Category Archives: General Practitioners

Closure of many more surgeries…. And there’s an epidemic of dementia coming….

Popular cities like Bristol do not expect to be without GP cover. There have been many more since I last posted on GP closures. The Headline generated by Amanda Cameron in Bristol Live 2nd August reads: 

Health chiefs explain decision to close two GP surgeries in Bristol – The decision left 15,000 patients needing to sign up with another surgery within three months

The shortage of GPs is one thing, due to retirement, career changes, part time, and emigration (as well as early retirement due to stress and overwork), but the fact that we have a wave of demented patients coming in the next few years has not become real to the politicians. And it is not just doctors who are under stress. Midwives and nurses too… After all they will be up for re-election before that time, and may not win. The same explanation applies to the inertia om medical recruitment, acknowledgement of dementia, climate change and several other areas….. A first past the post system means we are all subject to short termism. Mending the 4 health services will take decades. So will addressing climate change… The pace of technology advance, especially following CRISPR, is faster than any government can afford. There is only one solution and that is to ration health care, with co-payments according to means. A quality service needs to have equal opportunity for all, and whilst “extras” such as private rooms or choice of specialist are reasonable in a two tier system, different outcomes and life expectancies are not. Will new tests (such as that for dementia) be available to all? In the end it is caring, continuity and trust  that matter rather than technology, especially when we are old.

You may wonder “Perhaps a new health secretary will change things”. No chance.

Scream, Jeremy Hunt, NHS, cartoon

“..Announcing the closure, the CCG said supporting patients to transfer to a neighbouring practice was the “best long-term solution”.

At a meeting of its primary care commissioning committee on July 30, it emerged that the CCG considered three options before deciding to close the Bishopston and Northville surgeries.

Those options included keeping both surgeries open, merging them with other practices, or closing them and sending patients elsewhere.

Following extensive consultation with patients, the CCG concluded that closing them would have “on balance, a neutral impact” on most patients.

Patients might also benefit from “improved provision of care” from practices offering a wider range of services, CCG papers show…..”

Owain Clarke for BBC News 31st July 2019: Cwm Taf maternity crisis: Midwife stress adds to staff problems

Rhys Blakely on June 13th reports in the Times: NHS creaking under the strain of record dementia diagnoses

The head of the NHS dementia strategy has warned that the service is struggling to keep up as cases of the degenerative condition surge.

NHS figures released yesterday showed that nearly 454,000 people aged 65 or over in England have formally had dementia diagnosed: a record. The number of diagnoses has increased by 7 per cent in the past three years…… Alistair Burns, the NHS national clinical director for dementia, said: “The NHS is having to run to keep up as dementia becomes a challenge for more and more families.”

BBC news today: Alzheimer’s blood test ‘one step closer’ ( By testing for amyloid )

Researchers say they can accurately identify people on track to develop Alzheimer’s disease before symptoms appear, which could help the progress of drug trials.

US scientists were able to use levels of a protein in the blood to help predict its build-up in the brain.

UK experts said the results were promising – and a step towards a reliable blood test for Alzheimer’s to speed up dementia research.

Scotland calls for a new training philosophy and paradigm for General Practice. Its the shape of the job that matters, and it will take a decade to get enough GPs for 15 minute appointments.

The supply of doctors is finite, and has to be planned a decade ahead. Not only are doctors well paid (and regarded) but they are a moveable feast: transferrable skills mean they could work in one of many dispensations. The Commonwealth countries are particularly popular..

If the UK were to train 5 times as many doctors as we needed many more as a % would go overseas. There is a net 20% loss of all graduates from Wales, mainly to the UK, and a net 40-50% (my estimate) loss of medical graduates over 5 years.. SO it we don’t want the whole to be impractically expensive we have to persuade other countries to train enough doctors as well as the UK.

It would help if fewer women (more men) as a percentage of the total were trained. It would also help if there were a move to graduate as opposed to undergraduate entry. But even these changes, without insisting on 5 years “National Service” could fail unless the shape of the job is changed. 

The fact that Scotland suggests a new paradigm emphasises the 4 different dispensations, and the lack of a “National” health service.

