What is the alternative?

[Guinness]

So..now the tories are blaming the GP's for the NHS crisis...

I'm sure everyone would agree that there is a reasonable argument that GP surgeries should be open at weekends and after 5 o'clock...GP's and dentists etc..are the last bastion of 20th Century working hours, where the working man knocked off on Friday and went back in on Monday. Where Accrington shut down during 'wakes' week and between Christmas and New Year.

But...this is NOT the reason why our hospitals are in crisis..and I use the word 'CRISIS' because I've seen this first hand at BRH this week. There really are people on trolleys in corridors, lying in ambulances outside. 4 hours waiting to be seen by an A&E doctor, 3 hours in a corridor waiting to be assessed for a ward and another 2 hours before getting a bed and appropriate medication.

You get on a ward... and guess what...the beds are full of people who want to get out...but they can't..because there is no support for them if they did get out...for the last 10 years the tory government has eroded social care to breaking point. There is no-one to look after you at home so you stay in a bed that could be best used by someone with a more serious issue.

You'd think that something like this would be a godsend to an opposition politician...

And do you know what Jones is bleating about....internal politics, Yemen and bleedin' betting terminals..oh yeah and something from the paper pushing job title 'director of public health for lancashire' about the evils of having a fag...

Just take your free pension Jones and give me an alternative to the tories!

[Margaret Pilkington]

Guinness, as usual you are right( and i do not mean that in a snotty way).
This problem goes back a long way and it is multi faceted. It certainly predates this tory government.
I have been retired 14 years and we had problems finding beds during winter months when I was in post....many ops were cancelled and our beds given over to the medical teams.
The rot set in when business models were applied to health care, when politicians started to meddle in stuff that they knew nothing about(no change there then)...when they started applying target based care rather than care on a clinical need basis.

The other thing is that we fail to rake in money from the folk who are here and using the NHS when they should really be paying for their care.
It is not beyond the realms of possibility to organise some scheme to get the cash from health tourists..

We have more people livingon this small island and an ageing population so it should not be a surprise to anyone that the system is buckling uner pressure...it stands to reason that if more people use a service , the service is going to be stretched.

The general public have to bear some of the brunt too. Turning up at A&E with a minor aliment should be a criminal offence.
I have been in the situation of taking a history from a patient who presents as an emergency and when you ask how long they had this pain and they tell you two months...and they turn up at 10pm on a Saturday evening. It beggars belief.

I take your point though. Our representative is pretty much useless.

[DaveinGermany]

The misty eyed belief that the NHS of the past is fit for purpose in the 21st century lies at the heart of the UK's health care problems. It needs drastic modernisation & overhauling, but any politico who says as much is pretty much opening themselves up at least for frothing outrage or at worst de-selection by party/public.

At some point the public are going to have to accept that they'll be bound to pay directly for certain aspects of the system as the compulsory contributions from NI payments are insufficient to maintain the standards people expect.

Take a look at the Health systems throughout other European countries & they certainly don't seem to be suffering similar degradations as the NHS despite also having ageing populations, a massive influx of non paying immigrants & a lessened pool of contributors. I can only speak from my experiences here in Germany (and that was very recently pretty intensive) & in comparison with what is shown on the UK news Germany is by far superior in its operation.

Believe me, there are certain things about the German system that could be better but when compared to UK, I believe I'd rather be treated here than there!

[Margaret Pilkington]

We already pay for dental care and for eye tests(unless you are over 60 or have long term eye problems)...we pay for prescriptions too.
It isn't just about money...and if it were then the last labour government that encouraged private finance initiatives so that new facilities could be built but without saddling the government with debts was a very bad idea.(and during meetings about such things I made the comment that you would have to be mentally deficient to sign up to a mortgage when you didn't know how much you would be paying....or how long you would be paying it for)

Balfour Beattie must have rubbed their hands with glee when they were contracted to build the extension to RBH.
The hospital used to have its own works departments....plumbers, joiners, electricians, engineers builders. Work was done 'in house' at competitive rates.
Not anymore. The simplest jobs have to be done by Balfour Beattie at exorbitant rates(something like £240 to replace a lightbulb).
That, along with the rising costs of treatment and year on year savings which HAVE to be made.

Money wasted on agency staff. Locum doctors and agency nurses eat up great big chunks of budget.

I don't know what the answers are because so many stupid decisions have been made in the past which cannot be reversed...unless the current government decides that all those
PFI agreements are torn up. That would free up a lot of money.
Getting rid of some of the management structure would help too.
Especially those deals where a senior manager gets kicked out with a nice final payment and is re-employed on a lucrative contract the following month.

[DaveinGermany]

Originally Posted by Margaret Pilkington

I don't know what the answers are because so many stupid decisions have been made in the past which cannot be reversed...

Exactly! And that, from an ex-medical professional such as yourself convinces me even more that wiping everything out & starting over is the only way the NHS can be re-affirmed as a world leader in medical health.

