Education How long do you wait for a doctors appointment?

I am a full-time NHS employee (actually, until recently more than full-time) from conviction. Like many NHS colleagues I generally put in 5-10 hours of extra unpaid overtime on top of that, because that's what it takes to do the job well. A few weeks ago, I had to cancel my week's annual leave to deal with some exceptional circumstances at work (which is also, incidentally, why my project Ada has been on hold).

Money in the private sector is not that much better, although the facilities often are nicer. But in the long-term, like many of my colleagues I may have no choice, if the NHS continues to privatise services. Guy's gotta eat. I know many really good clinical psychologists (and I mean, really good) who work in private health care purely because that's where the jobs are, and they envy me my NHS job. Not for the money --which is by no means better-- but because that is where their heart lies.

Many consultants work part-time in the private sector because the NHS won't employ them full-time. Instead clinics get wildly overbooked and the staff run themselves ragged from 7-8.00am to about 7.00pm. And then patients complain about waiting times and disengaged health care professionals. I don't blame them for that because they simply don't know what goes on behind the scenes and it's not like they haven't got their own problems to worry about. But there are no villains here, only human beings having to make crappy choices in crappy circumstances and feeling crappy about that.

 

Now that is interesting. I feel a Freedom of Information request coming on to see whether my own authority practices this.

 

Again, no nefarious plot --it's all about money. Until recently I covered five services in four different locations because nobody can pay for a full-time band 8b psychologist --although they need much more than that. Now I cover three services in two locations. As a result waiting lists are of course huge in all of them, and it is hard to develop services and offer a consistent presence/input when you are scattered amongst a number of them. Staff training, consultation, inter-/multi-disciplinary working all suffers.

I know very few colleagues who are full time in one service only.

 

You are correct!

I had a minor operation last year on my hand, to remove rheumatoid arthritis eating away at my tendon. I saw a doctor in November and after that I spoke to someone who I know is a Surgeon (hand surgeon in matter of fact). "Don't worry, get your referral and tell them you want me, I'll see you as soon as I can" He explained to me that order of things is this: Doctors/Surgeons , Nurses, Doctors/Surgeons friends, Nurses Friends, everyone else..... I wasn't complaining at that! But it is not right really, but then you could argue it is a perk of the job? It took 8 weeks after that, which is 4 weeks before the deadline.

On the day of the operation, he put me down 2nd on the list "Only because I have to sort out elderly and diabetic people first, that chap is both" (points to the bed next to me!)

Does seem a big difference in wait times just for a GP appointment reading this thread!

The NHS is poorly ran, it's needs people who have ran PRIVATE BUSINESS to do the job. Public companies always over spend because is 'not there money'. As a tax payer it pisses me off!

What annoys me is that Doctors and Surgeons can work TWO JOBS public sector in the NHS on very good money and then they can work at a private hospital earning very good money again? I own my own business and work 80+ hours a week most people consider a full time job as 36 hours a week, does this mean that doctors and surgeons who work two jobs are doing 72 hours a week?

 

GiGo, you have literally no idea of what you speak. You're using your anecdote as a universal fact, whereas it is nothing like it. Your friend may have been willing to bend the rules and come up with some utter nonsense about priority order, but that isn't how it is done. People who jump lists due to being mates with the surgeon are an absolute minority to say the least. Do you really think that for the 8 weeks prior to you getting your operation he was therefore treating people higher on his little list? No. He was doing his normal clinical work. You just got slotted in to the first free slot he had, which says a lot for the amount of workload.

As for the day of the operation you were done second due to clinical priority. Seems totally fair to me. Somebody with a latex allergy would have also gone in front of you as well.

The NHS does not need private businesses to do the job, because they're a complete and utter shambles. You may be cross that the NHS spends money on staples or biscuits, but it's better than literally paying the profits of a private company so they can roll around in more money. Private companies only undertake healthcare work if they can make money - as a case in point, Circle just withdrew from their Hinchinbroke contract because, surprise surprise, they realised they won't make any money on the deal. So they gave up and lumbered the NHS with the debt they had run up in the meantime. Private sector efficiency indeed. If you need more examples, go Google Serco.

Surely a taxpayer has more problem with lining the pockets of corporate fat cats than a few inefficiencies in the current system? Bear in mind the NHS is the most efficient in the world (and the privately run US system is bottom).