Adrian O’Dowd for OnMedica 6th June 2019 reports: Call for new GP recruitment target

GP leaders in Scotland are calling for new recruitment targets to be set to boost the GP workforce north of the border and a 11% slice of NHS funding.

The Royal College of General Practitioners (RCGP) Scotland has published a new report called From the Frontline *, which draws on feedback from GPs across Scotland and their thoughts and experiences within the profession.

It has also launched a new campaign called #RenewGP, which calls for 11% of the Scottish NHS budget to make Scottish general practice “fit for the future”.

It also calls for GPs to be able to have minimum 15-minute appointments with patients in order to give them better care, but warns this would only be possible with more GPs in the system.

Tackling health inequalities was also crucial, said the report authors, who wanted GPs serving areas with high socio-economic deprivation to be appropriately resourced.

Central to all of the RCGP’s desire to improve general practice was planning for the future workforce and the report and campaign argue that as the population was living longer with more long-term conditions, Scotland needed more GP capacity to build and lead community healthcare teams………

There is no sustainable ideology – so leaders find their staff disengaged and that their job is impossible..

An exodus because of poor planning and the shape of the job. Deprofessionalisation….

Unreal manpower planning. It’s too late for a decade. GP services face ‘retirement crisis’. It’s the shape of the job silly.

Checklist will help decide if it’s time to die – as the shape of the job has reduced, recruitment has declined…

2014: Severe shortage of GPs is reaching crisis-point in Derbyshire – only 37% of GP training places filled – due political rationing of Medical School places 10 years ago, and the shape of the job

It’s the shape of the GP’s job that needs to change. The pharmacist will see you now: overstretched GPs get help…The fundamental ideology of the Health Services’ provision. Funding of this type admits 30 years’ manpower planning failure

2016: Martini GPs or Dead end jobs. The option is in the hands of politicians..

It was the best job in the world – for me 1979-2012 – but now there are not enough of us to cover the country

A GP in Milford Haven exposes the Inverse Care Law as applied by successive Governments, perversely and neglectfully..

fewer women should be allowed to train as doctors because men are ‘better value for money’… The answer is graduate entry to medical school.

Women perform better at 18, so change the age at entry to med school

 

 

David Oliver: Don’t blame GPs for late cancer diagnoses

Recent articles in the media, published after a study by cancer research on 135,000 people. Medical education teaches GPs to “live with uncertainty” because of the need to ration resources effectively. The access to sophisticated tests is rationed by hospital trusts who wish to limit demand as they have inadequate capacity. If we want earlier diagnosis we have to accept greater expense, more technology, more false positives, and more hopeful and unnecessary treatments…..

Laura Donelly in The telegraph 28th June reports: 

The study by Cancer Research UK found that just 37 per cent of all cancer diagnoses in England involved patients who had been given an urgent referral by their GP, because the disease was suspected. Just 32 per cent of diagnoses for bowel cancer and 28 per cent of 
diagnoses for lung cancer were identified this way.” Many other news media repeated the problem including The Yorkshire Post

David Oliver opines in the BMJ: David Oliver: Don’t blame GPs for late cancer diagnoses BMJ 2019;366:l4625

Being a GP isn’t easy. Under-resourcing, workforce gaps, the rising complexity and volume of work, and a media narrative too often laden with blame add to the challenges. On 28 June the Daily Telegraph ran a column entitled, “GPs failing to spot two thirds of cancers.”1 The article was more measured than the headline. But readers’ fear and anger are rarely tempered by less conspicuous details.

It reported a Cancer Research UK study, which had focused on two common cancers (lung and bowel), analysing 135 000 cases.2 The Telegraph mentioned “average waits of more than eight weeks for diagnosis,” adding that “the vast majority of cases that turned out to be cancer were never suspected by family doctors.”

The study, based on data from 2014-15, had concluded that only 37% of all cancers had been diagnosed after urgent referral by a GP suspecting or wanting to rule out the disease. This was true in 32% of bowel cancer cases and 28% of lung cancer cases. Patients who had not been referred for urgent assessment waited weeks longer for diagnosis. And 35% of lung cancer cases and 28% of bowel cancer cases were diagnosed only when patients presented to hospitals as an emergency.

