Category Archives: Consultants

Consultants are at the highest point of their profession – or are they? What ambitions do they have and are they able to do research easily?
How does sub-specialisation fit in with keeping ones skills as a generic doctor? If those generic skills are lost, does it matter?
Should all consultants be in teams run by tertiary centres and with opportunities to go to the centre for updating?
Are the consultants in your local hospital happy they are there? Would they have preferred to be elsewhere? And how do they see management and professional standards changing?

NHS plan ‘ends public right to choose hospital’ – A form of rationing well known to Wales

The Welsh did not complain about lack of choice when it was begun a decade ago, and the weak BMA in Wales made comment, but no hue and cry resulted in this “lowest common denominator” medicine. Choice is a fundamental plank of a liberal society, and its loss is justified in war, famine, civil war and national emergencies. But rarely has choice been threatened in an advanced democracy/ Standards really are falling, and the right to choice may only be available to those who can afford it. A two tier society once again, and exactly what Aneurin Bevan wanted to avoid when he started the original health service. The Welsh health service has excluded choice because the money moves with the patient. The English will be less accepting of this form of rationing…… Losing choice does work for commissioners in saving money; but it does not work in saving lives. In rural and poorer areas where there are under resourced and under staffed hospitals it may actually do harm. 

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Oliver Wright reports in the Times 22nd Feb 2019: NHS plan ‘ends public right to choose hospital’

Patients’ right to choose where they are treated is being threatened by radical plans to scrap competition in the NHS, ministers have been warned in leaked documents.

Plans to abolish the health service’s internal market are being resisted by Whitehall officials who have told Matt Hancock, the health secretary, that they would quietly reverse 30 years of policy, according to a Department of Health briefing seen by The Times.

Mr Hancock is understood to be ruling out any changes that would prevent patients selecting the NHS hospital or private provider where they are sent for treatment. But he has been told that if he blocks new laws the NHS could blame the government for the failure of a £20 billion reform plan that was expected to save 80,000 lives a year.

The confidential briefing reveals for the first time the scale of changes proposed by health chiefs, which officials believe amount to another major reorganisation of the NHS.

Last month Simon Stevens, the chief executive of NHS England, asked Theresa May to reverse market-based reforms introduced in 2012 by Andrew Lansley, then the health secretary. Mr Stevens wants to make hospitals, GPs and local services work together.

His proposals were presented as a tidying-up exercise, but a briefing for Mr Hancock privately warned that NHS England’s unpublished plans went much further and would undo the internal market introduced by Kenneth Clarke when he was health secretary in 1991. Since then NHS managers have bought services from self-governing hospitals and companies, which were encouraged to compete for business.

The briefing warns Mr Hancock that he must be comfortable with this before signing off, adding: “Removing the internal market will entail undoing some 30 or so years’ worth of policy and legislation in the English NHS, including some of the checks and balances that a market-type approach allows and could have broader implications, for example, how choice works in the NHS.”

Mr Hancock has backed ending enforced competition but he supports patient choice and has little appetite for a Commons battle to reform the NHS.

The briefing warns that Mr Stevens’s position “implies that primary legislation is essential” to implementing the long-term plan, published last month. “This presents a future risk that, in the event that the long-term plan is not delivered, the NHS blames the government if there is no bill. We don’t think you should accept this shift in emphasis.”

Department of Health sources played down a split with NHS England, suggesting a compromise would be found that made clear that legislation was not essential, and which minimised upheaval and protected choice.

NHS England said Mr Stevens did not want to remove patients’ choice on where they are treated. A spokesman said new laws would not be needed. But, he said, as requested by the Commons health and social care committee and the prime minister, “carefully targeted” legislative changes had been drawn up that would provide better services.

