HS2b was getting dangerously close to becoming more than hot air and some fancy CAD sketches at an overpriced consultancy. I think they would have canned HS2 were it not too far advanced when Covid came. Its logical to bin HS2b now, before the point of no return is reached.
A tunnel to Ireland is at least 10 - 15 years away from that sort of point, in the mean time its mostly just PR events and a bung or two to their favourite consultancies for some feasibility studies. Why cancel it until its really obvious it's not going to happen? Also in ten years time it's pretty much guaranteed to be someone else's problem - much better to leave this particular unexploded bomb for someone else to defuse.
Going back to HS2, I think the idea it's popular in the red wall is a London bubble myth. Notherners mostly drive, quite es small percentage use the train and even fewer regularly travel long distance by train. My town is 20 minutes from a station on the WCML, and its under 3hours to London. We've already suffered rampant house price inflation,especially of the larger/nicer houses as people figured they could move out of London and get back to the office a couple of days a week. This isn't a trend the locals wish to continue - rich southerners are better staying in the south, rather than turning more of the country into London commuter belt.
Almost no one in the north will benefit from HS2, its just another tool to suck everything closer to London and most northerners despise London and all its works. So cancel away - we want to pay less tax, not have it wasted on white elephants. Or if they really must spend it, they could fix some of the more appalling bits of the road network in the north - that might actually be useful for us northerners.
Northerners clearly don't despite ALL London's works as they are happy enough to take the gigantic subsidies those works fund.
I think you're looking at the wrong end of the telescope on this one. London spaffs money at the north, mostly on stuff Northerners don't actually want (see also very expensive trainsets so the London politicians can do their "northern" photo ops in Manchester and be sure to be back home in London in time for tea). They then have the cheek to expect the north to be grateful for their largesse.
Its also a circular game - London is full of consultants and lobbyists, tax payer funded pressure groups and the rest. They say they are investing £x in infrastructure in the North, then shovel half of the £x to their mates in London, before half the time cancelling the project anyway. This sort of activity is actually London subsidising London.
Of course this utter misdirection of funds happens at every level of government which is why the state should be cut back to being as small as possible, with as much direct democracy as possible.
A trivial example. My local council decided to paint 20mph signs on the road past my house. It makes zero difference to the speed of anyone driving down that street, and probably cost the equivalent of my entire council tax payment for the year. No rational person asked "would you like us to spend all your council tax on white paint" would say yes, but they did it anyway, at a time when they were also whinging and groaning about having no money because of government cuts.
It is difficult to believe that such a direct nudge makes zero difference to people's behaviour.
It's hard to ignore the '20' sign when the driver in front of you is obeying it.
I tested positive for COVID this week, along with 9 of 12 fully vaxxed friends (among others), days after we attended an outdoor wedding (that required proof of vaccination) in 1 of the lowest-risk states in the country. https://twitter.com/drmeowza/status/1429221776270135296
I think he's been hauled up on that comparing symptomatic disease with infection.
In addition, effectiveness against infection pre-delta was not 90% (+ it was not sterilising immunity). Pre-delta, this was around 55-80% depending on the study. Current observational data cited need to be interpreted carefully due to the several confounders in these studies.
People do go on about Joe Biden's age, but as I am older than he maybe I'm a bit sensitive about that. Sea Shanty Irish assures us that Biden has always been a trifle "meandery". In any case, although I cannot say I'm knowledgeable about the details of the withdrawal, I sympathize with the intent. Whatever: here's a recent thoughtful article about the topic by one of my favorite journalists.
I think that Bidens age does matter in one way. His early political life was formed during the Vietnam War* and its aftermath. He is instinctively averse to foreign interventions, even though his son did serve in Iraq.
*He didn't serve because of asthma, like his opponents bone Spurs.
So I'm single dosed with Pfizer, about 5 weeks in (after a major fight with the NHS who in their all-knowing wisdom had binned my medical records because I've failed miserably to be ill enough to see a doctor for years, thus couldn't book me a jab).
Saturday I had a bit of a sore throat / headache. Sunday morning I still had them, plus a bit of a fever, and flu like aching joints. Spent most of Sunday in bed feeling grim. No lose of taste or smell, no cough, sneezed a couple of times but not persistently. Concluded it was probably manflu.
Was chatting to my young lady (she's 165 miles away) and she insisted I took a LFT - came up strongly positive in seconds.
Got a drive through PCR to go to this morning, but I'm pretty sure it will be positive. Feeling a bit better this morning - still got a terrible sore throat (getting a throat swab for the PCR may actually cause so much pain I won't be able to do it - the LFT was a nasal one), but no fever.
Looks like I get 10 days isolation at home, which feels as if its probably going to be a bit silly - at the current rate of progress I think I'll be back to normal (and thus not infectious) in another couple of days.
Re your first paragraph, people moving house, and therefore likely GP, but no-one being told, has been a problem has been a problem for the NHS for years. Especially in areas like East London with a lot of short-term rentals.
The real NHS postcode lottery is the delivery of GP services. Our current GP practice is hideously poor. You get to see real differences in GPs when you move about the country, or even an area.
As an example: the little 'un had some jabs at ?four? years old. One in each arm. The next morning, one had come up with a 50-p sized redness. It was not bothering him, but I told the teacher. I got a phone call at lunchtime from the school telling me that his arm was swollen; they had fetched the nurse from the adjacent village college who had said he needed to see a doctor immediately.
I got his medical book and phoned the GP surgery. I told them a school nurse had said he needed to see a doctor, and they said they'd book him in the next week. They were adamant.
I went to the school, and his entire arm was swollen and red, and he had a fever. I had two choices: to take him to A&E, or try the doctor first as it was much nearer. I did the latter, stood in the queue, and when I reached the front, they said I'd have to take the original appointment. So I took his shirt off in the queue and showed them his arm, and explained it was an injection done at their surgery.
Five minutes later, I was in with a doctor. They called in the nurse who gave the injections, who could not remember which injection had gone into which arm.
Fortunately he was okay after a couple of days, but we still don't know which injection he had the reaction to ...
And this was one story of many. They really are utterly hopeless, yet there is not much chance of a change.
At one time I was professionally concerned with GP services and standards, and have no trouble in believing your story. It's like the little girl, isn't it. When they're good, they're very, very good, but when they're bad ...... Not sure about the situation now, but training of receptionists, the front-line staff, the people who control access used to be 'inadequate. Too often it appeared to patients that the receptionists duty was to 'protect' the GP from patients. And record-keeping, especially in the days of hand-writing could be abysmal.
IMHO the basic problem is the contractual system; GP's are usually (not invariably nowadays) small businesses, possibly single handed, maybe 2+ partners 'in contract' to provide services, perhaps with a practice manager, maybe not. And while some of those services are essential, some can be cherry-picked.
You're quite right that if people don't move about, they can't compare; I'm prepared to bet (!) that if I went to the practice where you had your awful experience I could find a few patients who thought the place was wonderful.
Perhaps, but talking to people, there wouldn't be many. I know of several families who have oved surgery to the nearest village, and one who has somehow moved to one on St Neots, eight miles away ...
Another story: I needed an urgent scan on my lungs. It is arranged and I go to Hinchinbrooke. A couple of days later I get a letter from the doctor saying the results are in. So I turn up with Mrs J, who is very worried, and the doctor doesn't know anything about it. I show him a letter, from the GP surgery, with his name, telling me to come in for the results. We wait, but they cannot find them. The result was that I had to take time off and go back to Hunchinbrooke for more scans...
The surgery blamed Hinchinbrooke. But I doubt it: why did the GP surgery send me a letter saying they had the results, along with an appointment time?
We have other stories, and I have heard worse from other people. Yet our previous GP in Romsey (Southampton, not Town), was superb: proactive, efficient, professional. And the one before that south of Cambridge was the same.
I wonder what GP services will be put in place for Cambourne West.
As far as I can tell, just an expansion to the existing surgery because of ' economies of scale'. Which will probably involve moving the library, or reducing it in size.
I have no idea if this is true, but a couple of people have said that the issue is that GP surgeries get paid not just by population, but by age as well. Since we have a very young population, they get less funding than if we we had more elderly people.
Anyone know if that's correct?
GP funding is quite complex. There is percapita funding and there is age weighting, but also bonuses for meeting vaccination targets in children etc.
Thanks for that. I've actually noticed the following in the document I linked to earlier: " Monkfield Medical Practice (MMP) had extra funding to start with because of the new town factor, this has now stopped. The Carr-Hill Formula is the main funding formula for medical practices and it takes account of average population: you get extra funding for older people living in the area.
Cambourne’s age distribution doesn’t fit the classic bell shape. Under this formula MMP stood to lose half its funding. They wrote a bid for exceptional case funding, which was successful but they will still lose £100,000 of funding. However they have been told by the Primary Care Trust (PCT) that this is as good as we can get so the situation has changed as MMP is no longer trying to kick up a fuss about the funding, they are trying to make the best of it. They are looking at where they can make cutbacks internally, e.g. by sending patients text messages, rather than sending letters. Their system sends automated text reminders for appointments. There were 300 appointments in November that people didn’t attend, which represents a huge amount of money lost.
Comment from audience: “you should charge the people who do not attend”. MMP: “unfortunately we can’t”. "
Comment from audience: how is money lost? Isn't it more likely that someone has naively averaged fixed costs over time and decided a ten minute appointment costs £50 or whatever, forgetting that the fixed costs are, well, fixed, and they have to pay the doctor, receptionist and rates whether people turn up or not?
I don't know, and that's a good question.
What was interesting about the above is that the practice was set to lose half its funding because of its age demographic. Even with the exceptional case funding, it might explain some of the issues we've had with them.
Although there have been some breakthrough infections with the delta variant, the vast majority (82 per cent) of people catching Covid currently have not had two doses.
Oh and another favourite story is the GP and I at her desk googling conditions because she had never heard of the potential condition, the symptoms of which I was presenting with.
IMV: the NHS is brilliant if you have conditions it knows about and can categorise. You may have to wait for a new hip, but they'll get it done. They're great with most cancers and heart problems.
They're terrible when it comes to conditions they cannot diagnose or categorise.
I've no idea about mental health conditions, but I doubt it's overall good.
Absolutely. If you are wheeled in to A&E then they are generally excellent.
Anything as you say complicated or involving MDTs or cross department liaison or which requires further investigation beyond first glance they are too often dreadful.
Oh gods yes. Horrendously bad in that situation. It's like they've never encountered the concept of communication when it happens. I know people who deal with Whitehall a lot, and they say its got nothing on the NHS when it comes to poor internal organisation.
Although there have been some breakthrough infections with the delta variant, the vast majority (82 per cent) of people catching Covid currently have not had two doses.
I don't know where they got this stat, but if correct, it is incredibly encouraging.
Agreed. I’m so bloody happy to be double vaccinated. It’s like a wee bonus Christmas present. Heck no, it’s *much* better than Christmas, even a Swedish one (which are ten times better than the Anglo-American variety).
Our middle child got his second vaccination yesterday. He was delighted and so am I. That’s all four adults done. Just the wee one left and he’s as fit as a fiddle and ineligible anyway.
If and when we do get it (we did antibody tests, and no one’s had it yet), I’m still expecting a dreadful week, but I’m kinda hoping I don’t end up in hospital.
If you are all mostly vaccinated and have done antibody tests, you wouldn’t be expecting negative results?
Depends which test. The antibodies from vaccine are to the spike protein; an infection also generates a load of (fairly useless) antibodies to the viral nucleoprotein, so you can discriminate quite easily between the two things.
So I'm single dosed with Pfizer, about 5 weeks in (after a major fight with the NHS who in their all-knowing wisdom had binned my medical records because I've failed miserably to be ill enough to see a doctor for years, thus couldn't book me a jab).
Saturday I had a bit of a sore throat / headache. Sunday morning I still had them, plus a bit of a fever, and flu like aching joints. Spent most of Sunday in bed feeling grim. No lose of taste or smell, no cough, sneezed a couple of times but not persistently. Concluded it was probably manflu.
Was chatting to my young lady (she's 165 miles away) and she insisted I took a LFT - came up strongly positive in seconds.
Got a drive through PCR to go to this morning, but I'm pretty sure it will be positive. Feeling a bit better this morning - still got a terrible sore throat (getting a throat swab for the PCR may actually cause so much pain I won't be able to do it - the LFT was a nasal one), but no fever.
Looks like I get 10 days isolation at home, which feels as if its probably going to be a bit silly - at the current rate of progress I think I'll be back to normal (and thus not infectious) in another couple of days.
Re your first paragraph, people moving house, and therefore likely GP, but no-one being told, has been a problem has been a problem for the NHS for years. Especially in areas like East London with a lot of short-term rentals.
The real NHS postcode lottery is the delivery of GP services. Our current GP practice is hideously poor. You get to see real differences in GPs when you move about the country, or even an area.
As an example: the little 'un had some jabs at ?four? years old. One in each arm. The next morning, one had come up with a 50-p sized redness. It was not bothering him, but I told the teacher. I got a phone call at lunchtime from the school telling me that his arm was swollen; they had fetched the nurse from the adjacent village college who had said he needed to see a doctor immediately.
I got his medical book and phoned the GP surgery. I told them a school nurse had said he needed to see a doctor, and they said they'd book him in the next week. They were adamant.
I went to the school, and his entire arm was swollen and red, and he had a fever. I had two choices: to take him to A&E, or try the doctor first as it was much nearer. I did the latter, stood in the queue, and when I reached the front, they said I'd have to take the original appointment. So I took his shirt off in the queue and showed them his arm, and explained it was an injection done at their surgery.
Five minutes later, I was in with a doctor. They called in the nurse who gave the injections, who could not remember which injection had gone into which arm.
Fortunately he was okay after a couple of days, but we still don't know which injection he had the reaction to ...
And this was one story of many. They really are utterly hopeless, yet there is not much chance of a change.
At one time I was professionally concerned with GP services and standards, and have no trouble in believing your story. It's like the little girl, isn't it. When they're good, they're very, very good, but when they're bad ...... Not sure about the situation now, but training of receptionists, the front-line staff, the people who control access used to be 'inadequate. Too often it appeared to patients that the receptionists duty was to 'protect' the GP from patients. And record-keeping, especially in the days of hand-writing could be abysmal.
IMHO the basic problem is the contractual system; GP's are usually (not invariably nowadays) small businesses, possibly single handed, maybe 2+ partners 'in contract' to provide services, perhaps with a practice manager, maybe not. And while some of those services are essential, some can be cherry-picked.
You're quite right that if people don't move about, they can't compare; I'm prepared to bet (!) that if I went to the practice where you had your awful experience I could find a few patients who thought the place was wonderful.
General Practice has changed a lot organisationally in recent years, with smaller practices amalgamating, with the rise of mega-practices. It is the directors of these 200+ Dr practices that are the ones that you see with the very big renumeration. They use salaried staff rather than partners, and often lots of locums. Quality of care is often an issue, particularly with many refusing face to face contacts.
