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DTMark

Privatising GP surgeries

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The shambles that is the NHS just rumbles on.

Roughly, the political position is that the Conservatives commit to "ringfence funding" and to "support our NHS" and spending has not been cut. Yet, a sizeable amount of the dogmatic electorate believes that they're the Nasty Party who want to privatise it and sell it off to their mates.

New Labour did indeed try to "marketise" parts of it, recognising some of its failings, however the current bunch want to remove all reforms and just throw more money at it. More money is always the answer, naturally.

In the meantime, the NHS for example spends £1,500 on a tub of cream that you can buy in Boots for £2. It is a shambles. If money does not have to be earned, there is no need to do anything efficiently. No motivation to improve anything. The electorate won't moan at you, they will moan at the government. The medical industry will slow hand-clap any minister who attempts to make change.

Health is a very difficult topic to "solve". In most markets, there is price discovery. Rolls Royce cars are expensive, but then nobody need have one. For most items you can ask people "What would you be prepared to pay for.." and then market a service to that price level.

With health and particularly with serious illness or that where the prognosis is death without treatment, were you to ask "What would you be prepared to pay?" there is no upper ceiling. The answer: "Literally anything". And that's why it's such a problem if operated entirely in the private sector. Some parts of it, especially surgery, would be priced to minimise the number of operations and maximise the profit by ultimately pricing most people out of using it.

Most other countries which have better outcomes operate a hybrid public/private system. It seems to be only this one where the service is "free".

Except it isn't, of course. It costs a fortune and the cost continues to increase.

So looking at one particular portion of the service: GP services. Which as I understand it are already "privatised". They're not State employees in the normal sense, something I think a lot of people forget.

They are self-employed and run practices as partners, paid for by the State with taxpayer's money.

I look at what is notionally "my" GP practise's website. It looks like something thrown together in about 1985. None of the login parts work very well. The next appointment is with a locum in three weeks.

I look at the list of clinical staff. None of them work more than three days a week. I wonder if those things might be connected.

No private company would operate like this. Were there a fee to see the GP a private company would naturally want as many staff as are required to service demand so as to maximise profit.

Were the private sector not crowded out here - I have to drive for half an hour to see my private GP, and that's the nearest, in a fairly affulent bit of the country, you'd get competition between practices. Some price regulation might be necessary. Those who cannot work and who have lifelong conditions requiring a lot of monitoring may require assistance to pay.

Ignore the electorate for a moment. Rather than thinking of this as a politician and the effect of such a policy, which causes the comprehensive lack of movement in any direction which might improve things, what would be the consequences for the user if the State simply stopped providing a GP service?

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27 minutes ago, DTMark said:

what would be the consequences for the user if the State simply stopped providing a GP service?

Well round here on a normal week absolutely nothing would change.
We'd have to go to the walk in centre (Which may or may not have now shut, who knows!)

My friend recently went in and asked for a prescription repeat and was rung up and offered an appointment shortly after she'd left - if she'd sit and wait she'd get to see someone to check her hands before prescribing. She did have to sit in the surgery as the doctor got behind but still amazing service by the receptionist. They won't last long.

We can self refer to mental health services and physio. What else do we need: Antiobiotics and pain killers.

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95% of GPs surgeries are private sector.

Except the GPs - despite being private contractors ot the NHS - get the NHS pension.

And they operate like a USSR bread store.

 

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I agree the NHS is badly organised yet the MSM who so love europe the rest of the time seem to forget the existence of the european health systems when they present the false dichotomy of NHS vs US insurance.

Anecdotal but in France when I've been to the GP paid something like 30 euros and the service was much better. Appointment on time, doctor takes their time to check everything, if you get blood tests they actually give you the results printed out (what is it with UK doctors guarding results as if we are all incapable of understanding numbers). The main thing is the difference in attitude as you are treated like a paying customer rather than them doing you a massive favour by giving you an appointment. Also I seem to recall they get more reasonable salaries -50k rather than 100k here?

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5 minutes ago, maudit said:

I agree the NHS is badly organised yet the MSM who so love europe the rest of the time seem to forget the existence of the european health systems when they present the false dichotomy of NHS vs US insurance.

Anecdotal but in France when I've been to the GP paid something like 30 euros and the service was much better. Appointment on time, doctor takes their time to check everything, if you get blood tests they actually give you the results printed out (what is it with UK doctors guarding results as if we are all incapable of understanding numbers). The main thing is the difference in attitude as you are treated like a paying customer rather than them doing you a massive favour by giving you an appointment. Also I seem to recall they get more reasonable salaries -50k rather than 100k here?

That's exactly the sort of thing I'm getting at here: also your conclusions.

Why can we not learn from other countries who do things better?

Why not just privatise GP services?

What would the problems be?

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6 minutes ago, DTMark said:

That's exactly the sort of thing I'm getting at here: also your conclusions.

