Category Archives: Rationing

Are we heading for Social Care collapse and failure? … we need to “not just care for people but also promote independence, wellbeing and prevention.”

Lets hear the political vision vision. Means testing for social care is current. We do not means test for medical care – officially – but more  people may now pay for private care. The national number is 10% but it may well increse in the next few years. The lottery that is the 4 health services extensds to hereditary and housing assets. NHSreality sees no reason that these assets should not be used for old age care, or health care. Many countries have rejected inheritance tax, which is another form of lottery as so few people / families trust each other enough to negate what is in effect a choice..

“People need to know what they are paying for, how much funding is needed and how costs will be shared” – Kings Fund report:  Social care reform: what is the vision? – Social care has been in the news this week, but what is the vision for it? With the sector having seemingly never been so prominent in public and political discussions, Natasha Curry and Nina Hemmings once more ask the key questions.

Reports in the media this week have been drip-feeding some tantalising glimpses of what might be going on behind the social care reform scenes in central government.

There has been talk of a tax on the over-40s, suggestions of a rise to national insurance, and speculation over a lifetime cap on costs. There have been mentions of individual insurance to cover costs, and even hints of a wholesale shift of social care responsibilities into yet-to-be-formed NHS integrated care systems.

The Secretary of State this week hinted at an ambition for social care that extends beyond previously narrow framings of reform centred on protecting people from selling their homes to pay for care. Instead, his speech pointed to aspirations for a system in which “everyone”, no matter their age, gets “the care they need”. A nod to prevention, oversight and accountability, and to recognising and rewarding carers, were welcome additions.

Looking back at the history of failed social care reform, the debate has all too often started and ended with funding. Inevitably, as the Secretary recognised, any meaningful reform to the care system will require more money to be raised from the electorate. But to gain public support, people need to know what they are paying for, how much funding is needed and how costs will be shared.

Clarity of vision

Our previous work looking at the care systems of Japan and Germany have highlighted there is no perfect system. Instead, each is the product of a set of complex negotiations and compromises that reflect social, cultural and political dynamics. But what underpins both is a vision and clear principles around which public and political support was built.

In Germany, the vision was based on social solidarity – guaranteeing access to a minimum level of care for all, regardless of age, means, postcode or condition – with ambitions to extend and expand benefits as it developed. A standard needs assessment and schedule of benefits across the country ensures consistency and fairness for all.

Japan based its system on Germany’s but started out with a different vision – an ambitious, generous system that would not just care for people but also promote independence, wellbeing and prevention. Like Germany, consistency of benefits and eligibility embedded a sense of fairness but, unlike Germany, Japan restricted access largely to people aged 65 and over.

Two different contexts, two different sets of priorities. Two different visions but each, crucially, designed to build public and political support. And both built upon existing, long-standing and familiar infrastructure.

Fair and sustainable funding

Once the vision is in place, attention can turn to funding. The various options available in England have been well rehearsed. The next step is selecting an option (or combination of options) that will meet the costs of the reformed system, and allow the vision to be realised……

Listen to expertise? This could be done by the end of 2021. Here is an oven-ready solution, Prime Minister.

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

The reality is that for most of us the state safety net is absent. If social care is means tested, then why not health care?

What principles should underpin the funding system for social care? Surely an ID card with tax status and means is now essential….

NHSreality is a “heretic”. The NHS has become the greatest cult of our time. As a “holy relic” it is granted immunity from meaningful change.. If social care is means tested, why not medical care?

The dissonant ideology between social care and the NHS: “One is heavily rationed and means-tested, the other free at the point of use and tax-funded”.

The 4 cuckoos in the 4 health service nests…? The next chancellors statement is a dangerous moment..

Dementia cannot kill off any one UK Health Service if you exclude it, but understanding is essential to reconfigure..

The UK 4 Health Services: Everything for everyone for ever for free? A summary.

Old Age funding: Denial of “hard Truths”. This is what is causing the popular disgust with politics.

Too little, too late. The enquiry must ask why no notice was taken of these reports..

Brexit threatens drug delivery after all… Surprised?