GPs see a whole range of conditions, often in early stages with undifferentiated symptoms that could easily be many things other than newly presenting cancer. The 2015 NICE guidelines on recognising and referring suspected cancer lowered the positive predictive value threshold for referring cases from 5% to 3%.3 Cancer Research’s Cancer in the UK 2019 report showed that, even in 2015-16, only 19% of cancers were diagnosed as emergencies (and only 6% through screening programmes)—so most were in fact diagnosed through GP assessment and referral.4

The data on Public Health England’s bespoke GP profiles illustrate that cancer still represents only a small percentage of a GP’s overall caseload.5 And some patients, with vague symptoms of cancer not specific to any one organ, risk being sent urgently down the wrong specialist route.

Patients’ own circumstances or care preferences also play a part in delayed diagnosis. A study by Abel and colleagues on 4647 NHS patients with a cancer diagnosis from presenting as an emergency found that 29% reported no prior GP consultation. Percentages were substantially higher in older, male, and deprived patients.6

Also consider that, if more patients were referred as urgent cases, our hospital services in radiology, specialty medicine, oncology, and surgery, which already have their own major workforce and workload challenges, would struggle to cope. Indeed, they’re already struggling, not least in balancing patients with suspected cancer against those with equally pressing clinical (if not target) priorities.

A Nuffield Trust analysis7 of performance against cancer waiting time targets showed that, since measurement started in 2009, we’ve generally maintained the operational standard of at least 94% of patients who are referred by GPs as “urgent” being seen within two weeks, with only a recent dip in performance. However, it also showed that the metric of at least 85% of such patients starting treatment within six weeks of referral has been breached for the past four years and has recently declined further. NHS England’s clinical review of national access standards is ongoing,8 partly in response to such issues.

Cancer Research UK has a fantastic track record of raising awareness, in line with its charitable mission. It’s just a shame that, in this case, the resulting media narrative placed excessive blame on GPs, using old data. I’m not sure that this helps patients or doctors.

Laura Donelly in The telegraph 28th June reports: Revealed. GPs failing to diagnose 2/3 of cancers

GPs are failing to spot two thirds of cancer cases, study … The Sun

The Yorkshire Post

 

 

 

This is the future for the next decade: fewer GPs and more distant access to all medical skills if you live in rural areas. Breakdown of many systems. Private Health options pending..

There are, according to the Daily Mail, over 10m people who are short of their normal GP service. This is an inexcusable dereliction of duty in a civilised society. Poor manpower planning, poor politics, unequal educational opportunity and standards, and poor funding are responsible, along with the decentralisation of control (devolution) in a system where doctors are free to move. Don’t forget that, as it implodes, you can go abroad for treatment.

You still have the option of private care, and as one doctor explains he knows that the queue-jump goes against everything a mutualised service stands for.

The Nuffield Trust reports on the uncertainties which will follow after Brexit. Staff shortages, drug supply chain problems, are just two. The structure of Social Care may break down as it is dependent on overseas staffing. But whatever shortages there are now will be worse after Brexit. GPs are an international commodity and can take their skills overseas. Most of the former British Empire and Commonwealth countries are also short of GPs, so there is a ready market waiting for newly qualified, or disillusioned GPs.

This temptation to move abroad also applies to consultants whose pension rules make it unproductive for them, however keen they are, to reduce waiting lists. James Phillips for Professional Pensions reports: Pensions tax issues leading to longer NHS waiting lists

The Kings Fund reports on the Health and Social Care system, and its threatened breakdown.

In my own area there is no “choice” (West Wales, Hywel Dda) so that if someone needs a “greenlight laser” they will not get referred. Older fashioned TURP (Transurethral resection of the prostate) has far more side effects and is far more intrusive, with slower recovery times. Consultants in Hywel Dda will not refer for this treatment under the Welsh Health Service, as the money would move with the patient and Hywel Dda would lose cash. There are plenty of other examples of improved care but they are always concentrated on cities, and rural citizens will get them less. In England, provided patients are prepared to wait and to travel themselves, “choose and book” (e.g. Cumbria) allows them access. This does not apply in Wales.

