Well not in Scotland. Indeed a good friend of my daughter had an interesting twist. She complained that the Universities were taking a 50:50 ratio and that this made it much harder for girls to get in than boys. She said that there were something like 9K girls applying (all with 5 As) and only about 3.5K boys. I think there were something like 3K places (can't swear to these numbers).
My friend has a theory on this, he thinks that the government are becoming increasingly irritated by women who study medicine for 6/7 years then do all the post-degree training and bugger off to get married and have kids to shift to becoming a part time locum. He says that from his course which was about 50/50 loads of his female friends have already done this. From my own family I know one doctor and one dentist who have both done this and moved to part time locum work in their early thirties.
It won't ever be said, but the increasing amounts of women Docs must be putting strain on staffing rentention - probably more than any slight policy change ever will.
Agreed Cyclefree. It takes time for people to get used to and, anyway, as I mentioned below once we start charging for no-shows it will soon sort out the problem. £20 for a no-show, three strikes and you're booted out of the practice.
The trouble with this is superficially it looks a good idea. But who wont pay? Most likely those with chaotic lives who don't turn up for appointments. Who then will chase them? There is no system in NHS for chasing individuals like this. So then we get into is it worth creating a system just to collect £20 etc etc.
Apologies for the lack of a piece this morning. Arthur Robin Herdson was born at 2.30am and so gave his dad an even higher priority than PB. He and his mum are doing fine. Have to give a lot of credit to the NHS staff who have given a lot of support throughout. That said, he was born by a last-minute-decision c-section and was originally due on Sept 20. I worry what might have been had he gone to term.
Congratulations to you both on the birth of a cost centre.
Agreed Cyclefree. It takes time for people to get used to and, anyway, as I mentioned below once we start charging for no-shows it will soon sort out the problem. £20 for a no-show, three strikes and you're booted out of the practice.
The trouble with this is superficially it looks a good idea. But who wont pay? Most likely those with chaotic lives who don't turn up for appointments. Who then will chase them? There is no system in NHS for chasing individuals like this. So then we get into is it worth creating a system just to collect £20 etc etc.
Don't pay = booted out the practice.
Once people realise their entitlement to 'free' care may come to a crashing end they will soon drag their butts to the appointment, or cancel it in time. A simple free automated text and online system with rebooking options, as operated by most private companies will sort it.
Every junior doctor who stays the course and makes consultant retires with a pension worth in excess of £2m, some who earn additional payments considerably more. These are very well paid public servants so what exactly is the problem?
Medicine continues to attract many of the brightest of our students. My next door neighbour's son had a disaster where he only got a B in one of his 5 highers. That was the end of his plan to follow his father into medicine. From friends of my daughter and my own experience many years ago medical students work much harder than any other category of student (dentists were similar) and unlike most parts of Universities these days those that underperform are chucked out.
Junior doctors also continue to work absurdly long hours, hours that impact on your social life and ultimately affect your psychological balance. I think the perception is that this contract will make that even worse by upping the anti social aspects of their work life balance. When you feel yourself already stretched thin or to the limit I can understand why that makes you angry or depressed.
What we really need are a lot more doctors who live more normal lives for rather more normal salaries. But they are so expensive to train that there is an obvious attraction to working those assets very hard and the NHS has operated on this basis for a long time. In the longer term this leads to poor retention in the profession and, I fear, quite poor medicine too.
I suspect that foxinsox has it right when he identifies failures in the training regime as being at the heart of this. Does anyone in the 21st century really believe that only those working 70 hours a week can gain enough experience? The solution, however, is not straightforward, especially for a service that has had several years now of much slower growth in its budgets than it was used to whilst demand continues to soar.
"My next door neighbour's son had a disaster where he only got a B in one of his 5 highers."
I had heard that medic degrees were going into clearing this year.
Well not in Scotland. Indeed a good friend of my daughter had an interesting twist. She complained that the Universities were taking a 50:50 ratio and that this made it much harder for girls to get in than boys. She said that there were something like 9K girls applying (all with 5 As) and only about 3.5K boys. I think there were something like 3K places (can't swear to these numbers).
50:50? Are they allowed to do this? I suppose medicine might be allowed to as need male and female doctors as people have preferences.
There was mutiny aboard the Queen Victoria cruise ship after pro-EU peer Patience Wheatcroft lectured her fellow passengers about the perils of Brexit.
Baroness Wheatcroft must have expected it to be plain sailing after being invited by Cunard to be a guest speaker on the ship’s swanky 14-day cruise
However, she hadn’t counted on the swell of public opinion and the waters turned distinctly choppy after Wheatcroft, below, regally set out her campaign for a second referendum to overturn the June vote, saying she would do everything in her power to stop Britain leaving Europe.
Cue maritime mayhem. According to one Brexiteer on board, the Tory peer was ‘nearly lynched’ after several audience members walked out in protest.
Should be a space at the end of the yard arm, somewhere
If there's any truth to this, it will make May and Hunt more determined not to back down, strengthening @TSE's bet.
The BMA JDC leaders had to resign because their members rejected the new contract in a ballot (note that contrary to how it was reported the JDC did not make a recommendation, though some of the leadership did individually). This is not a strike where militant leaders bamboozle the workers, it is very much the opposite with the grassroots fed up with the BMA leadership for being insufficiently militant. Having had the first strike for 40 years they are no longer virgins and will strike much more easily in the future.
.
I am off to work shortly, but I think that governments should learn to be more careful of people who feel that they have nothing to lose. That is how Leave won. Many will feel forced to end their UK medical careers if the contract is imposed.
Many juniors see the shift patterns of the new contract impossible to sustain, and covering rota gaps too. It is very difficult to come to the end of a working day (or night) and for no-one to appear for handover. In practice these staff are usually forced to carry on, which is not sustainable forever.
If I were 25 years younger as a Doctor, I would emigrate. There is no future for British medicine.
Off to work? Are you sure you're a doctor? It's Saturday, and the NHS shuts down over the weekend.
By and large it does and its a disgrace. Go to your local hospital in the daytime mid-week and good luck trying to find a parking space. Go on a Saturday or Sunday and the car parks and the hospital is a complete ghost town.
There is more to the NHS than just A&E.
The problem with A&E is that many GP's practises are shut at the weekend(mine is) you get a message to ring 101) and after 7pm so there is nowhere for anyone to go to bar A and E..
The GP's practises should be open at weekends, ALL of them with at least one GP on duty
That is not necessarily true. I have just dropped off one of mine with a nasty ear infection at a walk in centre used by my GP when the practice is closed and it is open 7 days a week. Saves a trip to A&E or suffering until Monday.
Well not in Scotland. Indeed a good friend of my daughter had an interesting twist. She complained that the Universities were taking a 50:50 ratio and that this made it much harder for girls to get in than boys. She said that there were something like 9K girls applying (all with 5 As) and only about 3.5K boys. I think there were something like 3K places (can't swear to these numbers).
My friend has a theory on this, he thinks that the government are becoming increasingly irritated by women who study medicine for 6/7 years then do all the post-degree training and bugger off to get married and have kids to shift to becoming a part time locum. He says that from his course which was about 50/50 loads of his female friends have already done this. From my own family I know one doctor and one dentist who have both done this and moved to part time locum work in their early thirties.
That is not a theory it is a fact. And many doctors marry doctors (they don't have time to meet anyone else) so going part time is an easy economic decision when the kids come along. It results in most of the shortfalls suffered by the NHS, particularly in the GP end of the profession. The 50:50 ratios are a response to this. If it was purely on the qualifications of the applicants medicine would be female dominated by now.
Well not in Scotland. Indeed a good friend of my daughter had an interesting twist. She complained that the Universities were taking a 50:50 ratio and that this made it much harder for girls to get in than boys. She said that there were something like 9K girls applying (all with 5 As) and only about 3.5K boys. I think there were something like 3K places (can't swear to these numbers).
My friend has a theory on this, he thinks that the government are becoming increasingly irritated by women who study medicine for 6/7 years then do all the post-degree training and bugger off to get married and have kids to shift to becoming a part time locum. He says that from his course which was about 50/50 loads of his female friends have already done this. From my own family I know one doctor and one dentist who have both done this and moved to part time locum work in their early thirties.
It won't ever be said, but the increasing amounts of women Docs must be putting strain on staffing rentention - probably more than any slight policy change ever will.
Of course, with family pressure, women are also far less likely to work on weekend as well. Increasing staffing issues and resistance to a seven day NHS.
Well not in Scotland. Indeed a good friend of my daughter had an interesting twist. She complained that the Universities were taking a 50:50 ratio and that this made it much harder for girls to get in than boys. She said that there were something like 9K girls applying (all with 5 As) and only about 3.5K boys. I think there were something like 3K places (can't swear to these numbers).
My friend has a theory on this, he thinks that the government are becoming increasingly irritated by women who study medicine for 6/7 years then do all the post-degree training and bugger off to get married and have kids to shift to becoming a part time locum. He says that from his course which was about 50/50 loads of his female friends have already done this. From my own family I know one doctor and one dentist who have both done this and moved to part time locum work in their early thirties.
Cue feminist outrage, alas most of the militant feminists who would never consider doing that are far too thick to become doctors
The EU just gets more and more ridiculous: they order Apple to pay $14.5 billion in back taxes to Ireland. Apple appeals, and Ireland joins the appeal against the EU ruling.
What do you think should be happening in this situation? I mean, normally if a country breaks the rules they get fined, but the outcome of that is that the politically favoured company gets their state aid at the cost of the taxpayers of that country, which is what these rules are supposed to be preventing in the first place.
Because EU rules like this only apply to the "little people" ie not France especially (who do what they like with impunity and always get away with it and Germany (who can get away with behaving like France but culturally prefer to obey the rules normally)
First the EU bankrupted Ireland, sending in Gaulitiers to run their economy and loading billions of bank debt on it to save Germanys banks. Now they impose a retrospecitve fine on their public finances of about 10% of their GDP.