At the last election one of the Labour suggestions was supported by myself, even though it was anti-competitive (Anti-Trust) and that was the suggestion to form a state company for the production of generic drugs. I am dependent on a pair of generic hormonal replacement drugs myself, and if one of these is stopped for 2 days I will die. The just in time supply chain of a Liberal world is being challenged by the populistic protection of “putting myself/ ones own country first”. Drying up of trade, raising trade and tax barriers, reducing immigration and movement of peoples, will only lead to a reduction in living standards, and eventually life expectancy. We have to think through Covid-19, and retain our liberal values. So Brexit threatens drug delivery after all… Surprised?

LET PHARMACISTS ALTER PRESCRIPTIONS
Sir, It is vital that the UK and EU agree a deal on medicines regulation as soon as possible (“Drug firms told to stockpile for no-deal Brexit”, Aug 4). Pharmacists find themselves at the sharp end of this when patients cannot obtain the medicines that they need. It would prevent a lot of unnecessary delays if community pharmacists were allowed to make changes to a prescription when a medicine is in short supply or out of stock. This could be as simple as providing two weeks’ supply and asking the patient to collect the rest in a fortnight. At present any changes to quantities, strength or formulation can legally only be done by the prescriber. A change to medicines legislation is needed to enable pharmacists to speed up patients’ access to medicines, which would also have the added benefit of reducing the workload of GPs.
Sandra Gidley

President, Royal Pharmaceutical Society

Oliver Wright reports 4th August: Drug firms told to stockpile for no-deal Brexit

Ministers have told drug companies to start stockpiling medicines again and prepare for disruption if the UK fails to strike a Brexit deal with the EU.

In a letter to medical suppliers, officials at the Department of Health urged companies to “replenish” drug stock and be prepared to reroute shipping to avoid the Channel. They called on the companies to make stockpiling “a key part of contingency plans” and said that they should try to ensure that they held at least six weeks of supplies in hand by December 31.

Emphasising how Covid-19 has disrupted supply chains, the department said it accepted this might not be possible and that “a flexible approach to preparedness may be required”.

“The first priority of any contingency should be to maintain replenishment rates at necessary levels by securing capacity to reroute freight away from the short straits [the Channel] potential disruption points,” the letter said. “Companies are encouraged to review their own logistics arrangements and consider making plans for avoiding the short straits as a matter of priority.”

In a separate consultation published yesterday, the government revealed plans to fine lorry drivers destined for the Channel ports £300 if they drive into Kent after December 31 without necessary export paperwork. Ministers are concerned that in the absence of a trade deal the EU will impose strict import checks on all goods entering the EU, with the potential to gridlock cross-Channel travel.

Ministers are to set up a new assurance system to ensure that all lorries heading to ports have the correct paperwork long before they reach ports. Ministers said that those who failed to comply, not the company employing them, would be fined.

“The government’s intention is to legislate to enable penalties to be applied to hauliers bound for the EU that have not used the service on entering Kent,” the consultation said.

 

 

Chronic pain relief and Psychiatric conditions all need therapists… They have been rationed out.

Those of us in the porfession for many years know how easily a patient can transfer from acute post operative pain to chronic pain if they are not warned of the risks, educated, and “buy in” to the speedy reduction of painkillers and exercise. However, chronic pain relief and psychiatric conditions all need therapists… and these vital people have been rationed out. We should take a leaf out of the French solution, where only psychotic demented patients get drugs, and the money saved is spent on therapists. Since much of this “chronic pain” is iatrogenic, as a nation (and commissioners), we need to face up.. Without changes in the rules though, the commissioners and managers are impotent.

MEDICINE FOR PAIN
Sir, I note the recommendations from the National Institute for Health and Care Excellence about chronic pain (“Don’t give paracetamol to patients, doctors told”, Aug 4) but am surprised that the Nice guidance committee was chaired by a psychiatrist, given that we have a Faculty of Pain Medicine. As a retired consultant in pain medicine I developed one of the early multidisciplinary pain clinics. This included psychological and supportive therapy input emphasising the minimal medication approach with pain behaviour techniques, unless there was an underlying specific problem to target.

