NHS 'crisis'

[kernelbogey]

Lots of Doctors working part time. And who can blame them.

http://www.telegraph.co.uk/news/2017/06/15/gp-shortage-fuelled-rising-numbers-working-part-time/

Like you, I don't have any substantial issue with what (good) doctors earn, but there isn't a shortage of applicants for medicine, and by international standards ours are well paid , so the rewards are not , in general, the source of any supply issues.

I'm sure there are issues around junior doctors pay and conditions that need addressing , though.

I had the great privilege and pleasure of working with medical students at Southampton School of Medicine: they were remarkable young adults.

I'm unsure how the restrictions on entry to medical school have arisen. No doubt 'closed shop' thinking in the past - though that surely can't now be the defining issue. The medical students I knew were rigorously managed for professional standards. Entry to training is clearly not a straightforward matter of academic achievement - and rightly so.

[oddoneout]

TS - I wonder if that's because many of the part-timers are 'returnee' women doctors with families? I think that sector has been strongly encouraged in recent years because of the shortage of doctors in primary care.I have no issue with what doctors earn. They potentially have my life in their hands; that is, in their capacity for sound judgement.

That is certainly the case at my GP surgery, and does unfortunately make for long waiting times for appointments if, as I do, you need to see the same person for your health care. It's a bit of a catch 22 in that the practice does not have enough FT GPs( a situation going back several years) and so cannot function without the part-timers, but the balance between the 2 is not good. However we as patients are not in a position to do anything about it - all 3 practices in the town have closed their lists, so it's long waiting times(6-8 weeks for me) or no GP at all.
One of the other part-timers is an older man who possibly does not need FT earnings and doesn't want FT duties, and until recently there was another who had been FT in the practice but on reaching retirement age came back to do a day and a half and also cover where needed.

[oddoneout]

I had the great privilege and pleasure of working with medical students at Southampton School of Medicine: they were remarkable young adults.

I'm unsure how the restrictions on entry to medical school have arisen. No doubt 'closed shop' thinking in the past - though that surely can't now be the defining issue. The medical students I knew were rigorously managed for professional standards. Entry to training is clearly not a straightforward matter of academic achievement - and rightly so.

My daughter in law is a junior doctor and it's clear from conversations with her that being a GP is not a favoured career path. None of her year have done so, and when after maternity leave she was facing difficulties arranging suitable working hours she was adamant that the GP route was not an option. 'I'd rather go and stack shelves in Tesco'.
Being well paid is not necessarily enough to offset what many see as an unsatisfactory way to work, both for the patients, and for their own health.
I gather there is an added factor to the looming crisis of too few entries and the current age profile of existing GPs(too many reaching retirement age within a very short time span) which is that the pension contribution caps have a negative financial impact on older GPs, further reducing the numbers who might otherwise stay in service.

[kernelbogey]

That is certainly the case at my GP surgery, and does unfortunately make for long waiting times for appointments if, as I do, you need to see the same person for your health care. It's a bit of a catch 22 in that the practice does not have enough FT GPs( a situation going back several years) and so cannot function without the part-timers, but the balance between the 2 is not good. However we as patients are not in a position to do anything about it - all 3 practices in the town have closed their lists, so it's long waiting times(6-8 weeks for me) or no GP at all.
One of the other part-timers is an older man who possibly does not need FT earnings and doesn't want FT duties, and until recently there was another who had been FT in the practice but on reaching retirement age came back to do a day and a half and also cover where needed.

I am obviously in no position, Odds, to comment on your health needs. However, my own experience is that I have had excellent care over a number of years from one female GP, for one longstanding (virtually chronic) condition. Unfortunately her appointments are in such demand - she has particularly excellent interpersonal skills, which make her particularly effective, and therefore desirable as a GP - that it is almost impossible to book one. The standard of the other GPs in the practice is very high. I have found that the comprehensive notes on their IT system allow me to have confidence in the ability of other doctors to treat me. I'm more relaxed therefore about getting an early appointment with one of them, and relying on their shared professionalism. Just my experience, I emphasise.