Is that doctor working both NHS and private doing 72 hours a week? Quite possibly. The job doesn't stop when you walk out the door. My father-in-law is a dermatologist, and he spends an additional 3-4 hours every single day outside the normal 8-6 working day on administration work surrounding his patient load. So he's putting in roughly 13-14 hours a day, every day, and then more at weekends. He's easily pushing 70-80 hours no problem.

Further, if you only work 3 days a week for the NHS you only get paid for working for 3 days. You don't magically retain your full salary.

PS: Full time for a doctor is not 36 hours a week. That's hilarious. The EWTD caps us at 48 hours a week, but every single doctor I know usually works 55-60 without reporting the extra. For a new doctor, that earns them the princely sum of about £25-30k. Even a registrar, after 7 years more training and work will be taking home only about £50k. Those hours also include night and evening shifts. Simply put, don't become a doctor for the money.

 

You accuse GiGo of talking nonsense and mentioned than a few inefficiencies in the current system? That is utter ******** the NHS is broken but no one has the balls to admit it. These " few inefficiencies cost the NHS hundreds and hundreds of millions each year because the continued antiquated practices, over staffing at management level, god knows how many absolute well paid non jobs the list goes on and on.

Private companies only undertake healthcare work if they can make money and the NHS under the behest in the case the Tories farmed out ward cleaning to the private sector to the utter detriment of ward cleanliness. My partner had a weekend job as a ward cleaner and this was taken over by a private company and overnight instead of one ward thoroughly it was two wards as best as they could do. Ward cleanliness is still an issue and who suffers us the patient.

I can only speak of the experience with my own health board but I am now terrified of going into one particular hospital Be struck down with cancer again will probably mean I will not undergo any treatment given the appalling experience I had with my last treatment.

You also mention that the NHS is the best in the world. You should join a few of the health groups on FB and listen to the stories from around the world on treatment for the same condition. I can assure that there is good and bad practices everywhere but in no way would I put the NHS near the top.

 

Come on, evidence. You can't claim that the NHS is pissing "hundreds of millions" up the wall without actually backing up that statement (and no, the Daily Mail does not count). My link didn't say the NHS is the best in the world either, but it categorically demonstrates it is the most efficient. Go and actually read the piece.



The NHS is top rated on our quality of care and efficiency. We're second in equity, and third in timeliness. All whilst costing $3,405 a head per year, the cheapest on the list. Now, I'm not saying the system is perfect - NHS waiting lists are getting out of control, and we're disgustingly unhealthy as a nation due to rising obesity and its associated conditions. Our outcomes also need improving, but guess what, that requires more money.

This data isn't gathered from a few Facebook groups where people go to have a whinge, which is again anecdotal evidence. You really, really need to get a better grasp on the different levels of evidence quality before making judgements. Not to belittle your own experience, but in the greater scheme of the NHS it is essentially meaningless - unless it becomes a pattern, which indicates service improvements need to be made at a local level. Just because you feel you got poor care does not automatically mean everybody else in the UK experiences the same thing.

No system is perfect, and never will be. But the simple, demonstrated and evidence based fact, is that the NHS is pretty damn good. However, we're at risk of sliding backwards due to funding being withheld and cut. Yes, we can possibly cut out some management levels and save a few million here and there, but that also runs the risk of dumping workload on other people (be they management or clinicians).

As for your example of ward cleaning, that's exactly it. The private company comes in, claiming it can run a "better" service for less money. What they actually mean is they charge the NHS for two cleaners, only employ one and pocket the difference. That one cleaner has to do the job of two, which inevitably doesn't work out. How exactly is that an argument for privatisation?

 

The thing is, it's always a bit more complicated than that. I would argue that it shouldn't be a moral question, but one of service. If you get a better service at a private hospital, I couldn't care less if some fat cat gets the money. The same goes for the NHS, if you get a great service, then you likely won't care as much that funds are being poured into "biscuits". If, however, I went to a private clinic and they did a shoddy job, I would be annoyed with where the money is going, but then I would take my business elsewhere. That's where the NHS has difficulties as you can't really do that.

I agree with you that simply taking the managers from a private company and plonking them in the NHS won't work. It doesn't change the fundamental problem that was causing the inefficiency to begin with, the lack of competition.