Yes, it would be a good idea to recruit retired GPs, and many like myself would help out, but there are issues around medical indemnity and speed, and most of us would want to see the system founded on a financial rock rather than the quicksand of today.

John Hebditch reports from Aberdeen: Warnings of GP crisis as Abderdeen GP surgery will shut its doors next week.

and also Nearly 60% plan to cut hours and 25% to leave in near future.

Retired doctors urged to relieve rural NHS recruitment crisis

North-east medical practice to close after GP recruitment issues

17 overseas medics offered jobs at Shropshire’s A&Es

150 new medical staff taken on by Shropshire hospitals trust

Call for emergency meeting on Shrewsbury GP surgery closure

Shrewsbury GP surgery closure to affect thousands

Manchester Evening News July 4th.

People across Greater Manchester say they struggle to get GP appointments; “It really is a disgrace for those who genuinely need to seek medical advice urgently”

The Nuffield Trust reports: How far do the NHS’s financial problems really go? The bottom line: Understanding the NHS deficit and why it won’t go away

I still get e-mails advertising jobs in other countries with far less bureaucracy, more clinical freedom, and less intense time pressures, and a far greater income. It is this we are competing with. The only answer is to agree with all our G8 countries that we train more than enough doctors.

Queue jumping – The view of a GP David Wrigley in the Independent 2017

Going Abroad NHS

There is still little Private Practice option in General Practice, but this will change. As delays for serious symptoms become intolerable and all the ruses the experienced use to gain access fail, Private GP, like Private Dentistry will emerge..

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

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

Read the damning nature of this joint report.. GP shortages …. Our very own post-code lottery.

Private Medical Insurance options… Going to get more popular? Our leaders show us the way.

A general practitioner is trying to follow the dentists into private practice – clients will initially be the retired rich, but eventually many more of us.

 

Rethinking primary care user fees: is charging a fee for appointments a solution to underfunding? If we don’t keep the gatekeeper role for GPs the system will get constipated.

A recent report in the Times (Not on line) opines “Gatekeeping by GPs called into question. This is not new, as you can see from the debate following Matthew Paris’ article in 2015. The problem is not referrals, but the 90% who do not need a referral. Allowing others, less trained in dealing with uncertainty, will lead to more referrals, longer waits and a constipated system. The useless 111 service where there has seen no reduction in GP workload is another attempt to wriggle off the hook of under capacity and poor manpower planning. In his Imperial College funded report, Geva Greenfield and others report: “Rethinking primary care user fees: is charging a fee for appointments a solution to underfunding?”.

One solution is to make patients pay for their GPs and let them have appointments free with the nurses and paramedics. A two tier system by design. Lets see the comparisons in referral rates, expense and survival!! The result would be anarchy.. (sic) Geva Greenfield says “There is a trade-off that needs to be found between GPs serving as hgatekeepers to secondary care, and at the same time allowing patients to see a consultant when they wish”. We are trying to treat patients, and the governement are treating populations. Money matters, and the services are all rationed. (covertly)

Image result for money and NHS cartoon

Image result for money and NHS cartoon

This is the sort of thinking “outside the box” of current opinion that we have to get to talking about openly.

On November 26th 2018 Chris Smyth reported in the Times: Bypassing GPs could help to diagnose cancer sooner

In Pulse 2015: GPs should give up their Gatekeeping Roles

Matthew Paris on June 16th 2012 reported in the Times: GPs – little more than glorified receptionists

In this age of medical specialisation, if family doctors didn’t exist we wouldn’t feel the need to invent them

Next Thursday, family doctors plan to strike. Striking doesn’t suit the profession’s humanitarian image. Interviewed, doctors’ leaders struggle to insist (on the one hand) that nobody needing medical attention will be denied it, without implying (on the other) that few will suffer if doctors aren’t there.

How much, though, would we suffer? If family doctors had not existed, would we today have found it necessary to invent them?