There are some very good GPs and it is a hard job to do well, but very patchy. I saw a middle aged diabetic last week with no blood tests for 4 years. That isn't covid, just bad medicine.
Totally agree, although using locums isn't necessarily a bad thing. Fresh pair of eyes, and all that. If they keep the records properly, shouldn't be a problem. The use of salaried staff doesn't of itself give rise to problems either. In fact, it should improve the situation. Your, Dr F, are salaried, after all! AFAIK GP training doesn't include business management, and, to be fair, nor should they be expected to have good business management skills. As you say, ' it is a hard job to do well'!
Agree about the locums (loci?)
After seeing my doctor 3 times over a year with a worrying skin condition and being told it was nothing, it was a locum who finally decided it should be seen by a specialist who confirmed it was a Basal Cell Carcinoma and also asked why I had taken so long to come and see her about it.
That said, in terms of the actual running of the practice my GPs is the best I have ever used. They serve a large rural community and suffer terribly from pressures brought about by lack of space and a rapidly increasing population due to lots of new housing developments in the local villages. And yet they have adopted technology and tools such as 'Ask my GP' to make their systems both effective and quick. They use it as I envisage it should be used for rapid triage of cases so that they can concentrate on those that actually need a face to face appointment. This means that generally you get a face to face at the surgery on the same day and they have more time to actually talk to people and discuss general health to identify any possible issues that have not been raised.
Compare this with my sister's surgery back in Newark where waiting times to see a GP are still measured in weeks and they will discuss nothing but the specific issue you booked to see them about.
Really hope it gets cleared up soon and completely.
I have an annual check at The Mole Clinic. The thought of a GP knowing a dimple from a blister from something more sinister and then being able to refer you on is laughable.
Yours is another from the PB NHS shop of horrors anecdotes.
You'd have thought there'd be a mobile phone app to analyse spots by now.
The Mole Clinic do an online service. Not sure about an app. The form is for the extremely experience nurse there to take a picture of anything of concern and then send that to the doctor for further analysis. I suppose you could skip the nurse bit but then presumably there would be many many photos winging around not all for good reason.
The nurse is the triage but I would say (tbf because it's what they do all day) that her knowledge of skin cancers would be1,000x that of a typical GP.
Thanks for that. I've actually noticed the following in the document I linked to earlier: " Monkfield Medical Practice (MMP) had extra funding to start with because of the new town factor, this has now stopped. The Carr-Hill Formula is the main funding formula for medical practices and it takes account of average population: you get extra funding for older people living in the area.
Cambourne’s age distribution doesn’t fit the classic bell shape. Under this formula MMP stood to lose half its funding. They wrote a bid for exceptional case funding, which was successful but they will still lose £100,000 of funding. However they have been told by the Primary Care Trust (PCT) that this is as good as we can get so the situation has changed as MMP is no longer trying to kick up a fuss about the funding, they are trying to make the best of it. They are looking at where they can make cutbacks internally, e.g. by sending patients text messages, rather than sending letters. Their system sends automated text reminders for appointments. There were 300 appointments in November that people didn’t attend, which represents a huge amount of money lost.
Comment from audience: “you should charge the people who do not attend”. MMP: “unfortunately we can’t”. "
The reference to the PCT dates that discussion to 2013 or before.
Mr. Richard, when I watched local news, few years ago, almost all complaints about HS2 were that it wasn't going to a place and fears it may end up being cancelled here.
If it goes to Manchester/Lancashire and not Leeds/Yorkshire, people will not be pleased.
1. The #BritishMilitary here at #KabulAirport have shown breathtaking levels of toughness, professionalism and - rare in war times I must say - compassion. I've been moved to tears by their actions, diving into dangerous crowds to pull visa-holders into the base....
If Manchester gets HS2 and Leeds is delayed-not-cancelled-honest then that will not delight Yorkshire.
Luckily, it's not brimming with marginals.
It will delight those areas it would go through but not stop at.
Admittedly those people who want to go in 15 years time from Leeds to Birmingham somewhat faster than they can do currently might be aggrieved.
That totally misses a fundamental point. If people in those areas want to go *anywhere* on the rail network, it might be harder and/or more expensive for them to do so, as HS2 frees up a heck of a lot of capacity on the 'traditional' network.
Thanks for that. I've actually noticed the following in the document I linked to earlier: " Monkfield Medical Practice (MMP) had extra funding to start with because of the new town factor, this has now stopped. The Carr-Hill Formula is the main funding formula for medical practices and it takes account of average population: you get extra funding for older people living in the area.
Cambourne’s age distribution doesn’t fit the classic bell shape. Under this formula MMP stood to lose half its funding. They wrote a bid for exceptional case funding, which was successful but they will still lose £100,000 of funding. However they have been told by the Primary Care Trust (PCT) that this is as good as we can get so the situation has changed as MMP is no longer trying to kick up a fuss about the funding, they are trying to make the best of it. They are looking at where they can make cutbacks internally, e.g. by sending patients text messages, rather than sending letters. Their system sends automated text reminders for appointments. There were 300 appointments in November that people didn’t attend, which represents a huge amount of money lost.
Comment from audience: “you should charge the people who do not attend”. MMP: “unfortunately we can’t”. "
The reference to the PCT dates that discussion to 2013 or before.
Could be, but the document was from a meeting in Feb 2016.
Mr. Richard, when I watched local news, few years ago, almost all complaints about HS2 were that it wasn't going to a place and fears it may end up being cancelled here.
If it goes to Manchester/Lancashire and not Leeds/Yorkshire, people will not be pleased.
Is there any reason why Manchester was phase 2a, and Leeds phase 2b - Manchester et al had already had 10 billion tipped into the WCML by Blair et al ?
If Manchester gets HS2 and Leeds is delayed-not-cancelled-honest then that will not delight Yorkshire.
Luckily, it's not brimming with marginals.
It will delight those areas it would go through but not stop at.
Admittedly those people who want to go in 15 years time from Leeds to Birmingham somewhat faster than they can do currently might be aggrieved.
That totally misses a fundamental point. If people in those areas want to go *anywhere* on the rail network, it might be harder and/or more expensive for them to do so, as HS2 frees up a heck of a lot of capacity on the 'traditional' network.
They really should have called it “High Capacity Rail 2050” or something similar. Calling it HS2 simply fixates people on line speed, rather than the true benefit of building another north-south line.
Mr. Richard, when I watched local news, few years ago, almost all complaints about HS2 were that it wasn't going to a place and fears it may end up being cancelled here.
If it goes to Manchester/Lancashire and not Leeds/Yorkshire, people will not be pleased.
Is there any reason why Manchester was phase 2a, and Leeds phase 2b - Manchester et al had already had 10 billion tipped into the WCML by Blair et al ?
Population and capacity constraints on the WCML, I'd have thought. The eastern leg always looked like poor value for money, in particular the station at Toton.
- Lord Botham appointed to Australia - Baroness Hoey appointed to Ghana - Stephen Timms MP appointed to Switzerland and Liechtenstein - David Mundell MP appointed to New Zealand - Mark Eastwood MP appointed to Pakistan - Marco Longhi MP appointed to Brazil - Conor Burns MP appointed to Canada - Lord Walney [John Woodcock] appointed to Tanzania - Felicity Buchan MP appointed to Iceland and Norway - Sir Jeffrey Donaldson MP appointed to Cameroon, in addition to his role as Prime Minister’s Trade Envoy to Egypt.
General Practice has changed a lot organisationally in recent years, with smaller practices amalgamating, with the rise of mega-practices. It is the directors of these 200+ Dr practices that are the ones that you see with the very big renumeration. They use salaried staff rather than partners, and often lots of locums. Quality of care is often an issue, particularly with many refusing face to face contacts.
There are some very good GPs and it is a hard job to do well, but very patchy. I saw a middle aged diabetic last week with no blood tests for 4 years. That isn't covid, just bad medicine.
Because we're all interested in politics, we're tempted to draw political conclusions from anecedotal evidence. Experiencing medicine in four countries (Austria, Denmark, Switzerland, UK with half a dozen different GPs as I moved around for work), my view FWIW is that there's a good deal of random variation and no one set of GPs really stands out as better or worse. Because it's not done to denounce a bad doctor in the way that you would a sloppy supermarket (you were ill, maybe you weren't seeing things clearly, and he's got lots of degrees and other patients seem happy...), it's difficult to get a clear picture.
My father had a private specialist who accidentally prescribed him at 10 times the correct dose, and it was only after he repeatedly told the doctor that he was sleeping all day, every day and surely this couldn't be quite right did the specialist deign to check. Another relative had an NHS GP who switched her depression medication to Prozac and refused to believe that it wouldn't work, as a result of which she lost her job and had two years of deep depression. I'm not convinced that either case tells us anything except that if things are clearly going wrong you shouldn't just assume your doctor is right but get a second opinion.
My own experience is that NHS treatment is generally very good, but record-keeping used to be totally crap and has now improved to so-so and computerisation took hold. but that's anecdotal too. Seeing someone outside your home area remains challenging - why there was so much opposition to a national database with all medical records still baffles me.
If Manchester gets HS2 and Leeds is delayed-not-cancelled-honest then that will not delight Yorkshire.
Luckily, it's not brimming with marginals.
It will delight those areas it would go through but not stop at.
Admittedly those people who want to go in 15 years time from Leeds to Birmingham somewhat faster than they can do currently might be aggrieved.
That totally misses a fundamental point. If people in those areas want to go *anywhere* on the rail network, it might be harder and/or more expensive for them to do so, as HS2 frees up a heck of a lot of capacity on the 'traditional' network.
That assumes that they want to go anywhere on the rail network and that there will be additional demand for rail services from any extra capacity.
Already dubious assumptions pre covid but with the increase in working from home far more so now.
So I'm single dosed with Pfizer, about 5 weeks in (after a major fight with the NHS who in their all-knowing wisdom had binned my medical records because I've failed miserably to be ill enough to see a doctor for years, thus couldn't book me a jab).
Saturday I had a bit of a sore throat / headache. Sunday morning I still had them, plus a bit of a fever, and flu like aching joints. Spent most of Sunday in bed feeling grim. No lose of taste or smell, no cough, sneezed a couple of times but not persistently. Concluded it was probably manflu.
Was chatting to my young lady (she's 165 miles away) and she insisted I took a LFT - came up strongly positive in seconds.
Got a drive through PCR to go to this morning, but I'm pretty sure it will be positive. Feeling a bit better this morning - still got a terrible sore throat (getting a throat swab for the PCR may actually cause so much pain I won't be able to do it - the LFT was a nasal one), but no fever.
Looks like I get 10 days isolation at home, which feels as if its probably going to be a bit silly - at the current rate of progress I think I'll be back to normal (and thus not infectious) in another couple of days.
Re your first paragraph, people moving house, and therefore likely GP, but no-one being told, has been a problem has been a problem for the NHS for years. Especially in areas like East London with a lot of short-term rentals.
The real NHS postcode lottery is the delivery of GP services. Our current GP practice is hideously poor. You get to see real differences in GPs when you move about the country, or even an area.
As an example: the little 'un had some jabs at ?four? years old. One in each arm. The next morning, one had come up with a 50-p sized redness. It was not bothering him, but I told the teacher. I got a phone call at lunchtime from the school telling me that his arm was swollen; they had fetched the nurse from the adjacent village college who had said he needed to see a doctor immediately.
I got his medical book and phoned the GP surgery. I told them a school nurse had said he needed to see a doctor, and they said they'd book him in the next week. They were adamant.
I went to the school, and his entire arm was swollen and red, and he had a fever. I had two choices: to take him to A&E, or try the doctor first as it was much nearer. I did the latter, stood in the queue, and when I reached the front, they said I'd have to take the original appointment. So I took his shirt off in the queue and showed them his arm, and explained it was an injection done at their surgery.
Five minutes later, I was in with a doctor. They called in the nurse who gave the injections, who could not remember which injection had gone into which arm.
Fortunately he was okay after a couple of days, but we still don't know which injection he had the reaction to ...
And this was one story of many. They really are utterly hopeless, yet there is not much chance of a change.
At one time I was professionally concerned with GP services and standards, and have no trouble in believing your story. It's like the little girl, isn't it. When they're good, they're very, very good, but when they're bad ...... Not sure about the situation now, but training of receptionists, the front-line staff, the people who control access used to be 'inadequate. Too often it appeared to patients that the receptionists duty was to 'protect' the GP from patients. And record-keeping, especially in the days of hand-writing could be abysmal.
IMHO the basic problem is the contractual system; GP's are usually (not invariably nowadays) small businesses, possibly single handed, maybe 2+ partners 'in contract' to provide services, perhaps with a practice manager, maybe not. And while some of those services are essential, some can be cherry-picked.
You're quite right that if people don't move about, they can't compare; I'm prepared to bet (!) that if I went to the practice where you had your awful experience I could find a few patients who thought the place was wonderful.
Perhaps, but talking to people, there wouldn't be many. I know of several families who have oved surgery to the nearest village, and one who has somehow moved to one on St Neots, eight miles away ...
Another story: I needed an urgent scan on my lungs. It is arranged and I go to Hinchinbrooke. A couple of days later I get a letter from the doctor saying the results are in. So I turn up with Mrs J, who is very worried, and the doctor doesn't know anything about it. I show him a letter, from the GP surgery, with his name, telling me to come in for the results. We wait, but they cannot find them. The result was that I had to take time off and go back to Hunchinbrooke for more scans...
The surgery blamed Hinchinbrooke. But I doubt it: why did the GP surgery send me a letter saying they had the results, along with an appointment time?
We have other stories, and I have heard worse from other people. Yet our previous GP in Romsey (Southampton, not Town), was superb: proactive, efficient, professional. And the one before that south of Cambridge was the same.
I wonder what GP services will be put in place for Cambourne West.
As far as I can tell, just an expansion to the existing surgery because of ' economies of scale'. Which will probably involve moving the library, or reducing it in size.
I have no idea if this is true, but a couple of people have said that the issue is that GP surgeries get paid not just by population, but by age as well. Since we have a very young population, they get less funding than if we we had more elderly people.
Anyone know if that's correct?
GP funding is quite complex. There is percapita funding and there is age weighting, but also bonuses for meeting vaccination targets in children etc.
Thanks for that. I've actually noticed the following in the document I linked to earlier: " Monkfield Medical Practice (MMP) had extra funding to start with because of the new town factor, this has now stopped. The Carr-Hill Formula is the main funding formula for medical practices and it takes account of average population: you get extra funding for older people living in the area.
