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The future of the NHS (if any)

...on serious topics that don't fit anywhere else at present.
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Alan H
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Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1701 Postby Alan H » January 14th, 2017, 11:52 am

Latest post of the previous page:

This would be laughable if it wasn't so serious: GPs urged to commit to seven-day service or lose funding
GPs in England must keep their surgeries open for longer to meet demand from patients, or risk losing funding, Downing Street has warned.

It said many patients were going to under-pressure A&E departments because they could not get appointments.

The government wants to see surgeries open between 08:00 and 20:00, seven days a week, unless they can prove the demand is not there.

The British Medical Association accused ministers of "scapegoating" doctors.

Downing Street said surgeries should do more to ensure they offer appointments in the evening and at weekends.

It said: "Most GPs do a fantastic job, and have their patients' interests firmly at heart.

"However, it is increasingly clear that a large number of surgeries are not providing the access that patients need - and that patients are suffering as a result because they are then forced to go to A&E to seek care.
Can anyone see any teeny little problems with this?
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

Zeff
Posts: 142
Joined: August 6th, 2016, 2:13 pm

Re: The future of the NHS (if any)

#1702 Postby Zeff » January 14th, 2017, 3:22 pm

Alan H wrote:This would be laughable if it wasn't so serious: GPs urged to commit to seven-day service or lose funding
GPs in England must keep their surgeries open for longer to meet demand from patients, or risk losing funding, Downing Street has warned.

It said many patients were going to under-pressure A&E departments because they could not get appointments.

The government wants to see surgeries open between 08:00 and 20:00, seven days a week, unless they can prove the demand is not there.

The British Medical Association accused ministers of "scapegoating" doctors.

Downing Street said surgeries should do more to ensure they offer appointments in the evening and at weekends.

It said: "Most GPs do a fantastic job, and have their patients' interests firmly at heart.

"However, it is increasingly clear that a large number of surgeries are not providing the access that patients need - and that patients are suffering as a result because they are then forced to go to A&E to seek care.
Can anyone see any teeny little problems with this?

It strikes me as a very confrontational approach. Apparently, the Government have decided what hours surgeries need to keep - end of story. Anyone who doesn't comply might not get paid properly. There's also an underlying assumption that there are enough GPs.

Another point is that GPs can see patients at their own discretion or as directed by the government. Patient's demands presumably aren't as important in a free universal service (or a private one which limits their choices) as the only sanction patients have is to go to another doctor. The non-super-rich can't go anywhere. So there must be a compromise between the Government and the doctors. Generally, GPs provide an out-of-hours service as they think is appropriate. This Government seems to want local doctors to have little say in what hours they work and simply obey the government or suffer loss of pay and resources.

Many conflicts with doctors in the NHS certainly appear UKGov induced to me. All the surgeries in my area are very good though. Some surgeries seem to be very badly run and have GPs with dubious ability and an apparently poor approach to patient care but those problems aren't likely to be solved with this Government's approach or its "solutions".

Just my view. I live in Scotland.

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Alan H
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Re: The future of the NHS (if any)

#1703 Postby Alan H » January 15th, 2017, 12:12 am

Zeff wrote:It strikes me as a very confrontational approach
It certainly is. The real question is whether this confrontation is deliberate - perhaps an attempt to set the public against GPs - or a diversion for the press (the DM particularly) to cover over negative stories about underfunding.

Apparently, the Government have decided what hours surgeries need to keep - end of story. Anyone who doesn't comply might not get paid properly. There's also an underlying assumption that there are enough GPs.


There seems to be no dispensation for single-handed practices - I'm sure lone GPs will not appreciate being told to work 16 hours a day, seven days a week. Maybe May and Hunt think this is acceptable. However, I strongly suspect many will already be working long hours. Of course there aren't enough GPs; Hunt has already admitted that (even though it's still not quite clear from where he's going to magic the 5,000 in 2020.

Another point is that GPs can see patients at their own discretion or as directed by the government. Patient's demands presumably aren't as important in a free universal service (or a private one which limits their choices) as the only sanction patients have is to go to another doctor. The non-super-rich can't go anywhere. So there must be a compromise between the Government and the doctors. Generally, GPs provide an out-of-hours service as they think is appropriate. This Government seems to want local doctors to have little say in what hours they work and simply obey the government or suffer loss of pay and resources.
There's a long story about GPs and OOH in England that I don't think happened in Scotland but this may well result in private GPs getting more business: you do have to wonder if that is May's whole point or a nice additional benefit...

Many conflicts with doctors in the NHS certainly appear UKGov induced to me.
Yup.

