What do we want from our NHS and how should we pay for it.

Are you talking just about General medicine or all the other services as well eg dentistry, optics, chiropody, hearing, other community services?

kitty that is what I mean I am not sure exactly what is covered by the NHS perhaps you may be able to enlighten me?

I think the list is huge whitewave. I have a vested interest in dentistry bit most people think of medicine when they talk about the NHS,

From a dentistry point of view 'flows' isn't quite the word to use. That bit of the NHS is totally over managed and,also, should be much more 'national'. Different areas choose how they spend their money and, as recent events in Nottingham have shown, there is no consistency! DH is a domiciliary dentist but our neighbouring counties have no provision at all!

But, most people are more concerned about medicine as in GPS and hospitals etc so I'll get off my soapbox and wait to see whatever anyone else has to say.

When you say no provision do you mean no NHS dentistry available? So what do children do?

No provision for domiciliary dentistry for people who can't physically get to a surgery. Not good with an aging population.

As far as children go, we used to have a system in our area where dentists had 'exempt' only contracts but now, unless the dentist takes NHS adults, they are not allowed any sort of contract with the NHS. Other areas are different!

So there is no national overall consistency with regard to dental provision on the NHS. Each area decides its own system of provision, which may mean gaps in certain provision and there is nothing overseeing this? This may mean lack of provison for children because of the way the contracts are structured between the dentist and the NHS is that right?

Pretty much spot on! Exempt patients include people claiming certain benefits, pregnant and 'nursing mothers' as well as children. And, there are managers galore!

Broadly speaking (and this is very broad as the detail is extensive) the NHS runs with GPs as the gatekeepers to other services. Everyone is entitled to a full range of GP services i.e. Primary Care (although what is on offer in various surgeries can differ a little) and the GP is . GPs make referrals to other services(Consultant/Specialist services in hospitals) and now hold a collective budget (commissioning ) for this. GPs although contracted to the NHS are technically self employed; they may or may not also employ nurses in the practice with varying specialities and a range of other professions allied to medicine (PAMs) e.g. physio.

That's your starter for ten whitewave there is a great deal more- I'll offer a bit more later when you get the discussion going.

In Sweden, they have a very good care system which is partly funded by patients paying a small charge for each visit they make. I know a few years ago it was only something like £10, and I think even that was lifted for those not working. I don't see why we couldn't have something similar here.

I don't think it was each visit, I think it was for each course of treatment.

I should have posted this podcast (see thread below) on here - this is what I want from my NHS and it would include "paying it forward"

www.gransnet.com/forums/health/1211866-Its-time-that-clinical-encounters-became-human-encounters-podcast

He has a most appealing voice and it goes quite quickly! - like listening to the radio...

janerowena the sheer cost of administrating a small charge for each contact would probably consume more than the amount collected. Its a really tough one. It would generate all sorts of forms: exemption forms, forms to reclaim etc as well as umpteen new staff throughout the country to run the system. Of course that could create jobs with all the attendant benefits associated with that eg new staff would be tax payers too. Maybe that's why medical insurance is so popular in other countries as it shifts the responsibility for collecting the money from the NHS burocracy? Don't know. This thread could run and run.

It's not really that difficult, Jane10.
Some patients have had to pay for NHS dentistry, optical services and prescription charges for decades.

I'm not saying I advocate a charge for seeing a GP. Just that the bureaucracy is already there, and it's a myth that NHS services are free at the point of delivery.

There would be a lot more money for direct patient care if a law was introduced banning all structural change within the NHS for at least ten years, preferably fifteen or twenty.

That way, the people who are employed to 'manage change', write impact assessments, new protocols, redesign websites, etc, could all be given their P45s.

jane a I agree with your post. It is a myth that NHS services are free at the point of delivery. It may have applied way back when, but it is no longer true.

Handing out P45s equally as valid, but it won't stop this culture though: I have a friend who is on £500 a day and all she has been doing for the five years (straight from university) is one NHS Trust structural review after another, as a project lead on a consultancy basis.

... that should be "the past 5 years ..."

Meant to put this up earlier, forgot! I've copied and pasted this from a thread I started a couple of days ago; it sums up my feelings about the NHS!

"This year, so far, since April,m I have had a total knee replacement, both cataracts done, and yesterday went to the pre op assessment for a hip replacement. Today - operation booked for 17th December! (yes, I know there might be a cancellation....)

I cannot tell you how pleased I am, nor how impressed I am by the consistent efficiency, kindness and attention to detail of the local (North Devon) NHS, from GP to consultant, to receptionists, physiotherapists etc. "

I'll now update myself with the new posts, before I forget...

And I have no idea how I would have paid for all that; I wonder to how much my contributions over my working life amounted?

Is it that our contributions are too small, or that the number of contributors is declining as the number of end users increases?

Would one pay / have paid more for what one can get? How much more would make a significant difference?

I agree with the points alluded to about a top heavy management structure, unnecessary innovation and so on.

And don't get me started on NHS employees being given huge redundancy payments and then being re-employed

I think more needs to be done to educate people on how to keep themselves healthy as we're on a slippery slope with obesity levels rising etc. I'm not saying that it's anyones fault if they get ill by the way; I realised a long time ago that a lot of serious illness is quite often just down to rotten bad luck. But, starting with children at school health and wellbeing should be encouraged more than it is. And something needs to be done about people not attending GP/Hospital appointments; I dread to think how much that costs the NHS. I still don't understand why GP's stopped having to do night visits but are now allowed to work at out of hours centres at night.

Getting back to the way dentistry is run in the UK with no national overall provision - is this true of GP's and hospital services? Are contracts drawn up with consultants GP's etc? or how is that done?

Why I am saying is that clearly dentistry is now (and has been for a number of years) no longer free at the point of delivery, and I am not sure that I would want that nor the way the contracts are negotiated with the dentists as it seems to me that is the reason so many people find it difficult to get on a NHS dentist list

Until the top heavy management systems are sorted out, the NHS will never be fit for purpose. I would like someone to come up with a viable way of reducing the number of highly paid, but highly stressed, managers. There seemingly have to be systems in place that treat professionals as though they are going to behave like naughty school children unless someone sits in the corner checking them.

Dh, with nearly 50 years experience has a 'line manager' who, we assume is well paid, to make sure he doesn't go over his financial limit even if that leaves vulnerable people with no provision. There used to be another practitioner carrying out the same role as DH. Between them they worked 1.6 of a week. When the full time practitioner retired, Dh asked if he could have some of his funding as he was very likely to be busier being the only one. He was told to come back and ask again when his funding allocation was nearly gone and they would see if they could find him more money. The managers talk in units of activity. DH sees vulnerable, mostly old, people - ie patients.

Yes that is because they are encouraged to do so by the accountants.

I was thinking about that the other day and wondered if it would be possible for the practitioners to run things. The problem with that is that they would be called away from their valuable work. Maybe the way forward is for the practitioners to run the hospital, unit etc and employ administrators who were told how the practitioners wanted things run.

Not sure if it's possible to keep politics out of this, but this is what I do not want, arms companies running NHS services.

Does it cost us more in administrating the system, than the system itself, do you think?