However, as so often is the case, the acute and surgical specialties have received the principal funding in the health service while chronic illness has had “Cinderella” recognition. On the other hand, patients continue to visit primary and secondary care on a long-term basis. It is to be hoped that this report might increase resources, but one wonders if the therapists are available.
Dr Richard Atkinson

Ret’d consultant in pain medicine, Sheffield

Katie Gibbons reports 4th August: Don’t give paracetamol to chronic pain patients, doctors told – New advice prescribes exercise for chronic pain

Sensible rationing of dementia drugs – a lead from France

Patients were left in pain for decades by health scandals

Rationing in the recent news. Obscene denial of the truth by politicians…There’s a painful list of conditions we are no longer treating on the NHS

A redacted summary from Betsi Cadwaladr: in 2015. Now 5 years later still no full report as:  ” Calls for health board to release full psychiatric ward report”.

The “reality” is that all health services are rationed. Until we face this fact we cannot have the honest debate needed. Therefore rich persons will get better care than the average citizen, as we cannot have Everything for everyone for ever for free everywhere, as the Hergest Unit in Betsi Cadwaladr proves. Psychiatry is an issue because their patients are on the fringes of society, rarely influence elections, and are not valued by the average citizen unless they have a first degree relative affected. Most prisoners have psychiatric issues, and most of these were not addressed either before, or after their offence.

James Williams reports for BBC Wales: Betsi Cadwaladr: Calls for health board to release full psychiatric ward reportA redacted summary 

Opposition parties are calling for a health board to release the full 2013 report into “worrying standards of care” at a mental health unit.

The Holden Report warned the Hergest unit at Ysbyty Gwynedd, Bangor, was “in serious trouble”. A redacted summary was released in 2015.

In June, the Information Commissioner’s Office told Betsi Cadwaladr health board to release the full report after a Freedom of Information request.

But it appealed against the decision.

The health board said “publishing this full report would breach the confidence of those members of staff who contributed to it”.

A review of the 42-bed Hergest psychiatric unit was commissioned after complaints by staff.

The report’s author, Robin Holden, said staff relationships had “broken down to a degree where patient care is undoubtedly being compromised”……..

GPs and Population Health – its illogical to combine

It is the duty of governernment to look after “populations” and the duty of a doctor / GP to look after individuals. Once a Doctor is asked to do both there is an obvious conflict of interest. A GP might have to advise his patient that a service was, in his opinion, not good enough locally. He might wish to advise the patient to either choose to go elsewhere, (English option, but not in Wales) or to go privately. He might advise on ways to game the system, perhaps by moving area/region. The conflicting duties and the ethical dilemmas that result are not explored by the authors of the paper below. The reason for this suggested need at all is that we have neglected to train enough public health physicians for decades, ( “rationing places” ) and experience matters. 

In the latest edition of the Journal of General Practice August 2020 K Thomas and others try to explore the option of a GP doing the population job:  GP with an extended role in population health by  Kathrin ThomasEleanor BarryStephen WatkinsJack Czauderna and Luke N Allen –

How do we move from supporting sick individuals to creating healthy communities? Allen et al 1 recently laid out their vision of: ‘… a near future where practices collaborate to share data and work alongside public health teams, patients, and local organisations to proactively engage with communities to make them more health-promoting places to grow, learn, work, and age. GPs would help identify modifiable determinants and support the development of interventions to address them.’

We propose a new workforce role that could help to make this vision a reality.

POPULATION HEALTH

Population health is the improvement of health and wellbeing, and the reduction of health inequalities, across an entire population. The King’s Fund outlined four pillars for population health: wider determinants of health; health behaviours and lifestyles; places and communities we live in; and an integrated health and care system.2

The shift towards population health is part of a wider global trend. The World Health Organization’s Declaration of Astana 3 and the unanimously adopted United Nations General Assembly resolution on universal health coverage4 name the integration of public health and primary care as the main vehicle for delivering better health outcomes. Co-producing population-level interventions to promote health and prevent disease is becoming a central activity of primary care all over the world.

This fits with the social model of health that sees …

Physician Burnout Is a Public Health Crisis, Ethicist Says– MEDSCAPE

There is more money spent on “lobbying” by Big Pharma than on Public Health consultants…

The NHS Atlas of Variation – published by NHS England and Public Health England – looks at service performance in more than 200 local areas. Lives being put at risk, NHS report suggests

How town planning can make us thin and healthy: Architects show that more green space and

less housing density has a clear effect on public health

Public health: how does the UK compare with Europe? Interactive map

Dec 2019: Exit interviews, especially if done by outsiders, will tell health boards, politicians and the public the truth. There is no way to get sufficientt GP diagnosticians (Or public health doctors)  in time…

Gaming the system works – if you have time and the publicity / “source force”. It is unsafe to be a cancer patient in Wales…Just pray you don’t get cancer, then you won’t need to play.

