Accident & Emeregcny Demand unsustainable...

wotsthat

kabayiri wrote: »

Do we have to find ways to put people off using A&E ? Perhaps a nominal charge would make people think twice.

Making people wait for over four hours seems like a good start at putting them off.

Charging would be more effective - a youth near me has an ambulance out about 5 times a year because he fails to control his blood sugar correctly and thinks nothing of it.

Pretty sure a £50 charge would make him more disciplined about his medication and diet - he'd be healthier too.

olly300

wotsthat wrote: »

Making people wait for over four hours seems like a good start at putting them off.

Charging would be more effective - a youth near me has an ambulance out about 5 times a year because he fails to control his blood sugar correctly and thinks nothing of it.

Pretty sure a £50 charge would make him more disciplined about his medication and diet - he'd be healthier too.

The only way to make someone like that more disciplined is for them to have a near death experience or a serious infection where he nearly loses a limb.

If the ambulance costed money he would simply not call them out and some stranger would end up calling them when he is found collapsed in the street.

Many people with illnesses they can control through life style refuse to even try.

BobQ

Sampong wrote: »

Utter rubbish as usual from you BobQ. You're so bored that you try to justify your existence by constant attacks on people's points of views. I've seen you exhibit this extensively against Graham. And it's not the first time you've made thinly veiled inferences that I am a fruitcake...........

I never "inferred" anything, or maybe you meant "implied".

For the record (as you well know) it was Cameron who accused UKIP of being full of fruitcakes.

I was just pointing out that you were complaining about someone demanding you provide evidence when you criticise Cameron for doing the same. Infer what you wish about yourself, but I was not implying anything.

Do show me where I have made constant attacks on Graham? Graham does at least debate a range of issues. Your posts are predominantly about two issues.

wotsthat

olly300 wrote: »

The only way to make someone like that more disciplined is for them to have a near death experience or a serious infection where he nearly loses a limb.

Apparently young diabetics are particularly poor patients - the treatment isn't 'cool' and apart from the odd trip in an ambulance the effects of poor blood sugar control aren't apparent for a couple of decades - a lifetime away.

It's not that they refuse to take control - they don't understand the risks. When you're 18 though £50 might make an impact.

Graham_Devon

Mr._Pricklepants wrote: »

The rise is A&E admissions has only one cause; the opt-out of 90% of GP's out of after-hours care.

http://www.telegraph.co.uk/health/healthnews/10016521/GPs-blamed-for-crisis-in-out-of-hours-health-care.html



Only a sampong would conclude immigrants are to be blamed.

This made little difference to A&E attendances. GPs still do out of hours....thats why you get a GP visit you if required in the middle of the night. They are just not responsible themselves for their own area as it were.

Plus, the opt out happened in 2004. The increase has happened recently.

The problem in this one is one of many things. Firstly, targets have been changed.

It used to be that to be seen within the timeframe, you simply had someone come see you, assess you and then send you away to wait. You had then "been seen". This has been changed. Now, you wait to be seen. You wait the same length of time, it's just that the box ticking exercise is no longer carried out as there is no incentive to do so.

Secondly, data is now collected better, though this is not something unique to this last year, though relatively recent.

Third, NHS cuts have obviously had an impact. You can't shut down local services and expect the users of that service to simply dissapear. They will go elsewhere.

Fourth....and I have absolutely nothing to back this up, but it has been a trend locally....people are turning up at A&E, seemingly to complain of a problem as this problem then gets written into their records. Basically, a case of keeping benefits going (as in, there are records of ongoing problems). This IS related to recent changes.

Fifth, out of hours GP care is now much better linked to primary care. GPs can now deny any medication to be given to patients out of hours. Patients would often be refused further medication by the GP, so would ring out of hours to say they needed urgent medication. The out of hours would then give it. Now they have access to shared records and shared care they can see the notes not to give it. So instead of using out of hours, the patients are using A&E.

Sixth, alcohol related attendances are up a LOT!

Plus lots of other reasons. A lot of it will be cuts though.

Graham_Devon

As for the GP stuff, I see a lot of anger at GPs here. But essentially this comes down to money.

It's OK suggesting GPs should open longer and it wouldn't cost them any more, but it would cost them significantly more.

We also can't expect them to go to work on a Saturday or work into the evening for no pay. That's a government decision.

They do do out of hours, just not under their surgery. There isn't a bunch of out of hours GPs just sitting around, they are the same GPs who run surgeries in the day. Some do this extra work and some don't, it's up to them. Indeed, some only do nights. But there are plenty who do a full day and then go into an out of hours service to do a night.

