'Incoherent!' Andy Burnham gives his take on Sunak's plans after HS2 derailed

[Borchester]

Again, after my procedure 10 days ago I found my resting pulse rate to be 43 BPM, seeing as I'm not an elite athlete I thought it was a bit low. Called the GP's surgery at 9:30 on Thursday, got an appointment at 14:30 that day, got referred to the hospital, had a call from them around 18:00, went in 10:00 the next day for an ECG and was declared fine by lunch time. This isn't a one off either, as I said before, this is the experience I get all the time.

Same here.

I am more or less licked onto the NHS conveyor belt and never have to wait more than a day or so for an appointment. Like Nick, it could be hours, but I like to take my time. That said, unlike Steve, I don't have anything serious other than old age and there isn't a cure for that, so I don't have much to worry on.

Interesting development (at least to me), is that the last two medics that I have seen have been Associate Physicians. They seem to know their stuff and are I assume cheaper to train, so they may be the way forward.

The shortage of GPs was predicted several decades ago. More and more GPs are women and women like children and so they tend to retire earlier and work shorter hours, so we probably have more doctors now than before, but not putting in the same amount of time

[Nick]

You are lucky. It used to be pretty similar to that down here before covid. The best doctors chose to retire during the pandemic and their replacements all seem to be part timers obviously moonlighting for the private sector. And I never speak to - let alone see - the same doctor twice.

Again, after my procedure 10 days ago I found my resting pulse rate to be 43 BPM, seeing as I'm not an elite athlete I thought it was a bit low. Called the GP's surgery at 9:30 on Thursday, got an appointment at 14:30 that day, got referred to the hospital, had a call from them around 18:00, went in 10:00 the next day for an ECG and was declared fine by lunch time. This isn't a one off either, as I said before, this is the experience I get all the time. 

[srb7677]

That's a long post, obviously heartfelt. But I can say it doesn't reflect our experience in London N16.

Our GP is contactable online, and a return phone call from the GP is received the same day, often within a hour or two. If a face to face consultation is necessary,it happens also on the same day.

All arrangements are made with the GP, not receptionists who, among their other tasks, organise contacts with the GP for those patients who are not online.

This works well for London where there are 2450 patients for each fully qualified GP....

You are lucky. It used to be pretty similar to that down here before covid. The best doctors chose to retire during the pandemic and their replacements all seem to be part timers obviously moonlighting for the private sector. And I never speak to - let alone see - the same doctor twice.

[patman post]

Yes, why do the powers that be, including GPs themselves, not see any problem with non-medically qualified receptionists determining whether your medical condition is serious enough to actually need to see a doctor, and whether it is something that can wait for weeks or needs to be seen more urgently?

I mean the ludicrousness of this idea is glaring and must surely be costing lives. I mean imagine if we had a problem with our cars and the office secretary decided if it was bad enough to need a mechanic? Or if we had a legal problem and the bloody receptionist decided if our case warranted seeing a solicitor? Perhaps if we go to Accident and Emergency, the hospital porter should decide whether our condition is serious enough to warrant being seen by a medical professional?

At my surgery now the waiting room is almost empty, the doors to it permanently locked with no access unless the receptionist lets you in. The best you can get even if you are suffering a medical crisis is a call back in perhaps a couple of weeks time, at a time of their choosing. If you are supposed to be at work that day, tough. Employers are supposed to let staff have time off at the convenience of surgeries, whereas we used to be able to book an appointment that fitted in with work. And we used to be able to actually see a doctor within days, or get a same day guaranteed call back.

No wonder now so many people are overloading hospitals by rocking up at A&E. Because GP services have become so crap that they are next to useless if you require urgent attention.