The deep mind approach to “gaming the system”..

Gaming – a possible solution. A new business opportunity. For a big city in the UK to help rural Wales..

Choice and “Gaming the System”

“There are the ingredients for social unrest”….. and reducing inequality accidentally could come at a price…

NHSreality was warning about the possibility of local outbreaks of civil unrest before covid-19. When a secretary of state warns us this is real. Now that cancer treatments are on hold and private hospitals are commandeered, there is no choice for those that need urgent treatment. The safety net for the whole country was holed before covid, and now it has been taken away. We are all walking the tighrope of health risk, and the  governement, rightly given its poor preparation and manpower planning, is putting the population ahead of the individual. This form of rationing has not been seen for decades, but now it is overt, perhaps other forms of rationing will be discussed more openly and without the uusal “denial”. The only virtue in all this is that stopping private health care reduces inequality – but by dumbing us all down to the same standard. Successive governements have failed at the risk management of the 4 dispersed health services. In May 2015 NHSreality warned that worse was to come..

Tightrope Walking Cartoons and Comics - funny pictures from ...

James Forsyth opines in the Times Saturday 1st Augusyt 2020: If you think this is bad, just wait for winter – Local lockdowns are one thing but when unemployment and flu rise, a new minister will be needed to help deal with the crisis

But in the last fortnight, the mood has darkened in government. There is nervousness in Whitehall that the Office for National Statistics survey data, which is regarded as the gold standard for knowing whether the virus is in retreat or not, is showing a general uptick. The slew of local lockdowns in the northwest announced late on Thursday are an attempt to deal with this problem in one of the worst-hit regions. But given that there seems to be a broad increase in the virus, these local restrictions may not be enough and more national measures may be coming soon. “The last month has been the easiest it will be,” warns one of those at the heart of the government’s response.

“This is going to be a very nervous month in terms of tracking the virus,” one cabinet minister tells me. Another minister is even more despondent, simply declaring that “the second spike has started”.

…..The cocktail of winter weather, mass unemployment — the Office for Budget Responsibility predicts that joblessness will peak at the end of this year — and lockdown has the potential to be toxic. One secretary of state fears “there are the ingredients for social unrest. It is going to be much harder to enforce a lockdown in the depths of winter”.

Five months from now, parks won’t offer the safety valve they did in April. Now that the country knows what it is facing, the government must be ready for the challenges ahead. There will be no excuse for being unprepared for the concurrent crises that are coming this winter.

A&E waits (and now booking on line!) are symptomatic of a complete failure. The safety net has been removed, and fear is returning – in spades

The health of an intelligent democratic population deserves better. Yes to honest rationing…

What nonsense from Mr Drakeford…. Politician afraid to acknowledge the poor manpower planning, and his responsibility to the whole population..

The Health Services Procurement – inefficient and risky… Centralisation and management control is needed

May 2015: Setting sail in a boat already holed. The new government will fail unless it rations health. Proportional representation would be better than the inevitable mess to come..

BBC News: James Gallagher reports 30th August:  We’re now at the limit of easing lockdown

In endorsing Zoom, Our health minister seems unconcerned with litigation risk,

Our health minister seems unconcerned with litigation risk, and cost. The Insurance companies could put the risk in its place, and inform the Times leader correspondent. There is no substitute for examination, and the inability to live with uncertainty may put off many potential GPs in the long run. Not examining will be grasped as another form of rationing.

Kaya Burgess reports in the Times 30th July 2020: Matt Hancock hails Zoom medicine as GPs go online

The Leader:

The Times view on remote GP appointments: Doctor Zoom

Technological innovation has helped the NHS weather the pandemic. General practitioners should embrace plans to make consultations remote

 

The Times view on remote GP appointments: Doctor Zoom

Technological innovation has helped the NHS weather the pandemic. General practitioners should embrace plans to make consultations remote

The Times

The National Health Service turned 72 this month. Those who have endured the tedium of attempting to book an appointment with a general practitioner at short notice could be forgiven for thinking that it is still run from the first half of the 20th century.