Well, no longer do we in the UK have to go cap in hand appealing to the ECJ over anything. We make our own rules and if they don't like it then we can send the Navy round to discuss it with them. If Ireland had any sense they would rejoin the UK with the same rights and privileges as the Isle of Man has and be done with the EU.
All the claims in this post are wrong.
It's not a fine on Ireland's finances, they're telling Ireland they have to charge Apple the taxes, which then go to the taxpayers of Ireland.
The EU didn't force Irish banks to get into debt, and it was the Irish government that decided to stand behind it.
The EU sometimes fines France for breaking the rules.
Apologies for the lack of a piece this morning. Arthur Robin Herdson was born at 2.30am and so gave his dad an even higher priority than PB. He and his mum are doing fine. Have to give a lot of credit to the NHS staff who have given a lot of support throughout. That said, he was born by a last-minute-decision c-section and was originally due on Sept 20. I worry what might have been had he gone to term.
The EU just gets more and more ridiculous: they order Apple to pay $14.5 billion in back taxes to Ireland. Apple appeals, and Ireland joins the appeal against the EU ruling.
What do you think should be happening in this situation? I mean, normally if a country breaks the rules they get fined, but the outcome of that is that the politically favoured company gets their state aid at the cost of the taxpayers of that country, which is what these rules are supposed to be preventing in the first place.
Because EU rules like this only apply to the "little people" ie not France especially (who do what they like with impunity and always get away with it and Germany (who can get away with behaving like France but culturally prefer to obey the rules normally)
First the EU bankrupted Ireland, sending in Gaulitiers to run their economy and loading billions of bank debt on it to save Germanys banks. Now they impose a retrospecitve fine on their public finances of about 10% of their GDP.
Well, no longer do we in the UK have to go cap in hand appealing to the ECJ over anything. We make our own rules and if they don't like it then we can send the Navy round to discuss it with them. If Ireland had any sense they would rejoin the UK with the same rights and privileges as the Isle of Man has and be done with the EU.
All the claims in this post are wrong.
It's not a fine on Ireland's finances, they're telling Ireland they have to charge Apple the taxes, which then go to the taxpayers of Ireland.
The EU didn't force Irish banks to get into debt, and it was the Irish government that decided to stand behind it.
The EU sometimes fines France for breaking the rules.
Apologies for the lack of a piece this morning. Arthur Robin Herdson was born at 2.30am and so gave his dad an even higher priority than PB. He and his mum are doing fine. Have to give a lot of credit to the NHS staff who have given a lot of support throughout. That said, he was born by a last-minute-decision c-section and was originally due on Sept 20. I worry what might have been had he gone to term.
Every junior doctor who stays the course and makes consultant retires with a pension worth in excess of £2m, some who earn additional payments considerably more. These are very well paid public servants so what exactly is the problem?
Medicine continues to attract many of the brightest of our students. My next door neighbour's son had a disaster where he only got a B in one of his 5 highers. That was the end of his plan to follow his father into medicine. From friends of my daughter and my own experience many years ago medical students work much harder than any other category of student (dentists were similar) and unlike most parts of Universities these days those that underperform are chucked out.
Junior doctors also continue to work absurdly long hours, hours that impact on your social life and ultimately affect your psychological balance. I think the perception is that this contract will make that even worse by upping the anti social aspects of their work life balance. When you feel yourself already stretched thin or to the limit I can understand why that makes you angry or depressed.
What we really need are a lot more doctors who live more normal lives for rather more normal salaries. But they are so expensive to train that there is an obvious attraction to working those assets very hard and the NHS has operated on this basis for a long time. In the longer term this leads to poor retention in the profession and, I fear, quite poor medicine too.
I suspect that foxinsox has it right when he identifies failures in the training regime as being at the heart of this. Does anyone in the 21st century really believe that only those working 70 hours a week can gain enough experience? The solution, however, is not straightforward, especially for a service that has had several years now of much slower growth in its budgets than it was used to whilst demand continues to soar.
For medicine in many cases experience is the only way.
A client of mine, for instance, has developed a technology for measuring blood flow through arteries during a corony arterial bypass graft. combined with imaging to allow for correct placement of the gratt.
Rapid adoption in Scandiland and the US. NHS not using - despite NICE recommendation - because doctors prefer old approach of putting their finger on the artery to judge blood flow. (Of course the data shows much greater readmission rates with the manual technique, but what does data prove, eh?)
That would seem to be a vivid demonstration that too much "experience" is positively harmful!
Unless someone has the cojones to force adoption it's necessary...
Every junior doctor who stays the course and makes consultant retires with a pension worth in excess of £2m, some who earn additional payments considerably more. These are very well paid public servants so what exactly is the problem?
Medicine continues to attract many of the brightest of our students. My next door neighbour's son had a disaster where he only got a B in one of his 5 highers. That was the end of his plan to follow his father into medicine. From friends of my daughter and my own experience many years ago medical students work much harder than any other category of student (dentists were similar) and unlike most parts of Universities these days those that underperform are chucked out.
Junior doctors also continue to work absurdly long hours, hours that impact on your social life and ultimately affect your psychological balance. I think the perception is that this contract will make that even worse by upping the anti social aspects of their work life balance. When you feel yourself already stretched thin or to the limit I can understand why that makes you angry or depressed.
What we really need are a lot more doctors who live more normal lives for rather more normal salaries. But they are so expensive to train that there is an obvious attraction to working those assets very hard and the NHS has operated on this basis for a long time. In the longer term this leads to poor retention in the profession and, I fear, quite poor medicine too.
I suspect that foxinsox has it right when he identifies failures in the training regime as being at the heart of this. Does anyone in the 21st century really believe that only those working 70 hours a week can gain enough experience? The solution, however, is not straightforward, especially for a service that has had several years now of much slower growth in its budgets than it was used to whilst demand continues to soar.
"My next door neighbour's son had a disaster where he only got a B in one of his 5 highers."
I had heard that medic degrees were going into clearing this year.
Well not in Scotland. Indeed a good friend of my daughter had an interesting twist. She complained that the Universities were taking a 50:50 ratio and that this made it much harder for girls to get in than boys. She said that there were something like 9K girls applying (all with 5 As) and only about 3.5K boys. I think there were something like 3K places (can't swear to these numbers).
50:50? Are they allowed to do this? I suppose medicine might be allowed to as need male and female doctors as people have preferences.
I think its quite new. Not sure when it was introduced but I don't think it was there 10 years ago.
Agreed Cyclefree. It takes time for people to get used to and, anyway, as I mentioned below once we start charging for no-shows it will soon sort out the problem. £20 for a no-show, three strikes and you're booted out of the practice.
The trouble with this is superficially it looks a good idea. But who wont pay? Most likely those with chaotic lives who don't turn up for appointments. Who then will chase them? There is no system in NHS for chasing individuals like this. So then we get into is it worth creating a system just to collect £20 etc etc.
Don't pay = booted out the practice.
Once people realise their entitlement to 'free' care may come to a crashing end they will soon drag their butts to the appointment, or cancel it in time. A simple free automated text and online system with rebooking options, as operated by most private companies will sort it.
My dentist asks for payment in advance of treatment. I paid for treatment two months ago I am having next week. GP appointment takes deposit of a fiver. ( those on benefits etc of course are not required to do so but a consistent no show then risks removal from Surgery. If you want the treatment or consultation you would turn up anyway. No charge for changing appointments. Works well for all concerned.
As I said shock treatment now required or we all lose this valuable service.
Well not in Scotland. Indeed a good friend of my daughter had an interesting twist. She complained that the Universities were taking a 50:50 ratio and that this made it much harder for girls to get in than boys. She said that there were something like 9K girls applying (all with 5 As) and only about 3.5K boys. I think there were something like 3K places (can't swear to these numbers).
My friend has a theory on this, he thinks that the government are becoming increasingly irritated by women who study medicine for 6/7 years then do all the post-degree training and bugger off to get married and have kids to shift to becoming a part time locum. He says that from his course which was about 50/50 loads of his female friends have already done this. From my own family I know one doctor and one dentist who have both done this and moved to part time locum work in their early thirties.
It won't ever be said, but the increasing amounts of women Docs must be putting strain on staffing rentention - probably more than any slight policy change ever will.
Of course, with family pressure, women are also far less likely to work on weekend as well. Increasing staffing issues and resistance to a seven day NHS.
I have about 20 friends who are Docs. Most militant resistance is from two girls.
The only bloke who mentions it to me is very circumspect. Doesn't like the way it has been handled by the BMA or the HS. Said he was happy with the last compromise by the Govt.
That Daily Mail link contains a clip of Blair being his usual arse, this time on French radio, saying Brexit may not happen. It's quite hard to conceive how one human being can be such a tit.
Well not in Scotland. Indeed a good friend of my daughter had an interesting twist. She complained that the Universities were taking a 50:50 ratio and that this made it much harder for girls to get in than boys. She said that there were something like 9K girls applying (all with 5 As) and only about 3.5K boys. I think there were something like 3K places (can't swear to these numbers).
My friend has a theory on this, he thinks that the government are becoming increasingly irritated by women who study medicine for 6/7 years then do all the post-degree training and bugger off to get married and have kids to shift to becoming a part time locum. He says that from his course which was about 50/50 loads of his female friends have already done this. From my own family I know one doctor and one dentist who have both done this and moved to part time locum work in their early thirties.
That is not a theory it is a fact. And many doctors marry doctors (they don't have time to meet anyone else) so going part time is an easy economic decision when the kids come along. It results in most of the shortfalls suffered by the NHS, particularly in the GP end of the profession. The 50:50 ratios are a response to this. If it was purely on the qualifications of the applicants medicine would be female dominated by now.