[Lat-Literal]

Mr Blair substantially increased the GPs' salaries - in many cases to a six figure salary per annum - when it was not generally perceived that they were especially low. The general public would have preferred more modest increases being given to nurses. One of the downsides is that the variation in GPs' incomes with that of the average patient means that the service providers and clients live in completely different worlds. It now takes a special kind of doctor to have the imagination to show full empathy. Another impact has been part-time working. If I had the choice between five days on £100,000 and four days on £80,000, I would opt for the latter in the name of work/life balance, especially if I were a mother of four children.

That particular development is not necessarily a terrible thing as long as there are enough people to fill the jobs. But in this century, vacancies have increased from just over zero to just over 12%. This is in parallel with unlimited immigration from the EU which has clearly provided no answer whatsoever - although our population numbers are substantially increasing to place additional demands on services - and a rapid rise in university students to 50%. It wouldn't have required a genius in any government to have insisted that sufficient course places be made available and I cant for the life of me understand why that isn't Mr Hunt's principal objective. For too long, this country has been run by tweedle dumb and tweedle dumber.

Incidentally, I believe that the reason why my own GP surgery was open on Boxing Day was linked to the fact that the main GPs there are Hindu and Muslim. There is absolutely no reason in a 24/7 multicultural society why GPs surgeries shouldn't be open for long hours 365 days of the year. All political opposition to the very idea on principle is sheer hubris. But thin air isn't enough. It does require boosts for medical schools so that they offer all of the necessary places and probably a penny on income tax to make it happen in the workplace.

[french frank]

But in this century, vacancies have increased from just over zero to just over 12%. This is in parallel with unlimited immigration from the EU which has clearly provided no answer whatsoever

Doesn't it suggest the situation would be much greater than 12% without the immigration?

And:

"EU immigration contributes to financial pressure on the NHS, but its annual impact is small compared to other factors. Whether EU immigrants pay enough into the public finances overall to cover their costs is difficult to say, and researchers give different answers. However, it does appear that they make more of a net contribution than other groups. The UK doesn’t claim back as much as it could of the cost of treating Europeans who come here for a shorter period as visitors or to live as pensioners, which is mostly down to the NHS not asking for money it is due." [Full Fact:https://fullfact.org/europe/eu-immig...-pressure-nhs/

For the record, the researchers who disagree in this paper are UCL and Migration Watch …

[kernelbogey]

And - separate issue of course - the NHS is heavily reliant on nurses from the EU, as I observed (and benefitted from) in the superb hospital treatment I referred to in an earlier post.

[Lat-Literal]

Doesn't it suggest the situation would be much greater than 12% without the immigration?

And:

"EU immigration contributes to financial pressure on the NHS, but its annual impact is small compared to other factors. Whether EU immigrants pay enough into the public finances overall to cover their costs is difficult to say, and researchers give different answers. However, it does appear that they make more of a net contribution than other groups. The UK doesn’t claim back as much as it could of the cost of treating Europeans who come here for a shorter period as visitors or to live as pensioners, which is mostly down to the NHS not asking for money it is due." [Full Fact:https://fullfact.org/europe/eu-immig...-pressure-nhs/

For the record, the researchers who disagree in this paper are UCL and Migration Watch …

Thank you.

I didn't specifically put the increase in population numbers down to the EU. My point about EU membership is that it hasn't prevented an increase in GP vacancies to over 12%. Whether that increase would have been higher without it is one of many unknowns. The fear with EU, not that it really needs to be stated, is the inability for us to manage population numbers, especially in the future. Now we have India saying it wants free movement in order to secure a trade deal. I suspect, though, that is a bargaining chip. The ideal would be an element of free movement, that is, free movement for Indian doctors. As for us not claiming any money due to us from the EU, it's yet another aspect of the more ridiculous ways of this country.

(BUT: I'm a little uncomfortable with us poaching experience from elsewhere, be it India or Latvia - we should be able to produce enough doctors in our own multicultural country)

And - separate issue of course - the NHS is heavily reliant on nurses from the EU, as I observed (and benefitted from) in the superb hospital treatment I referred to in an earlier post.