At the same time, if you go and make everything private, you run into other issues. On one had you may have competition help to route out some inefficiencies, but it won't affect everything positively. There will still be shoddy businesses that fall by the wayside, and in healthcare that obviously affects the end user. You also have the issue of ensuring complications don't arise between payment sand hospitals etc. which is a problem in the US. Get taken to the wrong hospital for your insurer and there can be dire consequences, alternatively your hospital may not have the services you require etc.

Of course, people will make the point that you could use a mandatory nationwide insurance policy and then privatise everything, will all funding coming from your central insurance pot. But then you step back and realise that's the same bloody thing as before, a tax and the same old NHS.

It's not an easy one to fix from the ground up.

Which is why I currently like the idea of just trying to streamline all the crap that gets in the way of people and their treatment. Crap like "we want to easily compare our financials" etc. (I could probably come up with some more examples with some extra thought). Those are issues that many patients might not know about, but doctors and nurses etc certainly do. My Aunt is a nurse and she constantly complains about some of the inefficiencies they have to deal with in their wards. These are things that can't easily be fixed by them currently, although she's certainly tried. One example is connecting certain IV devices. Again I can't remember the specifics unfortunately, but the gist is that it's a procedure performed by the patient where you carefully connect two tubes/connectors. You can't touch the ends as it would compromise the sterility. Patients with troubled sight or motor control find this very difficult and can often fail. This results in decent numbers of failed units, and as you know, everything health related is expensive. A fix is a jig that helps prevent these failures by making the process easier for those I listed. I've been asked to look into that solution, but whether the system would allow it to be used on a larger scale (should it work) is anybody's guess, most likely not I reckon.

 

I remember head butting a hockey ball whilst playing hockey to save a goal mind you. But what happened is it cracked my skull and I got a protective small lump on the skull. Wanted it removed made an appointment only for them to contact me a year later to ask if they could postpone the appointment. Hence I still have that lump. They are Freggin useless in some places. Trust the nhs ain't the best. There is good and bad in all places. But is it improving is my question and I cannot see that happening?

 

This is the last time I am going to respond to you as I find you obnoxious.
These groups I referred to on FaceBook were for one the Tonsil Cancer Support Group where as it states in the group title we go for support yes we whinge, we rant, we moan we complain we also laugh and we praise but most all we go for support from those that are either going though what I am going though or have gone though it. I have had more advice support than I every got from the NHS oncology clinic in Edinburgh. So perhaps you should really check before opening your mouth and denigrating such groups that can offer what the NHS either cannot and will not.

I have plenty of evidence of money wastage I actually mentioned a few earlier but obviously it suited your purpose to ignore what I had posted.

As for your pretty little image I wonder where the UK would come when it fleshed it out a bit as I am pretty sure we are nowhere near the top when it comes to cancer treatment care survival ETC ETC but as long as the averages across the board put us up there that's all right.

 

Oh it totally gets more complicated, hence keeping it somewhat simple and my facetious use of biscuits (although one Trust I worked at did indeed ban biscuits being purchased). If you got a better service from a private provider then that's great - the problem is that reality is showing the private services to either be no better, worse or simply more expensive.

The NHS has an internal competition market. Hospitals compete with each other for services and patients. They tender for clinics. One example is Moorfields Eye Hospital in London - over the years they've tendered and won contracts that now mean there are satellite Moorfields clinics at other hospitals, miles from Moorfields itself. What is now happening is that private companies are able to apply for these contracts as well, resulting in the disasters around Serco etc.

You're also absolutely right about what happens when privatisation begins to dominate - we end up with the insurance problem. The US healthcare system wastes multitudes more money than the NHS does on billing departments that are required to vaguely keep track of the money being thrown around. Their charges go up to pay for these legions of administrators, resulting in an expensive and inefficient healthcare system that simply doesn't deliver in anything except the ability to see a doctor the same day.

Finally, yes. Take the current NHS and streamline it. Take the bloody endless paperwork away, remove the ridiculous 4 hour A&E targets that harm patient care. As I said previously, remove the jobs that are totally superfluous. Concentrate on delivering excellent clinical care, that is patient focused, as fast as possible. This doesn't mean opening things up to competition, as that usually just ends up with corners being cut.