Well that's based on A-Levels which are biased towards women. It will be interesting to see how the gap changes with the new system which is probably more favourable to men. I got a B in biology because I was basically much lazier than my female friends who wrote up to 4 drafts of their coursework and had them marked by the teacher and made endless revisions. I did two and then handed the second one in without any changes. Smashed the exams but the damage was done. That experience is repeated thousands of times at schools and colleges across the country.
Agreed Cyclefree. It takes time for people to get used to and, anyway, as I mentioned below once we start charging for no-shows it will soon sort out the problem. £20 for a no-show, three strikes and you're booted out of the practice.
The trouble with this is superficially it looks a good idea. But who wont pay? Most likely those with chaotic lives who don't turn up for appointments. Who then will chase them? There is no system in NHS for chasing individuals like this. So then we get into is it worth creating a system just to collect £20 etc etc.
Don't pay = booted out the practice.
Once people realise their entitlement to 'free' care may come to a crashing end they will soon drag their butts to the appointment, or cancel it in time. A simple free automated text and online system with rebooking options, as operated by most private companies will sort it.
Are cancelled appointments really a bad thing for GP and even outpatients? In my experience, they ease some of the strain placed on the system as other appointments overrun their 10-minute slots.
Apologies for the lack of a piece this morning. Arthur Robin Herdson was born at 2.30am and so gave his dad an even higher priority than PB. He and his mum are doing fine. Have to give a lot of credit to the NHS staff who have given a lot of support throughout. That said, he was born by a last-minute-decision c-section and was originally due on Sept 20. I worry what might have been had he gone to term.
Congratulations to you both on the birth of a cost centre.
Agreed Cyclefree. It takes time for people to get used to and, anyway, as I mentioned below once we start charging for no-shows it will soon sort out the problem. £20 for a no-show, three strikes and you're booted out of the practice.
The trouble with this is superficially it looks a good idea. But who wont pay? Most likely those with chaotic lives who don't turn up for appointments. Who then will chase them? There is no system in NHS for chasing individuals like this. So then we get into is it worth creating a system just to collect £20 etc etc.
Don't pay = booted out the practice.
Once people realise their entitlement to 'free' care may come to a crashing end they will soon drag their butts to the appointment, or cancel it in time. A simple free automated text and online system with rebooking options, as operated by most private companies will sort it.
Are cancelled appointments really a bad thing for GP and even outpatients? In my experience, they ease some of the strain placed on the system as other appointments overrun their 10-minute slots.
For medicine in many cases experience is the only way.
A client of mine, for instance, has developed a technology for measuring blood flow through arteries during a corony arterial bypass graft. combined with imaging to allow for correct placement of the gratt.
Rapid adoption in Scandiland and the US. NHS not using - despite NICE recommendation - because doctors prefer old approach of putting their finger on the artery to judge blood flow. (Of course the data shows much greater readmission rates with the manual technique, but what does data prove, eh?)
That would seem to be a vivid demonstration that too much "experience" is positively harmful!
Unless someone has the cojones to force adoption it's necessary...
Yes but doctors working 70 hours a week "learning" the skill (badly) of judging blood flow by touch is a waste of time. I suspect that many of the aspects of medicine will be deskilled over the coming years through the use of smart systems and technology. Training should adapt to making sure that doctors know how to use that technology effectively.
Do you support or oppose the junior doctor strikes? Support 57% (-17) Oppose 43% (+17)
Some mistake surely? I was assured by PB Tories only days ago that the junior doctors have lost 'all' public support with their latest strike proposals.
That's a huge swing against them and the strike hasn't happened yet.
Hmm. The words 'lose all support' were definitely used.
Would you care to take a bet on when public support will swing aginst the docs?
Miss Freeman, Blair's a fascinating example of perception and reality varying so wildly, the difference between competence in campaigning and in governing, and how swiftly public opinion can change.
He'll go down in history as the worst post-war PM of the 20th century, simply because nobody will speak up for him*.
Blair, Brown and Cameron all suffered from short-termism and an ill-considered view of the future (cf constitutional buggery, blowing money and borrowing endlessly, and the referendum that sunk Cameron).
*I'm not saying he doesn't deserve that necessarily, just that other PMs have supports and detractors and Blair has practically no supporters now.
Well not in Scotland. Indeed a good friend of my daughter had an interesting twist. She complained that the Universities were taking a 50:50 ratio and that this made it much harder for girls to get in than boys. She said that there were something like 9K girls applying (all with 5 As) and only about 3.5K boys. I think there were something like 3K places (can't swear to these numbers).
My friend has a theory on this, he thinks that the government are becoming increasingly irritated by women who study medicine for 6/7 years then do all the post-degree training and bugger off to get married and have kids to shift to becoming a part time locum. He says that from his course which was about 50/50 loads of his female friends have already done this. From my own family I know one doctor and one dentist who have both done this and moved to part time locum work in their early thirties.
That is not a theory it is a fact. And many doctors marry doctors (they don't have time to meet anyone else) so going part time is an easy economic decision when the kids come along. It results in most of the shortfalls suffered by the NHS, particularly in the GP end of the profession. The 50:50 ratios are a response to this. If it was purely on the qualifications of the applicants medicine would be female dominated by now.
Well that's based on A-Levels which are biased towards women. It will be interesting to see how the gap changes with the new system which is probably more favourable to men. I got a B in biology because I was basically much lazier than my female friends who wrote up to 4 drafts of their coursework and had them marked by the teacher and made endless revisions. I did two and then handed the second one in without any changes. Smashed the exams but the damage was done. That experience is repeated thousands of times at schools and colleges across the country.
I'm quite pleased that there was no coursework for my A Levels.
Apologies for the lack of a piece this morning. Arthur Robin Herdson was born at 2.30am and so gave his dad an even higher priority than PB. He and his mum are doing fine. Have to give a lot of credit to the NHS staff who have given a lot of support throughout. That said, he was born by a last-minute-decision c-section and was originally due on Sept 20. I worry what might have been had he gone to term.
Congratulations! And if I may, compliments to you and your wife on a sound choice of baby's names - wisely eschewing fashion trends!
Agreed Cyclefree. It takes time for people to get used to and, anyway, as I mentioned below once we start charging for no-shows it will soon sort out the problem. £20 for a no-show, three strikes and you're booted out of the practice.
The trouble with this is superficially it looks a good idea. But who wont pay? Most likely those with chaotic lives who don't turn up for appointments. Who then will chase them? There is no system in NHS for chasing individuals like this. So then we get into is it worth creating a system just to collect £20 etc etc.
Don't pay = booted out the practice.
Once people realise their entitlement to 'free' care may come to a crashing end they will soon drag their butts to the appointment, or cancel it in time. A simple free automated text and online system with rebooking options, as operated by most private companies will sort it.
Are cancelled appointments really a bad thing for GP and even outpatients? In my experience, they ease some of the strain placed on the system as other appointments overrun their 10-minute slots.
Nothing wrong with cancelled appointments, it's the failure to attend hospital, GP and dental appointments that wastes time and money.
Well not in Scotland. Indeed a good friend of my daughter had an interesting twist. She complained that the Universities were taking a 50:50 ratio and that this made it much harder for girls to get in than boys. She said that there were something like 9K girls applying (all with 5 As) and only about 3.5K boys. I think there were something like 3K places (can't swear to these numbers).
My friend has a theory on this, he thinks that the government are becoming increasingly irritated by women who study medicine for 6/7 years then do all the post-degree training and bugger off to get married and have kids to shift to becoming a part time locum. He says that from his course which was about 50/50 loads of his female friends have already done this. From my own family I know one doctor and one dentist who have both done this and moved to part time locum work in their early thirties.
That is not a theory it is a fact. And many doctors marry doctors (they don't have time to meet anyone else) so going part time is an easy economic decision when the kids come along. It results in most of the shortfalls suffered by the NHS, particularly in the GP end of the profession. The 50:50 ratios are a response to this. If it was purely on the qualifications of the applicants medicine would be female dominated by now.
Well that's based on A-Levels which are biased towards women. It will be interesting to see how the gap changes with the new system which is probably more favourable to men. I got a B in biology because I was basically much lazier than my female friends who wrote up to 4 drafts of their coursework and had them marked by the teacher and made endless revisions. I did two and then handed the second one in without any changes. Smashed the exams but the damage was done. That experience is repeated thousands of times at schools and colleges across the country.
Our education system is enormously biased towards women at the present time and under performing boys is a major issue. Some of those militant feminists should see the opportunities opening up and retrain!
For medicine in many cases experience is the only way.
A client of mine, for instance, has developed a technology for measuring blood flow through arteries during a corony arterial bypass graft. combined with imaging to allow for correct placement of the gratt.
Rapid adoption in Scandiland and the US. NHS not using - despite NICE recommendation - because doctors prefer old approach of putting their finger on the artery to judge blood flow. (Of course the data shows much greater readmission rates with the manual technique, but what does data prove, eh?)
That would seem to be a vivid demonstration that too much "experience" is positively harmful!
Unless someone has the cojones to force adoption it's necessary...
Yes but doctors working 70 hours a week "learning" the skill (badly) of judging blood flow by touch is a waste of time. I suspect that many of the aspects of medicine will be deskilled over the coming years through the use of smart systems and technology. Training should adapt to making sure that doctors know how to use that technology effectively.
Agreed. Medicine is surely one of those white collar industries that are going to face increasing automation - likely reducing the impending staffing crises that Dr. Fox keeps reminding us of.
I still insist that few Docs will emigrate - all those I know bar one playboy-type have mortgages, families, wives/husbands and are generally far too middle class to uproot
Mr. Max, a fair comment on the education system being more female-friendly at the moment. A problem is that when men do worse than women (or boys than girls) it's portrayed by some as natural female superiority (the 'women are wonderful' effect) whereas when the reverse is true, some reach immediately for discrimination and societal unfairness.