Cambourne’s age distribution doesn’t fit the classic bell shape. Under this formula MMP stood to lose half its funding. They wrote a bid for exceptional case funding, which was successful but they will still lose £100,000 of funding. However they have been told by the Primary Care Trust (PCT) that this is as good as we can get so the situation has changed as MMP is no longer trying to kick up a fuss about the funding, they are trying to make the best of it. They are looking at where they can make cutbacks internally, e.g. by sending patients text messages, rather than sending letters. Their system sends automated text reminders for appointments. There were 300 appointments in November that people didn’t attend, which represents a huge amount of money lost.
Comment from audience: “you should charge the people who do not attend”. MMP: “unfortunately we can’t”. "
Comment from audience: how is money lost? Isn't it more likely that someone has naively averaged fixed costs over time and decided a ten minute appointment costs £50 or whatever, forgetting that the fixed costs are, well, fixed, and they have to pay the doctor, receptionist and rates whether people turn up or not?
I don't know, and that's a good question.
What was interesting about the above is that the practice was set to lose half its funding because of its age demographic. Even with the exceptional case funding, it might explain some of the issues we've had with them.
I suspect that means half the extra funding it has had. I find it very, very difficult to believe that any practice lost half it's funding unless circumstances were truly exceptional.... half the GP's left and took their share of the patients or something like that. Secondly this can't be a recent letter; PCT's were abolished by the Lansley 'reforms' (which were meant to put more power in the hands of GP's) almost ten years ago.
Mr. Richard, when I watched local news, few years ago, almost all complaints about HS2 were that it wasn't going to a place and fears it may end up being cancelled here.
If it goes to Manchester/Lancashire and not Leeds/Yorkshire, people will not be pleased.
Do you really think that people want disruption in order to gain something they may never use ?
Now you can buy off the people who will be inconvenienced but that's going to cost even more money.
Which is difficult when there are so many other demands on government spending.
Mr. W, no idea, but Leeds has repeatedly, by multiple parties, had trams dangled only to be withdrawn (costing millions in proposals and raising hopes only to frustrate them).
It's also a major, perhaps the major, northern transport hub.
So I'm single dosed with Pfizer, about 5 weeks in (after a major fight with the NHS who in their all-knowing wisdom had binned my medical records because I've failed miserably to be ill enough to see a doctor for years, thus couldn't book me a jab).
Saturday I had a bit of a sore throat / headache. Sunday morning I still had them, plus a bit of a fever, and flu like aching joints. Spent most of Sunday in bed feeling grim. No lose of taste or smell, no cough, sneezed a couple of times but not persistently. Concluded it was probably manflu.
Was chatting to my young lady (she's 165 miles away) and she insisted I took a LFT - came up strongly positive in seconds.
Got a drive through PCR to go to this morning, but I'm pretty sure it will be positive. Feeling a bit better this morning - still got a terrible sore throat (getting a throat swab for the PCR may actually cause so much pain I won't be able to do it - the LFT was a nasal one), but no fever.
Looks like I get 10 days isolation at home, which feels as if its probably going to be a bit silly - at the current rate of progress I think I'll be back to normal (and thus not infectious) in another couple of days.
Re your first paragraph, people moving house, and therefore likely GP, but no-one being told, has been a problem has been a problem for the NHS for years. Especially in areas like East London with a lot of short-term rentals.
The real NHS postcode lottery is the delivery of GP services. Our current GP practice is hideously poor. You get to see real differences in GPs when you move about the country, or even an area.
As an example: the little 'un had some jabs at ?four? years old. One in each arm. The next morning, one had come up with a 50-p sized redness. It was not bothering him, but I told the teacher. I got a phone call at lunchtime from the school telling me that his arm was swollen; they had fetched the nurse from the adjacent village college who had said he needed to see a doctor immediately.
I got his medical book and phoned the GP surgery. I told them a school nurse had said he needed to see a doctor, and they said they'd book him in the next week. They were adamant.
I went to the school, and his entire arm was swollen and red, and he had a fever. I had two choices: to take him to A&E, or try the doctor first as it was much nearer. I did the latter, stood in the queue, and when I reached the front, they said I'd have to take the original appointment. So I took his shirt off in the queue and showed them his arm, and explained it was an injection done at their surgery.
Five minutes later, I was in with a doctor. They called in the nurse who gave the injections, who could not remember which injection had gone into which arm.
Fortunately he was okay after a couple of days, but we still don't know which injection he had the reaction to ...
And this was one story of many. They really are utterly hopeless, yet there is not much chance of a change.
At one time I was professionally concerned with GP services and standards, and have no trouble in believing your story. It's like the little girl, isn't it. When they're good, they're very, very good, but when they're bad ...... Not sure about the situation now, but training of receptionists, the front-line staff, the people who control access used to be 'inadequate. Too often it appeared to patients that the receptionists duty was to 'protect' the GP from patients. And record-keeping, especially in the days of hand-writing could be abysmal.
IMHO the basic problem is the contractual system; GP's are usually (not invariably nowadays) small businesses, possibly single handed, maybe 2+ partners 'in contract' to provide services, perhaps with a practice manager, maybe not. And while some of those services are essential, some can be cherry-picked.
You're quite right that if people don't move about, they can't compare; I'm prepared to bet (!) that if I went to the practice where you had your awful experience I could find a few patients who thought the place was wonderful.
Perhaps, but talking to people, there wouldn't be many. I know of several families who have oved surgery to the nearest village, and one who has somehow moved to one on St Neots, eight miles away ...
Another story: I needed an urgent scan on my lungs. It is arranged and I go to Hinchinbrooke. A couple of days later I get a letter from the doctor saying the results are in. So I turn up with Mrs J, who is very worried, and the doctor doesn't know anything about it. I show him a letter, from the GP surgery, with his name, telling me to come in for the results. We wait, but they cannot find them. The result was that I had to take time off and go back to Hunchinbrooke for more scans...
The surgery blamed Hinchinbrooke. But I doubt it: why did the GP surgery send me a letter saying they had the results, along with an appointment time?
We have other stories, and I have heard worse from other people. Yet our previous GP in Romsey (Southampton, not Town), was superb: proactive, efficient, professional. And the one before that south of Cambridge was the same.
I wonder what GP services will be put in place for Cambourne West.
As far as I can tell, just an expansion to the existing surgery because of ' economies of scale'. Which will probably involve moving the library, or reducing it in size.
I have no idea if this is true, but a couple of people have said that the issue is that GP surgeries get paid not just by population, but by age as well. Since we have a very young population, they get less funding than if we we had more elderly people.
Anyone know if that's correct?
GP funding is quite complex. There is percapita funding and there is age weighting, but also bonuses for meeting vaccination targets in children etc.
Thanks for that. I've actually noticed the following in the document I linked to earlier: " Monkfield Medical Practice (MMP) had extra funding to start with because of the new town factor, this has now stopped. The Carr-Hill Formula is the main funding formula for medical practices and it takes account of average population: you get extra funding for older people living in the area.
Cambourne’s age distribution doesn’t fit the classic bell shape. Under this formula MMP stood to lose half its funding. They wrote a bid for exceptional case funding, which was successful but they will still lose £100,000 of funding. However they have been told by the Primary Care Trust (PCT) that this is as good as we can get so the situation has changed as MMP is no longer trying to kick up a fuss about the funding, they are trying to make the best of it. They are looking at where they can make cutbacks internally, e.g. by sending patients text messages, rather than sending letters. Their system sends automated text reminders for appointments. There were 300 appointments in November that people didn’t attend, which represents a huge amount of money lost.
Comment from audience: “you should charge the people who do not attend”. MMP: “unfortunately we can’t”. "
Comment from audience: how is money lost? Isn't it more likely that someone has naively averaged fixed costs over time and decided a ten minute appointment costs £50 or whatever, forgetting that the fixed costs are, well, fixed, and they have to pay the doctor, receptionist and rates whether people turn up or not?
I don't know, and that's a good question.
What was interesting about the above is that the practice was set to lose half its funding because of its age demographic. Even with the exceptional case funding, it might explain some of the issues we've had with them.
I suspect that means half the extra funding it has had. I find it very, very difficult to believe that any practice lost half it's funding unless circumstances were truly exceptional.... half the GP's left and took their share of the patients or something like that. Secondly this can't be a recent letter; PCT's were abolished by the Lansley 'reforms' (which were meant to put more power in the hands of GP's) almost ten years ago.
I took it to mean it loses half its funding because we have a non-standard age demographic, when compared to a practice that has a standard age demographic. Perhaps that's wrong, though.
I was waiting and expecting that response. !!!!!!!!!!!!!!!!
Typical PB wit
From BBC live feed:
Posted at 7:36 Deadly firefight at airport A firefight broke out between unidentified gunmen and security forces at an entrance to Kabul airport on Monday, according to German army officials.
One Afghan guard was killed and three others injured, officials said, with US and German forces also involved in the incident.
General Practice has changed a lot organisationally in recent years, with smaller practices amalgamating, with the rise of mega-practices. It is the directors of these 200+ Dr practices that are the ones that you see with the very big renumeration. They use salaried staff rather than partners, and often lots of locums. Quality of care is often an issue, particularly with many refusing face to face contacts.
There are some very good GPs and it is a hard job to do well, but very patchy. I saw a middle aged diabetic last week with no blood tests for 4 years. That isn't covid, just bad medicine.
Because we're all interested in politics, we're tempted to draw political conclusions from anecedotal evidence. Experiencing medicine in four countries (Austria, Denmark, Switzerland, UK with half a dozen different GPs as I moved around for work), my view FWIW is that there's a good deal of random variation and no one set of GPs really stands out as better or worse. Because it's not done to denounce a bad doctor in the way that you would a sloppy supermarket (you were ill, maybe you weren't seeing things clearly, and he's got lots of degrees and other patients seem happy...), it's difficult to get a clear picture.
My father had a private specialist who accidentally prescribed him at 10 times the correct dose, and it was only after he repeatedly told the doctor that he was sleeping all day, every day and surely this couldn't be quite right did the specialist deign to check. Another relative had an NHS GP who switched her depression medication to Prozac and refused to believe that it wouldn't work, as a result of which she lost her job and had two years of deep depression. I'm not convinced that either case tells us naything except that if things are clearly going wrong you shouldn't just assume your doctor is right but get a second opinion.
My own experience is that NHS treatment is generally very good, but record-keeping used to be totally crap and has now improved to so-so and computerisation took hold. but that's anecdotal too. Seeing someone outside your home area remains challenging - why there was so much opposition to a national database with all medical records still baffles me.
Good last point. Moving around (on account of incidence vs home vs other factors) means that no one knows what the last input was and you too often have to start again.
As for you "shouldn't just assume your doctor is right", you answer it yourself when you say "it's not done to denounce a bad doctor" (and how the F would you know they are bad). To do so is a huge ask for much of the population. Your doctor is a figure of authority and who exactly do you ask for this second opinion? The doctor you think might have it wrong? Describe for me if you would that conversation. The vast majority of people don't have the will or capacity to do this.
This morning at 4:13 p.m. CEST it arrived at the North Gate of the airport #Kabul a firefight between Afghan security forces and unknown attackers. An Afghan security force was killed and three others wounded....
American and German forces were also involved in the further course of the battle. All soldiers of the #BundeswehrimEinsatz are unharmed.
Totally off topic - one for the moth experts. My parents have this one in the garden and cannot identify it. Anyone know what it is? https://imgur.com/a/HQWL0BR
So I'm single dosed with Pfizer, about 5 weeks in (after a major fight with the NHS who in their all-knowing wisdom had binned my medical records because I've failed miserably to be ill enough to see a doctor for years, thus couldn't book me a jab).
Saturday I had a bit of a sore throat / headache. Sunday morning I still had them, plus a bit of a fever, and flu like aching joints. Spent most of Sunday in bed feeling grim. No lose of taste or smell, no cough, sneezed a couple of times but not persistently. Concluded it was probably manflu.
Was chatting to my young lady (she's 165 miles away) and she insisted I took a LFT - came up strongly positive in seconds.
Got a drive through PCR to go to this morning, but I'm pretty sure it will be positive. Feeling a bit better this morning - still got a terrible sore throat (getting a throat swab for the PCR may actually cause so much pain I won't be able to do it - the LFT was a nasal one), but no fever.
Looks like I get 10 days isolation at home, which feels as if its probably going to be a bit silly - at the current rate of progress I think I'll be back to normal (and thus not infectious) in another couple of days.
Re your first paragraph, people moving house, and therefore likely GP, but no-one being told, has been a problem has been a problem for the NHS for years. Especially in areas like East London with a lot of short-term rentals.
The real NHS postcode lottery is the delivery of GP services. Our current GP practice is hideously poor. You get to see real differences in GPs when you move about the country, or even an area.
As an example: the little 'un had some jabs at ?four? years old. One in each arm. The next morning, one had come up with a 50-p sized redness. It was not bothering him, but I told the teacher. I got a phone call at lunchtime from the school telling me that his arm was swollen; they had fetched the nurse from the adjacent village college who had said he needed to see a doctor immediately.
I got his medical book and phoned the GP surgery. I told them a school nurse had said he needed to see a doctor, and they said they'd book him in the next week. They were adamant.
I went to the school, and his entire arm was swollen and red, and he had a fever. I had two choices: to take him to A&E, or try the doctor first as it was much nearer. I did the latter, stood in the queue, and when I reached the front, they said I'd have to take the original appointment. So I took his shirt off in the queue and showed them his arm, and explained it was an injection done at their surgery.
Five minutes later, I was in with a doctor. They called in the nurse who gave the injections, who could not remember which injection had gone into which arm.
Fortunately he was okay after a couple of days, but we still don't know which injection he had the reaction to ...
And this was one story of many. They really are utterly hopeless, yet there is not much chance of a change.
At one time I was professionally concerned with GP services and standards, and have no trouble in believing your story. It's like the little girl, isn't it. When they're good, they're very, very good, but when they're bad ...... Not sure about the situation now, but training of receptionists, the front-line staff, the people who control access used to be 'inadequate. Too often it appeared to patients that the receptionists duty was to 'protect' the GP from patients. And record-keeping, especially in the days of hand-writing could be abysmal.
IMHO the basic problem is the contractual system; GP's are usually (not invariably nowadays) small businesses, possibly single handed, maybe 2+ partners 'in contract' to provide services, perhaps with a practice manager, maybe not. And while some of those services are essential, some can be cherry-picked.
You're quite right that if people don't move about, they can't compare; I'm prepared to bet (!) that if I went to the practice where you had your awful experience I could find a few patients who thought the place was wonderful.
Perhaps, but talking to people, there wouldn't be many. I know of several families who have oved surgery to the nearest village, and one who has somehow moved to one on St Neots, eight miles away ...
Another story: I needed an urgent scan on my lungs. It is arranged and I go to Hinchinbrooke. A couple of days later I get a letter from the doctor saying the results are in. So I turn up with Mrs J, who is very worried, and the doctor doesn't know anything about it. I show him a letter, from the GP surgery, with his name, telling me to come in for the results. We wait, but they cannot find them. The result was that I had to take time off and go back to Hunchinbrooke for more scans...