Your choice.

However, you're right, our cancer outcomes aren't top of the league either. So we obviously need to work on it. But again, just because you had a bad experience doesn't mean the NHS as a whole is a crock of **** and needs to be kicked to the curb. If you want to make this a discussion solely about the services with which you have direct experience, then fine, but don't then make sweeping statements about the NHS as a whole.

As for the FB groups? Great, you found them positive, and I have recommended support groups and the like to plenty of patients. Doesn't mean they're a reliable statistical tool on which you can make a judgement.

 

I think that's overly simplistic. In 2013 ONS figures put tobacco related sales tax value in the UK at about 18 billion. If the NHS cost isn't neutralised then that should be raised from the top of the NHS to the treasury. Even if you add the wider costs of smoking on society, the policy exchange commission came up with about 14 billion meaning smoking is a net gain to the treasury, this is a conflict of interest that goes beyond the thread though.

The NHS responsibility on smoking alone is an example of how things are screwed up though. Whilst I agree that people should make lifestyle changes to improve their health, and am sure that you're making the point for the right reasons, take a look at this commentary on medical profession in the UK and their relationship with tobacco, pharma, and their stance on e-cigaretteslink

Even if you step back and look at the motivation side of it all the NHS campaigns are all wrong, drawing attention to the number of smokers. Even people with a rudimentary grasp of influence and behavioural economics can point out that is exactly the wrong thing to do.



Another comment was made earlier in the thread on the cost of no-shows to GP appointments. I would ask in return why this hasn't been replicated (or even attempted) nationally. link (sorry, I've misplaced the link to the original research paper)

/rant - you can get back on topic now.

Yes the NHS are burdened with nonsense targets and a whole lot more, but I am not seeing them take advantage of significant opportunities that are within their control to improve things.

 

On the subject of no shows what the figures do not show is the mistakes or downright uselessness of bureaucracy within the NHS. In one year I have been sent to a clinic that did not operate on that day. I have been sent two separate times to the same clinic on the same day. I have bern sent to the wrong specialist and even the wrong hospital.

 

There are a whole bunch of myths around the NHS.

- Private health care is better. No, it really is not. Ask any American --mistakes still happen, waste of resources still happens, lack of resources still happens, and doctors who shouldn't be allowed to practice still practice. All NHS consultants that I know of having been struck off over the last few years also practised in private services. But it is the NHS that got them struck off.

- If only we had people from private industry leading the NHS, it would be better and more efficient. There is so much wrong with that idea that I don't know where to start --apart from the fact that practice has shown that it does not work (cf. Circle Health quits its contract to manage Hitchingbrooke Hospital after running into exactly the same problems it was hired to ameliorate). Commercial services give people what they want. the NHS gives people what they need. People often have a much better idea of what they want than what they need; buying a holiday, widescreen TV or internet service is a lot easier than making treatment decisions around your cancer.

And if you don't like the TV you can take it back. If you don't like your ISP you can cancel the contract. But health care decisions can be about life and death. I am reminded of a man in the US who had severe tooth ache. Being an unskilled occasional labourer, he did not have private health care insurance and little money so he had a choice: pay for extraction (costly) or pay for painkillers. He couldn't afford both. He chose the painkillers. Two days later he died of a root canal infection that had reached his brain. he got what he wanted, not what he needed.

- The NHS is wasteful and inefficient. Not nearly as much as private health care, sorry. See Cei's post. And yes, all sorts of health outcomes have been taken into account.

- Alcohol and tobacco raise more money for the Treasury than it costs the NHS to treat. If the duty on alcohol and tobacco was called "Health Tax" that would be nice. But unfortunately the NHS doesn't see any of that money. What we do see is a government remarkably reluctant to levy a minimum price on alcohol --even though that strategy has been proven to reduce alcohol misuse. Why? Bad for business, is why.

@ GMC: all your arguments about how the NHS could increase patient compliance and health behaviours is very nice, but it still puts the responsibility for those with the NHS, not with the patient. What, we can't keep an appointment that is in our own health interests? We can't look after our own health? Why do people cry about "nanny states" right until it becomes time to take some personal responsibility?

On the NHS stance towards "vaping": we don't know whether vapers (which are much less regulated) are safer than cigarettes. At face value it seems so, but research is coming out that says quite the opposite.