[It's a shame that the obvious examples of better male body image (cf the beach body ready ads) and female openness to talking about personal matters (cf higher male suicide rates) aren't raised to try and improve both genders' mental health, instead of indulging the over-sensitive in the former and not talking that much about the latter].
For medicine in many cases experience is the only way.
A client of mine, for instance, has developed a technology for measuring blood flow through arteries during a corony arterial bypass graft. combined with imaging to allow for correct placement of the gratt.
Rapid adoption in Scandiland and the US. NHS not using - despite NICE recommendation - because doctors prefer old approach of putting their finger on the artery to judge blood flow. (Of course the data shows much greater readmission rates with the manual technique, but what does data prove, eh?)
That would seem to be a vivid demonstration that too much "experience" is positively harmful!
Unless someone has the cojones to force adoption it's necessary...
Yes but doctors working 70 hours a week "learning" the skill (badly) of judging blood flow by touch is a waste of time. I suspect that many of the aspects of medicine will be deskilled over the coming years through the use of smart systems and technology. Training should adapt to making sure that doctors know how to use that technology effectively.
Sure - but equally a lot is judgement and can't be deskilled. In my profession we are much kinder to our juniors that we used to be but they still work 70+ hours a week. Sometimes learning by doing is the only way
The EU just gets more and more ridiculous: they order Apple to pay $14.5 billion in back taxes to Ireland. Apple appeals, and Ireland joins the appeal against the EU ruling.
What do you think should be happening in this situation? I mean, normally if a country breaks the rules they get fined, but the outcome of that is that the politically favoured company gets their state aid at the cost of the taxpayers of that country, which is what these rules are supposed to be preventing in the first place.
Because EU rules like this only apply to the "little people" ie not France especially (who do what they like with impunity and always get away with it and Germany (who can get away with behaving like France but culturally prefer to obey the rules normally)
First the EU bankrupted Ireland, sending in Gaulitiers to run their economy and loading billions of bank debt on it to save Germanys banks. Now they impose a retrospecitve fine on their public finances of about 10% of their GDP.
Well, no longer do we in the UK have to go cap in hand appealing to the ECJ over anything. We make our own rules and if they don't like it then we can send the Navy round to discuss it with them. If Ireland had any sense they would rejoin the UK with the same rights and privileges as the Isle of Man has and be done with the EU.
All the claims in this post are wrong.
It's not a fine on Ireland's finances, they're telling Ireland they have to charge Apple the taxes, which then go to the taxpayers of Ireland.
The EU didn't force Irish banks to get into debt, and it was the Irish government that decided to stand behind it.
The EU sometimes fines France for breaking the rules.
Every junior doctor who stays the course and makes consultant retires with a pension worth in excess of £2m,
Can they do that anymore?
I thought the Life Time Allowance had been cut to £1.25 million with further cuts anticipated?
The Life Time Allowance is related to tax relief not the value of the pension. And the public sector cheats by undervaluing final salary benefits compared with the cost of buying the equivalent in the market.
Re women in NHS. Of course particular allowance just has to be made for pregnancy and childbirth no one should ever deny that.
I consult to one company where a young female engineer joined some 3 years ago. I have hardly seen her as she has spent most of the time on maternity leave and is now on her third. Her job of course is left open yet we have to get temps in which at no fault to them but disrupt the flow of projects and puts additional work on us. Then all change again on this ladies return and no sooner that happens back again back to a temp.
There is maternity leave for one , maybe 2 a couple years later and then there is someone just taking the complete utter piss.
Re women in NHS. Of course particular allowance just has to be made for pregnancy and childbirth no one should ever deny that.
I consult to one company where a young female engineer joined some 3 years ago. I have hardly seen her as she has spent most of the time on maternity leave and is now on her third. Her job of course is left open yet we have to get temps in which at no fault to them but disrupt the flow of projects and puts additional work on us. Then all change again on this ladies return and no sooner that happens back again back to a temp.
There is maternity leave for one , maybe 2 a couple years later and then there is someone just taking the complete utter piss.
I still like Andrea Leadsom's idea of exempting micro businesses from all red tape - including maternity leave in this would be eminently sensible.
Well not in Scotland. Indeed a good friend of my daughter had an interesting twist. She complained that the Universities were taking a 50:50 ratio and that this made it much harder for girls to get in than boys. She said that there were something like 9K girls applying (all with 5 As) and only about 3.5K boys. I think there were something like 3K places (can't swear to these numbers).
My friend has a theory on this, he thinks that the government are becoming increasingly irritated by women who study medicine for 6/7 years then do all the post-degree training and bugger off to get married and have kids to shift to becoming a part time locum. He says that from his course which was about 50/50 loads of his female friends have already done this. From my own family I know one doctor and one dentist who have both done this and moved to part time locum work in their early thirties.
That is not a theory it is a fact. And many doctors marry doctors (they don't have time to meet anyone else) so going part time is an easy economic decision when the kids come along. It results in most of the shortfalls suffered by the NHS, particularly in the GP end of the profession. The 50:50 ratios are a response to this. If it was purely on the qualifications of the applicants medicine would be female dominated by now.
Well that's based on A-Levels which are biased towards women. It will be interesting to see how the gap changes with the new system which is probably more favourable to men. I got a B in biology because I was basically much lazier than my female friends who wrote up to 4 drafts of their coursework and had them marked by the teacher and made endless revisions. I did two and then handed the second one in without any changes. Smashed the exams but the damage was done. That experience is repeated thousands of times at schools and colleges across the country.
Our education system is enormously biased towards women at the present time and under performing boys is a major issue. Some of those militant feminists should see the opportunities opening up and retrain!
Indeed it is, but I do think the newest changes will redress that balance a bit. Universities aren't going to know what hit them in a couple of years when 70/30 course intakes move back to 50/50 for medicine, dentistry, biology, biochemistry and other sciences that have been corrupted by Labour's easy to game qualifications.
Congratulations to David H. - I don't know if your new addition is your first, but if so, prepare for one of life's most wonderful and rewarding experiences .
Quick hols question - has anyone any recommendations for a quality hotel or B&B close to central Avignon. We're going down by Eurostar (absolute bargain, 5.5 hours from St Pancras) for a cycling hol and have a few days free...
Well not in Scotland. Indeed a good friend of my daughter had an interesting twist. She complained that the Universities were taking a 50:50 ratio and that this made it much harder for girls to get in than boys. She said that there were something like 9K girls applying (all with 5 As) and only about 3.5K boys. I think there were something like 3K places (can't swear to these numbers).
My friend has a theory on this, he thinks that the government are becoming increasingly irritated by women who study medicine for 6/7 years then do all the post-degree training and bugger off to get married and have kids to shift to becoming a part time locum. He says that from his course which was about 50/50 loads of his female friends have already done this. From my own family I know one doctor and one dentist who have both done this and moved to part time locum work in their early thirties.
That is not a theory it is a fact. And many doctors marry doctors (they don't have time to meet anyone else) so going part time is an easy economic decision when the kids come along. It results in most of the shortfalls suffered by the NHS, particularly in the GP end of the profession. The 50:50 ratios are a response to this. If it was purely on the qualifications of the applicants medicine would be female dominated by now.
Well that's based on A-Levels which are biased towards women. It will be interesting to see how the gap changes with the new system which is probably more favourable to men. I got a B in biology because I was basically much lazier than my female friends who wrote up to 4 drafts of their coursework and had them marked by the teacher and made endless revisions. I did two and then handed the second one in without any changes. Smashed the exams but the damage was done. That experience is repeated thousands of times at schools and colleges across the country.
Our education system is enormously biased towards women at the present time and under performing boys is a major issue. Some of those militant feminists should see the opportunities opening up and retrain!
Indeed it is, but I do think the newest changes will redress that balance a bit. Universities aren't going to know what hit them in a couple of years when 70/30 course intakes move back to 50/50 for medicine, dentistry, biology, biochemistry and other sciences that have been corrupted by Labour's easy to game qualifications.
Did you make a decision on Switzerland by the way?
Agreed Cyclefree. It takes time for people to get used to and, anyway, as I mentioned below once we start charging for no-shows it will soon sort out the problem. £20 for a no-show, three strikes and you're booted out of the practice.
The trouble with this is superficially it looks a good idea. But who wont pay? Most likely those with chaotic lives who don't turn up for appointments. Who then will chase them? There is no system in NHS for chasing individuals like this. So then we get into is it worth creating a system just to collect £20 etc etc.
Don't pay = booted out the practice.
Once people realise their entitlement to 'free' care may come to a crashing end they will soon drag their butts to the appointment, or cancel it in time. A simple free automated text and online system with rebooking options, as operated by most private companies will sort it.
Agreed. !!
With regret my surgery has just removed online booking that worked really well because a handful of Luddites have not got internet. We all have gone back 20 years and now have to dial and redial for one line into the surgery for 20 mins sometime longer only to be told all appointments gone and next available will be week Thursday. How that improves the Luddites chances of getting an appointment is beyond me.
On the other hand we have 3 or 4 surgeries in a small market town and they are going to combine but I fear they won't modernise. It is probably going to get worse as a result.
Apologies for the lack of a piece this morning. Arthur Robin Herdson was born at 2.30am and so gave his dad an even higher priority than PB. He and his mum are doing fine. Have to give a lot of credit to the NHS staff who have given a lot of support throughout. That said, he was born by a last-minute-decision c-section and was originally due on Sept 20. I worry what might have been had he gone to term.
Did you make a decision on Switzerland by the way?
Yes, I've handed in my notice and I start in Zurich in January if 2017. Can't wait. I'm about to put my flat on the market and cash in as well, house price rises in West London have been crazy since I bought.
