24/7 NHS

Are you saying this government will put money back into the NHS, Ana, and stop the privatisation? I do hope so.
At the moment it is difficult to work out whether they are going to give it an extra £8 billion a year or altogether over the next parliament. There is also the question of the £22 billion to be saved by even more efficiency when many hospitals are already in deficit, one in six GP posts not filled, etc.
Facts, not supposition.

Just reread your OP, Vampire.
After my husband fell off the ladder and ended up in Hull Royal having an operation on his spine, there were lots of times when my mother said when did that stop. For example they said they had not xrayed his feet so missed the fractured heel; my mother wanted to know when they had stopped xraying the feet of people who fell off ladders. She used to be a nurse there.
I agree; 24/7 should have always been there. When did it change?

durhamjen, I am not saying that. Where did you get that assumption idea from?

Ana The Daily Telegraph article you linked to used a graph to conclude that the increase in visits to A&E is solely down to Labour's introduction in 2004 of GP contracts. I think it is fairly well known that a correlation does not necessarily imply causation, especially in a matter as complex as this where so many variables are involved.

From 1948 to 2004 GPs' contracts made them personally responsible for their patients' care for 24 hrs a day, 7 days a week, 365 days a year. By the 1960's there was a major recruitment crisis and doctors were recruited from abroad.

Dr Eric Rose, now retired, has written an article based on his many years' experience working as a GP. He said that by the late 1970's the responsibility for out-of-hours care was becoming so onerous that it was affecting many GPs' physical and mental health and that of their families.

By 1996 out-of-hours co-operatives were being formed and by 2000 home visits were the exception and GPs were coming under pressure to monitor more strictly their out-of-hours services.

Around that time, there was again a serious shortage of GPs and a great deal of unrest - with more doctors going overseas to work. Those remaining balloted overwhelmingly for a new contract. This is the background to the GP contract that Labour introduced.

A King's Fund Report in January 2015 looked, amongst other things, at the claim that a lack of access to out-of-hours care had led to an increase in A&E attendances and concluded that there was no evidence to support this contention.

In 2003/14 the number of non-GP attendances did jump by 18% but this reflected the introduction of walk-in centres and minory injury units rather than A&E. It was also found that those people who did attend A&E did so during working hours, although it was accepted that some patients were unsure as to how they should access out-of-hours GP care.

The report highlighted the fact that out-of-hours care is provided not only by GPs but also by, for example, District Nurses, whose numbers have been reduced by 30% over the past 5 years, leading to pressure on GPs and emergency services.

A 24/7 NHS is enormously complicated to achieve and isn't just about access to GPs. Much has already been said here abut problems in the way nursing contracts are constructed and the shortages of clinical staff of all grades but I would add in that Social Services only have skeleton staff at weekends so arranging discharge from hospital for patients needing care comes to a standstill at weekends which in turn means beds are not freed up for new admissions and the system doesn't crank up again until late on Monday or possibly even Tuesday.

I would also like to add in that in my view until more diagnostic tools are available in GP surgeries (plain Xrays , ultrasounds, blood analysers etc) there will always be a big queue for hospital tests and uneceesary admissions. I was sent by the DoH to the USA some years ago to look at how the system works there and leaving aside the funding arrangements for the moment what I saw in GP practice was an array of diagnostic tools that I have mentioned. They thought it dreadfully expensive and wasteful and inefficient in terms of prompt treatment to send someone to hospital for routine tests.

I am glad you have reiterated Eleothan the toll on doctors' health and well-being that providing such a service can cause.

Teetime - you are so right about the nonsense of a system that has basic diagnostic tests based in hospital centres rather than on the ground. And I would include physio, counselling etc as services which should be available at all GP surgeries. So much wasted time and money.

The 24/7 statement is probably attractive to a lot of people but it is meaningless, isn't it? If you have an urgent need to see a doctor whether in or out of normal hours, it should be an emergency, suitable for A&E. If it isn't urgent, you can usually wait a day or two. It seems to me typical of this party's approach to government to 'solve' a crisis (shortage of GPs and A&E doctors) by inventing a target which creates a new, wholly unrealistic demand. There is a shortage of teachers who want to be heads, so the government solution to underperforming schools is to parachute in a super-head. Where will they get these extra doctors, nurses, ancillary staff and head teachers? How about putting the service out to tender?

This is why it is difficult to recruit GPs.

www.pulsetoday.co.uk/home/finance-and-practice-life-news/gps-spend-fifth-of-consultation-time-on-non-health-problems/20009996.article

They do not have time to do their jobs properly.

