Let's turn the clock back to 1948

PS. I suspect some of their grandparents don't have much of a clue either - despite many of them (the females at any rate) having had "cookery" lessons in school.

Schools do teach about the major food groups.

Blondiescot

We must not only protect the NHS at all costs and resist any attempts to privatise it, but call for it to be properly funded. Yes, it has changed out of all recognition since it was founded in 1948, but we need only cast our eyes across the Atlantic to see what a privatised healthcare system could mean. Does anyone seriously think it would be better to have that kind of system, where those who could afford it would still have a decent level of healthcare, but those who could not would be left to suffer?

The problem is that privatisation is already happening. The 'Exeter Medical Centre' in Exeter, near where I live, is owned by Ramsay Healthcare, an Australian healthcare company. NHS patients are being referred there now, "for free".....for now.....the hearing aid service has been privatised......the 'government' is employing private agency staff to cover for lack of 'regular' NHS staff (deliberate) at 3/4 times the cost.

People desperate for treatment and operations are "going private" by either using equity money, or taking out loans, simply because the waiting list for many treatments is many months, even years.

I'm afraid it's happening right now and people just aren't seeing it.

You're right Rameses. Many services bearing the NHS logo have already been outsourced to private companies, including diabetes eye screening, mental healthcare and physio. All of these providers are taking a cut for themselves. That's in addition to the private GPs, who charge a fee.

To be honest I do not care a stuff how my healthcare is funded, providing it is quick, efficient and effective and free and unrationed at point of use.

Over the last decade or more I have had my fill of poor, inefficient and slow health provision by the NHS that came close to killing my daughter and left DH with major problems following negligent rehabilitation after bypass surgery.

DH is about to have a private appointment with a specialist just to discuss all the potential treatments available for his medical problem, because everything about his interactions with both consultants and his GP, whom he gets on well with, suggest that he is only being told only of the treatments that will be as cheap as possible and convenient for them. He is not being told of other treatments that might be more expensive, and many are being presented to him in a negative way to put him off them.

He may well after such a discussion decide to do nothing and live with the status quo. He would just like a discussion that isn't biassed and limited by NHS diktats.

Rameses All GP surgeries are privately owned and run, and always have been. I think most consultants are self employed and decide how many sessions a week they will work. Dentists and opticians have always been in the private sector.

We do not pay for GPs services, dental treatment and eye care is subsidised, so a large proportion of the medical care provided through the NHS is provided by prvate contractors, so nothing new there.

25Avalon

It has been taken apart and rebuilt several times and each time more funding has been thrown at the wrong part of the NHS with more administrative roles and allied expenditure when it should go to patient level.

Definitely what I saw working in the NHS and what I see now as a patient. The admin are also too involved in what should be medical decisions. There is also a culture of bullying staff who dare to raise issues.

What roles are these admin staff employed to do?

M0nica

Rameses All GP surgeries are privately owned and run, and always have been. I think most consultants are self employed and decide how many sessions a week they will work. Dentists and opticians have always been in the private sector.

We do not pay for GPs services, dental treatment and eye care is subsidised, so a large proportion of the medical care provided through the NHS is provided by prvate contractors, so nothing new there.

No, Monica, GP surgeries aren’t. A number of GP practices are run by Health organisations now - some are fully NHS run, with the GPs contracted directly by the NHS. In deprived areas it’s impossible to recruit GPs to partnerships, and this is an alternative model.
Consultants in hospitals aren’t self employed, they are employed by the NHS Trust/equivalent that they work for, for a specific number of sessions per week, and are paid through the NHS payroll system like other NHS employees. Many are what they term as maximum part time NHS employees, working 8or 9 sessions per weeks for the NHS.

Casdon I refer you to this current BMJ document www.bmj.com/careers/article/the-bmj-s-guide-to-gp-partnerships

It starts: A GP partner is a self-employed general practitioner who, alongside other GPs, and sometimes also nurses or other healthcare staff, is responsible for running their own practice. Besides providing services and managing patients, GP partners also manage the practice staff, the finances and the administrative work associated with running the practice.

Unlike salaried GPs or GP locums, GP partners are not only healthcare professionals but also business owners. They therefore have more responsibilities, but also a lot more control over their work.

That seems very clear to me .

MOnica There are GP practices in England which are not run/owned following the "partner" model. Many GPs are concerned that the government wants to phase out the model.

"GPs all own their practices" myth:

keepournhspublic.com/but-arent-all-gps-private-anyway/

Operose, which is owned by US healthcare provider Centene, runs about 70 GP practices under an Alternative Provider of Medical Services (APMS) contract.

M0nica

Casdon I refer you to this current BMJ document www.bmj.com/careers/article/the-bmj-s-guide-to-gp-partnerships

It starts: A GP partner is a self-employed general practitioner who, alongside other GPs, and sometimes also nurses or other healthcare staff, is responsible for running their own practice. Besides providing services and managing patients, GP partners also manage the practice staff, the finances and the administrative work associated with running the practice.