''There is maternity leave for one , maybe 2 a couple years later and then there is someone just taking the complete utter piss.''
IF you're working in a small niche business where it takes someone a couple of years to learn the ropes (as we are), maternity leave is a complete nightmare. Locums just don;t exist. The rest of you simply work harder.
Did you make a decision on Switzerland by the way?
Yes, I've handed in my notice and I start in Zurich in January if 2017. Can't wait. I'm about to put my flat on the market and cash in as well, house price rises in West London have been crazy since I bought.
Hope it works out well for you but don't be a stranger!
2. Sack every single NHS manager. Okay, slight exaggeration but it's ridiculous Blairite nonsense to have such top-heavy over-paid managers who don't know anything about the profession. There are eye-watering pay-offs that have been lavished on managers. That's our money. .
Who allocates resources then? Is it any coincidence that the abolition of the PCTs and the mass removal of the much derided 'manager' that the NHS has had a massive explosion in its deficit?
Agreed Cyclefree. It takes time for people to get used to and, anyway, as I mentioned below once we start charging for no-shows it will soon sort out the problem. £20 for a no-show, three strikes and you're booted out of the practice.
The trouble with this is superficially it looks a good idea. But who wont pay? Most likely those with chaotic lives who don't turn up for appointments. Who then will chase them? There is no system in NHS for chasing individuals like this. So then we get into is it worth creating a system just to collect £20 etc etc.
Don't pay = booted out the practice.
Once people realise their entitlement to 'free' care may come to a crashing end they will soon drag their butts to the appointment, or cancel it in time. A simple free automated text and online system with rebooking options, as operated by most private companies will sort it.
Are cancelled appointments really a bad thing for GP and even outpatients? In my experience, they ease some of the strain placed on the system as other appointments overrun their 10-minute slots.
Cancelled appointments no because if in time can be reallocated as was mentioned so long as you don't have a handful of Luddites in your surgery still using semaphore or fecking carrier pigeons for communications.
No shows Yes they are because when you phone to get one they are at that point taken and you could have had the one taken by the imbecile who could not be arsed to turn up.
All doctors overrun to a point but it's accepted because we ourselves realise we may want more time for reassurance etc . I do note though that GPs want to increase the appointment time to 15 mins rather than 10 average. That cuts both ways because it simply appears they decrease their patient count while increasing their pay rather than more likely consideration of patient care.
I am aware one of my points has counteracted the other. This is the NHS in a nutshell though as observed by the layman.
Mr. Taffys, and that's why the proposals to increase mothers' rights will only hurt women trying to get jobs. The more onerous the burden on employers, the less likely (especially small) businesses are to employ women.
Mr. Moses, I'm something of a Luddite myself, but wouldn't approve of that move. Having internet and the telephone is better both for those who want to use the internet and those who want to use the telephone, surely?
Just reading the FT article on sartorial changes in the city. No wonder smart booksellers fit in so well in Hedgie-central Mayfair, apparently the uniform - sports jacket, good trousers and suede loafers - is identical....
Or maybe they saw us walking out of the auction houses and thought - aha, that is how the snappy gent should dress these days.
Two heroic British names in one. And another Caesarean on the site
Thought you might be pleased. The two forenames are both family ones (two of Arthur's gt-grandparents for Arthur, his maternal grandfather for Robin) but yes - he has more than a little heroic glimmer to him. And why not.
Mr. Taffys, and that's why the proposals to increase mothers' rights will only hurt women trying to get jobs. The more onerous the burden on employers, the less likely (especially small) businesses are to employ women.
Mr. Moses, I'm something of a Luddite myself, but wouldn't approve of that move. Having internet and the telephone is better both for those who want to use the internet and those who want to use the telephone, surely?
Yes but the Internet was quicker so the weird logic went that those with broadband plus gave an unfair advantage over those whose preference was to use two fecking baked bean tins and a length of string.
Never occurred to them to retain some online and some for call ins. Now we are "technically wise" all back in the Stone Age.
Mind you its one step up still from 20 years ago where we all queued outside a locked front door in the pouring rain before before all shuffling in to take our number in line for morning surgery. It's was so antiquated I could swear I saw long shanks riding by once or twice
The relationships between the patient, GPs A&E and Hospitals are dysfunctional.
Why in a small market town, are there 6 GP practices? That is 6 lots of overheads, duplication, profit for private business and a ton of waste. Still access is limited and the appointment system is diabolical and hours are not patient friendly.
Why is the A&E in the larger adjacent town overrun, broke and struggles with waiting times?
The six GP surgeries in a small town should be combined in surgery in the town. They should be open 24 / 7. They should employ Nurses, Drs and provide basic services that fills about 65% of A&E. I would no longer have a specific GP, it would largely be a drop in, not appointment, so I see who is on duty. Appointments would be for people with recurring conditions that need to be monitored, and with a work rota that is manageable.
To make improvements we need to start by sorting out the initial point of contact with the NHS. Right now it is unworkable. The above changes the relationship between patient, GP and A&E, and therefore access to the hospital.
Then we get onto the 'Super' Hospitals such as Adenbrookes. The race to the top to be the biggest has blinded the Administrators and Medics that the race should be to be the best. Big Hospitals don't work. By and large the rule is that the larger the organisation the poorer the care a patient receives.
Why are anesthetists, Consultants etc supplementing income from the reviled immoral private sector? Seems hypocritical to me. If they have the time then the NHS, who employ them, need that time for 7 day working. Make a choice, it is private or NHS for you salary. As is said down thread, the investment, equipment and infrastructure is there, use it!
I could do another 20 or 30 pages of rant at the dire service NHS provides, but I'll stop now.
There are lots of administrative reason why that would be really difficult - but this cuts the key mismatch between perception and reality.
For you, the idea of a walk in see whoever clinic is amazing, you get seen whenever for what I assume is a relatively minor problem.
For the elderly with lots of comorbidities, it is a nightmare, but not only that it is inefficient. If Someone with diabetes, a couple of previous heart attacks, COPD, perhaps RA on 10-15 drugs pitches up to someone who they have never met before, you can spend 10 minutes getting your head around all the different medications and conditions. Their breathlessness has increased - it takes time to look back and see what has been tried.
However if they have a known GP who is up to speed, they saw a couple of weeks ago then the process moves hugely quicker. This efficiency time saving isn't really realised by a lot of people until it affects them, usually when they are 70+. The supposed optimum practice size seems to be about 4 doctors looking after about 9000ish patients.
Agreed Cyclefree. It takes time for people to get used to and, anyway, as I mentioned below once we start charging for no-shows it will soon sort out the problem. £20 for a no-show, three strikes and you're booted out of the practice.
The trouble with this is superficially it looks a good idea. But who wont pay? Most likely those with chaotic lives who don't turn up for appointments. Who then will chase them? There is no system in NHS for chasing individuals like this. So then we get into is it worth creating a system just to collect £20 etc etc.
Don't pay = booted out the practice.
Once people realise their entitlement to 'free' care may come to a crashing end they will soon drag their butts to the appointment, or cancel it in time. A simple free automated text and online system with rebooking options, as operated by most private companies will sort it.
Are cancelled appointments really a bad thing for GP and even outpatients? In my experience, they ease some of the strain placed on the system as other appointments overrun their 10-minute slots.
Cancelled appointments no because if in time can be reallocated as was mentioned so long as you don't have a handful of Luddites in your surgery still using semaphore or fecking carrier pigeons for communications.
No shows Yes they are because when you phone to get one they are at that point taken and you could have had the one taken by the imbecile who could not be arsed to turn up.
All doctors overrun to a point but it's accepted because we ourselves realise we may want more time for reassurance etc . I do note though that GPs want to increase the appointment time to 15 mins rather than 10 average. That cuts both ways because it simply appears they decrease their patient count while increasing their pay rather than more likely consideration of patient care.
I am aware one of my points has counteracted the other. This is the NHS in a nutshell though as observed by the layman.
The issue of collections is complicated. This isn't like other services where you can withhold future services until the fee has been paid. The GMC come screaming at you then. Also do you offlist children who cannot get to the appointment themselves? They also have to be provided with medical care - if they get offlisted a couple of times, are there even any more local practices for them to register with?
The relationships between the patient, GPs A&E and Hospitals are dysfunctional.
...
To make improvements we need to start by sorting out the initial point of contact with the NHS. Right now it is unworkable. The above changes the relationship between patient, GP and A&E, and therefore access to the hospital.
Then we get onto the 'Super' Hospitals such as Adenbrookes. The race to the top to be the biggest has blinded the Administrators and Medics that the race should be to be the best. Big Hospitals don't work. By and large the rule is that the larger the organisation the poorer the care a patient receives.
Why are anesthetists, Consultants etc supplementing income from the reviled immoral private sector? Seems hypocritical to me. If they have the time then the NHS, who employ them, need that time for 7 day working. Make a choice, it is private or NHS for you salary. As is said down thread, the investment, equipment and infrastructure is there, use it!
I could do another 20 or 30 pages of rant at the dire service NHS provides, but I'll stop now.
There are lots of administrative reason why that would be really difficult - but this cuts the key mismatch between perception and reality.
For you, the idea of a walk in see whoever clinic is amazing, you get seen whenever for what I assume is a relatively minor problem.
For the elderly with lots of comorbidities, it is a nightmare, but not only that it is inefficient. If Someone with diabetes, a couple of previous heart attacks, COPD, perhaps RA on 10-15 drugs pitches up to someone who they have never met before, you can spend 10 minutes getting your head around all the different medications and conditions. Their breathlessness has increased - it takes time to look back and see what has been tried.
