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DougBaker
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Investing a little to prevent certain groups of people from killing the wider population does make economic sense.

Jonathan Kay
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In your list of priorities for improvements to the NHS where would you put "Seven day service"?

Jonathan

Roger Ford
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I think it would be a shame to close A&E[1] on Sundays.

[1]  or whatever it's called this week. I lose track.

Golf Juliet Tango
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Jonathan, better weekend service is important. You know the statistics which justify this. On a simple, non-accute example why 7 day service is required, let me illustrate. The ex had a hip-replacement on a Thursday, Friday mostly in recovery, initial physiotherapy but a slight relapse (possibly due to the excessive heat) meant that some physiotherapy was postponed. No real cover on Saturday or Sunday, so additional nights In hospital were required. If the recovery period can not be managed why do operations on Thursday, let alone on Friday.
As an aside, my day rate is the same whatever day of the week is required, likewise the same for early starts or late finishes.

Stephen Hubbard

Democratic dissent is not disloyalty, it is a positive civic duty

andy couchman
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I think the topic needs a bit of thinking about. Many NHS people will hate it (I would!) and it will have costs and other issues attached which may be scary as well as hard to quantify. Some will demand higher payment for working weekends and demand industrial action if they don't get it. For many non-public employees weekend working is both the norm and not more highly rewarded but for most that's probably not true.  

But people are ill seven days a week and there must be some economies by opening at weekends. Certainly OP departments could presumably be smaller to treat the same number of people and the savings to the economy overall could be pretty significant as weekday only workers need to take off less time. More weekend working may also help cement the view that the NHS is there to benefit its customers. At the moment, little weekend working looks to be there to benefit the system - not the customers and not the staff either. Every stakeholder thinks they're being screwed. That's not healthy...

One downside is that more people may prefer weekend treatment, so work gets skewed towards weekends.

On balance, yes investigating (quickly) would be a high priority.

Andy

Jonathan Kay
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The NHS was about the second most important issue to the electorate, this is the flagship project of the Secretary of State, and the Prime Minister chose the subject for his first speech.

I was expecting a few more than 3 responses, and many more rants. Or does it sort of work alright most of the time? Or it doesn't but there is no hope of improvement?

Anyone?

Jonathan

Jonathan Kay
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GJT: I think that clinical support services for inpatients might one of the areas where there might be some worthwhile improvements. I tried to manage that in Oxford... with mixed success.

Jonathan

Jonathan Kay
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But people are ill seven days a week and there must be some economies by opening at weekends. Certainly OP departments could presumably be smaller to treat the same number of people and the savings to the economy overall could be pretty significant as weekday only workers need to take off less time.

Partly agree with most of that.

The unplanned care is in place 24 x 7. But there's still the mystery of excess deaths of patients admitted to hospital at weekends.

Staff costs dominate just about everything else in healthcare and estate costs and equipment costs only make a small contribution. But elective care at weekends isn't unusual. My father has just had an elective CT scan on a Sunday afternoon. I'm not sure what the barriers are to more of this. But mandating it from the top might be counterproductive.

Yes, you get very different economic outcomes if you include costs to patients. But most experiments show that additional appointments outside office hours are not popular with patients: there's some data coming through on this for primary care at the moment. That's a big risk at the moment: mandating those without adding extra staff might decrease productivity.

Jonathan

Jonathan Kay
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Major speech by the Secretary of State tying several issues around general practice.

Includes:
"Innovation in the workforce skill mix will be vital too in order to make sure GPs are supported in their work by other practitioners. I have already announced pilots for new physicians’ associates, but today I can announce those pilots are planned to ensure 1,000 physicians’ associates will be available to work in general practice by September 2020."

So today's question. "Physician associate" is an unregulated title with about two years' training. In your most recent encounters* with primary care how many things were done by a GP that you would have chosen to be done by a "Physician associate"?

Jonathan

* I know that most of you are rich healthy adult men with jobs, but try, or think about your parents' or children's encounters.

Ian B
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But there's still the mystery of excess deaths of patients admitted to hospital at weekends.

Sorry Jonathan, but that's not a mystery to those of us who've has the misfortune to be in hospital over a weekend.

There is no access to Consultants, and trying to get hold of anyone more senior or clinically trained than a staff nurse is nearly impossible. If you develop anything seriously wrong, and aren't on the ball enough, or able, to raise a significant noise about the issue it has to wait until mid-morning on Monday.

As for first line care and Physician Associates. I've been trying to get my GP to address the cause of pain I've been experiencing since March.
Firstly getting through to the surgery to make an appointment requires 30+ redials at 8.30am, and then the next appointment is over a week away.
I got fed up with repeated appointments just being prescribed stronger painkillers I decided to request an MRI scan. In order to do so I have to book an appt with GP!  GP then advises scan could be 6-8 weeks, so I decide to use private insurance as pain is getting unbearable. GP then has to fill out the private form needed for the insurance. All that could have been done by an "Associate".

If the followup is as much hassle then I'll do what I always discourage others from doing, and go and sit in A&E until seen or referred to a specialist.

The Completely Superior Ride Seven Wink