The surgery blamed Hinchinbrooke. But I doubt it: why did the GP surgery send me a letter saying they had the results, along with an appointment time?
We have other stories, and I have heard worse from other people. Yet our previous GP in Romsey (Southampton, not Town), was superb: proactive, efficient, professional. And the one before that south of Cambridge was the same.
I wonder what GP services will be put in place for Cambourne West.
As far as I can tell, just an expansion to the existing surgery because of ' economies of scale'. Which will probably involve moving the library, or reducing it in size.
I have no idea if this is true, but a couple of people have said that the issue is that GP surgeries get paid not just by population, but by age as well. Since we have a very young population, they get less funding than if we we had more elderly people.
Anyone know if that's correct?
GP funding is quite complex. There is percapita funding and there is age weighting, but also bonuses for meeting vaccination targets in children etc.
Thanks for that. I've actually noticed the following in the document I linked to earlier: " Monkfield Medical Practice (MMP) had extra funding to start with because of the new town factor, this has now stopped. The Carr-Hill Formula is the main funding formula for medical practices and it takes account of average population: you get extra funding for older people living in the area.
Cambourne’s age distribution doesn’t fit the classic bell shape. Under this formula MMP stood to lose half its funding. They wrote a bid for exceptional case funding, which was successful but they will still lose £100,000 of funding. However they have been told by the Primary Care Trust (PCT) that this is as good as we can get so the situation has changed as MMP is no longer trying to kick up a fuss about the funding, they are trying to make the best of it. They are looking at where they can make cutbacks internally, e.g. by sending patients text messages, rather than sending letters. Their system sends automated text reminders for appointments. There were 300 appointments in November that people didn’t attend, which represents a huge amount of money lost.
Comment from audience: “you should charge the people who do not attend”. MMP: “unfortunately we can’t”. "
Comment from audience: how is money lost? Isn't it more likely that someone has naively averaged fixed costs over time and decided a ten minute appointment costs £50 or whatever, forgetting that the fixed costs are, well, fixed, and they have to pay the doctor, receptionist and rates whether people turn up or not?
I don't know, and that's a good question.
What was interesting about the above is that the practice was set to lose half its funding because of its age demographic. Even with the exceptional case funding, it might explain some of the issues we've had with them.
I suspect that means half the extra funding it has had. I find it very, very difficult to believe that any practice lost half it's funding unless circumstances were truly exceptional.... half the GP's left and took their share of the patients or something like that. Secondly this can't be a recent letter; PCT's were abolished by the Lansley 'reforms' (which were meant to put more power in the hands of GP's) almost ten years ago.
I took it to mean it loses half its funding because we have a non-standard age demographic, when compared to a practice that has a standard age demographic. Perhaps that's wrong, though.
Sadly I have experience of misleading quasi-political statements from GP practices seeking to justify something or other. Generally a reduction in services.
General Practice has changed a lot organisationally in recent years, with smaller practices amalgamating, with the rise of mega-practices. It is the directors of these 200+ Dr practices that are the ones that you see with the very big renumeration. They use salaried staff rather than partners, and often lots of locums. Quality of care is often an issue, particularly with many refusing face to face contacts.
There are some very good GPs and it is a hard job to do well, but very patchy. I saw a middle aged diabetic last week with no blood tests for 4 years. That isn't covid, just bad medicine.
Because we're all interested in politics, we're tempted to draw political conclusions from anecedotal evidence. Experiencing medicine in four countries (Austria, Denmark, Switzerland, UK with half a dozen different GPs as I moved around for work), my view FWIW is that there's a good deal of random variation and no one set of GPs really stands out as better or worse. Because it's not done to denounce a bad doctor in the way that you would a sloppy supermarket (you were ill, maybe you weren't seeing things clearly, and he's got lots of degrees and other patients seem happy...), it's difficult to get a clear picture.
My father had a private specialist who accidentally prescribed him at 10 times the correct dose, and it was only after he repeatedly told the doctor that he was sleeping all day, every day and surely this couldn't be quite right did the specialist deign to check. Another relative had an NHS GP who switched her depression medication to Prozac and refused to believe that it wouldn't work, as a result of which she lost her job and had two years of deep depression. I'm not convinced that either case tells us anything except that if things are clearly going wrong you shouldn't just assume your doctor is right but get a second opinion.
My own experience is that NHS treatment is generally very good, but record-keeping used to be totally crap and has now improved to so-so and computerisation took hold. but that's anecdotal too. Seeing someone outside your home area remains challenging - why there was so much opposition to a national database with all medical records still baffles me.
On the latter point, if there were a national medical database then, first, it is a short step to ID cards. Second and perhaps more importantly, the government would have sold it off to some American big pharma concern. And it would be hosted on American servers anyway. And it would have been hacked, and even if it hadn't, some plank in Whitehall would have taken a copy and lost it on the tube.
On seeing doctors outside your home area, besides MPs who commute between London and constituency homes, who cares?
General Practice has changed a lot organisationally in recent years, with smaller practices amalgamating, with the rise of mega-practices. It is the directors of these 200+ Dr practices that are the ones that you see with the very big renumeration. They use salaried staff rather than partners, and often lots of locums. Quality of care is often an issue, particularly with many refusing face to face contacts.
There are some very good GPs and it is a hard job to do well, but very patchy. I saw a middle aged diabetic last week with no blood tests for 4 years. That isn't covid, just bad medicine.
Because we're all interested in politics, we're tempted to draw political conclusions from anecedotal evidence. Experiencing medicine in four countries (Austria, Denmark, Switzerland, UK with half a dozen different GPs as I moved around for work), my view FWIW is that there's a good deal of random variation and no one set of GPs really stands out as better or worse. Because it's not done to denounce a bad doctor in the way that you would a sloppy supermarket (you were ill, maybe you weren't seeing things clearly, and he's got lots of degrees and other patients seem happy...), it's difficult to get a clear picture.
My father had a private specialist who accidentally prescribed him at 10 times the correct dose, and it was only after he repeatedly told the doctor that he was sleeping all day, every day and surely this couldn't be quite right did the specialist deign to check. Another relative had an NHS GP who switched her depression medication to Prozac and refused to believe that it wouldn't work, as a result of which she lost her job and had two years of deep depression. I'm not convinced that either case tells us anything except that if things are clearly going wrong you shouldn't just assume your doctor is right but get a second opinion.
My own experience is that NHS treatment is generally very good, but record-keeping used to be totally crap and has now improved to so-so and computerisation took hold. but that's anecdotal too. Seeing someone outside your home area remains challenging - why there was so much opposition to a national database with all medical records still baffles me.
On the latter point, if there were a national medical database then, first, it is a short step to ID cards. Second and perhaps more importantly, the government would have sold it off to some American big pharma concern. And it would be hosted on American servers anyway. And it would have been hacked, and even if it hadn't, some plank in Whitehall would have taken a copy and lost it on the tube.
On seeing doctors outside your home area, besides MPs who commute between London and constituency homes, who cares?
You are on holiday in Norfolk (god help you) and get struck down with XXXX. You are hospitalised, ICU, the lot. Spend the next few days/weeks in hospital with a cocktail of meds, secondary investigations, etc.
General Practice has changed a lot organisationally in recent years, with smaller practices amalgamating, with the rise of mega-practices. It is the directors of these 200+ Dr practices that are the ones that you see with the very big renumeration. They use salaried staff rather than partners, and often lots of locums. Quality of care is often an issue, particularly with many refusing face to face contacts.
There are some very good GPs and it is a hard job to do well, but very patchy. I saw a middle aged diabetic last week with no blood tests for 4 years. That isn't covid, just bad medicine.
Because we're all interested in politics, we're tempted to draw political conclusions from anecedotal evidence. Experiencing medicine in four countries (Austria, Denmark, Switzerland, UK with half a dozen different GPs as I moved around for work), my view FWIW is that there's a good deal of random variation and no one set of GPs really stands out as better or worse. Because it's not done to denounce a bad doctor in the way that you would a sloppy supermarket (you were ill, maybe you weren't seeing things clearly, and he's got lots of degrees and other patients seem happy...), it's difficult to get a clear picture.
My father had a private specialist who accidentally prescribed him at 10 times the correct dose, and it was only after he repeatedly told the doctor that he was sleeping all day, every day and surely this couldn't be quite right did the specialist deign to check. Another relative had an NHS GP who switched her depression medication to Prozac and refused to believe that it wouldn't work, as a result of which she lost her job and had two years of deep depression. I'm not convinced that either case tells us naything except that if things are clearly going wrong you shouldn't just assume your doctor is right but get a second opinion.
My own experience is that NHS treatment is generally very good, but record-keeping used to be totally crap and has now improved to so-so and computerisation took hold. but that's anecdotal too. Seeing someone outside your home area remains challenging - why there was so much opposition to a national database with all medical records still baffles me.
Good last point. Moving around (on account of incidence vs home vs other factors) means that no one knows what the last input was and you too often have to start again.
As for you "shouldn't just assume your doctor is right", you answer it yourself when you say "it's not done to denounce a bad doctor" (and how the F would you know they are bad). To do so is a huge ask for much of the population. Your doctor is a figure of authority and who exactly do you ask for this second opinion? The doctor you think might have it wrong? Describe for me if you would that conversation. The vast majority of people don't have the will or capacity to do this.
Most community pharmacists can recollect an unpleasant experience suffered when trying to point out to a GP that Homer had nodded.
Mr. Richard, when I watched local news, few years ago, almost all complaints about HS2 were that it wasn't going to a place and fears it may end up being cancelled here.
If it goes to Manchester/Lancashire and not Leeds/Yorkshire, people will not be pleased.
Do you really think that people want disruption in order to gain something they may never use ?
Now you can buy off the people who will be inconvenienced but that's going to cost even more money.
Which is difficult when there are so many other demands on government spending.
That's a very narrow way of looking at it. "I don't need it, therefore no-one should have it." For one thing, their circumstances may change, and they may need to use it. Or their friends or relatives. It will also bring in more investment and jobs.
There are vast amounts of infrastructure that people nearby never use. Many people living near motorways will rarely, or never, use them. But the trucks carrying their food to the supermarket might, or their relatives when they come to visit. Or it might reduce the traffic on the local roads.
The same is true for railways: just because you don't use a particular line, doesn't mean you never will, or that its existence is bad for the country.
I don't use the new A14 Huntingdon bypass despite living near it, but I'm glad it was built. It's good for the area as a whole.
In what sense is Scotland's drug deaths emergency an emergency if it's been going on for years? Trainspotting was made in the 90s. To be fair to the Daily Record (and to prove I followed the link before commenting) at least its headline writer said crisis which is slightly better.
As for your "shouldn't just assume your doctor is right", you answer it yourself when you say "it's not done to denounce a bad doctor" (and how the F would you know they are bad). To do so is a huge ask for much of the population. Your doctor is a figure of authority and who exactly do you ask for this second opinion? The doctor you think might have it wrong? Describe for me if you would that conversation. The vast majority of people don't have the will or capacity to do this.
Yes, exactly, especially if you're not well. I wasn't saying people ought to do it - I absolutely see why they don't, except in 1-1 gossip with friends which you can't rely on anyway.
But I think that without going as far as to say "my doctor is crap", if the treatment given is persistently not helping, it's reasonable to change practice or just to say "No offence, but I'd like a second opinion, please." The doctor is legally required to facilitate it (I think).
Clearly while most US voters still support the withdrawal they disagree with the way Biden has managed it. In particular decisions such as that to remove the military before all civilians and US allies and westerners were evacuated, leading to the chaotic scenes at Kabul airport.
Note too that 60% of US voters in the CBS poll think the Taliban's return makes it more likely terrorism will return. If that leads to another terrorist attack on US soil before 2024 then Biden and Harris are likely toast, with only Buttigieg having a chance of stopping Trump's return to the Oval Office
General Practice has changed a lot organisationally in recent years, with smaller practices amalgamating, with the rise of mega-practices. It is the directors of these 200+ Dr practices that are the ones that you see with the very big renumeration. They use salaried staff rather than partners, and often lots of locums. Quality of care is often an issue, particularly with many refusing face to face contacts.
There are some very good GPs and it is a hard job to do well, but very patchy. I saw a middle aged diabetic last week with no blood tests for 4 years. That isn't covid, just bad medicine.
Because we're all interested in politics, we're tempted to draw political conclusions from anecedotal evidence. Experiencing medicine in four countries (Austria, Denmark, Switzerland, UK with half a dozen different GPs as I moved around for work), my view FWIW is that there's a good deal of random variation and no one set of GPs really stands out as better or worse. Because it's not done to denounce a bad doctor in the way that you would a sloppy supermarket (you were ill, maybe you weren't seeing things clearly, and he's got lots of degrees and other patients seem happy...), it's difficult to get a clear picture.
My father had a private specialist who accidentally prescribed him at 10 times the correct dose, and it was only after he repeatedly told the doctor that he was sleeping all day, every day and surely this couldn't be quite right did the specialist deign to check. Another relative had an NHS GP who switched her depression medication to Prozac and refused to believe that it wouldn't work, as a result of which she lost her job and had two years of deep depression. I'm not convinced that either case tells us anything except that if things are clearly going wrong you shouldn't just assume your doctor is right but get a second opinion.
My own experience is that NHS treatment is generally very good, but record-keeping used to be totally crap and has now improved to so-so and computerisation took hold. but that's anecdotal too. Seeing someone outside your home area remains challenging - why there was so much opposition to a national database with all medical records still baffles me.
On the latter point, if there were a national medical database then, first, it is a short step to ID cards. Second and perhaps more importantly, the government would have sold it off to some American big pharma concern. And it would be hosted on American servers anyway. And it would have been hacked, and even if it hadn't, some plank in Whitehall would have taken a copy and lost it on the tube.
On seeing doctors outside your home area, besides MPs who commute between London and constituency homes, who cares?
You are on holiday in Norfolk (god help you) and get struck down with XXXX. You are hospitalised, ICU, the lot. Spend the next few days/weeks in hospital with a cocktail of meds, secondary investigations, etc.
You finally return home to Bristol.
Yes of course there are edge cases but for most people an edge case is just that. The reason it took up so much time in Westminster is that MPs are potentially affected every week, especially those with chronic conditions, not once a year if that.
General Practice has changed a lot organisationally in recent years, with smaller practices amalgamating, with the rise of mega-practices. It is the directors of these 200+ Dr practices that are the ones that you see with the very big renumeration. They use salaried staff rather than partners, and often lots of locums. Quality of care is often an issue, particularly with many refusing face to face contacts.
There are some very good GPs and it is a hard job to do well, but very patchy. I saw a middle aged diabetic last week with no blood tests for 4 years. That isn't covid, just bad medicine.