However if they have a known GP who is up to speed, they saw a couple of weeks ago then the process moves hugely quicker. This efficiency time saving isn't really realised by a lot of people until it affects them, usually when they are 70+. The supposed optimum practice size seems to be about 4 doctors looking after about 9000ish patients.
Simple approach to that. The market.
If there was one of Moses practices around, then the largely healthy people who need the odd tetanus jab and anti-bs once every few years for an ear infection can leave the model that only suits the over-70s and chronically ill for the easy access super practice.
As with this ridiculous idea that broadband giving people an advantage meaning reversion to the stone age, having medical provision modelled only around the chronically ill is rigid public sector thinking.
Apologies for the lack of a piece this morning. Arthur Robin Herdson was born at 2.30am and so gave his dad an even higher priority than PB. He and his mum are doing fine. Have to give a lot of credit to the NHS staff who have given a lot of support throughout. That said, he was born by a last-minute-decision c-section and was originally due on Sept 20. I worry what might have been had he gone to term.
Don't worry about what might have been.
Enjoy the here and now!
Congratulations!
Cheers. Yes, absolutely - we will be enjoying the here and now: having breakfasted, I'll be off to the hospital shortly. But there will be other parents who'll need the same care and attention during the doctors' strike and they won't always get it. We didn't have an easy pregnancy or birth and in these cases even more than others, having the right staff there in the right numbers really matters.
The issue of collections is complicated. This isn't like other services where you can withhold future services until the fee has been paid. The GMC come screaming at you then. Also do you offlist children who cannot get to the appointment themselves? They also have to be provided with medical care - if they get offlisted a couple of times, are there even any more local practices for them to register with?
I agree with your good points made and as always with the NHS it's not as clear cut as we all would wish. I really don't know what the answer is as there will always be these "specific cases" all with merit. I do know we cannot continue as we are and endless supplies of cash is not going to change this one iota. It requires a real and grown up and open discussion and engagement with nothing left off the table between all concerned.
Two exceptions.....The unions and Labour should remain outside that room and preferably even off the premises.
'If imposition is as bodged as I expect (and Hospital HR departments are notoriously hopeless), then I expect that we will see further rota gaps appearing. I also expect absenteeism to worsen as a reflection of poor morale.'
So because the junior doctors don't like a change in their contract (which their union said was a good deal ) they are going to pretend to be sick. We also know from the leaked BMA emails that the strikes were never about patient care and only about money.
Have these greedy callous scumbags got no limits on what they they are prepared to inflict on their patients ?
Meanwhile my sister will no doubt have her cancer treatment delayed again.
'If imposition is as bodged as I expect (and Hospital HR departments are notoriously hopeless), then I expect that we will see further rota gaps appearing. I also expect absenteeism to worsen as a reflection of poor morale.'
So because the junior doctors don't like a change in their contract (which their union said was a good deal ) they are going to pretend to be sick. We also know from the leaked BMA emails that the strikes were never about patient care and only about money.
Have these greedy callous scumbags got no limits on what they they are prepared to inflict on their patients ?
Meanwhile my sister will no doubt have her cancer treatment delayed again.
Scots are a sophisticated and complex political audience who are impressed by competence, and who will not be gulled into backing independence by silly online surveys and bombastic rhetoric without basis in fact. We might rant against the reality of Brexit, but that doesn’t mean we’re particularly keen to swap one insecurity, which is at least cushioned by the economic might of the UK, for the even greater insecurity of independence, with little go-it-alone Scotland exposed to the squalls of the international markets. When Ms Sturgeon says that ‘the idea of Westminster as some sort of safe harbour for Scotland is completely redundant’, a majority of Scots would respond, ‘steady on, hen.’
Did you make a decision on Switzerland by the way?
Yes, I've handed in my notice and I start in Zurich in January if 2017. Can't wait. I'm about to put my flat on the market and cash in as well, house price rises in West London have been crazy since I bought.
The relationships between the patient, GPs A&E and Hospitals are dysfunctional.
...
I could do another 20 or 30 pages of rant at the dire service NHS provides, but I'll stop now.
There are lots of administrative reason why that would be really difficult - but this cuts the key mismatch between perception and reality.
For you, the idea of a walk in see whoever clinic is amazing, you get seen whenever for what I assume is a relatively minor problem.
For the elderly with lots of comorbidities, it is a nightmare, but not only that it is inefficient. If Someone with diabetes, a couple of previous heart attacks, COPD, perhaps RA on 10-15 drugs pitches up to someone who they have never met before, you can spend 10 minutes getting your head around all the different medications and conditions. Their breathlessness has increased - it takes time to look back and see what has been tried.
However if they have a known GP who is up to speed, they saw a couple of weeks ago then the process moves hugely quicker. This efficiency time saving isn't really realised by a lot of people until it affects them, usually when they are 70+. The supposed optimum practice size seems to be about 4 doctors looking after about 9000ish patients.
Simple approach to that. The market.
If there was one of Moses practices around, then the largely healthy people who need the odd tetanus jab and anti-bs once every few years for an ear infection can leave the model that only suits the over-70s and chronically ill for the easy access super practice.
As with this ridiculous idea that broadband giving people an advantage meaning reversion to the stone age, having medical provision modelled only around the chronically ill is rigid public sector thinking.
You don't seem to understand quite how practices are funded - the practice for the over 70's would collapse as there is a per person payment premium, topped up by payments for certain targets
However even if that were sorted, these practices would have to cover huge areas to reach enough people to make them work. But what at the point of crossover? At any time a chronic health complaint could happen.
Essentially there is a trade off of continuity vs access. These instant access services already exist in the market, there are multiple private online GPs who will see for a price. Some large cities also have walk in centres for this kind of stuff. But it is difficult to roll out accross a huge area due to trying to match populations, obligations for visits etc. If this super practice existed, but were say 10 miles away or a closer one 2 miles away what would get chosen? I could not see this working in practice.
F1: the chief operating officer (I think) of Force India has stated that Perez *is* signed up for Force India next year, despite suggestions to the contrary.
Agreed Cyclefree. It takes time for people to get used to and, anyway, as I mentioned below once we start charging for no-shows it will soon sort out the problem. £20 for a no-show, three strikes and you're booted out of the practice.
The trouble with this is superficially it looks a good idea. But who wont pay? Most likely those with chaotic lives who don't turn up for appointments. Who then will chase them? There is no system in NHS for chasing individuals like this. So then we get into is it worth creating a system just to collect £20 etc etc.
Don't pay = booted out the practice.
Once people realise their entitlement to 'free' care may come to a crashing end they will soon drag their butts to the appointment, or cancel it in time. A simple free automated text and online system with rebooking options, as operated by most private companies will sort it.
Are cancelled appointments really a bad thing for GP and even outpatients? In my experience, they ease some of the strain placed on the system as other appointments overrun their 10-minute slots.
Nothing wrong with cancelled appointments, it's the failure to attend hospital, GP and dental appointments that wastes time and money.
It is not cancelled doctor appointments which are the issue at our surgery it is the No Shows.
Our Patient Participation Group has discussed introducing fines for these patients but it is primarily the drug addicts and mentally disturbed who don't show and the threat of a fine is not likely to change their behaviour.
We have introduced text message reminders for those with mobile telephones and we publish monthly no show numbers in the waiting area. This has brought about a small reduction in no shows.
Embarrassingly I was late for a blood test appointment with a nurse when I was so engrossed trying to sort out an issue at our local constituency party.
Probably the biggest problem at our surgery is that many of the doctors are not prepared to be practice partners and are just salaried. In general, partners are more committed to the practice whilst the salaried doctors just do the scheduled appointments. Just shows the benefit of introducing more capiitalism into the NHS.
Apologies for the lack of a piece this morning. Arthur Robin Herdson was born at 2.30am and so gave his dad an even higher priority than PB. He and his mum are doing fine. Have to give a lot of credit to the NHS staff who have given a lot of support throughout. That said, he was born by a last-minute-decision c-section and was originally due on Sept 20. I worry what might have been had he gone to term.
The relationships between the patient, GPs A&E and Hospitals are dysfunctional.
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For the elderly with lots of comorbidities, it is a nightmare, but not only that it is inefficient. If Someone with diabetes, a couple of previous heart attacks, COPD, perhaps RA on 10-15 drugs pitches up to someone who they have never met before, you can spend 10 minutes getting your head around all the different medications and conditions. Their breathlessness has increased - it takes time to look back and see what has been tried.
However if they have a known GP who is up to speed, they saw a couple of weeks ago then the process moves hugely quicker. This efficiency time saving isn't really realised by a lot of people until it affects them, usually when they are 70+. The supposed optimum practice size seems to be about 4 doctors looking after about 9000ish patients.
Simple approach to that. The market.
If there was one of Moses practices around, then the largely healthy people who need the odd tetanus jab and anti-bs once every few years for an ear infection can leave the model that only suits the over-70s and chronically ill for the easy access super practice.
As with this ridiculous idea that broadband giving people an advantage meaning reversion to the stone age, having medical provision modelled only around the chronically ill is rigid public sector thinking.
You don't seem to understand quite how practices are funded - the practice for the over 70's would collapse as there is a per person payment premium, topped up by payments for certain targets
However even if that were sorted, these practices would have to cover huge areas to reach enough people to make them work. But what at the point of crossover? At any time a chronic health complaint could happen.
Essentially there is a trade off of continuity vs access. These instant access services already exist in the market, there are multiple private online GPs who will see for a price. Some large cities also have walk in centres for this kind of stuff. But it is difficult to roll out accross a huge area due to trying to match populations, obligations for visits etc. If this super practice existed, but were say 10 miles away or a closer one 2 miles away what would get chosen? I could not see this working in practice.
So meanwhile methods don't change despite the working age non-chronically ill population subsiding the NHS.
Simple solution. Stop paying GPs via per person payment premium. Pay per appointment and other measures.