We pay general practitioners more than we pay airline pilots, but they are becoming glorified gatekeepers: a portal to the more specialist medical care that our health service offers in growing measure. As GPs have receptionists, so the NHS itself uses GPs as its receptionists. Are we investing too much in the citizen’s first port of call, to the detriment of investment in the specialist attention to which, to an increasing degree, surgeries are likely to end up referring the patient?……..

……..Nurse-led primary care, too, is plainly on its way and expanding fast, with (the research is clear) excellent results. Walk-in and appointment clinics are becoming more common, especially evening clinics. Sexually transmitted disease, family planning, coughs and colds, eye, ear nose and throat … in all these fields specialist practices staffed by nurses and pooled doctors, rather than personal GPs, are where we’re going.

The only question is how fast. Let’s hope next Thursday’s strike prompts us to speed this thinking up. Decades ago, at the bookshop Foyles, you had to get a little chitty from a person in a booth before you could get your purchase. One day we’ll remember the GP surgery in the same way, with the same amusement that the archaic practice lingered so long.

The response June 18th 2012:

Sir, Matthew Parris (Opinion, June 16) is not quite correct in describing GPs as “becoming glorified gatekeepers”. We have already had that role (among others) for decades.

It is true that part of this role is to refer to secondary care, but he seems to miss the corollary of this; that we also judge when not to refer, thus saving patients, and the country, the burden of over-investigation and over-treating. The internet has expanded everyone’s access to specialist knowledge, but has not, perhaps, increased our ability to apply that knowledge appropriately. We know more, but understand less.

Mr Parris also fails to acknowledge that GPs have a vital role in the other direction of travel; from specialist care to the community. In this past week I have picked up the care of patients after their discharge from heart by-pass surgery, psychiatric in-patient treatment, dermatology, gynaecology, child autism and palliative care clinics.

In addition, we need to manage patients whose symptoms and conditions cover several specialties, as well as those who have exhausted all secondary care investigation without any diagnosis being reached.

“A decent grasp of the whole thing” is exactly what GPs need.

Dr Jonathan Knight
GP, Ipswich

Sir, Matthew Parris assumes that his interaction with his GP is typical of the work that GPs do. I have been working in general practice since 1987 and my experience is very different. We spend most of our time managing long-term illness such as high blood pressure, diabetes, kidney disease and asthma. When I was in training in the 1980s these conditions were managed in hospital but are now managed mainly in primary care. Of course I do not profess to be an expert in everything so I may refer to colleagues for opinions about aspects of a patient’s care, but they are then usually discharged to my care.

Allowing less-qualified health professionals to manage patients has never been shown to be more cost effective than using GPs.

It is this system of every patient having a GP, enshrined in Bevan’s original vision for the NHS, that other health systems around the world have strived to emulate. We should not discard it lightly.

Steve Charkin
London NW3

Sir, Matthew Parris says that he believes he could refer himself appropriately to a specialist, but he is not our typical patient. GPs’ time is predominantly taken up with the very young and the elderly, particularly those with chronic, complex and multifaceted medical conditions. For these folk, it is their GP who sees the “big picture”, the context and impact on the individual and their family, while each specialist focuses in on his own area of expertise. Approximately 90 per cent of healthcare needs are met in the community, by GPs and their practice nurses, with only 10 per cent of care being hospital-based, at far greater expense. It is true that a GP’s role includes “gate keeping” access to expensive specialist opinion, but I would suggest this is essential.

As Mr Parris concedes, most GP consultations do not lead to a referral to a specialist. His vision of a future without GPs to manage the majority of our health concerns would be financially unsustainable and bewildering to many. Would a woman with lower abdominal pain and back ache refer herself to a gynaecologist, urologist, gastroenterologist, oncologist or orthopaedic surgeon? Does she need a specialist at all if it is just a urine infection? How does she know?

While a single day of industrial action will cause no more inconvenience than the extra bank holiday for the Diamond Jubilee, Mr Parris belittles our role at his peril.