Because we're all interested in politics, we're tempted to draw political conclusions from anecedotal evidence. Experiencing medicine in four countries (Austria, Denmark, Switzerland, UK with half a dozen different GPs as I moved around for work), my view FWIW is that there's a good deal of random variation and no one set of GPs really stands out as better or worse. Because it's not done to denounce a bad doctor in the way that you would a sloppy supermarket (you were ill, maybe you weren't seeing things clearly, and he's got lots of degrees and other patients seem happy...), it's difficult to get a clear picture.
My father had a private specialist who accidentally prescribed him at 10 times the correct dose, and it was only after he repeatedly told the doctor that he was sleeping all day, every day and surely this couldn't be quite right did the specialist deign to check. Another relative had an NHS GP who switched her depression medication to Prozac and refused to believe that it wouldn't work, as a result of which she lost her job and had two years of deep depression. I'm not convinced that either case tells us naything except that if things are clearly going wrong you shouldn't just assume your doctor is right but get a second opinion.
My own experience is that NHS treatment is generally very good, but record-keeping used to be totally crap and has now improved to so-so and computerisation took hold. but that's anecdotal too. Seeing someone outside your home area remains challenging - why there was so much opposition to a national database with all medical records still baffles me.
Good last point. Moving around (on account of incidence vs home vs other factors) means that no one knows what the last input was and you too often have to start again.
As for you "shouldn't just assume your doctor is right", you answer it yourself when you say "it's not done to denounce a bad doctor" (and how the F would you know they are bad). To do so is a huge ask for much of the population. Your doctor is a figure of authority and who exactly do you ask for this second opinion? The doctor you think might have it wrong? Describe for me if you would that conversation. The vast majority of people don't have the will or capacity to do this.
Most community pharmacists can recollect an unpleasant experience suffered when trying to point out to a GP that Homer had nodded.
At one point several years ago I stood in the middle of a ward at Addenbrooke's during the consultant's round (with a gaggle of whatevers in tow) and shouted at him that unless (my mother) was treated in the next two days I would call the police. And she was and I would have done.
He really, really didn't like that, as you can imagine.
Few things are less cherry at the start of a week than reading about GP mistakes.
So given covid backlogs to medical treatment is private medical insurance ** now worth it ?
Or would paying for private consultancy or treatment if required be a better ?
** Affordable but more than double the cost of home and car insurance combined.
Look carefully at the cover. Most policies require a GP referral to cover payment, and there are significant excesses and exclusions. Many policies will refuse cover for chronic conditions (lasting greater than 6 weeks) or those where NHS is available on a reasonable timescale. Every month I have a Private patient who is annoyed at their refusal of cover by the insurance company that they were relying on.
That said, waiting lists have mushroomed for elective procedures and even for outpatient appointments. In my dept we are now booking routine referrals to outpatients from Dec 2020.
Self funding private care is a reasonable option, and putting those premiums into a savings pot instead of an insurance company gives you control and flexibility. You get to keep the money too if unused.
A lot depends on your own financial resources and existing health status and risks.
Totally off topic - one for the moth experts. My parents have this one in the garden and cannot identify it. Anyone know what it is? https://imgur.com/a/HQWL0BR
General Practice has changed a lot organisationally in recent years, with smaller practices amalgamating, with the rise of mega-practices. It is the directors of these 200+ Dr practices that are the ones that you see with the very big renumeration. They use salaried staff rather than partners, and often lots of locums. Quality of care is often an issue, particularly with many refusing face to face contacts.
There are some very good GPs and it is a hard job to do well, but very patchy. I saw a middle aged diabetic last week with no blood tests for 4 years. That isn't covid, just bad medicine.
Because we're all interested in politics, we're tempted to draw political conclusions from anecedotal evidence. Experiencing medicine in four countries (Austria, Denmark, Switzerland, UK with half a dozen different GPs as I moved around for work), my view FWIW is that there's a good deal of random variation and no one set of GPs really stands out as better or worse. Because it's not done to denounce a bad doctor in the way that you would a sloppy supermarket (you were ill, maybe you weren't seeing things clearly, and he's got lots of degrees and other patients seem happy...), it's difficult to get a clear picture.
My father had a private specialist who accidentally prescribed him at 10 times the correct dose, and it was only after he repeatedly told the doctor that he was sleeping all day, every day and surely this couldn't be quite right did the specialist deign to check. Another relative had an NHS GP who switched her depression medication to Prozac and refused to believe that it wouldn't work, as a result of which she lost her job and had two years of deep depression. I'm not convinced that either case tells us naything except that if things are clearly going wrong you shouldn't just assume your doctor is right but get a second opinion.
My own experience is that NHS treatment is generally very good, but record-keeping used to be totally crap and has now improved to so-so and computerisation took hold. but that's anecdotal too. Seeing someone outside your home area remains challenging - why there was so much opposition to a national database with all medical records still baffles me.
Good last point. Moving around (on account of incidence vs home vs other factors) means that no one knows what the last input was and you too often have to start again.
As for you "shouldn't just assume your doctor is right", you answer it yourself when you say "it's not done to denounce a bad doctor" (and how the F would you know they are bad). To do so is a huge ask for much of the population. Your doctor is a figure of authority and who exactly do you ask for this second opinion? The doctor you think might have it wrong? Describe for me if you would that conversation. The vast majority of people don't have the will or capacity to do this.
One of the biggest bugbears people have is GP receptionists. Too often they come across as rude, and as trying to actively stop you seeing the medical staff. Not fair for all. I'm sure. It doesn't help that they ask patients about their conditions, presumably as a basic form a triage. Most patients rightly suspect that they do not have medical training, certainly nothing beyond a basic 'how do you triage a patient in the GP surgery', and get very annoyed at this. And yet there probably is a good reason for doing this - to make sure the patient gets to the right medical practitioner (be it GP, nurses, pharmacists). Maybe there needs to be a way to change the messaging?
As for your "shouldn't just assume your doctor is right", you answer it yourself when you say "it's not done to denounce a bad doctor" (and how the F would you know they are bad). To do so is a huge ask for much of the population. Your doctor is a figure of authority and who exactly do you ask for this second opinion? The doctor you think might have it wrong? Describe for me if you would that conversation. The vast majority of people don't have the will or capacity to do this.
Yes, exactly, especially if you're not well. I wasn't saying people ought to do it - I absolutely see why they don't, except in 1-1 gossip with friends which you can't rely on anyway.
But I think that without going as far as to say "my doctor is crap", if the treatment given is persistently not helping, it's reasonable to change practice or just to say "No offence, but I'd like a second opinion, please." The doctor is legally required to facilitate it (I think).
I think a sense of fairness also comes into it. Most people realise that a GP's job cannot be easy at times: having to deal with patients who are often not the nicest people, and often all the worse for being in pain or discomfort. I find it hard to describe symptoms at times, and interpreting what people say might be difficult for a whole host of reasons. Then you get the patients who turn up regularly for vague complaints.
In the anecdotes I mention below, however, there was apparent incompetence. And that's what I find awful.
In addition: aiui it's hard to move surgery if you haven't moved house - according to some people who've tried.
Totally off topic - one for the moth experts. My parents have this one in the garden and cannot identify it. Anyone know what it is? https://imgur.com/a/HQWL0BR
As for your "shouldn't just assume your doctor is right", you answer it yourself when you say "it's not done to denounce a bad doctor" (and how the F would you know they are bad). To do so is a huge ask for much of the population. Your doctor is a figure of authority and who exactly do you ask for this second opinion? The doctor you think might have it wrong? Describe for me if you would that conversation. The vast majority of people don't have the will or capacity to do this.
Yes, exactly, especially if you're not well. I wasn't saying people ought to do it - I absolutely see why they don't, except in 1-1 gossip with friends which you can't rely on anyway.
But I think that without going as far as to say "my doctor is crap", if the treatment given is persistently not helping, it's reasonable to change practice or just to say "No offence, but I'd like a second opinion, please." The doctor is legally required to facilitate it (I think).
Many many years ago I went to my then local GP for some condition or other of my elbow and without looking at the offending elbow he referred me to a private consultant. Where he had a connection.
I responded that how could he just refer me to someone without even looking at the symptoms, etc, and a couple of weeks after that I received a letter (that's how long ago it was) to tell me that I was no longer a patient at that practice.
I would have complained/raised merry hell but the practice was at the time treating my father who was quite unwell so I didn't want to rock the boat.
Mr. Richard, when I watched local news, few years ago, almost all complaints about HS2 were that it wasn't going to a place and fears it may end up being cancelled here.
If it goes to Manchester/Lancashire and not Leeds/Yorkshire, people will not be pleased.
First irony is that this is whatever the opposite of pork-barrelling is; the new Conservative strength is more in the East of the country, and those are the places that would benefit more (either directly or indirectly) from HS2 to Leeds. Unless there's a worked-out theory that HS2 would just import more Citizens of Nowhere to places that are currently marginally Conservative. If Romford is anything to go by, the last thing some people want is a load of poncy London commuters moving in with their fancy coffee shops, avocado toast and e-scooters.
Second irony is that, if the plan isn't to cancel this bit of HS2, just to postpone it (like Foreign Aid), you get the worst of both worlds. The planning blight will continue, there will be the costs of keeping the scheme ticking over but the benefits of the new line will be delayed.
Clearly while most US voters still support the withdrawal they disagree with the way Biden has managed it. In particular decisions such as that to remove the military before all civilians and US allies and westerners were evacuated, leading to the chaotic scenes at Kabul airport.
Note too that 60% of US voters in the CBS poll think the Taliban's return makes it more likely terrorism will return. If that leads to another terrorist attack on US soil before 2024 then Biden and Harris are likely toast, with only Buttigieg having a chance of stopping Trump's return to the Oval Office
Voter cognitive dissonance at play here. They supported the withdrawal even though it turns out it was a bad / unnecessary thing to do.
Much like with Iraq. If you supported the invasion, you should have been doing so on the basis of how it was likely to be conducted, not on how you would like it to have been.
It didn’t take too long with Iraq for the cognitive dissonance to dissipate and instead voters pretended to themselves they had never supported the invasion, rather than just that “it was the right thing but done badly”.
If the same happens here then it’s a really big problem for the Democrat Party.
As for your "shouldn't just assume your doctor is right", you answer it yourself when you say "it's not done to denounce a bad doctor" (and how the F would you know they are bad). To do so is a huge ask for much of the population. Your doctor is a figure of authority and who exactly do you ask for this second opinion? The doctor you think might have it wrong? Describe for me if you would that conversation. The vast majority of people don't have the will or capacity to do this.
Yes, exactly, especially if you're not well. I wasn't saying people ought to do it - I absolutely see why they don't, except in 1-1 gossip with friends which you can't rely on anyway.
But I think that without going as far as to say "my doctor is crap", if the treatment given is persistently not helping, it's reasonable to change practice or just to say "No offence, but I'd like a second opinion, please." The doctor is legally required to facilitate it (I think).
Locally anyway, it's easier to count the teeth in a hen than to change GP's.
I'm out of the touch with the details now, but a GP used at least to be able to remove a patient from their list if the 'relationship had broken down'. And, if my memory is correct, some were more likely to have difficulty in maintaining relationships than others.
General Practice has changed a lot organisationally in recent years, with smaller practices amalgamating, with the rise of mega-practices. It is the directors of these 200+ Dr practices that are the ones that you see with the very big renumeration. They use salaried staff rather than partners, and often lots of locums. Quality of care is often an issue, particularly with many refusing face to face contacts.
There are some very good GPs and it is a hard job to do well, but very patchy. I saw a middle aged diabetic last week with no blood tests for 4 years. That isn't covid, just bad medicine.
Because we're all interested in politics, we're tempted to draw political conclusions from anecedotal evidence. Experiencing medicine in four countries (Austria, Denmark, Switzerland, UK with half a dozen different GPs as I moved around for work), my view FWIW is that there's a good deal of random variation and no one set of GPs really stands out as better or worse. Because it's not done to denounce a bad doctor in the way that you would a sloppy supermarket (you were ill, maybe you weren't seeing things clearly, and he's got lots of degrees and other patients seem happy...), it's difficult to get a clear picture.
My father had a private specialist who accidentally prescribed him at 10 times the correct dose, and it was only after he repeatedly told the doctor that he was sleeping all day, every day and surely this couldn't be quite right did the specialist deign to check. Another relative had an NHS GP who switched her depression medication to Prozac and refused to believe that it wouldn't work, as a result of which she lost her job and had two years of deep depression. I'm not convinced that either case tells us anything except that if things are clearly going wrong you shouldn't just assume your doctor is right but get a second opinion.
My own experience is that NHS treatment is generally very good, but record-keeping used to be totally crap and has now improved to so-so and computerisation took hold. but that's anecdotal too. Seeing someone outside your home area remains challenging - why there was so much opposition to a national database with all medical records still baffles me.
On the latter point, if there were a national medical database then, first, it is a short step to ID cards. Second and perhaps more importantly, the government would have sold it off to some American big pharma concern. And it would be hosted on American servers anyway. And it would have been hacked, and even if it hadn't, some plank in Whitehall would have taken a copy and lost it on the tube.
On seeing doctors outside your home area, besides MPs who commute between London and constituency homes, who cares?
You are on holiday in Norfolk (god help you) and get struck down with XXXX. You are hospitalised, ICU, the lot. Spend the next few days/weeks in hospital with a cocktail of meds, secondary investigations, etc.
You finally return home to Bristol.
Yes of course there are edge cases but for most people an edge case is just that. The reason it took up so much time in Westminster is that MPs are potentially affected every week, especially those with chronic conditions, not once a year if that.
I'm not sure that falling ill or having an accident outside your home area is an edge case but I don't have the stats so can't say. And nor can you, obvs.
General Practice has changed a lot organisationally in recent years, with smaller practices amalgamating, with the rise of mega-practices. It is the directors of these 200+ Dr practices that are the ones that you see with the very big renumeration. They use salaried staff rather than partners, and often lots of locums. Quality of care is often an issue, particularly with many refusing face to face contacts.
There are some very good GPs and it is a hard job to do well, but very patchy. I saw a middle aged diabetic last week with no blood tests for 4 years. That isn't covid, just bad medicine.
Because we're all interested in politics, we're tempted to draw political conclusions from anecedotal evidence. Experiencing medicine in four countries (Austria, Denmark, Switzerland, UK with half a dozen different GPs as I moved around for work), my view FWIW is that there's a good deal of random variation and no one set of GPs really stands out as better or worse. Because it's not done to denounce a bad doctor in the way that you would a sloppy supermarket (you were ill, maybe you weren't seeing things clearly, and he's got lots of degrees and other patients seem happy...), it's difficult to get a clear picture.
My father had a private specialist who accidentally prescribed him at 10 times the correct dose, and it was only after he repeatedly told the doctor that he was sleeping all day, every day and surely this couldn't be quite right did the specialist deign to check. Another relative had an NHS GP who switched her depression medication to Prozac and refused to believe that it wouldn't work, as a result of which she lost her job and had two years of deep depression. I'm not convinced that either case tells us anything except that if things are clearly going wrong you shouldn't just assume your doctor is right but get a second opinion.