I think my argument there would be that had the Blair government prioritised nurses' salaries over GPs' salaries, more British people would have been able to afford being nurses. As with GPs, I really do think we need to question morally what a mass movement of nurses from Eastern Europe into the NHS does to the citizens of those countries and their welfare.

[Pulcinella]

(BUT: I'm a little uncomfortable with us poaching experience from elsewhere, be it India or Latvia - we should be able to produce enough doctors in our own multicultural country)

I am MORE THAN A LITTLE uncomfortable with this: I think it appalling that we poach and don't train enough ourselves.

I think that there is a real problem with university course acceptance criteria and student retention.

[Lat-Literal]

I am MORE THAN A LITTLE uncomfortable with this: I think it appalling that we poach and don't train enough ourselves.

I think that there is a real problem with university course acceptance criteria and student retention.

We are on the same page.

I am genuinely perplexed as to why the education system from schools onwards isn't acting as a funnel into the NHS, certainly at GP level.

And I have never really seen a convincing explanation.

Great salary.

Pressures undoubtedly but eased by the possibilities for part time working

It isn't even as if we have one narrow gene pool that happens for some reason to be hopeless at achieving in medicine.

[LeMartinPecheur]

Incidentally, I believe that the reason why my own GP surgery was open on Boxing Day was linked to the fact that the main GPs there are Hindu and Muslim. There is absolutely no reason in a 24/7 multicultural society why GPs surgeries shouldn't be open for long hours 365 days of the year.

Lit-Lat: this looks rather an urban perspective. Not quite so easy to achieve down here in Cornwall I fear!

[kernelbogey]

Making degree-entry to nursing and midwifery compulsory must have deterred many with aptitude for nursing.

[Beef Oven!]

I am genuinely perplexed as to why the education system from schools onwards isn't acting as a funnel into the NHS.

Same here.

Take nursing, the NHS can't identify a target group and market a career that offers a job for life; complete mobility to work in the NHS anywhere in the UK that takes one's fancy; the option to work in the USA, Canada, Australia and pretty much anywhere in the world; eat as much you like clinical and professional training; more continuous professional development than one could shake a stick at; a superb pension scheme; excellent rates of pay; up to 9 weeks paid leave per year; paid carers leave; paid special purposes leave; paid adoption leave; paid maternity leave ...........

If one can't sell a job like that to young people, one's not fit to run a business.

[Lat-Literal]

I agree with all of the last three posts.

There might be an argument for waiving tuition fees on GP courses for the years beyond Year 3 to attract more from "ordinary" backgrounds but this would require costing.

I will leave it there, I think, but I thought I would advise the OP that the Minor Injuries Units in Wiltshire are in Chippenham and Trowbridge.

Not exactly blanket coverage. I have two within a four mile radius.

It adds to LMP's point about Cornwall and rural areas generally but each of them in Wilts is open for long hours and as late as 11pm for everyone other than the intoxicated.

(Further research shows there were seven MIUs in Wiltshire until 2007. I could make a party political point on that date but wont. Cornwall has 14 but 10 are planned for closure!)

[Ferretfancy]

One evening a few weeks ago I had a nasty fall leaving Embankment tube station, with a heavy blow on top of my head which bled very badly. Within seconds I was helped up by a man who turned out to be a plain clothes policeman. In the tube station office I was immediately seen by a young paramedic for some rapid first aid. As I take warfarin he thought it best to send me to hospital, and in a few minutes I was in an ambulance taking me to St Thomas's,where my head was glued back on. ( Yes! They use superglue nowadays) This was a very stressful experience, but my point is that all those who helped me did a superb job.

No doubt there are thoughtless admin staff. My local group practice has had its share of receptionists who sometimes give the impression that they can resolve medical issues, but the pressure is heavy and there are quite a few thoughtless customers who can make things difficult. The short answer is that we should all be paying more taxes in a reformed system which can allocate resources fairly. Advocates of private treatment might well remember that all medical staff are trained at public cost. As far as I know there are no private medical schools