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Heath and Safety Executive news 22nd Feb 2019: Patients’ 30-year right to choose where they are treated under threat as part of NHS England reshuffle

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The long term trsaining implications of farming out arthroplasties (Joint replacements) may not have been considered…

There are issues arising from the under capacity for the 4 health services. In the long term this includes training standards: will all the juniors get the same levels of exposure and experience as when these operations were conducted in state hospital units? In the short term NHSreality expects a lower level of infections (Staph and Strep), and cross infections (Campylobacter, Norovirus, MRSA). This may affect through-put. as the least risky patients will be operated on in the private system, whereas those with multiple pathologies will be retained. In the long run, if we believe in only state provision, we need cold orthopaedic hospitals matching the private ones.  And it does not apply to all 4 jurisdictions….. Is there another perverse outcome: that training will suffer so that only those already doing these operations will get enough practice, thus self perpetuating private demand? We don’t know yet, but rest assured the managers making the decision will have moved on, and few Trusts have an “Educational Lead” who could report on the longer term implications.

This article is about England. It’s high time the Times and others stopped referring to the NHS when there is nothing “National” about the service we get (especially in Wales).

There will be no private option for the miners of Tredegar, but there will be for the bankers of London. Exactly what Aneurin Bevan wanted to AVOID IN 1948..

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Rosemary Bennet reports 21st Jan 2019: Offer long-suffering patients private care, hospitals ordered

Patients who have waited six months for hospital treatment must be contacted by GPs and offered faster treatment elsewhere under NHS plans.

More than 4.15 million patients are on a waiting list, including more than half a million who have waited more than 18 weeks for treatment. Some 200,000 people have been waiting for six months or more, up by more than 45 per cent since last year.

Successive governments have pledged that patients referred to hospital should be offered a choice of provider, including private hospitals. Ministers have said that such policies give more rights to patients, while providing hospitals with an incentive to keep their waiting lists down, as they receive income for each case treated.

However, research has repeatedly suggested that many GPs do not offer such options routinely. The latest polls showed that only four in ten patients reported having been given a choice of hospital for their appointment.

The new promise, contained in NHS planning guidance for 2019-20, says that hospitals or local planning bodies will be obliged to contact patients who have been on lists for six months to advise them about quicker alternatives.

Professor Derek Alderson, president of the Royal College of Surgeons, said: “We are greatly concerned about the growing number of patients waiting more than six months for treatment. Any initiative to help reduce the number of people waiting a long time is therefore welcome. However, this option will primarily benefit patients in cities where it is easier to travel to another hospital, or those living in areas where a local private hospital may have capacity.” He added that different surgical teams would then need to become familiar with the patient, which could cause delay.

Professor Alderson said it was a welcome start but more needed to be done to reduce waiting times. “We continue to be engaged in NHS England’s review of performance standards,” he said. “While we accept that some changes to targets for planned treatment may be sensible . . . we could not support any revisions that leave patients in doubt as to how quickly they will be seen.”

If I pay for private treatment, how will my NHS care be affected? – NHS – 

In Wales if you start by seeing someone privately, but then elect to go to the Health Service, you should be put to the bottom of the waiting list. But we all know that if you have cancer or a problem that needs urgent attention the “rule” will be broken. The answer to the question is “You’re still entitled to free NHS care if you choose to pay for additional private care.”

Do I need a GP referral for private treatment? – NHS -Yes, but expect poorer communication.

What is an NHS Private Patient Unit? – NetDoctor

[PDF] Interface between NHS and private treatment: a practical guide … – BMA

[PDF] Defining the boundaries between NHS and Private Healthcare • The Warrington CCG…

Treating private patients in NHS hospitals – benefit or cost? — Centre for Health and Public Interest

[PDF] NHS treatment of private patients: the impact on NHS finances … – Centre for Health and Public Interest

As it gets worse, YOU are going to have to wait longer and longer – or pay up. A “grim reality”..

The evidence basis of all practice(s) needs to be challenged – continuously. There are perverse Incentives in private systems, but why do the UK health services still overtreat?

NHS rationing: hip-replacement patients needlessly suffering in pain on operation waiting lists

Orthopaedic waiting lists: time for more, and equal access to, non-urgent centres

2014 !! South Wales NHS: Plan to centralise services on five sites


GP pension boost may halt exodus: why when “the NHS ….is the least national health service in the developed world, an insult to the memory of Aneurin Bevan.”?