Dr Isabel Cook
Reading

Sir, Before getting rid of GPs Matthew Parris might be wise to wait until he is a bit older when he may have to see more than one specialist at the same time. He will find that the treatment for one condition often aggravates another and he will then be grateful for a generalist’s opinion. He will also find it more efficient to keep seeing the same GP so that he does not have to keep repeating his past history.

Dr Richard Stott
Epsom, Surrey

Sir, As a GP I know Matthew Parris is right. A lot of what GPs do is pointless or could be done by others. So there is a simple solution: stop giving us work.

John Booth
Middlesbrough

Sir, There is overwhelming evidence that GPs deliver highly effective, cost-effective care to our patients. Moreover, we do so with the trust of our patients, and with care and kindness.

I invite Mr Parris to sit through a surgery with me at any time, where he will see first hand how GPs care for the elderly, the frail, the disadvantaged and the ill. I’m sure that afterwards his perceptions of general practice will be different.

Professor Clare Gerada
Chair of Council, Royal College of General Practitio

 

Tere is a toxic culture, and disengagement everywhere in Health and Social Care. Also in the CQC …

GP list sizes in England can be found here. 

Standards are falling in most areas because of the pressure of work both in Hospital and General Practice. Occasional well respected and popular training practices are the least under pressure. In social care standards are also falling, and one inspector (Greg Hurst reports in the Times 13th June 2019) has quit citing a toxic culture in the Care Quality Commission. He should be listened to, as there is a toxic culture, and disengagement everywhere in Health and Social Care. Of course there will always be examples of individuals who break the mould, but in general NHSreality says it as it is. The Times report is below..

Image result for toxic culture cartoon

Mary MacCarthy in Pulse December 2018: Cappling GP lists would make GPs and patients safer: 

Nick Bostock in GPonline 12th December 2018 reports that since 2004, there has been a 50% increase in GP list sizes.

and earlier that year, he reported with Teni Oluwunmi  that the number of GP practices had declined by 263!!

and last year, according to the Mail by 138

Emma Bower for GPonline 5th June 2019 also suggests that Scotland needs a new target for the GP workforce. With increasingly elderly population with multiple pathologies and complexity, 15 minute appointments are also needed. (BBC News)

Anal Carcinoma needs prevention with HPV vaccine? A nurse comments on her own illness…in Healthonline

Research in the US has discovered what the drug manufacturers should have found: drugs for shrinking enlarged prostates cause delay in the diagnosis if the prostate goes malignant. Another case of Big Pharma and overtreatment.

Barry Stanley-Wilkinson gives his exit interview from the CQC. (Greg Hurst reports in the Times 13th June 2019) has quit citing a toxic culture in the Care Quality Commission.

Waiting lists are getting longer, even for cancer diagnosis and treatment. Nick MacDermott in the Sun12th June 2019 so keep up the private insurance payments as long as you can, especially if you live in Wales.

An inspector whose report highlighting failings at a scandal-hit hospital was never published resigned from the regulator, protesting that some of its staff were too close to the private company that ran the hospital.

Barry Stanley-Wilkinson also complained of a “toxic” culture at the Care Quality Commission and said many of its inspectors felt that they worked in a “bullying, hostile environment”.

Mr Stanley-Wilkinson resigned six months after he led an inspection in 2015 of Whorlton Hall, a private hospital in Co Durham for adults with learning disabilities or autism. Police arrested ten carers at the hospital last month after Panorama on the BBC broadcast footage of staff appearing to mock and intimidate patients.

The inspector reported in 2015 that some patients had accused staff of bullying and inappropriate behaviour. He said patients did not know how to protect themselves from abuse and recommended that the hospital should be given a rating of “requires improvement”.

His report was never published and a new CQC team that inspected Whorlton Hall in 2016 gave it a “good” rating. Mr Stanley-Wilkinson’s resignation email, sent to the CQC in January 2016, was published yesterday by parliament’s joint committee on human rights, which took evidence from two CQC executives. He expressed frustration that his report on Whorlton Hall had not been published “despite significant findings that compromised the safety, care and welfare of patients”.

He referred to a complaint about his report by the hospital, which was then run by the healthcare company Danshell, and pointed out that it had previously been run by Castlebeck, which ran Winterbourne View, a care home where there had been an abuse scandal in 2011. Whorlton Hall was taken over by Cygnet Health Care this year.