All the surgeries in my area are very good though. Some surgeries seem to be very badly run and have GPs with dubious ability and an apparently poor approach to patient care but those problems aren't likely to be solved with this Government's approach or its "solutions".
It seems that the Government have failed to even understand the problem, never mind find an appropriate solution.

Just my view. I live in Scotland.
You're lucky.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Alan H
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Re: The future of the NHS (if any)

#1704 Postby Alan H » January 15th, 2017, 11:47 am

If only there was someone in overall charge of the NHS who could take responsibility for this mess and sort it out... NHS in crisis as cancer operations cancelled due to lack of beds
Patients with cancer are having their operations cancelled by hospitals with increasing regularity as the NHS winter crisis deepens, the Observer can reveal.

In an alarming escalation, the previously unthinkable step of calling off cancer surgery has become more commonplace in the last fortnight, as a rapid increase in patient numbers has placed intolerable pressures on beds and staff.

The revelation will fuel increasingly bitter arguments between the government and NHS staff, both over the extent of the crisis and where blame lies.

Today, writing for this newspaper, the chair of King’s College Hospital, London, Lord Kerslake, a former head of the civil service, suggests Theresa May’s government is not sufficiently in touch with the reality facing NHS hospitals and staff to appreciate the severity of the crisis.

While ministers play down the pressures as normal for midwinter, and direct blame at managers and GPs, Kerslake says the only way services are maintained at current levels is because of “extraordinary efforts of both senior and frontline staff”. He adds: “Even with this, the picture is of enormous fragility, not just at my trust but across the whole NHS.”


May’s inconvenient truth: the NHS cannot carry on as it is
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Alan H
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Re: The future of the NHS (if any)

#1705 Postby Alan H » January 15th, 2017, 8:35 pm

You’re ‘Ordering’ GPs Are You Mrs May?
I haven’t blogged for a while. The reason will shock our esteemed Prime Minister. It’s because I’ve been a bit busy - see Mrs May, I’m a GP. So waking up on Saturday to hear your briefing to the press suggesting that I am to blame for the current crisis in the NHS, and that you will ‘order’ me and all my colleagues to be open 7 days a week, 8am to 8pm, made me pick up my laptop.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Alan H
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Re: The future of the NHS (if any)

#1706 Postby Alan H » January 17th, 2017, 10:38 am

More than 7,000 nurses could face axe under secret NHS plans
ore than 7,000 nurse posts could be axed from NHS hospitals across the country despite a mounting Accident & Emergency crisis, new plans reveal.

Every area has been ordered to draw up meaures to save £22bn and reorganise health services in order to meet rising demand from an ageing population.

But new documents suggest that the proposals could result in the loss of more than 17,000 staff by 2020 - including 7,300 nurses and midwives.

Last night senior nurses said the implications for safety were “truly frightening” with widespread shortages of staff already in overstretched hospitals.

The forecasts, seen by Health Service Journal, also reveal that the plans rely on a dramatic reversal in trends which have seen casualty units under unprecedented pressure.

While A&E attendances across England have risen by 4.5 per cent and emergency admissions by 3.5 per cent in the past 12 months, the plans rely on a 4.2 per cent fall in attendances, and a 0.8 per cent drop in admissions.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Alan H
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Re: The future of the NHS (if any)

#1707 Postby Alan H » February 12th, 2017, 12:39 am

The original article is behind a paywall, but this has an extract: Pressure on NHS makes new Mid Staffs 'inevitable' - Sir Robert Francis

Image
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Alan H
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Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1708 Postby Alan H » February 15th, 2017, 4:39 pm

An interesting discussion about the NHS including charging patients and why it's a bad idea on this week's Radio 4 Inside Health.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Alan H
Posts: 24003
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1709 Postby Alan H » February 18th, 2017, 3:57 pm

Health cuts most likely cause of major rise in mortality, study claims
An unprecedented rise in mortality in England and Wales, where 30,000 excess deaths occurred in 2015, is likely to be linked to cuts to the NHS and social care, according to research which has drawn an angry response from the government.

The highly charged claim is made by researchers from the London School of Hygiene & Tropical Medicine, Oxford University and Blackburn with Darwen council, who say the increase in mortality took place against a backdrop of “severe cuts” to the NHS and social care, compromising their performance.

The Department of Health (DH) responded by accusing the authors of the paper and accompanying commentary, published in the Journal of the Royal Society of Medicine on Thursday, of bias.

The researchers ruled out other possible causes of the increase, including cold weather, flu and the relatively low effectiveness of the flu vaccine that year, noting that fatalities from the virus rose “but not exceptionally”.

