Is the government trying to break the GP service?

Where I live we have an out of hours GP service which operates from 7pm until 8am and then all day Saturday and Sunday. It is based in our local hospital. All gp's are on a rota so they may do one evening/ one daytime shift per month. There are always 2 doctors, one triage nurse and one ambulance service driver there at any one time. You merely ring, speak to the triage nurse, if she feels that you need to come in you trott along and see the doctor. If the doctor feels you are more serious than first thought you are sent through the door to a&e. If you need a home visit the ambulance driver takes the doctor and is there to assist if necessary. It's worked well for a number of years.

That's sound ideal, Grannyben. There's nothing like that where I live.

Hospitals, ambulance services and GPs are all run by different providers, sometimes private, sometimes NHS, all commissioned by a Clinical Commissioning Group. Presumably my CCG has decided it's not worth paying for a proper 24/7 service, which puts extra pressure on hospital trusts and ambulance services, who can't hand patients over.

The whole thing is a shambles. CCGs spend over £3 billion on buying in services on the legal and admin costs - and we end up with a shambolic postcode lottery. The 2011 Health and Social Bill was 'sold' as a way of putting control into patients' hands, but it's done nothing of the sort.

I think that the GP service needs to be expanded with extra staff, extra funding etc etc.
The first port of call, unless it is an actual accident or emergency, should be the GP service and having a proper service 24/7 with all the funding that requires should be the aim. It would take time and money but worth it unless they are prepared to re-open the 'minor injuries' units in local hospitals, many of which have been closed.

Our 'local' hospital is 20 miles away. The very local community hospital has no minor injuries unit any longer.

I paid the equivalent of £70 to see a GP in Australia, that was about 5 years ago and, of course, the exchange rate varies.
I paid £80 many years ago there for blood tests and a very grumpy consultant to phone me with the results.

A&E was free because it was on a reciprocal basis.

Yes quite Whitewave re private care. I have relatives who pay an eye watering amount of money to stay in BUPA now they are over 75. They know perfectly well though that BUPA won't be any use in an emergency or an acute illness. Because in this country the private sector just doesn't do the really hard and expensive stuff.

So all our troubles are over - it was those nasty GPs all along!!! I can't wait to see what mine has to say about it.

A group of people in my town have been trying to re-open the minor injuries unit, but the argument is that it's too expensive to staff 24/7 with the kind of equipment that it needs for safe care. Apparently, when it was open, over half of people were transferred to A & E anyway and going to the minor injuries unit just wasted time.

I'm still a bit sceptical about that. I think its success would depend on people being fairly sure what's actually wrong with them. A bad cut needing cleaning up and stitches, a dislocation, etc would be fine, but a bump on the head could turn nasty quite quickly, as could unspecified chest pains.

My 'local' hospital is over 30 miles away, although there's a nearer hospital (just under 20 miles away), but it's in a different authority.

1 in 3 GPs considering retirement in the next five years. Not a good idea to lose the little goodwill there is left.

www.theguardian.com/society/2017/jan/14/mays-scapegoat-attempt-could-spark-mass-resignation-says-top-gp-nhs-crisis

My local hospital has the urgent care/minor injuries unit at the A&E, so it's pointless telling people not to go to the A&E.
You walk in, go to the desk and the receptionist sends you to the minor injuries; then the minor injuries sends you the opposite way as it's too serious for them to cope with.

There's little doubt that the government wants to break the GP service, as it currently exists. It wants to get rid of GP partnerships and replace them with salaried GPs, employed by companies such as Circle and Virgin Healthcare.

The public would, I think prefer, healthcare centres, capable of dealing with minor ops, minor injuries and a full range of tests.

The big question is whether GPs would want to work in them and whether they would offer better value for money, given that shareholders would want a profit. There's a real danger that companies could go bankrupt and walk away, as they have done with some care homes.

I have seen it suggested that they set up as charity groups, to stop the profit motive.

In an ideal world, we'd take the profit motive out of all public services imo. We have a veterinary practice locally, set up as a not for profit organisation. It's very busy as you can imagine but who'd have thought we could end up with a similar set up for health?!

dj, how would that work?
Charities are still very much financial entities as far as I can see?

Plus sometimes, charities can work fine in their first few years, but then after that have to work very hard to keep the money rolling in.

Plus the supply of grants which may have been rather easy to find in say the first 10 years, have been somewhat exhausted after that.

The government should stop giving so much money in foreign aid to countries who are rich - eg India and China and channel it back to NHS. Also charge foreigners who do not have British passports for services - particularly A & E.

I am NOT suggesting they work 12 hours a day ,7 days a week ..just that they have a ROTA so that there is always a doctor available.And as foor my daughter taking her baby to A and E thats what she had to do ,and in my eyes a 20 mile trip with a sick baby without medical backup was very wrong !