But, if the GP is seeing patients, they need other staff. They need receptionists, they need someone with the ability to run the place, deal with the building etc. They need chemists open close to them (A&E are able to send you off with medication, the GP wouldn't be able to unless they have a chemist close to them open all the time). They need collections for blood tests up and running. No point in taking a urine sample on a saturday when the hospitals won't actually collect it. They need people to answer the phone and do routine admin tasks. It's not quite as simple as plonking a GP in front of a desk.

wotsthat

Graham_Devon wrote: »

We also can't expect them to go to work on a Saturday or work into the evening for no pay. That's a government decision.

I was unfortunate enough to be at a 'homeowners' party awhile ago with three doctors. They were quite bemused (but not unhappy) that 'agenda for change' and the like meant they were being paid more for doing less.

One of the biggest failures of politicians is that they spent decades arguing that spending more = better. Give people money and tell them to spend it and that's exactly what they'll do for better or worse.

My wife's a midwife - in the last few years the expenses regime has changed 3 or 4 times - when she started the expenses were comically in her favour but now I'm subsidising her to do her job.

If anyone's hoping to have a baby soon they better hope the recession continues -an improving economy is going to give many in healthcare the exit they're looking for.

Graham_Devon

wotsthat wrote: »

I was unfortunate enough to be at a 'homeowners' party awhile ago with three doctors. They were quite bemused (but not unhappy) that 'agenda for change' and the like meant they were being paid more for doing less.

One of the biggest failures of politicians is that they spent decades arguing that spending more = better. Give people money and tell them to spend it and that's exactly what they'll do for better or worse.

My wife's a midwife - in the last few years the expenses regime has changed 3 or 4 times - when she started the expenses were comically in her favour but now I'm subsidising her to do her job.

If anyone's hoping to have a baby soon they better hope the recession continues -an improving economy is going to give many in healthcare the exit they're looking for.

In 2004, GPs were indeed handed an amazing package. Literally too good to be true. One of the things that was quite simply amazing at the time is that the GPs didn't even ask for it. It just came out of the blue.

For around 2 years, this trend continued. New staff were taken on to provide the new services (who had heard of healthcare assistants pre 2004!?). So they didn't just get a load of money, new services were offered....even if we don't recognise them.

However, since then, things have gone into reverse, and that money is being taken back, not literally, but by recycling the same money.

They are not in poverty, not by any means, but I think the 2004 contract thing really got the publics backs up. But the GPs didn't ask for it, of course they will accept it, who wouldn't. But it WAS 9 years ago.

People may not realise it, but there are new services now, provided by that money and GP costs have gone up immeasurably to supply these services. Healthcare assistants is just one example of many that didn't even exist prior to 2004.

The amount of work in coding everything correctly is absolutely collosal, and has meant a lot of expense for primary care. This is all behind the scenes, but 10 years ago, your GP could simple code "COPD". He can't now. It has to be severe, moderate, new event, existing event, linked to a medication, linked to a problem. A patient has to be checked thoroughly is they have asthma and COPD coded, whereas before it didn't matter, it does now....it affects everything down the line. Hosptials send data to the patient record which the surgery has to review, accept, which then throws up other issues. A lot of the stuff is behind the scenes, but a good 10 mins could be spent on your records without you even knowing making sure your allergies are not degraded and will be uploaded correctly in order that when you are collected by the ambulance, they don't give you a drug you are sensitve to. The NHS don't just know these things, they all come from people sitting in your GP surgery, of whom the GPs employ and pay for.

wotsthat

Graham_Devon wrote: »

In 2004, GPs were indeed handed an amazing package. Literally too good to be true. One of the things that was quite simply amazing at the time is that the GPs didn't even ask for it. It just came out of the blue.

I remember it. The government gambled (and sold gold reserves on the bet) that 'buying' GP's would lead to more commitment to delivering a better service. If ever there was a time I wished I'd worked harder at school this was it. I don't go to the doctors much (touch wood) but Dr. Google is currently providing a better service than my GP.

Graham_Devon

wymondham wrote: »

I tend to go to A&E when I can't book a doctors appointment for 3 weeks.....

If this is true, and you cannot see any doctor at your surgery within 48 hours, then write a complaint. The surgery is not fulfilling it's contract.

However, if you want to see a specific GP on a specific day, then yes, you may find yourself waiting that length of time.

I'd find it hard to believe that you couldn't get an appointment, or at least a phone consultation with your GP within 48 hours though. It's a basic requirement, and certainly, if you complained, the GP surgery would have to respond with evidence that they can offer appointments.

There are a lot of complaints from patients about this very thing. I'm not saying you are, but often it's just wasting time, money and NHS resources, as the complaints have to be followed up, when all it boils down to is that the patient didn't want an appointment with a different doctor, or didn't want the 11am appointment as they had a hair appointment.

They say you can't please all the people all the time. Put simply, you can't. But you should always have access to a GP within 48 hours. The time may not suit you, but the offer should be there. I'd be stunned if a surgery actually got away with no availability for 3 weeks. That's enough for the local NHS to take control of the contract.