The idea that successive governments bear responsibility for the manpower crisis has not occurred to the media it seems. Whilst the stressed out GPs, denied access to quick diagnostic tests, have a choice: they can “live with uncertainty” in an increasingly litigious world, or refer. Which choice they make determines the efficiency of the 4 health services. Most inexperienced GPs have higher referral rates, and the more experienced live with more uncertainty, and use time as a diagnostic tool. They play the odds…  When Ed Conway opines, in the same edition of the Times as the report below, he is correct that the “Rules ( of the game ) and red tape make the NHS second best”, and he is right that “..the NHS ….is the least  national health service in the developed world, an insult to the memory of Aneurin Bevan, whose goal was that the miners of Tredegar would have the same quality if service as London stockbrokers.”

He is right that AI could be more useful, right that IT has been badly used, right that some services and follow ups could be done by people other than doctors. He however misses the point that doctors are the only people who make a diagnosis….  He does not comment on the missed waiting targets and other performance indicators, or who is responsible for the manpower crisis. Changing them is an admission of defeat, and a time horizon for the extra 5000 GPs that cannot be met. Indeed, since the announcement of the extras 3 years ago we have 1000 less…

In West Wales we have no tertiary hospital in our area, and we have lower standards and survival for acute coronary events, and we suspect from many other conditions. We pay the same taxes, and although not Tredegar, we suffer from the same inequalities as b=the miners did before the old “N”HS.

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Chris Smyth reports 11th Jan 2019: GP pension boost may halt exodus

GPs could get more generous pensions to prevent so many leaving the NHS.

Matt Hancock, the health secretary, is pressing Philip Hammond, the chancellor, to change pension tax rules that are said to encourage GPs to retire early.

The Treasury believes that the change would be unfair, unnecessary and costly. The pensions of other high-earners in the public sector, such as senior army officers and High Court judges, would be boosted as well.

It is also unconvinced that pensions are a significant cause of a shortage of GPs. A Treasury source said: “The secretary of state for health has just inherited the biggest single cash injection the health service has ever had. He can now put that money to work supporting NHS staff and frontline services.”

Mr Hancock is prepared to push for changes after being told that a worsening shortage of GPs threatens efforts to improve local care and keep patients out of hospital, ideas that are at the heart of the ten-year, £20 billion plan for the NHS announced this week.

GP numbers have fallen by 1,000 since a government pledge to recruit 5,000 four years ago, and doctors complain that they are overworked coping with an older, sicker population.

They argue that the loss is worsened by a cap of £1 million on the tax-free amount that can be accumulated in a pension pot. Many doctors hit this limit in their fifties, making it less attractive to carry on working.

Some complain of being hit with annual tax bills of tens of thousands of pounds because of related rules that limit the amount that can be contributed to a pension each year. GPs earn an average of £92,500 and the average age at which GPs retire has fallen by two years since 2011 to 58.

Mr Hancock told the GPs’ magazine Pulse: “The biggest concern I have raised with me [on GP retention] is around the tax treatment of pensions.”

Richard Vautrey, chairman of the British Medical Association’s GP committee, said that doctors “had been unfairly hit by complex regulations and tax changes. “At a time of plummeting morale, and amid a deepening recruitment and retention crisis, such charges make taking on extra work, or continuing to work full-time, an extremely unattractive prospect,” he said.

Boosting GP and other local care is crucial to the success of the ten-year plan, which promises that budgets for such services will rise faster than hospital spending for the first time.

Simon Stevens, chief executive of NHS England, has also blamed the pensions rules for driving doctors in their fifties out of the NHS.

Ed Conway: Rules and red tape make NHS second best

Don’t drop NHS waiting targets, doctors plead

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The benefits to the NHS of staying in the EU

No harm at this political juncture, or reminding NHSreality readers of The benefits to the NHS of staying in the EU (The Times letters 4th April 2016.

Sir, As health professionals and researchers we write to highlight the benefits of continued EU membership to the NHS, medical innovation and UK public health.

We have made enormous progress over the decades in international health research, health services innovation and public health. Much of this is built around shared policies and capacity across the EU. The future for European citizens’ health lies in teamwork.