I think it might help if they opened on a Saturday even if they closed maybe one afternoon in the week. I strongly believe that they should bring back the convalescent homes so that the so called bed blockers could be moved. Many of them need looking after but do not necessarily need medical nursing.

I go to a branch surgery which is only a few minutes walk from my home but I knew when I registered that it had limited opening hours. If they make this compulsory it will close and I will have to find somewhere else. Many surgeries have long waiting lists so they won't be able to absorb the numbers that go to my surgery and I will have to get a bus rather than being able to walk.

There is a need to pump money into elderly care outside of hospital. This crisis was entirely predictable as others have pointed out.

The fragmentation of health services via outsourcing has been a disaster. It gobbles up millions of pounds in admin etc and forces people like GPs to engage with politics and practice management when their skills lie in other directions.

Goodwill has been lost (see also teachers, social workers etc.) by central dogma and an unwillingness to listen to those who actually deliver the service.

The NHS is a precious thing - but I can see no way that it is going to be preserved with things as they are heading.

Ankers.
Maybe the person you know who doesn't like the hard work members of the medical profession are subjected to should consider looking elsewhere.

GP's are people. They have the same need as anyone else for rest and recuperation. 7 days a week is asking small practices to stretch to the extreme. People need sleep, they need a break from the workday routine, they need time with their families. GPs are no different.

We are in an area that is desperate to keep its A&E service but we are most likely to lose one of them. Shropshire and Telford and Wrekin is the area I am talking about. We should of course be able to keep them both,we are about to lose also a women and children's hospital that we payed for 2 years ago, but that's another story....but money for the NHS is stretched. So the same will happen to the NHS as happened to the Fire Service and the Police Service. They will be cut to the bone. GPs will have to take up the slack. Pharmacists too will be cut down and closed in every area where possible.

Where is the extra money for extra staff in the NHS now that we have all these extra thousands of people re-immigration? There is none. The nurses who are already stretched will just have to cope as best they can.

For all the posturing of the politicians (of every party) not enough money is being spent on the NHS to provide staff, beds and equipment. One solution that would help is to put up taxes by a few pence and make sure that that money is ring fenced for the NHS, but they won't do it because every political party needs brownie points for the coming election so they won't risk it.

Look at what happened to student tuition fees. Every Party has supported that massive jump. Why do you think students are turning away from medicine? Because it will give them a debt of £50th to £90th in fees. No-one wants that do they? In some areas that is the price of a house, not London of course or the southern counties, but up North yes, you can buy houses for that so Mmmm do I train as a doctor/nurse or do I buy a house? Or do I go abroad and offer them my services instead? Manifesto promises are broken as soon as the Party is in power, they are not worth the paper they are printed on. As Nick Clegg said when tackled about tuition fees, 'What you can promise when out of office is not what you can promise when in office'.

So Joe Soap has to manage while politicians get a pay rise every year. Which means they can afford Private care so 'We are OK Ya! The NHS comes right down on their priorities because in the end their aim is to privatise it.

Mind you, it is up to the NHS Managers to use the money wisely and not squander it. Over prescribing tablets causes a lot of waste. Packets of pills, whether opened or not, cannot be re-used once they are dispensed to a certain patient. Even if you take them back to the chemist they have to be disposed of not used again. One area which needs looking at. Another area is providing social care for old folk, you and me, when they need it so that hospital beds are not used as nursing home beds. Another area they could save on is people taking back crutches and other equipment loaned to them by the hospitals, but they don't, they hang on to them 'just in case'. Shocking but true.

So, everyone has their part to play from top to bottom. No use waiting until the NHS crumbles before us is it.

All my opinion of course. Rant over. Sorry!

Not to mention agency nurses and layers of paperwork that nurses are supposed to cope with on top of their nursing duties. The list is endless.

Sorry, but it makes my blood boil. I used to be a nurse a long time ago.

Of course they are. They won't be content till we are all forced to have privat health insurance bought from their buddies.
I wonder if GPs were to decide in to leave the profession in high numbers how they would the present government explain that to their voters.
GPs are employees and as such can decide this us not for them anymore and retire or seek other employment.
The NHS and the Caring Professions are being treated abominally. In my opinion.
Does John H host Mastermind? Let's all turn it off!

GPs are not employees. Most of them are still self-employed, although the government wants to change their contracts.

Exactly! It's all part of the push towards a 24/7 GP service. GPs can currently choose their own hours, despite financial penalties. However, if they're employed by a private company, their contract will force them to work whatever hours they are told. If they do resign 'en masse', there just won't be enough GPs to go round and they'll have to be employed as locums, so the agencies make big fat profits. GPs are quite deliberately being scapegoated for the current crisis.