While technological innovations have transformed patient care, the same cannot be said for the archaic administration of hospitals and doctors’ surgeries, which can often feel like places where the modern internet fears to tread.

An NHS that still uses 9,000 fax machines and 10 per cent of the world’s remaining pagers is manifestly overdue the sort of digital reckoning set out by Matt Hancock, the health secretary, in a speech yesterday.

Now that the first peak of the coronavirus pandemic and the acute pressure it brought to bear on the NHS has passed, ministers and clinicians have an opportunity to apply lessons learnt and look to the future.

If Mr Hancock has his way, they will do so via webcam. From now on, he told the Royal College of Physicians, consultations should be conducted via phone or video call unless the clinician or patient has good reason to choose otherwise. The NHS and its doctors will be digital-first. Gone will be the days of early-morning calls on hold to overworked surgery receptionists. Few will miss them if they can zoom a doctor from home.

At least that is the hope. Any minister who attempts to digitise the health service is being bold. Historically, technology projects in the NHS have begun with good intentions and ended in expensive failure after lengthy delays. That is a large part of the reason its office infrastructure has resisted wholesale modernisation so stubbornly.

But the pandemic, as in other arms of the state, has shown there is an alternative. Only 10 per cent of GP appointments are now face-to-face, compared with 61 per cent via phone, 6 per cent by text and 4 per cent by email. Surgeries have adapted to the new reality of social  distancing with commendable speed. Only one in ten does not offer remote consultations. Long may this state of affairs continue.

Mr Hancock likens the pandemic to sheet lightning on a dark night, illuminating the NHS’s successes and failures. If anything he is too generous. The shortcomings were plain to see well before the pandemic.

Strained by the demands of a rapidly ageing population, general practice is in crisis. On average, patients get nine minutes with a doctor. If they see one at all. Punitive taxes on pension pots incentivise GPs, already free to opt out of weekend and evening duty, to work less and retire earlier. A&E departments thus end up overburdened.

Going digital will relieve some of the strain and ensure there is no longer such a thing as out of hours for primary care. The changes make sense for doctors too, as reflected by the cautious welcome Mr Hancock’s remarks received from GPs. Much of their time is wasted on paper-shuffling at the expense of patient needs.

It is right that the government will consult them on what red tape might be cut. Recent events have demonstrated that even an unwieldy supertanker like the NHS can move nimbly when circumstances demand it. Ensuring it stays that way will require Mr Hancock to make good on his promises to blast off its bureaucratic barnacles and shift power to doctors, who should set aside their suspicions of the health secretary’s evangelism for technology.

Nobody is proposing that elderly or acutely sick patients be banned from seeing their GP in person, as some fear. While the difficult birth of the government’s tracing app for the coronavirus is a cautionary tale, we know that technology can make remote consultations work.

As with many chronic illnesses, changes of habit have proved the best treatment for the NHS’s underlying conditions. Its doctors should embrace them.

The 4 cuckoos in the 4 health service nests…? The next chancellors statement is a dangerous moment..

Whilst we still have some choices, it looks as if the members of the public flying on EU holidays may have made the wrong choice. Covid 19 is resurgent in many places, and in the world as a whole the pandemic is far from over. As it becomes endemic in the advanced countries we have yet to see what will happen to the pandemic in those without the wealth and infrastruicture to cope. India has over 100000 new cases daily. If health is wealth, we in the UK have a chance to even up, but at the risk of perverse behavious as the super rich move their wealth and assets between different dispensations. The threat of a wealth tax is real and present, and it may be one of the only meaningful options, but it would be better if it was “world” based. Since that is impossible, we have to balance the relative short term good againt the long term harm. Do we encourage thrift and saving? Is it correct that those who spend their savings or income, ( Eg. on holidays in the EU? ) shuld pay little towards the recvovery, whilst those who stayed at home and did without should be taxed more? Security in old age was one of the reasons for saving, but the current talk is for a free Social Care system, rather than the alternative: a means tested Health Care system.The latter would make finacial sense long term, but the popularity of the first will win votes in the short term.

NHS manager as cuckoo chick.