 

A lot of decisions are based on expediency and not necessarily in the best interests of the patients. God forbid and fingers crossed I should ever get a life threatening condition they will not be able to give me an aspirin until I know all possible and probable side effects. I accepted without question consultant decisions who have one eye on the patient and the other on some pointless league table where a tick must be placed as soon as possible, this was a grave mistake.

I tried to change consultants and was told by an equally useless so called specialist nurse that this was impossible as there were no alternatives. Result I can no longer swallow solid food because of delays and errors. And don't get me started on making a formal complaint when the full might and unlimited funds are brought to bear and anything goes no matter how dirty.

Mind you I should not have been surprised after see how the NHS treats it's own employees that it discovers has exposed misdeeds ETC so us patients do not stand a chance.

We have come a long way from GP appointment times though. I hope to find out the reason why the huge increase as my local surgery has not bothered to respond to an email on the subject.

 

Where I am you phone the surgery and a doctor will phone back normally the same day, they ask what's wrong and prescribe you meds over the phone and sends the prescription to the chemist which you get delivered with in 48 hours.

Only if the doctor thinks it's needed will you get an appointment.

I guess 10,000 patient's on their books and only 5 doctors will cause this.

Hospitals here are worse my misses has been waiting 5 years for a knee replacement and still hasn't got any closer to getting it.

They certainly isn't perfect but they have to work with what they have

 

The funding issue is a government issue, tax from tobacco should cover the cost of tobacco related impact. I get that it doesnt and see that as a failing of the treasury and public sector - i.e. wider than NHS.

I'm not advocating a lack of personal responsibility for individuals, but engaging with people in a way that is unlikely to result in them behaving as you want is daft, yet it is what is happening here in terms of health improvement and appointments, among other things.

As to the vaping question, the evidence based argument is whether it is 98 or 100% safer. There is no evidence of material risk that has not been soundly refuted, whilst a lot of studies have been misrepresented or poorly constructed to cast doubt on a solution to nicotine addiction which benefits neither the tax coffers or the pharma companies.

 

Yeah, we psychologists have that conversation with the powers that run the NHS on a daily basis. The rule of thumb is: it takes thirty years for psychological insights to become standard practice in the NHS. And then they are misapplied by people who think they know how it works. Because human behaviour is, like, common sense, innit? You don't need a psychologist for that, do you?

The NHS is huge. It's an oil tanker: takes an eternity to change direction. With squabling politicians at the wheel, each trying to pull it in a different direction, while the crew desperately points to the seacliffs that it is inexorably bearing down on.

 

Some interesting studies researched the ideology of doctors and nurses before and after they complete their training. Turns out that new students have strong ethics and empathic ideals of how patients should be treated. After they complete training... not so much. What happened?

Overwhelm happened. Idealism crashing into the hard wall of reality: lack of resources, lack of staff, unskilled management, organically grown bureaucracy and the token economy of arbitrary targets imposed by goverment needing to prove to people that they are better at running a complex health service than the previous goverment (ooh, let's change things some more!) while working hard to dissociate themselves from any responsibility or accountability. I mean, what ****wits put the NHS through the biggest top-down reorganisation in history while at the same time demanding it makes 20% efficiency savings? In the context of a growing population?

A lot of decisions are made in that less than ideal context, trying to meet this patient-in-front-of-me's needs, all the other patients-on-our-waiting-list's needs, management's demands, system demands, arbitrary targets' demands, within the limits of medicine, resources and human beings, while trying to still look reasonably OK to a highly critical media because the last thing we need is patients in distress being more distressed at the thought of having to turn to the NHS for help.

When people are overwhelmed, they go stupid.

 

Overwhelmed may be one cause, but going native, adopting the environments behavioural norms, following social proofs all play a big part in behaviour change. Overwhelming might change behaviour but it doesn't usually change ideals. The change you describe in people is more likely to be a result of the andragogical approach and curriculum content.

Change has been misnamed, mistargeted, misdesigned, and mismanaged at every stage with the NHS but despite your previous comments about private industry not being the answer, I dont believe that anyone internal is free enough from political (small p) implications or unconscious biases like inattentional blindness, functional fixedness, and a whole host of others, to architect the change effectively.