On Monday 12th August 2019 the Daily Express published an article on the fact that some people were waiting on average 15 days to see their family doctor or as we say in the UK their General Practitioner (GP.)
As usual the media only touched on the issues and again I predicted this as per my papers in 1999 and 2001. Sadly nobody listened to me then.
There are four issues the mainstream media have (again!) failed to listen to!
- The abolition of grants and the introduction of tuition fees.
- The NHS appointments system.
- Long term illnesses
- Mass immigration
The abolition of grants and the introduction of tuition fees.
In 1999 (2) I published my dissertation. Now I predicted then that by 2010 a medical student who have no parental funding would be some £100,000 in debt on graduation. One in five of my 230 or so respondents said that they would resist any attempt to bring down their hours of work in order to pay off their debts. In those days a junior doctor would get paid half pay when doing anti social hours where in most jobs you got time and a half. How the doctor’s trade union the British Medical Association allowed that to happen is beyond me.
In the UK it takes 5 years to train a doctor. Then the doctor has to do two years internship and if you want to be a GP you have to do 5 years of training.
Now here’s the thing. Once you become a GP you have two choices. You can either be a full time GP with your own practice or work in a group practice. Then you have the stresses of hitting government targets with all the red tape. Or you can be a locum, earn 2–3 times the rate and not have all that red tape.
With a debt of some £100.000 to pay off what do you think the doctor is going to do? In my day it took some 5 years to pay off your undergraduate debts. Now it will take considerably longer!
personally know some full time GPs who have left being full time GPs, they just do locums for around 3 days per week and make more money doing that. I have got them into affiliate marketing, forex trading, network marketing and property. Some make more money from that than they do being a GP. Some are leaving medicine as a result of this.
Who can blame them?
It’s bad for patients however. When my Dad was in clinical practice he was a GP. He knew his patients intimately. He knew them from the cradle to the grave. In many cases he had several generation of the same family on his books. They got full continuity of care. With this system this won’t happen.
The NHS appointments system.
In the UK healthcare for citizens is paid for by the taxpayer- it’s called the National Health Service. It’s truly the envy of the world.
However in 1998 I wrote an letter in BMA news review on this and it’s shocking that only now are they taking action (3.) In those days NHS waiting lists nationwide were inflated by 20–30% by non attenders.
My five point plan in those days was.
- A reminder letter sent two weeks before the appointment.
- A follow up phone call to confirm attendance.
- There should be a list of people who can come at the last minute if there are any cancellations.
- If the patient still fails to attend there should be a financial penalty for non attendance.
- There should be a re-appointment fee if they want another one.
However in 2001 I went further (4.)
GPs have to refer the odd patient now and then to hospital. My Dad would tell you that in times gone by he’d send a referral letter and do the preliminary investigations and ask that the results be put in the medical notes prior to the specialist appointment. Hospitals say that they can’t do that and they don’t have the time.
My Dad being conscientious would then get the tests done by the hospital, get the results sent back to him, he’d clip the referral letter and the results together and send them to the specialist. Now that takes time. Many GPs don’t have the time to do that. The net result, the patient sees the GP, the GP refers, the specialist does the investigations an then has to call the patient back in. This wastes time and appointments.
The great urologist and orthopaedic surgeon.
I once trained with a great urologist and a great orthopaedic surgeon. Both had this fantastic practice of see the patient once in outpatients. The patient would be listed for surgery and given an open appointment to come back in between if need be. Many didn’t and this would free up appointments.
the operation, if appropriate, the patient would be given an open appointment to come back if complications followed. Many did not and again this freed up appointments.
Sadly many specialists follow up needlessly. I have often wondered if they did this to inflate their waiting lists so people went private.
Long term patients.
My Dad ensured that every patient with a long term illness such as asthma was reviewed every 3 months. In the short term this would inflate the waiting time. In the long run this meant that their signs and symptoms were under control. This would result in fewer referrals to hospital and fewer hospital admissions. Patients with long term conditions were encouraged to join specialist groups and in time would ideally know more about their condition than their doctors would!
This is how such a consultation would go.
Doctor “Nice to see you. How are things.”
Patient “No change, no symptoms”
“What are the latest medical advances in your condition.”
“Here they are.”
Doctor “Shall we just keep you on the PRN salbutamol?”
Doctor “I just need to do a quick examination and check your peak flow.”
5 minutes later.
Doctor “All normal, no change. Anything else?”
Doctor “OK, see you in 3 months.”
Many of my Dad’s patients with long term conditions were like this. Total health care cost to the taxpayer- minimal.
Due to EU quotas we have taken in far too many people. In 1990 the UK population was 55 million. In 2014 it was 62 million. We simply don’t have the infrastructure to support this.
This extract from BBC Question time explains it. (5) I always laugh when I see it.(5)
These are not refugees. These are economic migrants. If you look at the boats where are the women? Where are the children? The places they are “fleeing” from can’t be that dangerous if they have left their women and children behind. This video explains it all (6.)
I have no problem with a genuine refugee or asylum seeker. I have no problem with any immigrant so long as they fulfill certain minimum criteria.
They come legally.
They speak good English.
They respect UK law.
They respect UK culture.
They positively contribute to our society.
Whilst this article by the Daily Express highlighted a problem it failed to deal with the issues.
1 NHS GP waiting times scandal: Doctors in desperate plea to solve 15-day logjams https://www.express.co.uk/news/uk/1164745/NHS-crisis-GP-appointment-wait-times-doctors-waiting-list PUBLISHED: 13:18, Mon, Aug 12, 2019
2 Stress levels and suicide rates in medical students and junior doctor Varma S 1999 Unpublished
3 Non attenders abuse free NHS Letter of the week BMA news review 1 June 1998.
4 NHS Waiting lists BMA News Review 1 November 2001.
5 Russell Brand & Nigel Farage clash over immigration on Question Time (11/12/2014) https://www.youtube.com/watch?v=R7i-JIw1zig
6 The Truth About ‘Refugees’ https://www.youtube.com/watch?v=AfG1myglfhY