UK NHS: Government proposed changes from July 2024

What I don't understand is why you need a GP. Surely the patients could just go to the hospital and ask the receptionist for an MRI? What am I missing?

 

The doublespeak is pouring out. Mr Starmer says:
It’s about a shift in the balance of power away from passive deference to doctors and towards patients being able to get that second opinion, play a greater role in deciding their care and their treatment.

And yet the plan in to achieve this by paying GPs to not get a second opinion, so there will be nothing for the patient to decide!

 

Well the man is a pro.

 

Offer ? Who offered what ? Retail ?

This is a very big national contract snaffled up to train staff being blamed for the system. Around here almost all the hospital admin and reception need no extra training they are VERY good and the Health Trust somehow balances the books without nipping their time too much. Not all zones are so lucky I hear

What i observe is its the GP clinic-business that nips all personnel time abominably, turned GPs into hacks, and now it wants more money to retrain the OTHER staff. Who will retrain the GPs scripted bedside manner: "Good morning, what can I do for you, OI, don't tell me my job". Hallo..bye bye all day

I do not agree with Mr Streetng. I say no way is the admin and reception at the heart of the problem, so to me, this looks like another haemorrhage, sad to say. Claiming patient participation is one thing but its not the scientific evidence in itself. And I don't believe the patients surveyed said the office staff were the core problem

 

So you don't need a referral from a GP to get an MRI or CT scan in the UK?

 

Oh yes, you do. But since the GP will have no real idea whether or not an MRI or CT is a suitable test for most situations and anything that shows up needs a more expert opinion to Mae an accurate diagnosis I don't see why you need a GP rather than a hospital receptionist.

I may be biased by having a rheumatological perspective but I doubt it is so different for other things.

The real point is that if this 'GP' person was sitting in a hospital clinic where they could discuss the case there and then with a specialist in the next room and get the test downstairs it would all make much more sense. Moreover, this 'GP' would have vastly more expertise, having been learning that way every day for years.

 

But how would we know if we needed one?

 

Some tests can be requested by GPs and some not. It changes over time. To begin with MRI could only be requested by a senior hospital consultant, then that spread to other hospital doctors. Recently GPs have been able to order things like knee MRIs because a long process of assessment of benefits and risks has led to the conclusion that this is sensible.

In other words the current rules are purely based on what is considered safe and effective - on a case by case basis. How can there be any justification for overriding that? If the restriction is due to cost then since there is no new money nothing will change. The GP will say 'ah let's do an MRI' and look at their budget and say 'maybe not'.

 

There are plenty of sources of information on the net, including information pages from the NHS. If you suddenly have a pain in the knee with swelling you are already likely to think an MRI might show what is wrong. Look up 'what tests should I do for a painful knee with swelling' and you will get a Google AI answer I am pretty sure.

Point being that GPs really don't know more than this. Efficient assessment and test choice requires a level of training in a particular specialty that GPs just don't have. Or at least where they do their justification for asking for certain tests was recognised long ago.

 

Yes I tried it: Google AI:

What tests are useful for a painful swollen knee?

It gives everything a GP knows.

 

GPs seem to send a fair few people to A&E too. It's the only way they can access a specialist for something that needs a prompt second opinion, but isn't life threatening enough for an ambulance.

That's a mad way of running things, it's neither an accident nor an emergency. It's a GP who thinks it's probably not serious, but without access to imaging, neurological assessment, blood tests or whatever, can't quite rule out the possibility.

 

Not only do you need at least that but the CCG (now ICB) used to reject any requests if they didn’t meet their limits which a few years ago was ‘serious neurological symptoms for a month’ not including things like sciatica but ie brain even if a specialist suggested it to the gp

I’m also not sure which specialists can order what and if they’ve limits ?

But then that seemed to be very different in other parts of the country

there was a bit of talk about loosening that up and having scanning centres a year of two ago but I don’t know if that was just bluster like above and really from what I know it’s just ultrasound that really can end up in some community shop because the others are big expensive machines some of which are mobile anyway

 

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Another puzzle. Maybe I am imagining things

Since when did community clinics send hordes of people with reduced lung capacity, high cholesterol, high blood pressure, lost bone density, or severe period pains to a consultant for a specialist assessment ? But post-menopausal bleeding was fast-tracked to a specialist in case of cancer. So all that changes is to stop checking bleeds for cancer ?

Whats new ? This was known and provided for a long time already. Bit irritating, this Plan

 

And where are the staff ?

The use of private sector has limited throughput as much of the staff are part timers who also work for NHS - or perhaps given recent pension fiascos NHS consultants will now elect to work full time for private sector as it expands ...

 

Can women in the UK self-refer for mammograms? Do they need a doctor or nurse practitioner referral?

 

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Its very puzzling. Or stunning. Is this supposed to be an appealing prospect

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Uncounted doctors asap already told uncounted people not to worry because they don’t need further treatment so go go go get a life back, and it seems this did not work to deliver peace of mind

That was countless hours of consultation in community and hospital clinics, hours bought and sold and paid for to set everyone free after a quick fix or the all clear. All those cases closed asap

If peace of mind measures efficacy, it did not seem to work, that plan for uncounted doctors to tell uncounted people not to worry because they don’t need further treatment after a quick-fix or the all clear, so go get a life. There is no point in rolling it out all over, again and again. Maybe I saw stars

I do not make sense of the subsidised National Health Servivce (UK) paying a nurse a bit more than half what a commercial agency pays a nurse, then paying that commercial agency double what it pays it's nurses, then the NHS can moan about being strapped for cash and complain of staff shortages with umpteen vacant posts since so many of the underpaid nurses - whom they trained up to service the UK - had to go work for the profit of the agenices, instead

With all the outsourced clinics, how does the new fund for retraining office staff get distributed through what profitable agencies to which profitable agencies, to retrain people like hamsters on a wheel running faster and faster governed by a Time & Motion algorithm

 

There is a screening program for breast cancer - when women reach a certain age a letter comes through the post inviting you for a mammogram. But then reach an older age and those letters stop.

Source of the above quotes :

https://www.nhs.uk/conditions/breast-screening-mammogram/