“I am concerned about the relationship managers have had with the service,” Mr Stanley-Wilkinson wrote. “Discussions had taken place without my involvement despite me being the inspector.”

Paul Lelliott, deputy chief executive of the CQC, said the 2015 report had had inconsistencies and lacked evidence. Ian Trenholm, its chief executive, said the CQC planned to develop a new way to monitor institutions.

Image result for falling standards cartoon

 

To paraphrase Spike Milligan: “I told you the Health Services were all ill”.

NHSreality as well as Spike told you it was going to get worse. Is it not ironic that in a country where we have depended on nurses, carers and doctors from overseas (usually less developed countries than ourselves) that we are now threatening not to allow them in, and especially not from Europe and the EEC, which means we may well get staff from less culturally affiliated countries, OR we have to export our elderly, OR we have to look after them with robotics! Personal continuity of care has died in the 4 health services, but many of us, if we can afford it, will pay for it.

In the last few weeks the shortage of GPs and poor access to the health care system applicable in your Post Code has become more evident. Rich areas like Horsham cannot attract GPs, partly because the price of property is so high, and poorer areas of the country cannot attract GPs because of the poor housing and schooling problems. Gainsborough surgery closed suddenly… (Connor Creaghan 29th May 2019 in the Lincolnshire Post)

Don’t believe it when the government says they are learning from their mistakes. They still have no “honest language” and they have no exit interviews. These are their main mistakes….

The whole idea of a mutualised health service is to care for those with the bad luck to have a serious illness or a physical / mental handicap. The latter do not often vote, and numbers don’t influence an election so they have been left behind, to the benefit of voters. Our Minister of health seems more concerned with innovation and Big Pharma than she is in boosting numbers of staff!

In a world market (English speaking) Nurses and Doctors have skills and are people who can move. The best way to keep them is to look after them, and to train a surplus.

Image result for spike I told you i was ill

Meanwhile clinical acumen and skills, and organisational issues are in decline. Public health has been underinvested and now people are starting to suffer.

The cost of care is so great that we may end up exporting our elderly….

Nursing crisis extends all the time… Surgery, ICU, intensive care and now oncology and cancer care…

29th May 2019 BBC News: ‘Lessons learned’ over £24m Altrincham health hub failings

Sarah Page in the West Sussex county times 22nd Jan 2019: Shortage of GPs in Mid Sussex

and Martin Bagot on the Mirror 31st May reports that there are over half a million people who have had to change their GP.and Desperation recruitment from abroad (Philippines, India, Ireland and Australia are targets, but Bangladesh and Pakistan may be the reality)

BBC News 21st May: ‘Broken’ care system for most vulnerable

on 21st May ITV reported that there were not enough nurses and doctors to meet demand  and the implication of their report is that there won’t be in the foreseeable future.

The Government is in denial and Nicola Blackwood in a speech to the ABPI opined: “We are going to have one of the most exciting health innovation systems in the world.” It certainly will be different for those who fall foul of it…

Thank Goodness one health Trust has agreed to actually pay nursing trainees! Cornwall’s Megan Ford on 14th May in The Nursing Times.

The Yorkshire Post: Scandal of the growing wait for a GP appointment. (YP 11th May 2019)

Meka Beresford and Ollie Cole in Human Rights News report 21st March 2019: NHS staff shortages could double without radical action.

Nick Triggle admits through the BBC news 21st March that there is “No chance of training enough staff”.

BBC News 29th May: Glan Clwyd Hospital told to improve orthopaedic care by coroner

BBC News 31st May 2019: Llwynhendy TB outbreak: Family ‘disgusted’ after death

And Matthew Parris in 2018 asked “How does anyone know how to navigate the maze of our second-rate NHS: ( You can download the whole article below)

The Maze of the NHS – Matthew Parris

Just cry at the bribery, and the Death of the Goose that used to lay the golden eggs that used to make the Health Service(s) so efficient, and the envy of the world.

Say goodbye to continuity of care.

Image result for spike I told you i was ill