EU trade deals will not privatise the NHS as negotiations now contain clear safeguards. Decisions on NHS privatisation are in UK government hands alone.

EU immigration is a net benefit to our NHS in terms of finances, staffing and exchanges. Medical tourism brings surplus funding.

Finally, leaving the EU will not provide a financial windfall for the NHS. The UK’s contribution to the EU budget is part of an agreement allowing access to the single market. If we pulled out, adverse economic consequences far larger than any nominal savings are widely anticipated. This jeopardises an already cash-strapped NHS.

Our health services, health-research collaborations and public-health protection are more robust within the EU. Leaving would damage the progress we have made together. Brexit should carry a health warning.

Professor Martin McKee CBE, Professor of European Public Health, London School of Hygiene and Tropical Medicine
Professor Sir Simon Wessely, Vice Dean, Academic Psychiatry, King’s College London Dr Mike Galsworthy, Programme Director, Scientists for EU
Lord Bernie Ribeiro FRCS, Past President, Royal College of Surgeons London
Lord Nigel Crisp, Former Chief Executive NHS, London
Baroness Elaine Murphy FRCPsych, Professor of Psychiatry, London
Lord Alderdice FRCPsych, Senior Research Fellow, Harris Manchester College, University of Oxford
Professor Dame Jill Macleod Clark, Professor of nursing, University of Southampton
Sir George Alberti, Visiting Professor, King’s College, London
Sir Harry Burns, Professor of Global Public Health, University of Strathclyde
Sir Iain Chalmers, Co-ordinator, James Lind Initiative, Oxford
Sir Ian Gilmore, Professor, University of Liverpool
Sir Richard Thompson, Immediate past-president, Royal College of Physicians, London
Sir Robin Murray, Professor of Psychiatric Research, King’s College, London
Sir Sam Everington, GP, London
Sir Cyril Chantler, Formerly Chairman of The King’s Fund and the UCL Partners academic health science network, London
Mr Carl Philpott, Honorary Consultant ENT Surgeon, University of East Anglia
Professor Dominic Harrison, Director of Public Health, Blackburn with Darwen
Dr Anna Batchelor, Consultant anaesthetist, Newcastle upon Tyne
Dr Arpana Verma, Director Centre for Epidemiology, University of Manchester
Dr Christine Robinson, Research Assistant, University of Manchester
Dr Christopher A Birt, Honorary Clinical Senior Lecturer in Public Health, University of Liverpool
Dr Clare Gerada MBE, Former Chairwoman, Royal College of General Practitioners London
Dr David L Cohen, Consultant Physician, Northwood
Dr David Nicholl, Clinical Lead for Neurology & Neurophysiology (writing in a personal capacity), Sandwell & West Birmingham NHS Trust
Dr David Wrigley, GP, Carnforth, Lancashire
Dr Dominic Hurst, Clinical Lecturer in Primary Dental Care, Queen Mary University of London
Dr Geeta Nargund, Medical Director, Create Fertility London
Dr Harry Rutter, Senior Clinical Research Fellow, London School of Hygiene and Tropical Medicine
Dr Henry McKee, GP, Belfast Trust
Dr Iona Heath, Retired general practitioner, London
Dr Jane Young, Consultant Radiologist and Head of London School of Radiology, Whittington Health
Dr Jennifer Mindell, Reader in Public Health, UCL, London
Dr John-Paul Lomas, Specialist Trainee in Anaesthetics, Manchester
Dr Kevin O’Kane, Consultant in Acute Medicine, Guy’s and St Thomas’ NHS Trust
Dr Leila Lessof OBE, Former Director of Public Health, London
Dr Linda Papadopoulos, Psychologist, London
Dr Michel Coleman, Professor of Epidemiology and Vital Statistics, London School of Hygiene and Tropical Medicine
Dr Nicola Shelton, Reader in Population Health, London
Dr Omar Bouamra, Medical Statistician, University of Manchester
Dr Richard Horton, Editor-in-Chief, The Lancet, Elsevier
Dr Roberta Jacobson OBE, Honorary Senior Lecturer, Institute of Health Equity, London
Dr S Vittal Katikireddi, Senior Clinical Research Fellow, University of Glasgow
Dr Suzy Lishman, President, The Royal College of Pathologists
George Davey Smith, Professor of Clinical Epidemiology, University of Bristol
Jan van der Meulen, Professor of Clinical Epidemiology, London School of Hygiene & Tropical Medicine
Mr Gary Clough, Research Assistant, University of Manchester
Mrs Louise Johnson, Well North Executive Co-ordinator, University of Manchester
Ms Clare Huish, Research support assistant, Manchester
Ms Rosalynde Lowe CBE, Former Chairwoman Queen’s Nursing Institute, London
Prof Alastair H Leyland, Professor of Population Health Statistics, University of Glasgow
Prof Frank Kee, Clinical Professor, Queen’s University Belfast
Prof Gerard Hastings OBE, Professor, Stirlng and the Open University
Prof Humphrey Hodgson FMed Sci, Emeritus Professor of Medicine , UCL
Prof John S Yudkin, Emeritus Professor of Medicine, University College London
Prof Jonathan Weber, Director, imperial College Academic Health Science Centre, Imperial College London
Prof Mark S Gilthorpe, Professor of Statistical Epidemiology, University of Leeds