My own experience is that NHS treatment is generally very good, but record-keeping used to be totally crap and has now improved to so-so and computerisation took hold. but that's anecdotal too. Seeing someone outside your home area remains challenging - why there was so much opposition to a national database with all medical records still baffles me.
The reason there is so much opposition to a national database is simple Nick. We don't trust the politicians not to sell it to dodgy people and we don't trust civil servants not to leave it unencrypted on a bus.
Totally off topic - one for the moth experts. My parents have this one in the garden and cannot identify it. Anyone know what it is? https://imgur.com/a/HQWL0BR
Few things are less cherry at the start of a week than reading about GP mistakes.
So given covid backlogs to medical treatment is private medical insurance ** now worth it ?
Or would paying for private consultancy or treatment if required be a better ?
** Affordable but more than double the cost of home and car insurance combined.
Look carefully at the cover. Most policies require a GP referral to cover payment, and there are significant excesses and exclusions. Many policies will refuse cover for chronic conditions (lasting greater than 6 weeks) or those where NHS is available on a reasonable timescale. Every month I have a Private patient who is annoyed at their refusal of cover by the insurance company that they were relying on.
That said, waiting lists have mushroomed for elective procedures and even for outpatient appointments. In my dept we are now booking routine referrals to outpatients from Dec 2020.
Self funding private care is a reasonable option, and putting those premiums into a savings pot instead of an insurance company gives you control and flexibility. You get to keep the money too if unused.
A lot depends on your own financial resources and existing health status and risks.
Thanks, that's very helpful.
The self-funding if necessary option looks the best for me.
As for your "shouldn't just assume your doctor is right", you answer it yourself when you say "it's not done to denounce a bad doctor" (and how the F would you know they are bad). To do so is a huge ask for much of the population. Your doctor is a figure of authority and who exactly do you ask for this second opinion? The doctor you think might have it wrong? Describe for me if you would that conversation. The vast majority of people don't have the will or capacity to do this.
Yes, exactly, especially if you're not well. I wasn't saying people ought to do it - I absolutely see why they don't, except in 1-1 gossip with friends which you can't rely on anyway.
But I think that without going as far as to say "my doctor is crap", if the treatment given is persistently not helping, it's reasonable to change practice or just to say "No offence, but I'd like a second opinion, please." The doctor is legally required to facilitate it (I think).
Locally anyway, it's easier to count the teeth in a hen than to change GP's.
I'm out of the touch with the details now, but a GP used at least to be able to remove a patient from their list if the 'relationship had broken down'. And, if my memory is correct, some were more likely to have difficulty in maintaining relationships than others.
Yes, staff have a right to refuse to deal with abusive patients, with emergencies excepted. Rightly so.
Totally off topic - one for the moth experts. My parents have this one in the garden and cannot identify it. Anyone know what it is? https://imgur.com/a/HQWL0BR
Relating this back to doctors, maybe this is not a mint moth but something else that looks like one. That is the danger of diagnosis by Dr Google. A moth expert would know if that spot pattern is common and you really need to look at the antennae, or something. Same with dermatologists.
Few things are less cherry at the start of a week than reading about GP mistakes.
So given covid backlogs to medical treatment is private medical insurance ** now worth it ?
Or would paying for private consultancy or treatment if required be a better ?
** Affordable but more than double the cost of home and car insurance combined.
Look carefully at the cover. Most policies require a GP referral to cover payment, and there are significant excesses and exclusions. Many policies will refuse cover for chronic conditions (lasting greater than 6 weeks) or those where NHS is available on a reasonable timescale. Every month I have a Private patient who is annoyed at their refusal of cover by the insurance company that they were relying on.
That said, waiting lists have mushroomed for elective procedures and even for outpatient appointments. In my dept we are now booking routine referrals to outpatients from Dec 2020.
Self funding private care is a reasonable option, and putting those premiums into a savings pot instead of an insurance company gives you control and flexibility. You get to keep the money too if unused.
A lot depends on your own financial resources and existing health status and risks.
Getting private healthcare to pay out can be problematic. As many may know, I had a vast amount of problems with my ankle during my youth, including many operations. For a couple of years I had few problems, and thought it was over. Then it went wrong again, and I went back to my old surgeon. The healthcare provider refused to pay, as it was an 'old' injury.
The Prof. made a few phone calls, and threatened never to do any work for them again. Since he was slightly famous, we get an apology from the provider and they paid for a few more ops. Thanks to the Prof., I can walk and run. Without private healthcare, I have no doubt I would be slightly disabled.
Having said that, since many of the problems had been caused by a failed NHS op, there're problems there as well.
Interesting study from Israel suggesting limitations for the mRNA vaccine (would be interesting to see the comparable data in the UK for AZN).
Large-scale study of antibody titer decay following BNT162b2 mRNA vaccine or SARS-CoV-2 infection https://www.medrxiv.org/content/10.1101/2021.08.19.21262111v1 Immune protection following either vaccination or infection with SARS-CoV-2 decreases over time. Objective: To determine the kinetics of SARS-CoV-2 IgG antibodies following administration of two doses of BNT162b2 vaccine, or SARS-CoV-2 infection in unvaccinated individuals. Methods: Antibody titers were measured between January 31, 2021, and July 31, 2021 in two mutually exclusive groups: i) vaccinated individuals who received two doses of BNT162b2 vaccine and had no history of previous infection with COVID-19 and ii) SARS-CoV-2 convalescents who had not received the vaccine. Results: A total of 2,653 individuals fully vaccinated by two doses of vaccine during the study period and 4,361 convalescent patients were included. Higher SARS-CoV-2 IgG antibody titers were observed in vaccinated individuals (median 1581 AU/mL IQR [533.8-5644.6]) after the second vaccination, than in convalescent individuals (median 355.3 AU/mL IQR [141.2-998.7]; p<0.001). In vaccinated subjects, antibody titers decreased by up to 40% each subsequent month while in convalescents they decreased by less than 5% per month. Six months after BNT162b2 vaccination 16.1% subjects had antibody levels below the seropositivity threshold of <50 AU/mL, while only 10.8% of convalescent patients were below <50 AU/mL threshold after 9 months from SARS-CoV-2 infection. Conclusions: This study demonstrates individuals who received the Pfizer-BioNTech mRNA vaccine have different kinetics of antibody levels compared to patients who had been infected with the SARS-CoV-2 virus, with higher initial levels but a much faster exponential decrease in the first group...</i>
General Practice has changed a lot organisationally in recent years, with smaller practices amalgamating, with the rise of mega-practices. It is the directors of these 200+ Dr practices that are the ones that you see with the very big renumeration. They use salaried staff rather than partners, and often lots of locums. Quality of care is often an issue, particularly with many refusing face to face contacts.
There are some very good GPs and it is a hard job to do well, but very patchy. I saw a middle aged diabetic last week with no blood tests for 4 years. That isn't covid, just bad medicine.
Because we're all interested in politics, we're tempted to draw political conclusions from anecedotal evidence. Experiencing medicine in four countries (Austria, Denmark, Switzerland, UK with half a dozen different GPs as I moved around for work), my view FWIW is that there's a good deal of random variation and no one set of GPs really stands out as better or worse. Because it's not done to denounce a bad doctor in the way that you would a sloppy supermarket (you were ill, maybe you weren't seeing things clearly, and he's got lots of degrees and other patients seem happy...), it's difficult to get a clear picture.
My father had a private specialist who accidentally prescribed him at 10 times the correct dose, and it was only after he repeatedly told the doctor that he was sleeping all day, every day and surely this couldn't be quite right did the specialist deign to check. Another relative had an NHS GP who switched her depression medication to Prozac and refused to believe that it wouldn't work, as a result of which she lost her job and had two years of deep depression. I'm not convinced that either case tells us naything except that if things are clearly going wrong you shouldn't just assume your doctor is right but get a second opinion.
My own experience is that NHS treatment is generally very good, but record-keeping used to be totally crap and has now improved to so-so and computerisation took hold. but that's anecdotal too. Seeing someone outside your home area remains challenging - why there was so much opposition to a national database with all medical records still baffles me.
Good last point. Moving around (on account of incidence vs home vs other factors) means that no one knows what the last input was and you too often have to start again.
As for you "shouldn't just assume your doctor is right", you answer it yourself when you say "it's not done to denounce a bad doctor" (and how the F would you know they are bad). To do so is a huge ask for much of the population. Your doctor is a figure of authority and who exactly do you ask for this second opinion? The doctor you think might have it wrong? Describe for me if you would that conversation. The vast majority of people don't have the will or capacity to do this.
One of the biggest bugbears people have is GP receptionists. Too often they come across as rude, and as trying to actively stop you seeing the medical staff. Not fair for all. I'm sure. It doesn't help that they ask patients about their conditions, presumably as a basic form a triage. Most patients rightly suspect that they do not have medical training, certainly nothing beyond a basic 'how do you triage a patient in the GP surgery', and get very annoyed at this. And yet there probably is a good reason for doing this - to make sure the patient gets to the right medical practitioner (be it GP, nurses, pharmacists). Maybe there needs to be a way to change the messaging?
Don't disagree. I have never felt triaged by my local GP's receptionist and, in my many and various travels through the NHS have never come across a rude receptionist! Go figure.
But for a GP practice (assuming it is not private, where the GPs have their listed specialities) what triaging is there to be done? Unless you think they should have the right to refuse an appointment.
A friend who is an NHS GP said that a huge relief for them was when the app (no idea which one) was turned off at weekends which allowed people to instantly send a message to the surgery 24/7. She said that waiting a couple of days for the symptoms to dissipate meant that a far lower number of pings were received on the Mondays.
As for your "shouldn't just assume your doctor is right", you answer it yourself when you say "it's not done to denounce a bad doctor" (and how the F would you know they are bad). To do so is a huge ask for much of the population. Your doctor is a figure of authority and who exactly do you ask for this second opinion? The doctor you think might have it wrong? Describe for me if you would that conversation. The vast majority of people don't have the will or capacity to do this.
Yes, exactly, especially if you're not well. I wasn't saying people ought to do it - I absolutely see why they don't, except in 1-1 gossip with friends which you can't rely on anyway.
But I think that without going as far as to say "my doctor is crap", if the treatment given is persistently not helping, it's reasonable to change practice or just to say "No offence, but I'd like a second opinion, please." The doctor is legally required to facilitate it (I think).
Locally anyway, it's easier to count the teeth in a hen than to change GP's.
I'm out of the touch with the details now, but a GP used at least to be able to remove a patient from their list if the 'relationship had broken down'. And, if my memory is correct, some were more likely to have difficulty in maintaining relationships than others.
On the latter point, if there were a national medical database then, first, it is a short step to ID cards. Second and perhaps more importantly, the government would have sold it off to some American big pharma concern. And it would be hosted on American servers anyway. And it would have been hacked, and even if it hadn't, some plank in Whitehall would have taken a copy and lost it on the tube.
On seeing doctors outside your home area, besides MPs who commute between London and constituency homes, who cares?
Haven't you ever been ill while on holiday or away for some other reason? I was, in Switzerland. The hospital looked up my records (using my handy ID card, yes!) in 60 seconds flat - beat the hell out of waiting around while they called the surgery at the wekeend and tried to get the records from a locum or whatever happens here. If XYZ Inc or indeed a random Tube traveller got to look at my records too, I wouldn't have cared.
I know that some people have conditions they are worried about others seeing, so I'd be fine with an option to keep certain information out of the national database. But blood group, any allergy history, previous operations? The balance of risk is NOT having them readily available.
Few things are less cherry at the start of a week than reading about GP mistakes.
So given covid backlogs to medical treatment is private medical insurance ** now worth it ?
Or would paying for private consultancy or treatment if required be a better ?
** Affordable but more than double the cost of home and car insurance combined.
Look carefully at the cover. Most policies require a GP referral to cover payment, and there are significant excesses and exclusions. Many policies will refuse cover for chronic conditions (lasting greater than 6 weeks) or those where NHS is available on a reasonable timescale. Every month I have a Private patient who is annoyed at their refusal of cover by the insurance company that they were relying on.
That said, waiting lists have mushroomed for elective procedures and even for outpatient appointments. In my dept we are now booking routine referrals to outpatients from Dec 2020.
Self funding private care is a reasonable option, and putting those premiums into a savings pot instead of an insurance company gives you control and flexibility. You get to keep the money too if unused.
A lot depends on your own financial resources and existing health status and risks.
Thanks, that's very helpful.
The self-funding if necessary option looks the best for me.
It's what I do, though not needed to do so recently. I have the advantage that colleagues will often do free consultations, though investigations can be expensive.
The biggest worry is for the conditions that private hospitals do not cover, such as things needing ICU afterwards, which only a select few can provide. Recent maternity scandals all over the land too, as there is no real choice for most people.
As for your "shouldn't just assume your doctor is right", you answer it yourself when you say "it's not done to denounce a bad doctor" (and how the F would you know they are bad). To do so is a huge ask for much of the population. Your doctor is a figure of authority and who exactly do you ask for this second opinion? The doctor you think might have it wrong? Describe for me if you would that conversation. The vast majority of people don't have the will or capacity to do this.
Yes, exactly, especially if you're not well. I wasn't saying people ought to do it - I absolutely see why they don't, except in 1-1 gossip with friends which you can't rely on anyway.
But I think that without going as far as to say "my doctor is crap", if the treatment given is persistently not helping, it's reasonable to change practice or just to say "No offence, but I'd like a second opinion, please." The doctor is legally required to facilitate it (I think).
Locally anyway, it's easier to count the teeth in a hen than to change GP's.
I'm out of the touch with the details now, but a GP used at least to be able to remove a patient from their list if the 'relationship had broken down'. And, if my memory is correct, some were more likely to have difficulty in maintaining relationships than others.
Yes, staff have a right to refuse to deal with abusive patients, with emergencies excepted. Rightly so.
Indeed, there are some patients who are a pain, not in pain. I recall the drug addict who threatened 'uncooperative' health practitioners with an axe! He was on a rota among the local practices..... three months at each. It usually took him about that long to become abusive.
But there are major differences. The Öresund strait is shallow compared to Beaufort’s Dyke. It links Norway, Sweden and their hinterland to the Eurasian mainland, combined population 16 m + hinterland. Population of Ireland just 7 m and no hinterland, and it is not linking Ireland to the Eurasian mainland but to another island. Öresund was constructed just outside Denmark’s capital city and Sweden’s third largest city, in the heart of one of the industrial centres of Europe. Easy peasy to get nearby labour and supplies. Portpatrick? Err, no. But the real killer is rail. Demand for the Öresund section of track is absolutely humongous. Vast freight trains move over the bridge 24/7, 365 days a year. Ivor the Engine chugging over the Irish Sea is just never going to supply that volume of cash. (And aren’t the gauges different in Ireland and Scotland?) I could go on , but this is just a squirrel to detract from Johnson’s lack of policy.