Apologies for the lack of a piece this morning. Arthur Robin Herdson was born at 2.30am and so gave his dad an even higher priority than PB. He and his mum are doing fine. Have to give a lot of credit to the NHS staff who have given a lot of support throughout. That said, he was born by a last-minute-decision c-section and was originally due on Sept 20. I worry what might have been had he gone to term.
Congratulations! And if I may, compliments to you and your wife on a sound choice of baby's names - wisely eschewing fashion trends!
Names are always fascinating. For instance with "Arthur" they actually think that he was a 6th century warlord called Riothamus (not sure of spelling). This is because the year after each of Riothamus's main victories against the Second there is a marked spoke in the number of babies christened "Arthur"!
(This thesis posits that Riothamys was also know as "Artu" - the "bear")
As far as I can see my GP does the appointments in the morning then goes off to a hospital and does rounds there and sometimes is back for second surgery of the day. Sounds busy to me in fairness though often they are not available for surgeries all the time so perhaps not quite as bad as that?
On the other hand I am offered private medical by the company I am involved with and the consultant I see also works at the NHS hospital at certain times of the day. It is not unusual to have a private consultation appointment at 7 or even 8 in the evening? Mind you the last appointment i had took around 10 mins and cost 148 quid for the insurers. One coming out and one after me at least meant a revenue of at least 450 quid for 1/2 hours work if all were the same. ( noted the doc doesn't get that full whack hence the term revenue was used no fee)
I did get a nice cup of tea brought to me though.
In the meantime there are apparently staff shortages where expensive agency replacements are required ensuring even more drain on available resources. It's the disconnection of various services their skill sets on top of the application of available skilled labour that seems to show the system is not working as effectively as it could, as one cohesive force and pulling in the same direction as a team.
Quick hols question - has anyone any recommendations for a quality hotel or B&B close to central Avignon. We're going down by Eurostar (absolute bargain, 5.5 hours from St Pancras) for a cycling hol and have a few days free...
We stayed in a lovely hotel in Le Pontet (not too expensive) but a bike ride away from the centre
Apologies for the lack of a piece this morning. Arthur Robin Herdson was born at 2.30am and so gave his dad an even higher priority than PB. He and his mum are doing fine. Have to give a lot of credit to the NHS staff who have given a lot of support throughout. That said, he was born by a last-minute-decision c-section and was originally due on Sept 20. I worry what might have been had he gone to term.
Quick hols question - has anyone any recommendations for a quality hotel or B&B close to central Avignon. We're going down by Eurostar (absolute bargain, 5.5 hours from St Pancras) for a cycling hol and have a few days free...
We stayed in a lovely hotel in Le Pontet (not too expensive) but a bike ride away from the centre
Thanks - will take a look there too.
We're spending 5 days in Remy and Lagnes first; after the busy time of opening the shop I'm very much looking forward to it!
Meanwhile, how many hundreds of people are marching for Europe today.
What a disgrace - trying to overturn a democratic decision.
To be fair I don't mind a single market. It's all the unelected dictators at the top of the EU i despise. It does seem though that had the decision gone the other way that would have been it for ever and ever and ever so there!
Off out now as I am completely Brexited'd out for now......
Thanks for an interesting debate this morning on the NHS without hyperbole. It's the big table with everything on I was just talking about. Now the grown ups need to do it.
'If imposition is as bodged as I expect (and Hospital HR departments are notoriously hopeless), then I expect that we will see further rota gaps appearing. I also expect absenteeism to worsen as a reflection of poor morale.'
So because the junior doctors don't like a change in their contract (which their union said was a good deal ) they are going to pretend to be sick. We also know from the leaked BMA emails that the strikes were never about patient care and only about money.
Have these greedy callous scumbags got no limits on what they they are prepared to inflict on their patients ?
Meanwhile my sister will no doubt have her cancer treatment delayed again.
"Envy of the world" my arse
Anyone who's ever lived broad will agree with that. Pretty much nowhere else in the developed world is it so difficult to see a doctor.
Apologies for the lack of a piece this morning. Arthur Robin Herdson was born at 2.30am and so gave his dad an even higher priority than PB. He and his mum are doing fine. Have to give a lot of credit to the NHS staff who have given a lot of support throughout. That said, he was born by a last-minute-decision c-section and was originally due on Sept 20. I worry what might have been had he gone to term.
Congratulations! And if I may, compliments to you and your wife on a sound choice of baby's names - wisely eschewing fashion trends!
Names are always fascinating. For instance with "Arthur" they actually think that he was a 6th century warlord called Riothamus (not sure of spelling). This is because the year after each of Riothamus's main victories against the Second there is a marked spoke in the number of babies christened "Arthur"!
(This thesis posits that Riothamys was also know as "Artu" - the "bear")
I am most disappointed that the little one was not called Hillary in good and very topical fashion
Well not in Scotland. Indeed a good friend of my daughter had an interesting twist. She complained that the Universities were taking a 50:50 ratio and that this made it much harder for girls to get in than boys. She said that there were something like 9K girls applying (all with 5 As) and only about 3.5K boys. I think there were something like 3K places (can't swear to these numbers).
My friend has a theory on this, he thinks that the government are becoming increasingly irritated by women who study medicine for 6/7 years then do all the post-degree training and bugger off to get married and have kids to shift to becoming a part time locum. He says that from his course which was about 50/50 loads of his female friends have already done this. From my own family I know one doctor and one dentist who have both done this and moved to part time locum work in their early thirties.
That is not a theory it is a fact. And many doctors marry doctors (they don't have time to meet anyone else) so going part time is an easy economic decision when the kids come along. It results in most of the shortfalls suffered by the NHS, particularly in the GP end of the profession. The 50:50 ratios are a response to this. If it was purely on the qualifications of the applicants medicine would be female dominated by now.
Well that's based on A-Levels which are biased towards women. It will be interesting to see how the gap changes with the new system which is probably more favourable to men. I got a B in biology because I was basically much lazier than my female friends who wrote up to 4 drafts of their coursework and had them marked by the teacher and made endless revisions. I did two and then handed the second one in without any changes. Smashed the exams but the damage was done. That experience is repeated thousands of times at schools and colleges across the country.
Who is doing the coursework, the pupils or the teachers?
Meanwhile, how many hundreds of people are marching for Europe today.
What a disgrace - trying to overturn a democratic decision.
To be fair this is not a petition to have a second referendum to keep the UK in the EU, which was the question on the referendum ballot paper (unlike the earlier petition which was not from BSE) but to keep the UK in the Single Market, which was not. Polls show most voters (including almost half those who voted Leave) want at least some membership of the Single Market and a free trade deal even if they also want control of free movement so I don't think it is really trying to overturn a democratic decision
Apologies for the lack of a piece this morning. Arthur Robin Herdson was born at 2.30am and so gave his dad an even higher priority than PB. He and his mum are doing fine. Have to give a lot of credit to the NHS staff who have given a lot of support throughout. That said, he was born by a last-minute-decision c-section and was originally due on Sept 20. I worry what might have been had he gone to term.
Congratulations, though I'm disappointed you didn't call him something sensible like Moon Unit.
Apologies for the lack of a piece this morning. Arthur Robin Herdson was born at 2.30am and so gave his dad an even higher priority than PB. He and his mum are doing fine. Have to give a lot of credit to the NHS staff who have given a lot of support throughout. That said, he was born by a last-minute-decision c-section and was originally due on Sept 20. I worry what might have been had he gone to term.
Congratulations, though I'm disappointed you didn't call him something sensible like Moon Unit.
Or have a middle name like 'subsamples' or 'swingback'.
As far as I can see my GP does the appointments in the morning then goes off to a hospital and does rounds there and sometimes is back for second surgery of the day. Sounds busy to me in fairness though often they are not available for surgeries all the time so perhaps not quite as bad as that?
On the other hand I am offered private medical by the company I am involved with and the consultant I see also works at the NHS hospital at certain times of the day. It is not unusual to have a private consultation appointment at 7 or even 8 in the evening? Mind you the last appointment i had took around 10 mins and cost 148 quid for the insurers. One coming out and one after me at least meant a revenue of at least 450 quid for 1/2 hours work if all were the same. ( noted the doc doesn't get that full whack hence the term revenue was used no fee)
I did get a nice cup of tea brought to me though.
In the meantime there are apparently staff shortages where expensive agency replacements are required ensuring even more drain on available resources. It's the disconnection of various services their skill sets on top of the application of available skilled labour that seems to show the system is not working as effectively as it could, as one cohesive force and pulling in the same direction as a team.
Can I suggest that if an organisation is run with the bare minimum of staff, then when one or two of them are absent temporary replacements are essential.
Meanwhile, how many hundreds of people are marching for Europe today.
What a disgrace - trying to overturn a democratic decision.
To be fair this is not a petition to have a second referendum to keep the UK in the EU, which was the question on the referendum ballot paper (unlike the earlier petition which was not from BSE) but to keep the UK in the Single Market, which was not. Polls show most voters (including almost half those who voted Leave) want at least some membership of the Single Market and a free trade deal even if they also want control of free movement so I don't think it is really trying to overturn a democratic decision
True, but I was referring to the march for europers...
Apologies for the lack of a piece this morning. Arthur Robin Herdson was born at 2.30am and so gave his dad an even higher priority than PB. He and his mum are doing fine. Have to give a lot of credit to the NHS staff who have given a lot of support throughout. That said, he was born by a last-minute-decision c-section and was originally due on Sept 20. I worry what might have been had he gone to term.
Comments
Once people realise their entitlement to 'free' care may come to a crashing end they will soon drag their butts to the appointment, or cancel it in time. A simple free automated text and online system with rebooking options, as operated by most private companies will sort it.
It's not a fine on Ireland's finances, they're telling Ireland they have to charge Apple the taxes, which then go to the taxpayers of Ireland.
