Post by AndrewPost by Jeff LaymanPost by AndrewErr, I take it you have no actual working knowledge of NHS
systems like Patient Admin, Waiting Lists, Booking Lists,
Clinical data handling, Radiology and Radiography reporting
and plenty more ?.
Every NHS hospital functions along the same basic lines, so
a national standard Hospital system would be quite possible
and that is mostly there and has been for over 15 years. What has
held it back are the usual suspects who were given gargantuan
amounts of money to run the truly even more gargantuan database
required and are only interested in gouging as much money as
possible and not genuinely helping the NHS implement the most
effective systems. Not helped by endless committees who have to
make decisions for the 1.3 million staff and ultimately train
all the end-users (with high staff turnover) to actually use the
systems properly.
The NHS intranet allows doctors and other NHS users to
interact via secure email. Patient data flows from Pathology
labs and other sources back to GP surgeries electronically
and has been for ages. If everyone had a broadband connection
and a tablet or PC and went paperless then the NHS could
become far more efficient but the NHS' bread and butter are the
12 million pensioners, notable the over 75's and this group
are mostly internet refuseniks and insist on paper appointments
send by mail, and using the bloody phone to make changes or
ask for things like test results.
Of course it's the patient's fault! Why on earth should it be anything
else? It's obvious as the buggers won't use electronic methods of
communication - after all, they can barely use a telephone.
60 years ago, men retired at 65 and most were dead by 73 while women
'retired' at 60 and chattered on to 78. Now there are 1.6 million over
age 85 and 15,000 over 100 and cost the taxpayer an *average* of £30,000
each for their 'free' NHS, which now includes amazing (and eye-
wateringly expensive) treatments which did *not* exist 60 years ago and
the taxes this 85+ group have paid is peanuts compared to the staggering
cost that they are imposing on todays workers.
Aren't you jumping the gun a bit here? All we're discussing is the ease
or difficulty in getting an appointment with a GP - what treatment might
cost is another matter and further down the line.
I assume your conclusions were drawn from studies such as
<https://bmjopen.bmj.com/content/11/12/e054666>. The problem is that
even if 4/10 appointments are taken up by "frequent attenders" (mainly
elderly women, as they are more likely to get to an older age than
males), the number of GPs have increased proportionally above the growth
in population. From
<https://www.nuffieldtrust.org.uk/news-item/is-the-number-of-gps-falling-across-the-uk>
the number of GPs per 100000 population (UK) was about 43 in 1964, then
it dropped a little for six years, but then rose steadily to a peak of
67 in 2009. It dropped again to 60 in 2018. I didn't look for later
figures, but the total number of GPs in the UK increased from 49500 in
2018, to 54600 in 2022. That's about an 11% increase, while the UK
population increased from 66.4M to 67.5M over the same time - only 1.7%.
Add to that the number of "paramedics" in practices such as nurse
practitioners and clinical pharmacists who deal with an increasing
number of patients. Also add the pharmacists in shops who are being
asked to deal with minor ailments instead of GPs.
There's an interesting, if somewhat old (1988) paper at
<https://www.nuffieldtrust.org.uk/sites/default/files/2017-01/general-practice-web-final.pdf>.
There are good historical figures in the tables in Chapter 5. I wonder
how the figures in table 10 would compare with those today. On average
there were 26 consults a day, 4 home visits on one round, plus night
visits, and weekend out-of-hours calls!
Post by AndrewPost by Jeff LaymanLet me take you back 40, or even 60, years when there wasn't an internet
and all communications with a patient were by "snail" mail. That didn't
seem to be a problem then; patients turned up at hospital at the right
time.
Or not at all !!, just like they don't turn up for their GP appointment.
Ask your practice for their DNA stats.
I know the stats. I am on our practice "Patient Participation Group",
where a number of patients meets with the practice manager around 3
times a year to discuss various points.
Post by Andrew60 years ago stamps were peanuts even after discounting inflation.
What is the NHS' annual bill for sending pointless bits of paper
via Royal Mail when they could be sent electronically ?.
I don't disagree; all I was trying to point out was that a much slower
system seemed to work.