David Smith in his Economic Outlook in the Tomes 25th July 2020 remarks that “The NHS is likely to get more money – and will look more and more like a cuckoo in the nest: Austerity’s Limits – The cuckoo in the nest David Smith 25072020 

Meanwhile Philip Hammond, ex chancellor, warns us “Not to rule out a wealth tax”. How we do this will be VERY important. Argentinians have no savings in Peso, only in gold, land, and dollars. Are we going to see a gold buying rush in the UK because of the chancllor? The result of he dumbing down of health, its splitting into 4 systems, and its short termism is now unpon us. Meanwhile our health minister still doesn’t know what to do about masks in Wales! NHSreality recommends you wear one in all enclosed and congested places. There is no evidence of harm.

The cuckoo in the nest kills all other competitors for living … Without competition the infant gets all the love and attention of the parents, who wear themselves out bringing them up – and no thanks for doing so. The Health Service as founded now is a con. we cannot have Everything for everyone for ever for free everywhere.

Covid-19: Acts of omission BMJ 2020;370:m2929  – Editor’s Choice  BMJ 2020;370:m2929

The UK government is becoming known for acts of omission. No evidence exists of Russian interference in the 2016 Brexit referendum because the government didn’t and won’t look for it. Nor does it seek lessons from an immediate public inquiry to inform a future surge of covid-19.1 Nothing predicts behaviour like behaviour, and if over 60 000 excess deaths in six months will not force behaviour change then perhaps nothing will?

The pandemic is at its global height and anything but in retreat, exploiting a philosophical battle between prioritising health or banking on the economy. In the UK and US, the economy has won out. Wealth before health. Elsewhere, the role of health in generating wealth, and the emerging evidence behind it, is better understood.2 The European Union, for example, has announced a €750bn (£680bn; $860bn) coronavirus recovery fund.3 Out of the EU, England is marginalising independent scientific advice.45

Acts of commission are faring little better, as the persistent struggles with testing, contact tracing, and local data flows demonstrate.67 Positive talk doesn’t paper over the burden on health professionals and their need to rest and recuperate, or the lack of public confidence in seeking urgent care during a pandemic.89 A genuine opportunity exists to build back better by reducing unnecessary healthcare or making better use of hospital medicines data.1011

Clinicians can at least focus on clinical skills. Anosmia is among the myriad clinical presentations of covid-19, and one of the most talked about. Half of all patients with covid-19 lose their sense of smell, but most recover it within four weeks.12 The key challenge is staying alert for an alternative explanation. At the other end of the clinical spectrum, severely ill patients with breathlessness and agitation require palliation and clear communication about prospects with family and carers.13 As the system flails, health professionals are relied on to hold it together.

Despite encouraging reports about a possible covid-19 vaccine,14 expert consensus is that the winter will bring another surge of cases. Covid-19 is no mere political power game. Further mishandling of the response will lead to more excess deaths, and premature death is a losing game for both people and the economy.

Health is Wealth: How parts of Britain are now poorer than POLAND with families in Wales and Cornwall among Europe’s worst off

The reality is that for most of us the state safety net is absent. If social care is means tested, then why not health care?

Bribing lady doctors back to the profession is unlikey to work significantly. The policy is sign of a tragic manpower planning failure.

Over the last 20 years the percentage of female doctors has increased. In some medical schools, particularly for undergraduate entry, as opposed to graduate entry. At 21 the men seem to perform equally to the women, but at 18 their greater maturity gives women an advantage. The life work years of a woman are less than a man, for obvious reasons. By selecting an over representation of ladies, the manpower planning has gone tragically wrong. Enticing them back to work, and remember many have married doctors or taken a different career, will be unlikely to work unless the shape of the job is changed. The move towards indirect (computer) consultation, with the higher medico legal risks, is unlikely to be effective.

The added reward of £20k for all GPs starting up in unpopular areas is just another bribe. (Beth Kennedy in Pulse) The long term rationing of medical school places has come home to roost.

Kat Lay reports in the Times 24th July 2020: NHS to pay childcare costs for doctors retraining as GPs

The NHS will step in to cover childcare costs for doctors who want to retrain as GPs, in an attempt to boost numbers.

A new scheme will offer up to £2,000 towards the costs of caring for children or family members while doctors complete the placements necessary to return to work in general practice.