The EU didn't force Irish banks to get into debt, and it was the Irish government that decided to stand behind it.
The EU sometimes fines France for breaking the rules.
As I said shock treatment now required or we all lose this valuable service.
The only bloke who mentions it to me is very circumspect. Doesn't like the way it has been handled by the BMA or the HS. Said he was happy with the last compromise by the Govt.
On a more glorious note, congratulations David.
The words 'lose all support' were definitely used.
Would you care to take a bet on when public support will swing aginst the docs?
He'll go down in history as the worst post-war PM of the 20th century, simply because nobody will speak up for him*.
Blair, Brown and Cameron all suffered from short-termism and an ill-considered view of the future (cf constitutional buggery, blowing money and borrowing endlessly, and the referendum that sunk Cameron).
*I'm not saying he doesn't deserve that necessarily, just that other PMs have supports and detractors and Blair has practically no supporters now.
I thought the Life Time Allowance had been cut to £1.25 million with further cuts anticipated?
I still insist that few Docs will emigrate - all those I know bar one playboy-type have mortgages, families, wives/husbands and are generally far too middle class to uproot
Mr. Max, a fair comment on the education system being more female-friendly at the moment. A problem is that when men do worse than women (or boys than girls) it's portrayed by some as natural female superiority (the 'women are wonderful' effect) whereas when the reverse is true, some reach immediately for discrimination and societal unfairness.
[It's a shame that the obvious examples of better male body image (cf the beach body ready ads) and female openness to talking about personal matters (cf higher male suicide rates) aren't raised to try and improve both genders' mental health, instead of indulging the over-sensitive in the former and not talking that much about the latter].
BTW, googling this up you get this piece on how much EU fines are costing France. Breaking the rules isn't cheap.
http://m.challenges.fr/article/20141121.CHA0578/ces-2-2-milliards-d-amendes-que-la-france-va-devoir-payer-a-l-europe.html
I consult to one company where a young female engineer joined some 3 years ago. I have hardly seen her as she has spent most of the time on maternity leave and is now on her third. Her job of course is left open yet we have to get temps in which at no fault to them but disrupt the flow of projects and puts additional work on us. Then all change again on this ladies return and no sooner that happens back again back to a temp.
There is maternity leave for one , maybe 2 a couple years later and then there is someone just taking the complete utter piss.
Congratulations to David H. - I don't know if your new addition is your first, but if so, prepare for one of life's most wonderful and rewarding experiences
With regret my surgery has just removed online booking that worked really well because a handful of Luddites have not got internet. We all have gone back 20 years and now have to dial and redial for one line into the surgery for 20 mins sometime longer only to be told all appointments gone and next available will be week Thursday. How that improves the Luddites chances of getting an appointment is beyond me.
On the other hand we have 3 or 4 surgeries in a small market town and they are going to combine but I fear they won't modernise. It is probably going to get worse as a result.
IF you're working in a small niche business where it takes someone a couple of years to learn the ropes (as we are), maternity leave is a complete nightmare. Locums just don;t exist. The rest of you simply work harder.
No shows Yes they are because when you phone to get one they are at that point taken and you could have had the one taken by the imbecile who could not be arsed to turn up.
All doctors overrun to a point but it's accepted because we ourselves realise we may want more time for reassurance etc . I do note though that GPs want to increase the appointment time to 15 mins rather than 10 average. That cuts both ways because it simply appears they decrease their patient count while increasing their pay rather than more likely consideration of patient care.
I am aware one of my points has counteracted the other. This is the NHS in a nutshell though as observed by the layman.
Mr. Moses, I'm something of a Luddite myself, but wouldn't approve of that move. Having internet and the telephone is better both for those who want to use the internet and those who want to use the telephone, surely?
Or maybe they saw us walking out of the auction houses and thought - aha, that is how the snappy gent should dress these days.
Never occurred to them to retain some online and some for call ins. Now we are "technically wise" all back in the Stone Age.
Mind you its one step up still from 20 years ago where we all queued outside a locked front door in the pouring rain before before all shuffling in to take our number in line for morning surgery. It's was so antiquated I could swear I saw long shanks riding by once or twice
F1: third practice underway.
For you, the idea of a walk in see whoever clinic is amazing, you get seen whenever for what I assume is a relatively minor problem.
For the elderly with lots of comorbidities, it is a nightmare, but not only that it is inefficient. If Someone with diabetes, a couple of previous heart attacks, COPD, perhaps RA on 10-15 drugs pitches up to someone who they have never met before, you can spend 10 minutes getting your head around all the different medications and conditions. Their breathlessness has increased - it takes time to look back and see what has been tried.
However if they have a known GP who is up to speed, they saw a couple of weeks ago then the process moves hugely quicker. This efficiency time saving isn't really realised by a lot of people until it affects them, usually when they are 70+. The supposed optimum practice size seems to be about 4 doctors looking after about 9000ish patients.
Edited extra bit: commentator can't recall a virtual safety car at any of the races this year.
There was one less than a week ago [ahead of the real one]...
If there was one of Moses practices around, then the largely healthy people who need the odd tetanus jab and anti-bs once every few years for an ear infection can leave the model that only suits the over-70s and chronically ill for the easy access super practice.
As with this ridiculous idea that broadband giving people an advantage meaning reversion to the stone age, having medical provision modelled only around the chronically ill is rigid public sector thinking.
Arthur Robin Graham Herdson might have been more interesting ....
ARGH ....
Still sounds like Palmer's destined to go and Magnussen isn't safe either.
The issue of collections is complicated. This isn't like other services where you can withhold future services until the fee has been paid. The GMC come screaming at you then. Also do you offlist children who cannot get to the appointment themselves? They also have to be provided with medical care - if they get offlisted a couple of times, are there even any more local practices for them to register with?
I agree with your good points made and as always with the NHS it's not as clear cut as we all would wish. I really don't know what the answer is as there will always be these "specific cases" all with merit.
I do know we cannot continue as we are and endless supplies of cash is not going to change this one iota. It requires a real and grown up and open discussion and engagement with nothing left off the table between all concerned.
Two exceptions.....The unions and Labour should remain outside that room and preferably even off the premises.
'If imposition is as bodged as I expect (and Hospital HR departments are notoriously hopeless), then I expect that we will see further rota gaps appearing. I also expect absenteeism to worsen as a reflection of poor morale.'
So because the junior doctors don't like a change in their contract (which their union said was a good deal ) they are going to pretend to be sick.
We also know from the leaked BMA emails that the strikes were never about patient care and only about money.
Have these greedy callous scumbags got no limits on what they they are prepared to inflict on their patients ?
Meanwhile my sister will no doubt have her cancer treatment delayed again.
https://medium.com/@chrisdeerin/new-times-same-old-debate-556f87a867e1#.b0j1bmlsj
The VSC has been out plenty of times. A man whose job it is to comment on F1 races must have the memory of a fish not to remember even one.
He may have meant a VSC during practice. But there was one yesterday, I think. So that's even worse.
However even if that were sorted, these practices would have to cover huge areas to reach enough people to make them work. But what at the point of crossover? At any time a chronic health complaint could happen.
Essentially there is a trade off of continuity vs access. These instant access services already exist in the market, there are multiple private online GPs who will see for a price. Some large cities also have walk in centres for this kind of stuff. But it is difficult to roll out accross a huge area due to trying to match populations, obligations for visits etc. If this super practice existed, but were say 10 miles away or a closer one 2 miles away what would get chosen? I could not see this working in practice.
It is not cancelled doctor appointments which are the issue at our surgery it is the No Shows.
Our Patient Participation Group has discussed introducing fines for these patients but it is primarily the drug addicts and mentally disturbed who don't show and the threat of a fine is not likely to change their behaviour.
We have introduced text message reminders for those with mobile telephones and we publish monthly no show numbers in the waiting area. This has brought about a small reduction in no shows.
Embarrassingly I was late for a blood test appointment with a nurse when I was so engrossed trying to sort out an issue at our local constituency party.
Probably the biggest problem at our surgery is that many of the doctors are not prepared to be practice partners and are just salaried. In general, partners are more committed to the practice whilst the salaried doctors just do the scheduled appointments. Just shows the benefit of introducing more capiitalism into the NHS.
http://www.open-britain.co.uk/single_market_petition
Simple solution. Stop paying GPs via per person payment premium. Pay per appointment and other measures.
http://reaction.life/after-work-pint-tories-can-spend-next-decade-in-the-pub/
Clicktivists everywhere will rejoice.
Meanwhile, how many hundreds of people are marching for Europe today.
What a disgrace - trying to overturn a democratic decision.
(This thesis posits that Riothamys was also know as "Artu" - the "bear")
On the other hand I am offered private medical by the company I am involved with and the consultant I see also works at the NHS hospital at certain times of the day. It is not unusual to have a private consultation appointment at 7 or even 8 in the evening? Mind you the last appointment i had took around 10 mins and cost 148 quid for the insurers. One coming out and one after me at least meant a revenue of at least 450 quid for 1/2 hours work if all were the same. ( noted the doc doesn't get that full whack hence the term revenue was used no fee)
I did get a nice cup of tea brought to me though.
In the meantime there are apparently staff shortages where expensive agency replacements are required ensuring even more drain on available resources. It's the disconnection of various services their skill sets on top of the application of available skilled labour that seems to show the system is not working as effectively as it could, as one cohesive force and pulling in the same direction as a team.
We're spending 5 days in Remy and Lagnes first; after the busy time of opening the shop I'm very much looking forward to it!
Off out now as I am completely Brexited'd out for now......
Thanks for an interesting debate this morning on the NHS without hyperbole. It's the big table with everything on I was just talking about. Now the grown ups need to do it.
Definitely off out now....
'"Envy of the world" my arse
Envy of the Third world ?