Unlike salaried GPs or GP locums, GP partners are not only healthcare professionals but also business owners. They therefore have more responsibilities, but also a lot more control over their work.

That seems very clear to me .

I know my facts are correct Monica, as this is an area I was involved in for my last NHS role. Here are some examples of GP practices run by health organisations, there are many more throughout the UK.
practicebusiness.co.uk/record-number-of-gp-practices-taken-over-by-health-boards
www.pulsetoday.co.uk/news/referrals/hospital-foundation-trust-to-take-over-three-gp-practices/
GP partnerships are increasingly failing, the first thing the relevant health organisation does is to offer the vacant practice to others, if nobody wants to take it on, the health body is left with little option but to run it from within. In England they have gone down a commercial route, as growstuff indicated, in Wales, the practices are run through the local Health Board, as they are in Scotland too.

I am primarily talking about the past, what happened in 1948 and for most of the time since. I quite agree that diverse alternatives are being used, but it does not undermine the facts that for most of its existence much of the NHS has been provided by private entitiea

Casdon You know your facts are right. They may well be, but I suggested you take this up with the BMA, who, if you are right have themselves got it very wrong. I merely quoted from an official BMA document.

What has the BMA got wrong? There are still many partnerships, which are run as the BMA has described. However, increasingly GPs are retiring and some find they can't make ends meet financially, so the contract is offered to outsiders. This has been happening gradually since 2004.

M0nica

I am primarily talking about the past, what happened in 1948 and for most of the time since. I quite agree that diverse alternatives are being used, but it does not undermine the facts that for most of its existence much of the NHS has been provided by private entitiea

Casdon You know your facts are right. They may well be, but I suggested you take this up with the BMA, who, if you are right have themselves got it very wrong. I merely quoted from an official BMA document.

The article in the BMJ isn’t inaccurate Monica, joining a GP partnership is a viable career choice for doctors, and is the most prevalent arrangement still. However, being an option isn’t the same as being the only model. At the beginning of this careers options paper it mentions salaried GPs, and it is salaried GPs who run the non partnership practices which are managed directly by health organisations.

Moreover, the government is interested in pushing remote consultations and being a glorified 111 call handler isn't an appealing prospect for many newly qualified doctors, which is one reason fewer are opting to become GPs.

growstuff

Moreover, the government is interested in pushing remote consultations and being a glorified 111 call handler isn't an appealing prospect for many newly qualified doctors, which is one reason fewer are opting to become GPs.

There are a lot of factors. One of the biggest issues, but seldom mentioned is that GP practices, particularly in deprived areas, have since the inception of the NHS been very dependent on GPs who were primarily from the Indian sub continent taking up the partnerships. Many thousands of those GPs have retired in the last 15 years, and are not replaced because the UK is not training enough doctors to take their places, or recruiting enough from overseas either.

I know there are lots of factors.

I have a good friend, who is a GP partner in a leafy semi-rural practice. She and her fellow partner are due to retire in the next couple of years. They've been looking for another partner for over a year, but can't find anybody.

She's a popular "traditional" GP, who dislikes the overuse of telephone consultations and is told off by the practice manager if she does home visits. The government wants the local practices to work as a group, so that if patients phone up they could be dealt with by anybody in one of about ten different practices. It wouldn't necessarily be a GP. My friend envisages a time in a few years when all the local practices will be forced to work together. The idea of having a "family doctor" will be gone forever and it's not a prospect which appeals to many new recruits. Eventually, the patient's phone consultation could be with somebody in any part of the country or even the world. Such practices would be an attractive proposition for profit-driven health corporations and there would be nothing to stop them.

*Casdon, I think we are bith arguing on the same side.

Another factor is the cost of buying into a GP practice as a partner, now they run up huge debts as students, a lot of would be GPs just can’t afford to do it. Primary Care thankfully isn’t being privatised in Wales, but lots of young GPs are opting to go down the salaried doctor route rather than take on the stress of a partnership.
I also know that working as a GP is an isolating and grinding job, sitting in your surgery seeing and/or telephoning patient after patient who you know will wait many months for diagnosis, supporting them during their wait, and interspersed with lots of the ‘worried well’ is not a satisfying job for a highly trained clinician.
There certainly aren’t any easy answers.

Mamie

Just to point out that we pay a top-up insurance in France, but the lowest income groups do not have to pay. The insurance companies providing top-up cannot refuse because of pre-conditions and are tightly controlled.

But there are problems here now, as hospitals are overflowing with people suffering from influenza, Covid-19 and bronchiolitis. Also, doctors and medical staff have been striking. Macron gave a speech today saying that he intends to overhaul the health system in the next six months