Prof Trevor Powles CBE, Head Breast Cancer Cancer Centre, London
Professor Peter Kopelman, Emeritus Professor of Medicine (formerly Principal), St George’s, University of London
Prof Martin White, Programme Leader, Food Behaviours and Public Health, University of Cambridge
Prof Ray Powles CBE, Head, Haemato-oncology, Cancer Centre London
Prof Sir Mike Owen, Professor of Psychological Medicine, Cardiff University
Prof Tim Helliwell, Vice President for Learning, Royal College of Pathologists, Liverpool
Professor Adrian Renton, Director of Institute of Health and Human Development, London
Professor Aileen Clarke, Head of Division of Health Sciences, Warwick Medical School
Professor Allan H Young, Director, Centre for Affective Disorders, King’s College London
Professor Alwyn Smith CBE, Former President, UK Faculty of Public Health, Manchester
Professor Carol Dezateux, Professor of Epidemiology and Hon Consultant Paediatrician, London
Professor David Edwards, Professor of Paediatrics and Neonatal Medicine, Guy’s and St Thomas’ Hospital Trust
Professor Debbie A Lawlor, Professor of Epidemiology, University of Bristol, Bristol
Professor Derek Cook, Professor of Epidemiology, St George’s University of London
Professor Dorothy Bishop FRS, FBA, FMedSci, Professor of Developmental Neuropsychology, University of Oxford
Professor Gabriel Scally, Visiting Professor of Public Health, Bristol
Professor Jane Salvage, Nursing consultant, Lewes
Professor John Ashton CBE, Director of Public Health, Cumbria
Professor John Malcolm Harrington, Emeritus Professor of Occupational Medicine, Budleigh Salterton
Professor John Middleton, University of Wolverhampton, Wolverhampton
Professor KK Cheng, Director, Institute of Applied Health Research, University of Birmingham
Professor Liam Smeeth, Senior Clinical Research Fellow, London School of Hygiene and Tropical Medicine
Professor Lindsey Davies, Past president, UK Faculty of Public Health, London
Professor Martin Bobak, Professor or epidemiology, University College London
Professor Maurice Lessof, Former Professor of Medicine, Guy’s Hospital
Professor Patrick Saunders, Director, Carolan57 Ltd
Professor Peter Whincup, Professor of Epidemiology, St George’s, University of London
Professor Raymond Agius, Professor of Occupational and Environmental Medicine, University of Manchester
Professor Rod Griffiths CBE, Past President, Faculty of Public Health, London
Professor Rod Hay, Professor of Cutaneous Infection, King’s College NHS Trust London
Professor Rosalind Raine, Head of Department of Applied Health Research, UCL
Professor Rosalind Smyth CBE FMedSci, Director, UCL Institute of Child Health
Professor Simon Capewell, Chairman of Clinical Epidemiology, University of Liverpool
Professor Salman Rawaf, Professor of Public Health, Imperial College
Professor Shah Ebrahim, Hon. Professor of Public Health, London School of Hygiene Tropical Medicine
Professor Shanta Persaud, Professor of Diabetes & Endocrinology, King’s College London
Professor Simon Heller, Professor of Clinical Diabetes, University of Sheffield
Professor Sir Munir Pirmohamed, David Weatherall Chairman of Medicine and Consultant Physician, University of Liverpool
Professor Stephanie Amiel, Professor of Diabetic Medicine, King’s College London
Professor Trisha Greenhalgh OBE, Professor of Primary Care Health Sciences, University of Oxford
Dr Rachel Scantlebury, Public health registrar, London
Dr Verma Amar Nath, Retired General Medical Practitioner (NHS), Birmingham
Dr Ingrid Wolfe, Director, Children and Young People’s Health Partnership, Guy’s and St Thomas’ NHS Foundation Trust
Sir Eric Thomas, Former Vice Chancellor, University of Bristol
Lord Ara Darzi OM, Paul Hamlyn Professor of Surgery, Imperial College
Baroness Sheila Hollins, Former President Royal College of Psychiatrists, London
Lord Naren Patel, Former President Royal College of Obstetricians and Gynaecologists, Dundee
Professor Anna Gilmore, Professor of Public Health, University of Bath
Mrs Alexandra Johnson, CEO Joining Jack, Joining Jack, Wigan
Richard Fitzgerald, Consultant Radiologist, Royal Wolverhampton Hospitals NHS Trust
Anne Lennox, Chief Executive, Myotubular Trust
Professor Alison Woollard, Associate Professor, University of Oxford
Dr Simon Stockill, Medical Director, NHS Leeds West Clinical Commissioning Group
Professor Michael Laffan, Professor of Haemostasis and Thrombosis, London
Mr Daniel Mayhew BSc, Development Technician, Cambridge
Dr Martin Yuille, Reader, University of Manchester
Dr Alastair Cardno, Senior Lecturer in Psychiatry, University of Leeds
Ben Caplin, Senior Clinical Lecturer, UCL
Professor Chris Inglehearn, Ophthalmology, University of Leeds
Professor Matthew Hotopf, Director NIHR Biomedical Research Centre at the Maudsley, King’s College London
Dr Carolina Lopez, Consultant Radiologist, Bedford Hospital NHS Trust
Dr Chiara Marina Bettolo, Consultant Neurologist, Newcastle upon Tyne
Professor Peter Openshaw, Professor of Experimental Medicine, Imperial College London