[Neil]

This is an interesting read, a speech by Ken Hargreaves MP about Accrington Victoria Hospital

[Margaret Pilkington]

Neil, you are right it IS an interesting read.
The problems go back a long long way and they have been worsened dramatically by politicians using the NHS as a political football.
They should take their fingers out of the NHS pie and allow those who know about health care provision to manage the situation...though who would want to take on this poisoned chalice is beyond me.
Beds have been closed, hospitals shut down, A&E services reduced.
So in the face of such stupidity, why are we surprised to find the service on its knees?
When places like the walk in centre at AVH are being closed...there are protests because local people can see their services being eroded and withdrawn, with no real alternative being provided.
Do you really think anyone in authority cares one jot about the protests or the petitions?
Of course they don't. The changes are cut and dried before the public get wind of them.

What effect might the closure of the walk in centre have on A&E at RBH?
Well, for sure it won't make things easier.

[Neil]

Most people shouldn't be using a walk in centre, they should be using their GP but we have a problem with GP's in this country.

I'm not sure if I think minor injuries should be treated at AVH or if that should be a function of A&E at BRH.
Triage should funnel people in the right direction but doesn't.
I've found the triage system especially poor at BRH with the reception staff allowing someone to sit and wait for 30 mins to be seen by the triage nurse who described classic stroke symptoms to the receptionist. Only when I went to speak with the nursing team did triage happen.

[Margaret Pilkington]

Another one of the big problems which preceded this debacle is the decision in 2004 to allow GPs to opt out of providing out of hours cover. This was under the auspices of a Labour goverment presided over by the delightful Tony Blair.

The provision of health care has never been a 9-5 situation, and people who go into this profession are aware of this...and that there will be times at weekends, nights, public holidays when they are required to provide services.
GPs are no different and some of them are paid a lot of money to provide a service.
They know this when they take on the job. It is time the got themselves organised and provided services that reflect the pay they are getting.
As Guinness pointed out, the days when people worked Monday to Friday are long gone.
GP services should reflect the needs of their patients and not close on a Wednesday afternoon for 'staff training'. Yes, staff have to be trained, but the service still has to be maintained...with good appropriate management it can be done.

[Margaret Pilkington]

Originally Posted by Neil

Most people shouldn't be using a walk in centre, they should be using their GP but we have a problem with GP's in this country.

I'm not sure if I think minor injuries should be treated at AVH or if that should be a function of A&E at BRH.
Triage should funnel people in the right direction but doesn't.
I've found the triage system especially poor at BRH with the reception staff allowing someone to sit and wait for 30 mins to be seen by the triage nurse who described classic stroke symptoms to the receptionist. Only when I went to speak with the nursing team did triage happen.

Neil, you are right. There should be absolutely no need for a walk in centre, but plainly the GPs in this area are failing their patients by not matching their services to the needs of the population they are supposed to serve.

[Neil]

These are the opening times of my surgery which I regard as one of the best from stories I've heard about others.

I don't understand why they close on Wednesday afternoon and why they close for lunch. Why can't the doctors and reception staff stagger their lunch breaks to provide appointments all day to better suit their customers?

[Neil]

Originally Posted by Margaret Pilkington

Neil, you are right. There should be absolutely no need for a walk in centre, but plainly the GPs in this area are failing their patients by not matching their services to the needs of the population they are supposed to serve.

A few years ago I thought the GP unit was staffed in the evening by several local GP's. Was this how they were providing out of hours service before 2004 you mentioned?

[Margaret Pilkington]

No, Neil. Surgeries used to provide their own out of hours service in the dim and distant past.
The doctors worked on a rota and went out to see their own patients who needed the services of a doctor. It is a long long time since that happened. Now if you call a doctor out of hours you can get anybody.
It could be someone from a practice in Blackburn, it could be someone who has flown in from Germany for a lucrative weekends locum work...but what you can guarantee is that they will know nothing of your past history, other than what you can tell them(and with some members of the public that is worse than knowing nothing at all)

I would hazard a guess that your practice is the Rhyddings Surgery.
You are right on all counts it IS one of the better ones...The GPs do not seem to be driven by money...but they could manage the hours of opening better by staggering lunches for staff.

[Michael1954]

Originally Posted by Margaret Pilkington

Neil, you are right. There should be absolutely no need for a walk in centre, but plainly the GPs in this area are failing their patients by not matching their services to the needs of the population they are supposed to serve.

A few years ago mum and I had just arrived at our hotel in Blackpool for an holiday. As I was unloading the luggage I badly gashed my scalp on the underside of my hatchback door. There was a lot of blood which I staunched with a towel. We then checked into the hotel and the receptionist noticed blood trickling on my forehead. She advised me to go the the Walk In Centre on Talbot Road (she said I would be waiting for hours if I went to the A & E). I took her advice and the service was quick and excellent. The nurse stapled the wound and told me to come back at the end of my holiday to have the staples removed.

[Margaret Pilkington]

Your GP is paid to look after you whether you visit the practice or not. So if you go and get your care delivered by someone else(like a walk in centre) your GP is getting paid for doing nothing.
Michael, your situation is slightly different as you were a 'temporary resident'...and a town like Blackpool will always have loads of those.

The population has increased by more than 10% over the last decade...hospital services have shrunk by a similar amount( beds closed, hospital wards closed, A&E departments closed... Ok some areas got Urgent care centres as an alternative, if you can call them that)
Ask the people of Burnley how they feel about having the journey to Blackburn to an A&E and see how they feel about it.
If you were in Burnley having a heart attack, I am pretty sure you would not relish the wait for am ambulance to ferry you to the A&E at Blackburn ....and it reduces your chances of survival.