Lilygran, one of the problems is that recruitment is out to tender. Locum GPs, pool nurses, most ancillary staff are not recruited by the NHS but by agencies and outsourcing companies. That's why there is such a problem. NHS staff used to be proud of being part of the NHS.

No emoticon for irony, durhamjen. I feel sure that this policy is intended to create a further crisis, like the 'failing schools', to which the only solution will be privatisation or quasi-privatisation. Thanks for the link.

Sorry, Lilygran, didn't get it. I did wonder where you had been for the last few years but didn't like to say so!

Agree about education. Coasting schools now will be made academies. Even the "top" schools can be coasting, can't they?
Can Eton be made an academy if its results do not improve? Only if they go for free school status because their receipts are falling. No chance of that.

There are great problems with actually finding locum doctors for GP surgeries and hospitals. I know a couple of people who work for a company trying to fill GP and hospital doctors. Even when the pay is £85 an hour - which to me seems a high level of pay they cannot ind enough to fill the available staff.
If the UK are training and enough doctors and nurses perhaps it should consider making it an agreement when they start training to work for the NHS for five years ( or however many years is deemed necessary) before going to work in a other country. If they are not training enough of them then surely the long term solution is in the UK's own hands.

They should also agree not to do private work for five years after training, Bez.

www.pulsetoday.co.uk/commissioning/commissioning-topics/urgent-care/ccgs-told-to-ensure-no-patient-attends-ae-because-they-cant-see-gp/20009926.article

The posts at the bottom of this article are interesting, telling NHSEngland how impossible it is.

Very interesting, durhamjen. I note several of the posters on Pulse have commented that NHS England doesn't know what is actually happening out there in the consulting room/ department. It is so true of all the public sector. I suspect the politicians wouldn't be able to come up with such bloody silly policies if they knew what life is really like. Or ignore what practitioners say so they can pursue purely ideological aims.

GP's do their normal hours and then do out of hours work and get paid huge amounts for it [often ending up tired the nest day when they do their 'proper' job]. In the past the out of hours work was just part of their day job].

Tegan you must have had a bad experience with a GP! I don't think it's fair to suggest all GPs do that. Just as all consultants don't have private practices.

It is all so tiresome: people with no experience of a service being put in charge of government departments and allowed to act on their whims, unfettered by research evidence or conversations with those actually delivering the service.

First find your envelope, turn it over and start writing.

Would a business corporation employ and chief exec who knows b*** all about the company? I think not.

A retired doctor friend of mine reckons that part of the cause of the shortage of GPs is... ah-hem .... they have trained too many women and many of them are working part time instead of full time. Reckons nobody will say this because they don't want to be accused of sexism. No idea if he is correct or not but it is certain that there is a terrible shortage of GPs in some areas and they cannot recruit to fill vacancies. Cameron and Hunt don't seem to have any ideas about how they are going to address this. All very well talking about a nice idea but you can't conjure GPs out of thin air and you can't make them work longer hours by bribing them.
As for 24/7 hospitals this has to incur a cost and I cannot see how it is going to happen.
Current assumption is that on present funding, and given the rising demand, the NHS is going to have to make £22 billion "efficiency savings". (2-3% of total spend) In other words "cuts". The main scope for making cuts is staffing which is the biggest chunk of the bill for running a hospital. Cameron says he is going to give them another £8billion (over 5 years) which still adds up to £14 billion cuts which is terrifying. So how on earth he could get more staff cover over weekends against that background goodness only knows.

If hospitals are already vastly overspending on agency nurses (around here five big hospital trusts are spending 10 times what they spent two years ago) there's no chance they'll ever recruit enough to cover the current shortage, let alone extra!

One Bristol hospital trust is heading for a real crisis; the agencies can't even recruit fast enough for them

JessM, you and your friend are quite right. I have sounded off about this before, but will now do so again! "They" (not making party political points here, as the short-termism of all kinds of politicians who run the NHS is a BIG problem) knew years before the Working Time Directive was introduced that it was coming. "They" knew that when the medical schools started to admit students on exam results without gender quotas that a lot more women would be trained as they get better exam results. "They" presumably worked out that because of inescapable facts relating to human biology, some of these women were going to need time off to reproduce and then perhaps look for part-time jobs. (Another result, of course, is that male doctors don't see why they too shouldn't work part-time when they have young families, and who can blame them?)

So what should "They" have done? Seems obvious to me that making more places in medical schools available would have been the answer, but this is where we get into short-termism, and the buck of an expensive commitment is passed on to the next lot, and the next...