Clearly while most US voters still support the withdrawal they disagree with the way Biden has managed it. In particular decisions such as that to remove the military before all civilians and US allies and westerners were evacuated, leading to the chaotic scenes at Kabul airport.
Note too that 60% of US voters in the CBS poll think the Taliban's return makes it more likely terrorism will return. If that leads to another terrorist attack on US soil before 2024 then Biden and Harris are likely toast, with only Buttigieg having a chance of stopping Trump's return to the Oval Office
Voter cognitive dissonance at play here. They supported the withdrawal even though it turns out it was a bad / unnecessary thing to do.
Much like with Iraq. If you supported the invasion, you should have been doing so on the basis of how it was likely to be conducted, not on how you would like it to have been.
It didn’t take too long with Iraq for the cognitive dissonance to dissipate and instead voters pretended to themselves they had never supported the invasion, rather than just that “it was the right thing but done badly”.
If the same happens here then it’s a really big problem for the Democrat Party.
I think that's fairly unlikely. They supported the withdrawal even though it turns out it was a bad / unnecessary thing to do. is your view; it's not necessarily that of the majority. I think it's more likely that in six months' time most people will have forgotten about it.
If Manchester gets HS2 and Leeds is delayed-not-cancelled-honest then that will not delight Yorkshire.
Luckily, it's not brimming with marginals.
It will delight those areas it would go through but not stop at.
Admittedly those people who want to go in 15 years time from Leeds to Birmingham somewhat faster than they can do currently might be aggrieved.
That totally misses a fundamental point. If people in those areas want to go *anywhere* on the rail network, it might be harder and/or more expensive for them to do so, as HS2 frees up a heck of a lot of capacity on the 'traditional' network.
That assumes that they want to go anywhere on the rail network and that there will be additional demand for rail services from any extra capacity.
Already dubious assumptions pre covid but with the increase in working from home far more so now.
The increase in WFH is likely to be more demand for longer services, at the expense of the more traditional commuter line sardine cans. If I’m going to London only once a week, I’ll live a couple of hours away in Devon or Rutland.
As for your "shouldn't just assume your doctor is right", you answer it yourself when you say "it's not done to denounce a bad doctor" (and how the F would you know they are bad). To do so is a huge ask for much of the population. Your doctor is a figure of authority and who exactly do you ask for this second opinion? The doctor you think might have it wrong? Describe for me if you would that conversation. The vast majority of people don't have the will or capacity to do this.
Yes, exactly, especially if you're not well. I wasn't saying people ought to do it - I absolutely see why they don't, except in 1-1 gossip with friends which you can't rely on anyway.
But I think that without going as far as to say "my doctor is crap", if the treatment given is persistently not helping, it's reasonable to change practice or just to say "No offence, but I'd like a second opinion, please." The doctor is legally required to facilitate it (I think).
Locally anyway, it's easier to count the teeth in a hen than to change GP's.
I'm out of the touch with the details now, but a GP used at least to be able to remove a patient from their list if the 'relationship had broken down'. And, if my memory is correct, some were more likely to have difficulty in maintaining relationships than others.
Yes, staff have a right to refuse to deal with abusive patients, with emergencies excepted. Rightly so.
It's not just abusive, Foxy, as you are probably well aware.
Few things are less cherry at the start of a week than reading about GP mistakes.
So given covid backlogs to medical treatment is private medical insurance ** now worth it ?
Or would paying for private consultancy or treatment if required be a better ?
** Affordable but more than double the cost of home and car insurance combined.
Look carefully at the cover. Most policies require a GP referral to cover payment, and there are significant excesses and exclusions. Many policies will refuse cover for chronic conditions (lasting greater than 6 weeks) or those where NHS is available on a reasonable timescale. Every month I have a Private patient who is annoyed at their refusal of cover by the insurance company that they were relying on.
That said, waiting lists have mushroomed for elective procedures and even for outpatient appointments. In my dept we are now booking routine referrals to outpatients from Dec 2020.
Self funding private care is a reasonable option, and putting those premiums into a savings pot instead of an insurance company gives you control and flexibility. You get to keep the money too if unused.
A lot depends on your own financial resources and existing health status and risks.
Getting private healthcare to pay out can be problematic. As many may know, I had a vast amount of problems with my ankle during my youth, including many operations. For a couple of years I had few problems, and thought it was over. Then it went wrong again, and I went back to my old surgeon. The healthcare provider refused to pay, as it was an 'old' injury.
The Prof. made a few phone calls, and threatened never to do any work for them again. Since he was slightly famous, we get an apology from the provider and they paid for a few more ops. Thanks to the Prof., I can walk and run. Without private healthcare, I have no doubt I would be slightly disabled.
Having said that, since many of the problems had been caused by a failed NHS op, there're problems there as well.
That Prof, if he’s the one I’m thinking of, wrote a very good book.
To pay the car tax you either need your V5C serial number or the number on the reminder letter. Nothing else will do!
Why isn't my car's number plate or VIN number sufficient?
Yes sorry for your troubles but paying for this stuff online is one of the (few?) achievements of recent governments. It is super easy to do with at least some form of reference number unless you think they should know who you are??
That said, I am about to renew my driving license which task I approach with some trepidation.
Interesting study from Israel suggesting limitations for the mRNA vaccine (would be interesting to see the comparable data in the UK for AZN).
Large-scale study of antibody titer decay following BNT162b2 mRNA vaccine or SARS-CoV-2 infection https://www.medrxiv.org/content/10.1101/2021.08.19.21262111v1 Immune protection following either vaccination or infection with SARS-CoV-2 decreases over time. Objective: To determine the kinetics of SARS-CoV-2 IgG antibodies following administration of two doses of BNT162b2 vaccine, or SARS-CoV-2 infection in unvaccinated individuals. Methods: Antibody titers were measured between January 31, 2021, and July 31, 2021 in two mutually exclusive groups: i) vaccinated individuals who received two doses of BNT162b2 vaccine and had no history of previous infection with COVID-19 and ii) SARS-CoV-2 convalescents who had not received the vaccine. Results: A total of 2,653 individuals fully vaccinated by two doses of vaccine during the study period and 4,361 convalescent patients were included. Higher SARS-CoV-2 IgG antibody titers were observed in vaccinated individuals (median 1581 AU/mL IQR [533.8-5644.6]) after the second vaccination, than in convalescent individuals (median 355.3 AU/mL IQR [141.2-998.7]; p<0.001). In vaccinated subjects, antibody titers decreased by up to 40% each subsequent month while in convalescents they decreased by less than 5% per month. Six months after BNT162b2 vaccination 16.1% subjects had antibody levels below the seropositivity threshold of <50 AU/mL, while only 10.8% of convalescent patients were below <50 AU/mL threshold after 9 months from SARS-CoV-2 infection. Conclusions: This study demonstrates individuals who received the Pfizer-BioNTech mRNA vaccine have different kinetics of antibody levels compared to patients who had been infected with the SARS-CoV-2 virus, with higher initial levels but a much faster exponential decrease in the first group...</i>
But there are major differences. The Öresund strait is shallow compared to Beaufort’s Dyke. It links Norway, Sweden and their hinterland to the Eurasian mainland, combined population 16 m + hinterland. Population of Ireland just 7 m and no hinterland, and it is not linking Ireland to the Eurasian mainland but to another island. Öresund was constructed just outside Denmark’s capital city and Sweden’s third largest city, in the heart of one of the industrial centres of Europe. Easy peasy to get nearby labour and supplies. Portpatrick? Err, no. But the real killer is rail. Demand for the Öresund section of track is absolutely humongous. Vast freight trains move over the bridge 24/7, 365 days a year. Ivor the Engine chugging over the Irish Sea is just never going to supply that volume of cash. (And aren’t the gauges different in Ireland and Scotland?) I could go on , but this is just a squirrel to detract from Johnson’s lack of policy.
At the end of WWII my father was stationed at Aalborg, Denmark, employed in throwing weapons found in Denmark into the Kattegat, not far N of the Öresund strait
On the basis that my closest real Waitrose is about 15 miles away, I am pleased to declare this area the capital of online *fresh* fresh food deliveries.
To pay the car tax you either need your V5C serial number or the number on the reminder letter. Nothing else will do!
Why isn't my car's number plate or VIN number sufficient?
What's so difficult about putting the reminder letter on the desk next to your computer when you do it?
Ah, but what if, like me, you are an idiot and forget to do so before driving off on holiday such that the car tax was due to expire when you were away?
But there are major differences. The Öresund strait is shallow compared to Beaufort’s Dyke. It links Norway, Sweden and their hinterland to the Eurasian mainland, combined population 16 m + hinterland. Population of Ireland just 7 m and no hinterland, and it is not linking Ireland to the Eurasian mainland but to another island. Öresund was constructed just outside Denmark’s capital city and Sweden’s third largest city, in the heart of one of the industrial centres of Europe. Easy peasy to get nearby labour and supplies. Portpatrick? Err, no. But the real killer is rail. Demand for the Öresund section of track is absolutely humongous. Vast freight trains move over the bridge 24/7, 365 days a year. Ivor the Engine chugging over the Irish Sea is just never going to supply that volume of cash. (And aren’t the gauges different in Ireland and Scotland?) I could go on , but this is just a squirrel to detract from Johnson’s lack of policy.
We will end up knee deep in squirrels before this lot are thrown out.
To pay the car tax you either need your V5C serial number or the number on the reminder letter. Nothing else will do!
Why isn't my car's number plate or VIN number sufficient?
What's so difficult about putting the reminder letter on the desk next to your computer when you do it?
Ah, but what if, like me, you are an idiot and forget to do so before driving off on holiday such that the car tax was due to expire when you were away?
Welcome to my world.
My usual MO is to stare at said letter/form/notice every day on my desk or on email and pick it up/try to reply to it the day after it expires as a method to handle the situation.
Few things are less cherry at the start of a week than reading about GP mistakes.
So given covid backlogs to medical treatment is private medical insurance ** now worth it ?
Or would paying for private consultancy or treatment if required be a better ?
** Affordable but more than double the cost of home and car insurance combined.
Look carefully at the cover. Most policies require a GP referral to cover payment, and there are significant excesses and exclusions. Many policies will refuse cover for chronic conditions (lasting greater than 6 weeks) or those where NHS is available on a reasonable timescale. Every month I have a Private patient who is annoyed at their refusal of cover by the insurance company that they were relying on.
That said, waiting lists have mushroomed for elective procedures and even for outpatient appointments. In my dept we are now booking routine referrals to outpatients from Dec 2020.
Self funding private care is a reasonable option, and putting those premiums into a savings pot instead of an insurance company gives you control and flexibility. You get to keep the money too if unused.
A lot depends on your own financial resources and existing health status and risks.
Getting private healthcare to pay out can be problematic. As many may know, I had a vast amount of problems with my ankle during my youth, including many operations. For a couple of years I had few problems, and thought it was over. Then it went wrong again, and I went back to my old surgeon. The healthcare provider refused to pay, as it was an 'old' injury.
The Prof. made a few phone calls, and threatened never to do any work for them again. Since he was slightly famous, we get an apology from the provider and they paid for a few more ops. Thanks to the Prof., I can walk and run. Without private healthcare, I have no doubt I would be slightly disabled.
Having said that, since many of the problems had been caused by a failed NHS op, there're problems there as well.
That Prof, if he’s the one I’m thinking of, wrote a very good book.
Two very good books. I've got signed copies of both.
The funny thing is I had no idea who he was when he took my on. Just before the first op, I went for a consultation and his secretary said: "We've been trying to contact you. Sid's asked me to tell you he's been unavoidably detained. But between you and me, he's playing golf with Ayrton Senna."
I had zero idea who he was before that. Sid was a kind, good man, and a brilliant surgeon. After one op, he came into the ward with a bottle of whisky and said: "None of my friends are in London. Fancy a drink?" Then lit a cigar.
One of a kind. And I fluked into getting him.
Few people genuinely change lives for the better. Good doctors and surgeons can do just that. I just wish I'd thanked him more whilst he was still alive.
But there are major differences. The Öresund strait is shallow compared to Beaufort’s Dyke. It links Norway, Sweden and their hinterland to the Eurasian mainland, combined population 16 m + hinterland. Population of Ireland just 7 m and no hinterland, and it is not linking Ireland to the Eurasian mainland but to another island. Öresund was constructed just outside Denmark’s capital city and Sweden’s third largest city, in the heart of one of the industrial centres of Europe. Easy peasy to get nearby labour and supplies. Portpatrick? Err, no. But the real killer is rail. Demand for the Öresund section of track is absolutely humongous. Vast freight trains move over the bridge 24/7, 365 days a year. Ivor the Engine chugging over the Irish Sea is just never going to supply that volume of cash. (And aren’t the gauges different in Ireland and Scotland?) I could go on , but this is just a squirrel to detract from Johnson’s lack of policy.
Been over the Oresund on the train. Real serious **** you bridge and train.
Quite right re the rail gauges. Not to mention the lack of a railway line from Carlisle to Galloway except by a roundabout route.
To pay the car tax you either need your V5C serial number or the number on the reminder letter. Nothing else will do!
Why isn't my car's number plate or VIN number sufficient?
At a guess, it is to stop you accidentally paying someone else's tax by requiring a number with a built-in verification number. Or they just did not think it through properly when the system was commissioned umpteen years ago and now it would be too much hassle to change.
Mr. Richard, when I watched local news, few years ago, almost all complaints about HS2 were that it wasn't going to a place and fears it may end up being cancelled here.
If it goes to Manchester/Lancashire and not Leeds/Yorkshire, people will not be pleased.
Why would you want to leave Yorkshire? I can understand people in Manchester wanting to go elsewhere.
Seriously, though, the route (as planned) to Leeds isn't really that useful. It bypasses the most useful place for connections in South Yorkshire (Meadowhall) and ploughs through the countryside with no benefit to those near it.
The ECML gets you to London fast enough already if you really feel the need to go there. Is the extra capacity really going to be needed in the future when commuting is cut?
What happens with the electric motorway on the M180 will be much more interesting.
I find American politics particularly hard to read, but FWIW I assumed Biden was going to be a one term president, but maybe more effective than people were giving him credit for, due his decades of experience.
Clearly Afghanistan hasn't gone to plan, although the fundamental objective to get the hell out of the country is not going to change.
Trump would have won the last election if it weren't for the twin factors of Covid and a competent campaigner in Joe Biden. We have that to be thankful to Biden for, and that might have been a large part of the motivation of an old man without a lot to prove.
Comments
These tweets by @EricTopol & @devisridhar are incorrect.
Pfizer & Moderna vaccines were shown to be >90% effective at preventing COVID-19 (symptomatic disease), NOT “infection”.