Why can we not learn from other countries who do things better?

Why not just privatise GP services? 

What would the problems be?

Arguably for those of us who have the temerity to work for a living (and live in England), GP services are already partly privatised.

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6 minutes ago, DTMark said:

That's exactly the sort of thing I'm getting at here: also your conclusions.

Why can we not learn from other countries who do things better?

Why not just privatise GP services?

What would the problems be?

Arggh!!!! They are privatised.

https://www.bma.org.uk/connecting-doctors/the_practice/b/weblog/posts/independent-contractors-a-vital-part-of-the-past-present-and-future-of-general-practice

They manage to be both independent but a monopoly, protected by the BMA.

 

 

'However the survey is also clear that, despite the many problems, GPs believe that the current independent contractor model of individual practices is worth retaining and building on and should be the prime model for general practice in the future, whilst recognising that resources are also needed for practices to collaborate in the form of GP federations/networks.'

 

i.e. lucrative.

 

 

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1 hour ago, spygirl said:

95% of GPs surgeries are private sector.

Except the GPs - despite being private contractors ot the NHS - get the NHS pension.

And they operate like a USSR bread store.

 

That 

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Just now, DTMark said:

That's exactly the sort of thing I'm getting at here: also your conclusions.

Why can we not learn from other countries who do things better?

Why not just privatise GP services?

What would the problems be?

Because our politicians are thick?  I have no idea how they come up with their policies because it does not appear to be based on evidence. I can't see that there would be problems in France get some over prescribing even if you go to gp with a cold they will rx lots and spend is quite high. But other countries like germany and singapore may do things better.

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3 minutes ago, DTMark said:

Why not just privatise GP services?

You're starting to see the problems already. Payment by 'results' (read enrolling patients into as many scams as possible). GPs making unreasonable referral demands on the real doctors in hospitals because more money for them.

I'm not anti privatisation, but I tend to be for services most people can't just walk away from. If you want a new phone and the cheapest one you can get is £500, you can always walk away and not have a phone, then market forces have to react. Last thing you need is a doctor telling you you need knee replacement, not knowing if it's true or he just wants new golf clubs.

Here are a couple of quick fixes for the NHS that can be implemented quickly. Contribution - based care and fines for missing appointments without cancelling. 

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From spygirls' link above:

As independent contractors, GPs are in direct contact with, and accountable to, those who use their service, often committing to their practice and local community for the long-term, providing continuity of care from one generation to the next. They not only know their patients and families, they are part of the community.

Absolute garbage. It also assumes people remain living in the same area their entire lives like in Walford.

As a result it’s in the direct interest of the GPs running the practice to ensure they deliver what their patients need and to do it as effectively and efficiently as possible.

No, it isn't.

Overwhelmingly GPs achieve this, as demonstrated by consistently higher levels of satisfaction than other parts of the public sector.

Hilarious.

It’s why many practices are at the leading edge of healthcare innovation, as seen with GP IT systems being years ahead of those in hospital settings.

Just look at this.

However the traditional way of working is under threat as many practices struggle to cope with the tidal wave of increased bureaucracy and spiralling workload. As our survey shows, most are now seeing the benefit of working in collaboration with other practices in their area to share resources and provide greater sustainability and security for each member practice.

Wow, working in collaboration. If you can't be seen by "your" practice for two months, maybe you could see a GP at another nearby practice. How dynamic.

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3 minutes ago, maynardgravy said:

You're starting to see the problems already. Payment by 'results' (read enrolling patients into as many scams as possible). GPs making unreasonable referral demands on the real doctors in hospitals because more money for them.

I'm not anti privatisation, but I tend to be for services most people can't just walk away from. If you want a new phone and the cheapest one you can get is £500, you can always walk away and not have a phone, then market forces have to react. Last thing you need is a doctor telling you you need knee replacement, not knowing if it's true or he just wants new golf clubs.

Here are a couple of quick fixes for the NHS that can be implemented quickly. Contribution - based care and fines for missing appointments without cancelling. 

But there is already contribution based care in the form of deductions from salary. Why should anyone have to pay those? What about people who can't afford to pay for both their own healthcare such as a private GP service, and pay for everyone else's as well through deductions from pay? Why shouldn't they have choice?

Fines for missing appointments won't help much since there aren't any appointments.

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As a bloke, who's in his 40s, pretty good health, heres my issues with GPs:

1) GPs assume you work and live in the same area.

2) Despite sucking in ~8% of GDP the NHS/GPs fail to get a good records service. Something every other developed coutrny has managed.

3) GP surgeries act as dossers signoff centre/OAPs day care.

4) Ive never seen the same GP in my life - Ive only been a few times to be hoenst. When I had to go back within a week, I saw a different person. Idont care- just make sure the  records are up to date..

5) Going from helping relatives/friends with GPs, the abilty for the average GP fails to perform the most basic, simple obvious diagnosis. The value add is shit.