DH worked for many years as a GP in a 4-doctor practice (latterly 5-doctor) in which for geographical reasons they did all their own on-call. That meant 13 weekends a year and 52 week nights (yes, they had holidays, but of course they had to cover each others' holidays for on-call). Surprisingly enough, they also worked days of 8.30-7.00 and so by the end of a week with Saturday/Sunday at one end and Friday night at the other, do you think they were particularly sane? Or safe? I had to answer the phone on his nights on call, and so had to be in the house. The invention of the cordless phone meant that I could go to the toilet without keeping the door open and toilet paper handy in case I had to rush out (gory details can be imagined). The arrival of the mobile phone in the mid-90s was wonderful, as it meant that I could contact him with another call without his having to come all the way home and go out again.

The new contract, which seems to annoy so many people, was not an opportunity for GPs to "opt out" of doing nights and weekends, but putting it like that made them sound more selfish. In fact there were 2 contracts offered, one for day work and one for "out-of-hours", and people like DH took the day one - otherwise he would have retired long before he did. Naturally, we knew that there would be a financial penalty for giving up the nights and weekends. I still feel like spitting when I think of what "They" took off his pay, and therefore what value had been put on all those years of sleepless nights and disturbed family occasions. £6,000 per year. .

In fact, "They" hadn't done enough research and so didn't realise what they had been getting for very little for so many years, and that is why the costs of out-of-hours has risen so much. Serves "Them" right

Sorry this has been so long, but once I get started...

Does it matter whether GPs are full time or part time? What matters is the number of hours worked, not the number of people. That's what they call full time equivalent.

I noticed when I was teaching that two 50% timetable teachers did more work efficiently than one full time teacher, who was often worn out.

Many GPs feel the need to earn much more than the average person. Why?

Is there any other job where a person is expected to work a full day and then be on call at night? I would rather be seen by a GP who is refreshed and relaxed than someone who is totally exhausted. GPs sometimes have to make life and death diagnosis. An exhausted person is far more likely to make a mistake.

I don't understand the thing about 24/7 hospitals. They're already open 24/7 and, although senior doctors aren't usually there on a night, there are doctors on duty.

when I wish, how I wish, that politicians would actually listen to stories like yours! durhamjen, I'm sure you're right about part-timers in terms of how hard they work. Job sharers are particularly effective in my experience. But you need more bodies to cover the same hours and two part-timers actually cost more than one full-timer because of NI, pension and equipment etc.

I think the point is durhamjen is that there are only so many places in medical schools. This has always been limited as the training is long and costly. (and just maybe Doctors like to keep themselves in short supply...)
Numbers have not been allowed to expand in the same way as other subjects, for whatever reason.
So UK medical graduates are a finite resource.
If a large percentage of them only work part time then they effectively count as a half doctor not a whole doctor in terms of covering the workload.
It's a similar effect to the one you'd get if a significant percentage emigrate and never contribute to the NHS.

Solving the problem by NHS importing doctors from abroad is not easy - there may be problems with the standard of training and with the standard of English. But we have relied on this for many years. I have a lovely Ghanaian GP for instance.

Lianne Wood, Plaid Cymru, pointed out during one of the election debates that one of the problems with recruitment of doctors in Wales is that due to the changes in immigration rules brought in by the coalition it is a real struggle to recruit enough doctors - and then the NHS ends up paying eye-watering agency fees - or having to reduce a service.
e.g. I had a neighbour who was a Romanian Ob/Gyn consultant. He went to work in Australia last year. Ob/Gyn consultant services are having to be cut back here this year.
Point is that NHS cannot legally ship in planeloads of extra GPs and consultants from India or wherever to plug gaps - let alone ship in enough GPs to give an extended service.

I know someone who is in Year 4 of the 5 year doctor training programme.
He has been put off being a GP, which is a shame, as I think he would make a good one.
He is ambitious and pay matters to him. He regularly compares himself to how others are getting on who have not gone into medicine, including those who are now working abroad and earning a lot.
He is still undecided as to which branch of medicine he wants to go into, as are a lot of his colleagues.

Isn't it funny how "pay" is so often linked to "ambition" and "aspiration". Isn't it possible to be ambitious/aspirational in ways that don't necessarily rely entirely on what you are paid? I do understand that if you have studied very hard for a qualification and, particularly in the case of doctors, are taking on huge life and death responsibilities, then your salary should reflect that, but surely there should be some desire to help people/contribute to society as well?

In the US, where doctors can - and many do - earn vast amounts of money, it appears that money can become the primary motivator, leading to all sorts of unnecessary but profitable procedures being carried out.

I'm not, by the way, someone who believes that medics and other "caring professionals" should not be concerned with how much they are paid - everyone has bills to pay. I'm just reflecting on what drives people to follow a certain profession or occupation and wondering whether those who see money as their primary goal are necessarily the people who are best suited to the caring professions.