On his first day as prime minister last year Boris Johnson promised to recruit 6,000 more GPs to improve patient access mid widespread shortages.

The money will be offered as part of an “induction and refresher scheme” first introduced in 2016, designed to bring GPs who had left the NHS, or who had worked in similar roles overseas, into the health service by getting their skills up to date. It has been used by 500 doctors.

The scheme already includes a £3,500 bursary, as well as an £18,500 relocation package and payment of assessment and occupational health check fees.

Nikki Kanani, medical director for primary care at NHS England, said: “GPs, like those in any other walk of life, might take time out from their career to raise a family which can bring additional challenges, move or work abroad or gain experience in a different profession or role.

“But whatever the reason, there is a direct route for those that wish to return to a career in NHS general practice, at a time when the NHS needs all the expertise it can draw on to help in the ongoing response to coronavirus.”

The NHS has the equivalent of about 34,000 full-time GPs, a number which has remained stable for five years despite the headcount increasing by about 5,000.

Doctors’ unions say that many GPs have been pushed to work part time because of the increasing pressures of the job.

NHS schemes also aim to attract 26,000 more people in supporting roles such as physician associates, pharmacists and physiotherapists.

Analysis by the Nuffield Trust think tank last year showed a recent sustained fall in the number of GPs relative to the size of the population across the UK, for the first time since the 1960s. The trend is largely driven by doctors retiring, although there have also been issues with high drop-out rates during GP training programmes.

Samira Anane, the BMA GP committee workforce policy lead, said: “General practice continues to be in desperate need of doctors, and therefore it makes no sense for childcare and other caring responsibilities to be a barrier for those GPs who want to offer their valuable and much-needed skills to the NHS.

“These may be doctors who have taken time away from practice to have children and we must do all we can to support them when they want to return to the front line.

“We are glad that this support — already available to employed workers — is now available to those on this scheme, and, after pressure from the BMA, has been extended to returning GPs with other caring responsibilities as well.

“Doctors should not be forced to choose between caring for their families or caring for patients. We hope these changes will allow more skilled GPs back into the workforce.”

Those already on the scheme can claim costs back retrospectively up to April 1 this year. At the end of May this year 1,000 people had applied to join and 500 had completed the training.

Martin Marshall, chairman of the Royal College of GPs, welcomed the initiative. He said: “The GP workforce has been in dire straits for several years.”

However, he added: “We also need to see already considerable efforts to recruit more GPs to the profession redoubled, and clear plans outlined in the forthcoming NHS People Plan around tackling ‘undoable’ workload and retaining existing GPs in the profession. As we move to the next stages of the Covid-19 pandemic, and the focus of efforts to tackle the virus shift from hospitals to the community, we need every GP we can get on the front line, delivering patient care.”

How did we get to this? What manpower planning failure. Please let Health Service visas be dependent on good language and cultural awareness.. and integration

Why having so many women doctors is hurting the NHS: A provocative but powerful argument ……. Women should “lean in”..

What nonsense from Mr Drakeford…. Politician afraid to acknowledge the poor manpower planning, and his responsibility to the whole population..

Waiting times for important conditions get worse, especially in parts of the UK where prescriptions are free. Too few staff, and poor manpower planning. It is getting worse.

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

The reality of undersupply and poor manpower planning

Medical Student debt – time for government to change policy on doctor recruitment

 

Why did it take so long to use steroids in Covid?

When I was a young doctor I was encouraged to think for myself, and although they come with a warning, short term use could have great benefits. I and many colleagues are surprised that a high dose of Demamethazone took so long to be acknowledged as an important help in survival. The media attitude to steroids needs to be more informed.. The early rationing out of a cheap drug is a poor reflection on our system today.

Steroid Abuses Cartoons and Comics - funny pictures from CartoonStock

The WHO acknowledged this only on 26th June: WHO welcomes preliminary results about dexamethasone use …

The NHS: Dexamethasone and COVID-19 – SPS – Specialist Pharmacy …

and the BMJ: Dexamethasone in the management of covid -19 | The BMJ

only on 2nd and 3rd July 2020.

The tardiness of discovering and dissemminating this information may reflect on the management by algorhythm rather than allowing clinical experience to have the freedom to try cheap but unproven therapies.