Rather than looking abroad for doctors, we should be looking overseas for system design solutions.

The idealists in the government have their eyes on a longer term plan. It is an altruistic and worthy ideal, and the objectives have little against them. It is the practicality and feasibility of the plan which meet with most disbelief in the professions. A lot of what doctors do could be done over the phone, especially if the patient and their family are already known to the doctor, and repeat and follow up consultations, which every practice is trying to reduce, could often be managed this way. BUT the main purpose of a doctor, and what differentiates them from nurses, is the ability to make a diagnosis, and to be efficient in their use of technology and investigations. This is why GPs are gatekeepers. Many of the GPs currently working believe that not examining the patient, especially at first consultation or meeting,  is a risk, and they are unwilling to take this risk. Since continuity of care has died, particularly in the cities, the uncertainty inherent in not examining could cause more litigation and stress. Only some doctors are able and willing to live with this….. And they are unlikely to be those recruited overseas. Rather than looking abroad for doctors, we should be looking for system design solutions. 

Of course, those of us who actually realise the value of a consultation, continuity, and examination in order to make a diagnosis, will just have to go privately. 

See the source image

Nick Triggle for the BBC on 7th Jan 2019: NHS plan: What it means for you and Labours response from a day before (I wonder if they had read it?): Labour attacks Theresa May over proposals

Alex Matthews-King in the Independent opines: NHS 10-year plan relies on raiding other countries for thousands of nurses and doctors – ‘It is neither sustainable nor ethical long term to rely on other countries to provide our nurses’

An ambitious 10-year plan for the NHS unveiled by Theresa May relies upon recruiting thousands of nurses and doctors a year from overseas – a practice widely criticised for draining developing countries’ health services of vital qualified staff.

