3,500 to 5,000 as soon as possible to relieve the strain on surgeries and burnout that are pushing so many to quit.

Boris Johnson will not be able to fulfil his pledge to shorten waiting times to see a GP or a longstanding promise to expand the workforce by 5,000 doctors unless his government ensures that over half of all medical graduates become family doctors, she warned.

Growing numbers of GPs are giving up as a result of a relentless rise in the demand for patient care and the impact of punitive changes to doctors’ pensions. The NHS lost 576 full-time equivalent GPs last year – one in 50 of the total – according to latest official workforce figures published last week. In June it had 28,257 full-time, fully qualified GPs, compared with 28,833 a year earlier.

“GPs and our teams are facing intense resource and workforce pressures and it is causing a growing crisis in our patients’ access to general practice services, which the prime minister pledged to address when he took up office,” Stokes-Lampard said.

“We need to think big, and based on current workforce trends the college estimates that we need to start training at least 5,000 GPs every year to meet the government’s overall target to expand the GP workforce by 5,000 full-time GPs.”

Johnson recently declared “it cannot be right that people are waiting so long to see their GP”. He has promised to improve access but not given any details so far.

Many patients have to wait more than two weeks to see a GP, according to the most recent evidence.

In a letter to Rishi Sonak, the chief secretary to the Treasury, Stokes-Lampard said the rise in the number of GP trainees would need separate funding to the £4.5bn extra that is due to go into primary and community care by 2023-24.

It costs the government an estimated £150,000 to fund a GP during what is usually three years of training, on top of the £250,000 cost of undergraduate medical training.

Although the number of full-time GPs in post is falling, the number of medical graduates entering GP training is at an all-time high. It has risen from 2,671 in 2014 to 3,473 last year, which was the first time the target of 3,250 had been exceeded.

Nigel Edwards, the chief executive of the Nuffield Trust thinktank, said more GPs would mean fewer graduates becoming hospital doctors.

“I completely agree that more GPs are needed. The current shortfall has seen patients’ experience of waits get worse year after year, and created a vicious cycle as overwork makes doctors retire early.

“But we do need to remember there are only so many medical graduates coming through, so realistically we would need to cut back on trainees going into hospital, which may not be easy. And more GPs coming in won’t solve this problem alone if burnout keeps pushing them away again.”

A Department of Health and Social Care spokesperson said: “We have seen a record number of GP trainees enter training and we expect that trend to continue this year. We have also created an additional 1,500 undergraduate medical school places and opened five brand new medical schools so that more doctors are beginning careers in the NHS.

“The NHS People Plan – published later this year by NHS England – will set out our plans for securing the staff we need for the future, including for primary care.”

The NHS is at risk from a no-deal triple whammy. Winter is coming, along with a flu outbreak and a “no deal”……

The risks of Brexit to the 4 health services are in inflated costs (products are bought in US dollars), and staff (many are from overseas, mostly non-European). The triple whammy : Winter is coming, along with a flu outbreak and a “no deal”.  

Chris Hopson in the Times 26th August 2019: The NHS is at risk from a no-deal triple whammy

Whatever your views on Brexit, our key public services need to be fully prepared for no-deal, should that occur on October 31.

Foremost in our minds should be NHS hospital, ambulance, mental health and community service trusts that provide vital healthcare to a million patients every 36 hours.
How ready are they to manage a
no-deal Brexit?

The NHS has a proud tradition of performing well in a crisis. Trust leaders are used to preparing for emergencies, working closely with other public services. As you would expect, there is a huge amount of planning being done. But there are two features of a no-deal Brexit that frontline leaders believe are significant risks for the NHS.

The first, due to the timing, is an awkward potential triple whammy: a difficult winter, a flu outbreak and a no-deal. The NHS is at its busiest over winter. Emergency care performance figures, the worst in more than a decade, show how much pressure the service is under, with concern that we’re heading for a pressurised winter. Levels of flu in Australia, often a good predictor for UK winter flu, are at their highest for some years. Combine that with the prolonged negative impact of a
no-deal Brexit, should that occur, and you have an NHS chief executive’s nightmare scenario.

The second concern is how many risks are beyond the immediate control of NHS trusts and require close and effective working with other public services and, particularly, central government.

Trust leaders are very dependent on the work of others to secure 8,000 medicines and other medical devices from European supply routes. They are similarly reliant on others to ensure that the NHS can feed 120,000 patients a day and to guarantee the free flow of traffic in areas such as Kent so ambulances, patients and vital staff can reach their destination.

Trust leaders need greater support as an NHS free at the point of use for all EU citizens moves to being one where staff will, overnight, become responsible for eligibility checks. They need the government to remove obstacles and uncertainty for European staff on whom the health service is heavily dependent.

NHS leaders are working hard with other public services and Whitehall to manage these risks. But we need to recognise that this is a complex and resource-intensive task, especially when set alongside everything else an overstretched NHS is trying to do.

Chris Hopson is the chief executive of NHS Providers, which represents all English NHS hospital, ambulance, community and mental health trusts

Image result for winter coming cartoon