 

 

 

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1 hour ago, DTMark said:

It’s why many practices are at the leading edge of healthcare innovation, as seen with GP IT systems being years ahead of those in hospital settings.

I know it's not your text. Made me laugh though - for years hospitals have been sending out e-clinic letters, CAS cards, discharge summaries, prescriptions, Path and Rad results to GPs via DTS or MESH and got NOTHING back from GP systems.

EMIS/Vision/Systemone - the latter of which Dave Cameron has his grubby fingerprints all over - all crap.

1 hour ago, DTMark said:

But there is already contribution based care in the form of deductions from salary. Why should anyone have to pay those? What about people who can't afford to pay for both their own healthcare such as a private GP service, and pay for everyone else's as well through deductions from pay? Why shouldn't they have choice?

Fines for missing appointments won't help much since there aren't any appointments.

Think we're on a different page. I'm talking about substantial NI contributions to stop health tourism in all its forms - it's an epidemic. 

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6 minutes ago, maynardgravy said:

Think we're on a different page. I'm talking about substantial NI contributions to stop health tourism in all its forms - it's an epidemic. 

 

But... (to quote someone I annoyed yesterday) is it not better than they are housed here than sent back where they might have nothing?

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2 hours ago, maynardgravy said:

I know it's not your text. Made me laugh though - for years hospitals have been sending out e-clinic letters, CAS cards, discharge summaries, prescriptions, Path and Rad results to GPs via DTS or MESH and got NOTHING back from GP systems.

EMIS/Vision/Systemone - the latter of which Dave Cameron has his grubby fingerprints all over - all crap.

Very little of the outpatient details of diagnoses, prescriptions, test results are being recorded electronically on the GP systems. This will imo cause uk to fall behind on real world medical research as currently limited to what a gp records and A&E visits. Only positive is they are moving from read to snomed for coding.

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3 hours ago, maynardgravy said:

I know it's not your text. Made me laugh though - for years hospitals have been sending out e-clinic letters, CAS cards, discharge summaries, prescriptions, Path and Rad results to GPs via DTS or MESH and got NOTHING back from GP systems.

EMIS/Vision/Systemone - the latter of which Dave Cameron has his grubby fingerprints all over - all crap.

Think we're on a different page. I'm talking about substantial NI contributions to stop health tourism in all its forms - it's an epidemic. 

Why do we need to change contributions to stop health tourism?

Just ask the patient for their NHS number. If they don't know it the staff can look it up.

No NHS number, no treatment.

That this isn't done suggests to me that hospitals / the NHS must have money to burn and they aren't underfunded since this could be done so very easily.

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I don’t want to spam every thread with my bloody injury, but it is somewhat on my mind right now.

I have no knowledge of the NHS since family doctors used to do their rounds, but I wonder how it compares to today’s experience in Third World Cambodia.

Phoned hospital at 07:30 this morning and said I would be arriving for an X-ray and consultation with a ‘trauma’ doctor, whom I could see from their website was Russian.

Struggled into car at 08:30 and arrived 08:45 via ATM machine. My driver was allowed to park at main entrance whilst they got me into pre-arranged wheelchair.

Registration (never been to the place before) took 3 minutes. Was wheeled for BP check and met Russian Consultant at 9:00am. 20 minutes chat about circumstances of injury, then to X-ray, two done and back to Quack’s office for consultation of 20 further minutes on injury, treatment and medication.

Collected medicines (2 sets of tablets), plus written details of what my injury was, the cause and treatment, along with medication details and was wheeled back to waiting car in same spot, as their receptionists had alerted my driver. Time 09:55. Back home 10:00am and had s cup of tea.

Total cost $105.

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1 minute ago, Bkkandrew said:

I don’t want to spam every thread with my bloody injury, but it is somewhat on my mind right now.

I have no knowledge of the NHS since family doctors used to do their rounds, but I wonder how it compares to today’s experience in Third World Cambodia.

Phoned hospital at 07:30 this morning and said I would be arriving for an X-ray and consultation with a ‘trauma’ doctor, whom I could see from their website was Russian.

Struggled into car at 08:30 and arrived 08:45 via ATM machine. My driver was allowed to park at main entrance whilst they got me into pre-arranged wheelchair.

Registration (never been to the place before) took 3 minutes. Was wheeled for BP check and met Russian Consultant at 9:00am. 20 minutes chat about circumstances of injury, then to X-ray, two done and back to Quack’s office for consultation of 20 further minutes on injury, treatment and medication.

Collected medicines (2 sets of tablets), plus written details of what my injury was, the cause and treatment, along with medication details and was wheeled back to waiting car in same spot, as their receptionists had alerted my driver. Time 09:55. Back home 10:00am and had s cup of tea.

Total cost $105.

Ring GP.

Told theres no appointments for 3 weeks.

Drop dead.

6 weeks later a 'How did we do ?' surveys arrives

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