Might seem trivial, but using infection & disease interchangeably like this is misleading.
https://twitter.com/jakescottMD/status/1429577229164453890?s=20
In addition, effectiveness against infection pre-delta was not 90% (+ it was not sterilising immunity). Pre-delta, this was around 55-80% depending on the study. Current observational data cited need to be interpreted carefully due to the several confounders in these studies.
https://twitter.com/mugecevik/status/1429557095079231489?s=20
Finally, recent ONS data suggest very similar effectiveness against infection w/ alpha vs delta.
https://twitter.com/mugecevik/status/1429559803370684423?s=20
*He didn't serve because of asthma, like his opponents bone Spurs.
Total number of people eligible for evacuation has surged from 6,000 to over 12,000 as Afghan politicians & those who helped NGOs added
https://twitter.com/Steven_Swinford/status/1429708828912889858?s=20
So given covid backlogs to medical treatment is private medical insurance ** now worth it ?
Or would paying for private consultancy or treatment if required be a better ?
** Affordable but more than double the cost of home and car insurance combined.
What was interesting about the above is that the practice was set to lose half its funding because of its age demographic. Even with the exceptional case funding, it might explain some of the issues we've had with them.
Do you mean the Beaufort's Dyke bombs or something else?
https://vimeo.com/588381188/cbccb9392e
Government press release on it:-
https://www.gov.uk/government/news/young-covid-patients-share-stories-to-urge-others-to-get-jabbed
Test your source. The Telegraph are hell-bent right now on opposing anything resembling restrictions and are skewing coverage accordingly.
Luckily, it's not brimming with marginals.
The antibodies from vaccine are to the spike protein; an infection also generates a load of (fairly useless) antibodies to the viral nucleoprotein, so you can discriminate quite easily between the two things.
The nurse is the triage but I would say (tbf because it's what they do all day) that her knowledge of skin cancers would be1,000x that of a typical GP.
It is a fantasy but this bridge is very impressive
I have driven over it and i would expect so has @StuartDickson
BBC News - The real story of the Bridge
http://www.bbc.co.uk/news/magazine-35220191
Admittedly those people who want to go in 15 years time from Leeds to Birmingham somewhat faster than they can do currently might be aggrieved.
If it goes to Manchester/Lancashire and not Leeds/Yorkshire, people will not be pleased.
1. The #BritishMilitary here at #KabulAirport have shown breathtaking levels of toughness, professionalism and - rare in war times I must say - compassion. I've been moved to tears by their actions, diving into dangerous crowds to pull visa-holders into the base....
https://twitter.com/JaneFerguson5/status/1429328715994050563?s=20
- Lord Botham appointed to Australia
- Baroness Hoey appointed to Ghana
- Stephen Timms MP appointed to Switzerland and Liechtenstein
- David Mundell MP appointed to New Zealand
- Mark Eastwood MP appointed to Pakistan
- Marco Longhi MP appointed to Brazil
- Conor Burns MP appointed to Canada
- Lord Walney [John Woodcock] appointed to Tanzania
- Felicity Buchan MP appointed to Iceland and Norway
- Sir Jeffrey Donaldson MP appointed to Cameroon, in addition to his role as Prime Minister’s Trade Envoy to Egypt.
https://www.gov.uk/government/news/pm-announces-new-trade-envoys-to-boost-british-business-around-the-world
My father had a private specialist who accidentally prescribed him at 10 times the correct dose, and it was only after he repeatedly told the doctor that he was sleeping all day, every day and surely this couldn't be quite right did the specialist deign to check. Another relative had an NHS GP who switched her depression medication to Prozac and refused to believe that it wouldn't work, as a result of which she lost her job and had two years of deep depression. I'm not convinced that either case tells us anything except that if things are clearly going wrong you shouldn't just assume your doctor is right but get a second opinion.
My own experience is that NHS treatment is generally very good, but record-keeping used to be totally crap and has now improved to so-so and computerisation took hold. but that's anecdotal too. Seeing someone outside your home area remains challenging - why there was so much opposition to a national database with all medical records still baffles me.
German and US troops in gunfight at Kabul airport
Already dubious assumptions pre covid but with the increase in working from home far more so now.
Secondly this can't be a recent letter; PCT's were abolished by the Lansley 'reforms' (which were meant to put more power in the hands of GP's) almost ten years ago.
Typical PB wit
The draft deal also fails to Scotland's battle over alcohol-related deaths.
https://www.dailyrecord.co.uk/news/politics/snp-deal-greens-makes-no-24815933
Gender Identity, on the other hand.....
Now you can buy off the people who will be inconvenienced but that's going to cost even more money.
Which is difficult when there are so many other demands on government spending.
It's also a major, perhaps the major, northern transport hub.
Posted at 7:36
Deadly firefight at airport
A firefight broke out between unidentified gunmen and security forces at an entrance to Kabul airport on Monday, according to German army officials.
One Afghan guard was killed and three others injured, officials said, with US and German forces also involved in the incident.
https://www.bbc.co.uk/news/live/world-58279900
As for you "shouldn't just assume your doctor is right", you answer it yourself when you say "it's not done to denounce a bad doctor" (and how the F would you know they are bad). To do so is a huge ask for much of the population. Your doctor is a figure of authority and who exactly do you ask for this second opinion? The doctor you think might have it wrong? Describe for me if you would that conversation. The vast majority of people don't have the will or capacity to do this.
This morning at 4:13 p.m. CEST it arrived at the North Gate of the airport #Kabul a firefight between Afghan security forces and unknown attackers. An Afghan security force was killed and three others wounded....
American and German forces were also involved in the further course of the battle. All soldiers of the #BundeswehrimEinsatz are unharmed.
https://twitter.com/Bw_Einsatz/status/1429660329718566912?s=20
Edit: ok late to the party on that zinger...
https://imgur.com/a/HQWL0BR
On seeing doctors outside your home area, besides MPs who commute between London and constituency homes, who cares?
You finally return home to Bristol.
There are vast amounts of infrastructure that people nearby never use. Many people living near motorways will rarely, or never, use them. But the trucks carrying their food to the supermarket might, or their relatives when they come to visit. Or it might reduce the traffic on the local roads.
The same is true for railways: just because you don't use a particular line, doesn't mean you never will, or that its existence is bad for the country.
I don't use the new A14 Huntingdon bypass despite living near it, but I'm glad it was built. It's good for the area as a whole.
But I think that without going as far as to say "my doctor is crap", if the treatment given is persistently not helping, it's reasonable to change practice or just to say "No offence, but I'd like a second opinion, please." The doctor is legally required to facilitate it (I think).
Note too that 60% of US voters in the CBS poll think the Taliban's return makes it more likely terrorism will return. If that leads to another terrorist attack on US soil before 2024 then Biden and Harris are likely toast, with only Buttigieg having a chance of stopping Trump's return to the Oval Office
He really, really didn't like that, as you can imagine.
That said, waiting lists have mushroomed for elective procedures and even for outpatient appointments. In my dept we are now booking routine referrals to outpatients from Dec 2020.
Self funding private care is a reasonable option, and putting those premiums into a savings pot instead of an insurance company gives you control and flexibility. You get to keep the money too if unused.
A lot depends on your own financial resources and existing health status and risks.
It doesn't help that they ask patients about their conditions, presumably as a basic form a triage. Most patients rightly suspect that they do not have medical training, certainly nothing beyond a basic 'how do you triage a patient in the GP surgery', and get very annoyed at this. And yet there probably is a good reason for doing this - to make sure the patient gets to the right medical practitioner (be it GP, nurses, pharmacists). Maybe there needs to be a way to change the messaging?
In the anecdotes I mention below, however, there was apparent incompetence. And that's what I find awful.
In addition: aiui it's hard to move surgery if you haven't moved house - according to some people who've tried.
Looks like this one:
Pyrausta aurata * Mint Moth
http://www.dorsetnature.co.uk/pages-moth/bf-1361.html
ETA scooped by @SussexJames
I responded that how could he just refer me to someone without even looking at the symptoms, etc, and a couple of weeks after that I received a letter (that's how long ago it was) to tell me that I was no longer a patient at that practice.
I would have complained/raised merry hell but the practice was at the time treating my father who was quite unwell so I didn't want to rock the boat.
Second irony is that, if the plan isn't to cancel this bit of HS2, just to postpone it (like Foreign Aid), you get the worst of both worlds. The planning blight will continue, there will be the costs of keeping the scheme ticking over but the benefits of the new line will be delayed.
Much like with Iraq. If you supported the invasion, you should have been doing so on the basis of how it was likely to be conducted, not on how you would like it to have been.
It didn’t take too long with Iraq for the cognitive dissonance to dissipate and instead voters pretended to themselves they had never supported the invasion, rather than just that “it was the right thing but done badly”.
If the same happens here then it’s a really big problem for the Democrat Party.
I'm out of the touch with the details now, but a GP used at least to be able to remove a patient from their list if the 'relationship had broken down'.
And, if my memory is correct, some were more likely to have difficulty in maintaining relationships than others.
The self-funding if necessary option looks the best for me.
The Prof. made a few phone calls, and threatened never to do any work for them again. Since he was slightly famous, we get an apology from the provider and they paid for a few more ops. Thanks to the Prof., I can walk and run. Without private healthcare, I have no doubt I would be slightly disabled.
Having said that, since many of the problems had been caused by a failed NHS op, there're problems there as well.
Large-scale study of antibody titer decay following BNT162b2 mRNA vaccine or SARS-CoV-2 infection
https://www.medrxiv.org/content/10.1101/2021.08.19.21262111v1
Immune protection following either vaccination or infection with SARS-CoV-2 decreases over time. Objective: To determine the kinetics of SARS-CoV-2 IgG antibodies following administration of two doses of BNT162b2 vaccine, or SARS-CoV-2 infection in unvaccinated individuals. Methods: Antibody titers were measured between January 31, 2021, and July 31, 2021 in two mutually exclusive groups: i) vaccinated individuals who received two doses of BNT162b2 vaccine and had no history of previous infection with COVID-19 and ii) SARS-CoV-2 convalescents who had not received the vaccine. Results: A total of 2,653 individuals fully vaccinated by two doses of vaccine during the study period and 4,361 convalescent patients were included. Higher SARS-CoV-2 IgG antibody titers were observed in vaccinated individuals (median 1581 AU/mL IQR [533.8-5644.6]) after the second vaccination, than in convalescent individuals (median 355.3 AU/mL IQR [141.2-998.7]; p<0.001). In vaccinated subjects, antibody titers decreased by up to 40% each subsequent month while in convalescents they decreased by less than 5% per month. Six months after BNT162b2 vaccination 16.1% subjects had antibody levels below the seropositivity threshold of <50 AU/mL, while only 10.8% of convalescent patients were below <50 AU/mL threshold after 9 months from SARS-CoV-2 infection. Conclusions: This study demonstrates individuals who received the Pfizer-BioNTech mRNA vaccine have different kinetics of antibody levels compared to patients who had been infected with the SARS-CoV-2 virus, with higher initial levels but a much faster exponential decrease in the first group...</i>
But for a GP practice (assuming it is not private, where the GPs have their listed specialities) what triaging is there to be done? Unless you think they should have the right to refuse an appointment.
A friend who is an NHS GP said that a huge relief for them was when the app (no idea which one) was turned off at weekends which allowed people to instantly send a message to the surgery 24/7. She said that waiting a couple of days for the symptoms to dissipate meant that a far lower number of pings were received on the Mondays.
I know that some people have conditions they are worried about others seeing, so I'd be fine with an option to keep certain information out of the national database. But blood group, any allergy history, previous operations? The balance of risk is NOT having them readily available.
The biggest worry is for the conditions that private hospitals do not cover, such as things needing ICU afterwards, which only a select few can provide. Recent maternity scandals all over the land too, as there is no real choice for most people.
Why is it so bloody hard to pay your car tax?
To pay the car tax you either need your V5C serial number or the number on the reminder letter. Nothing else will do!
Why isn't my car's number plate or VIN number sufficient?
But there are major differences.
The Öresund strait is shallow compared to Beaufort’s Dyke.
It links Norway, Sweden and their hinterland to the Eurasian mainland, combined population 16 m + hinterland.
Population of Ireland just 7 m and no hinterland, and it is not linking Ireland to the Eurasian mainland but to another island.
Öresund was constructed just outside Denmark’s capital city and Sweden’s third largest city, in the heart of one of the industrial centres of Europe. Easy peasy to get nearby labour and supplies. Portpatrick? Err, no.
But the real killer is rail. Demand for the Öresund section of track is absolutely humongous. Vast freight trains move over the bridge 24/7, 365 days a year. Ivor the Engine chugging over the Irish Sea is just never going to supply that volume of cash. (And aren’t the gauges different in Ireland and Scotland?)
I could go on , but this is just a squirrel to detract from Johnson’s lack of policy.
They supported the withdrawal even though it turns out it was a bad / unnecessary thing to do. is your view; it's not necessarily that of the majority.
I think it's more likely that in six months' time most people will have forgotten about it.
We will see.
That said, I am about to renew my driving license which task I approach with some trepidation.
Also, not all VINs are eligible to be road registered. My 991.2 Cup is one such.
On the basis that my closest real Waitrose is about 15 miles away, I am pleased to declare this area the capital of online *fresh* fresh food deliveries.
https://uk.finance.yahoo.com/news/waitrose-rated-worst-online-supermarket-230100608.html
My usual MO is to stare at said letter/form/notice every day on my desk or on email and pick it up/try to reply to it the day after it expires as a method to handle the situation.
The funny thing is I had no idea who he was when he took my on. Just before the first op, I went for a consultation and his secretary said: "We've been trying to contact you. Sid's asked me to tell you he's been unavoidably detained. But between you and me, he's playing golf with Ayrton Senna."
I had zero idea who he was before that. Sid was a kind, good man, and a brilliant surgeon. After one op, he came into the ward with a bottle of whisky and said: "None of my friends are in London. Fancy a drink?" Then lit a cigar.
One of a kind. And I fluked into getting him.
Few people genuinely change lives for the better. Good doctors and surgeons can do just that. I just wish I'd thanked him more whilst he was still alive.
Quite right re the rail gauges. Not to mention the lack of a railway line from Carlisle to Galloway except by a roundabout route.
Seriously, though, the route (as planned) to Leeds isn't really that useful. It bypasses the most useful place for connections in South Yorkshire (Meadowhall) and ploughs through the countryside with no benefit to those near it.
The ECML gets you to London fast enough already if you really feel the need to go there. Is the extra capacity really going to be needed in the future when commuting is cut?
What happens with the electric motorway on the M180 will be much more interesting.
Clearly Afghanistan hasn't gone to plan, although the fundamental objective to get the hell out of the country is not going to change.
Trump would have won the last election if it weren't for the twin factors of Covid and a competent campaigner in Joe Biden. We have that to be thankful to Biden for, and that might have been a large part of the motivation of an old man without a lot to prove.