After examination of NHS performance data for the period, which shows the service missing almost all its targets, they concluded: “The evidence points to a major failure of the health system, possibly exacerbated by failings in social care.”

The rise in deaths from 2014 to 529,655 in 2015 was the biggest in percentage terms in almost 50 years and the mortality rate was the highest since 2008. The excess deaths were largely among older people who are most dependent on health and social care, the authors said.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Alan H
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Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1710 Postby Alan H » March 4th, 2017, 5:13 pm

Budget 2017: NHS reforms will 'fail' and put patients at risk without urgent help, warns Tory head of health committee
In an interview with The Independent, Dr Sarah Wollaston urged Chancellor Philip Hammond to change course – or watch the “suffering” public turn against the Government’s running of the health service.
A bit late, surely?
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Alan H
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Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1711 Postby Alan H » March 11th, 2017, 8:22 pm

In these austere times: Diktat for every hospital to change NHS logo ignored objections from chief executives and PR experts
ospitals were ordered to change their logo despite warnings from health service executives that the move would “cost an absolute fortune,” a leaked report reveals.

Every hospital has been issued with instructions to alter their publicity materials, moving the “NHS” lozenge so it is above the name of the trust, instead of beside it.

The move - revealed by the Telegraph last month - prompted fury from patients groups, with concern about the use of resources when the NHS is facing the greatest financial crisis in its history.

The measure is being introduced by an “NHS identity team” following a two year review.

Health officials said the changes would reduce “confusion and concern” among the public, claiming that current inconsistencies in use of the format could be fuelling pressure on Accident & Emergency units.

But the team’s research reveals that health officials were repeatedly warned that trusts could not afford to make such changes, and could not justify spending such sums.


Not compliant:

Image

Compliant:

Image
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Alan H
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Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1712 Postby Alan H » April 6th, 2017, 10:06 am

The Second NHS Reorganisation Is Well Under Way
“NHS funding growth is much slower than the historic long term trend.”

“Real terms funding per person will go down in 2018/19 and 2019/20.”

“The public are concerned for its future.”

“There is likely to be continued pressure on waiting times for routine care and some providers’ waiting times will grow.”

The words above are not taken from a Labour press release or a critical speech in Parliament, but from a new NHS England Plan, Next Steps on the NHS Five Year Forward View, which was published this week.

The document confirms that the NHS does not expect to meet the A&E target, to see 95% of patients within 4 hours, which Jeremy Hunt described as being “critical for patient safety,” for at least the next year. It also sets out plans for another round of rationing of treatments and the abandoning of the 18 week waiting target for surgery.
The most striking thing about the new plan is the confirmation that not only did the 2012 Health and Social Care Act waste billions of pounds, it has also been an abject failure. The payment by results system is being quietly shelved, while there is a desperate rush to replicate the functions of the Strategic Health Authorities that the 2012 Act scrapped.

This second reorganisation is happening much less publically than the first one. Whilst there was some publicity surrounding Sustainability and Transformation Plans, there has been much less coverage of the Vanguards or the move towards Accountable Care Organisations which feature heavily in the new document. The Healthwatch guidance on ensuring that local people have their say recommends that organisations should “involve local people from the start in coming up with potential solutions.” Based upon this test, the exercise has already been an abject failure, while there are also question marks over whether changes on this scale could be open to legal challenge without further legislation. Will the abandoning by the Government of the 18 week waiting time target for treatment also lead to a legal challenge because the NHS Constitution has been broken?


Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Alan H
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Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1713 Postby Alan H » April 24th, 2017, 10:59 am

Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Tetenterre
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Re: The future of the NHS (if any)

#1714 Postby Tetenterre » May 9th, 2017, 9:58 am

Just in case there is still anyone out there who thinks that the NHS is safe in Tory hands:

NHS GP practice sets up a private service - by paying up to £145 to jump the queue
Steve

Quantum Theory: The branch of science with which people who know absolutely sod all about quantum theory can explain anything.

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Alan H
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Re: The future of the NHS (if any)

#1715 Postby Alan H » May 9th, 2017, 10:02 am

Tetenterre wrote:Just in case there is still anyone out there who thinks that the NHS is safe in Tory hands:

NHS GP practice sets up a private service - by paying up to £145 to jump the queue
Aren't market forces a wonderful thing? Well, if you have money, anyway.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Dave B
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Re: The future of the NHS (if any)

#1716 Postby Dave B » May 9th, 2017, 11:01 am

Damn, forgot this forum leads with the first and not the last post!

Must be a way to "invert" it. Will look in settings.