The prime minister revealed parts of the blueprint detailing how the extra £20bn a year she announced last summer will deliver improvements in patient care across the beleaguered service, which has had to cope with years of real-terms cuts under austerity.

It includes targets to diagnose three-quarters of cancer cases early enough for successful treatment, treat more emergency patients and send them home on the same day, and a right for every patient to have online GP appointments via apps by 2024, among other initiatives.

However, to fulfil these commitments, it makes clear a “significant uplift” in international recruitment is needed right away to fill the more than 100,000 vacancies that currently exist. ……..

The FT reports:  Financial Times Theresa May claims Brexit bonus will help fund new NHS plan and is very jaundiced.

The reality is mistakes, cross infections, delays and all sorts of post code differential outcomes. Birmingham is reeling from repeated mistakes… (Birmingham Live)

In the Times Chris Smyth singles out one area for his headline: Millions of patients to see hospital doctors by Skype under NHS plan – Theresa May wants digital consultations to become NHS norm in order to give patients greater control

IT – the solution and a problem… Every patient deserves an examination. GPs must not be robots..

Too fast, too furious, too many…… The 10 minute consultation needs to be challenged.. Interview rape is commonplace.. There are not enough people with enough time to care.

Desperate situations require desperate measures. Virtual consultations are without evidence, risk GP burnout, errors for patients, and increased litigation costs..

The NHS can no longer provide everything to everyone, and we should “Look abroad for serious solutions to the NHS crisis”.

Primary care telephone triage does not save money or reduce practice workload

Why not introduce more NHS charges?

At saturation point – the system seizes up

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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


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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The thin edge of the wedge. Is private A&E going to thrive and become the shape of the future? Aneurin Bevan, what would you do?

Chris Smyth of The Times reports on the first Private A&E in London, (The private A&E will see you right now) and the leading article on the 15th derides the change. This development has been predicted by NHSreality for some time now, and the two tier unofficial health service is here. Politicians and the Media seem to conspire in a collusion of impotence. Is health just too toxic a subject for UK citizens to address? Nobody copies us now, and those that did have realised their error and changed the funding basis to be founded in reality rather than in the clouds.….”

Is Primary care to follow dentistry? Rather than Denplan, will GPplan to be marketed soon? The whole aspect of removing fear has been denied. We are bringing back fear… Those interested might like to read Bevans chapter 5 at the end of this post.

The Times view on private medical care: expansion signals a health service in trouble – It is the failures of NHS provision that are generating demand for private treatment

We report today that patients are increasingly turning to private provision for this care.

This is not only a rational decision for those patients who can afford private treatment for accident and emergency. It also has public benefits by easing pressures on the health service. Though it will be tempting for policymakers to rail against the emergence of a “two-tier” system, it would be more constructive if they focused on the failures of NHS provision that are generating the demand for private treatment.

The market for private provision of non-urgent operations is established. But demand for these services, generally known as casualty, emergency and urgent care units, suffered in the early years of this decade after the financial crisis of 2007-09. Even so, about 11 per cent of Britain’s population has some form of private medical insurance. The principal gap in these policies is that they do not provide cover for accident and emergency.

This is not because emergency treatment in the health service is so good that no one would want to go elsewhere. On the contrary, waiting times in hospitals are too long and getting longer.

We just cannot have Everything for everyone for ever. 

The Times article and leader are below:

Private A&E London Private AandE London

In Place of Fear A Free Health Service 1952 Chapter 5 In Place of Fear

Many A&Es are failing now. As delays, standards, and staffing gets worse, more and more demand will come for private A&E and ambulances.

A humanitarian crisis – and the goodwill of staff has disappeared. When will the public ask for private A&E?

When will private hospitals begin to offer alternative A&E option?” NHS worse in Wales”. Close the doors!

Surgery waiting lists at ten-year high. The perverse outcome is a two tier society…