Post by Andrew50 years ago people ended up crippled by the nerve damage caused by
un-diagnosed (or too-late diagnosed) Pernicious Anaemia because very
few hospitals had Coulter Counter Model 'S' blood cell counters which
measured all the vital parameters. If you had any sort of cancer or
leukaemia then your *only* chance of any sort of cutting edge treatment
was in just a handful of teaching hospitals. So many other diagnoses
back then that was a death sentence. If you want to go back to those
halcyon days, good luck.
There's nothing there that hasn't occurred since medicine became a
science rather than an art, and will continue to occur. And it's off
track - as I pointed out above that this is about getting an appointment
with a GP, not the latest monoclonal antibody treatment at umpteen £K a
year.
Post by AndrewPost by Jeff LaymanIf they wanted an appointment with the GP they phoned up in the
morning, and were told to come that day at nn o'clock and wait in the
waiting room. They saw the GP within 30 minutes of nn, and went away
with a prescription which was filled within a few minutes of being
handed in at the chemist's shop. Nowadays? If only...
Err, wrong. Even 30 years ago I could just turn up at my GP surgery,
morning or evening and wait to be seen. No appointment needed.
Quite possibly, but 30 years ago the internet had been around for
several years. I was using a pre-internet time as the example.
Post by AndrewThere were >10 million FEWER people fifty years ago and believe me, as
someone who worked in NHS path labs for 11 years between 1971 and
1984, things went wrong all the time, but the patient never knew.
What makes you think they know now? A few years ago I had some test
results showing I was in end-stage renal failure and required immediate
dialysis. I pointed out to my practice that all my other blood chemistry
results were normal, I had never had any kidney problems, and it looked
like a serious error had been made. A repeat test was negative, of
course. How much did that mistake cost the NHS? Fortunately I have a
detailed knowledge of medicine, and know when to question what GPs tell
patients.
Post by AndrewPost by Jeff LaymanCurrently there's very little chance of getting a phone appointment; at
my surgery they are "released" at 1100 on Wednesdays and 1600 on
Thursdays. A few minutes before these times the line is engaged. Quelle
surprise! Other than that it's eConsult. A rigmarole which annoys me the
thankfully rare times I have to use it. And if it works, I might get a
phone call from a doctor (or more usually a nurse practitioner these
days) any time in the morning or afternoon. So I have to hang around
waiting for a call.
And since 50% of people insisting on seeing a Doctor are time-wasters
this is the way to go. A significant number of people request
appointments just to get a sick note and then get abusive if the GP
says it isn't necessary.
Reference please, for 50% being time-wasters.
Post by AndrewPost by Jeff LaymanAnd if they have to communicate with me to arrange an appointment or do
something else, I get a text from a no-reply number with a link to a
website. I won't do *anything* on an Android phone which involves
health,
Why, are you paranoid ?. All your GP data has been uploaded to massive
databases anyway, supposedly in anonymised form.
I think you mean pseudo-anonymised form. That has been shown to be
susceptible to "reverse engineering". I'll bet you didn't even pay
attention when the "care.data" system was proposed. Fortunately that was
killed before birth despite various attempts at reincarnation since.
As to privacy on an Android phone, this was from less than a minute with
an internet search:
<https://www.bmj.com/content/373/bmj.n1248>
<https://pmc.ncbi.nlm.nih.gov/articles/PMC9237761/>
<https://campaignsoftheworld.com/news/the-dark-side-of-google/>
Post by AndrewPost by Jeff Laymanso I have to copy the link to my laptop and deal with it there.
It might be a crap website which is poorly designed, but I can't do
anything about it. I can't even email the surgery as they don't accept
emails from patients.
Yes it will, they will use the same email system as my GP does -
https://www.pmgdoctors.co.uk/contact1.aspx
Actually, my practice has just started including an email address on
their "contact" page. I'll ask them what it should be used for at my
next PPG meeting.
Post by AndrewPost by Jeff LaymanSo don't blame me as I'm hardly an "internet
refusenik", even though I passed 75 some years ago.
And you are part of the cohort that is pushing the NHS to its limits.
If you think things are bad now, wait until all the baby boomers are in
their 80's, 10 years from now. As far back as 2017 it was predicted that
debt/GDP would hit 200% by 2035 because of the financial implications
they will impose on the NHS.
Welcome to Soylent Green...
--
Jeff