----------------------------

Fixed it!
"Look forward; yesterday was a lesson, if you did not learn from it you wasted it."
Me, 2015

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Nick
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Re: The future of the NHS (if any)

#1717 Postby Nick » May 9th, 2017, 1:51 pm

Alan H wrote:
Tetenterre wrote:Just in case there is still anyone out there who thinks that the NHS is safe in Tory hands:

NHS GP practice sets up a private service - by paying up to £145 to jump the queue
Aren't market forces a wonderful thing? Well, if you have money, anyway.


Of course, market forces are there, whether you have a fully nationalised system or not. Ignoring them is one way of failing to provide optimum resource allocation.

In this specific case, it's not clear exactly what they are doing, as there seem to be some conflicts in the reporting, but this is a classic market response. In the light of an increase in demand, the rewards to suppliers increase. What has happened here, is that suppliers have responded by increasing the supply, over and beyond that provided by the NHS. So the pressure on the NHS is reduced, thus helping everyone. It effectively means an increase in funding for medicine, by those willing to pay for it.

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Alan H
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Re: The future of the NHS (if any)

#1718 Postby Alan H » May 9th, 2017, 2:09 pm

Nick wrote:What has happened here, is that suppliers have responded by increasing the supply, over and beyond that provided by the NHS. So the pressure on the NHS is reduced, thus helping everyone.
Nope. The article certainly could be clearer, but it does say:
However the new private service will be operated by the same NHS doctors from 8am until 8pm Monday to Friday and 8am until 12pm Saturdays.
Something has to give - and indeed it does:
But Dr Alder said with a crisis in general practice due to increasing demand, a recruitment crisis and lack of funding as well as news that private provider Virgin Care is taking over practices across the country, the private service is the only way to safeguard its future.

The Government is not trying to save general practice and now it is on the brink of collapse. But when it’s gone, they’ll realise how good we have been at blocking access to the hospitals. By then, it will be too late.

“We have to try something different now to make ourselves stronger in anticipation NHS primary care will be even worse. The worry is that Virgin Care, who are already buying up practices, are going to come in and would then just take us over. I suppose we’d rather be in charge of our own destiny.

“Five years ago, there would be far more people saying ‘how dare you do this to the NHS’ and ‘you’re causing it to fall apart by doing this’ rather than the other way around but now most people understand why and are quite interested. They see it as an option for the future for themselves."

The doctor said he hopes the private service will help relieve colleagues waiting lists and said the NHS practice will continue to operate as normal.

“I’d love to be able to say you can have 20 minutes with me on the NHS but that is not going to happen until we have twice as many GPs.

“We certainly won’t be using NHS resources, we’ll use ours which means if we do it in NHS time, we’ll find cover for that. (My emphasis)
So, while the NHS GPs are earning money from private patients, they presumably have to employ locums - possibly paid for by the NHS? All because of a lack of funding, etc in the first place.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Nick
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Re: The future of the NHS (if any)

#1719 Postby Nick » May 9th, 2017, 6:51 pm

Except that:
The NHS practice will continue to operate and current rules ban GPs from charging their own patients for any treatment as this is deemed to be a conflict of interest.
So they will be treating other patients. And not using NHS resources.

If they hire locums it comes out of their own money. GP's a self-employed, don't forget.

And what might the alternative be? I know of one GP who has retired, rather than put up with the hassle of running a practice. Had he had the opportunity to do more private work, he'd still be part of the NHS, and increasing the overall supply.

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Alan H
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Re: The future of the NHS (if any)

#1720 Postby Alan H » May 9th, 2017, 6:59 pm

Nick wrote:Except that:
The NHS practice will continue to operate and current rules ban GPs from charging their own patients for any treatment as this is deemed to be a conflict of interest.
So they will be treating other patients. And not using NHS resources.

If they hire locums it comes out of their own money. GP's a self-employed, don't forget.
Many are. So for those that are, that will take money away from the practice that would otherwise be available for frontline care.

And what might the alternative be?
The alternative... that's a difficult one...let me think... Oh! I know! Fund the NHS properly? That'd be novel, at least.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Tetenterre
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Joined: March 13th, 2011, 11:36 am

Re: The future of the NHS (if any)

#1721 Postby Tetenterre » May 12th, 2017, 10:56 am

Nick wrote:If they hire locums it comes out of their own money.
Except there's already a national shortage of GPs (including locums). It's even been getting "tricky" at my local surgery which, being small-town, tends to be a more attractive option. It's worse in Bournemouth according to GP friends.
Steve

Quantum Theory: The branch of science with which people who know absolutely sod all about quantum theory can explain anything.


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