Because of my Parkinsons Disease, my mental health has become more vulnerable and prone to sudden deteriorations into a crisis state. The last time this happened and I had to call in sick, and I contacted my surgery in a terrible state of anxiety and depression, I was told a GP would call me back 8 days later. What the actual F@@@? I could not afford to be off work for that long, and would have ended up being suicidal within a day or two if I did not immediately address it. Been there before. And so I had to make my own decisions re meds, taking a double dose of anxiety med for a couple of days which seemed to work. Other people I know have been forced to make similar decisions on their own for similar reasons.

Fortunately because of my condition, I now have access to a Parkinsons nurse at the local hospital, and he is also a mental health specialist. I am speaking to him this Friday and will discuss my meds with him. The fact that I keep getting periods of psychological difficulty but that a double dose of anxiety med always seems to bring me out of it, does tend to suggest that I need a higher dosage. But I have so little confidence in my surgery that I prefer to discuss this with the specialist. If I contact the surgery the frigging receptionist will end up deciding if I even need to be spoken to by a doctor at all, and if I do get to speak to one over the phone it will all too often be some locum I have never heard of who knows nothing about my history and is not a mental health specialist. And I'd have to wait for at least a week if not longer even for that.

GP surgeries need to be forced to start seeing patients again, which will immediately start taking some of the pressure off A&E. And will remove the need for patients to make their own decisions re meds, which has obvious potential risks.

That's a long post, obviously heartfelt. But I can say it doesn't reflect our experience in London N16.

Our GP is contactable online, and a return phone call from the GP is received the same day, often within a hour or two. If a face to face consultation is necessary,it happens also on the same day.

All arrangements are made with the GP, not receptionists who, among their other tasks, organise contacts with the GP for those patients who are not online.

This works well for London where there are 2450 patients for each fully qualified GP....

[srb7677]

Great long post above, srb and expanded on my complaint and our own experience is very similar.

And Covid was the dividing line between good and pathetic service. In fact service is an oxymoron.

Maybe Nick is getting the HS2 money spent on him oop North. There's certainly little happening in Kent.
I saw a doctor was suspended for drinking wine whilst speaking to patients online and one reported him. They are taking the pee.

Certainly we need more investment in GP services, with more being trained up. Perhaps we could consider no student loan repayments necessary for anyone working exclusively for the NHS, and anyone who works exclusively for the NHS for 20 years gets the debt entirely written off. We need to encourage more people to get medically qualified and trained and to devote all their time to NHS patients. Too many GPs and consultants only work part time for the NHS and the rest of the time in the lucrative private sector.

I hate to have to say this but we might need severe legal intervention. Eg make it mandatory for newly qualified GPs and hospital doctors to work at least 10 years exclusively for the NHS before being allowed to work in the private sector. We should mandate that all surgeries must offer appointment slots and that the right to see a doctor in such a slot should become mandatory. With patients able to book a slot that fits around their other commitments, eg work. Telephone consultations should only be made if the patient is happy to accept that. 

It should become illegal for non-medically qualified staff to triage patients. And if anyone suffers death, injury or avoidable emergency hospital admission due to their surgery not treating their condition seriously enough, they must be legally liable for that.

Yes there has always been the problem of hypochondriacs repeatedly wasting precious surgery time with trivial or imaginary issues. But trying to shut everyone out because of this is counterproductive.

Perhaps patients should be limited to two free GP consultations per year to tackle this with any further appointments being charged for, unless the GP himself or herself requests the booking, as can occur with those who have ongoing conditions, eg diabetes.

Something must be done, and I dont think it is just a matter of resources, though this is an issue. I think there is a serious attitude problem becoming part of the culture in surgeries, an assumption that we need to work around them and not them us. They got into some seriously bad habits during Covid and dont want to go back to being more patient-focussed again. They like it too much the way it is. And that is a problem that needs addressing.

[Barry]

Before Covid it used to be like that down here in Plymouth. Not anymore.

Great long post above, srb and expanded on my complaint and our own experience is very similar. 

And Covid was the dividing line between good and pathetic service. In fact service is an oxymoron.

Maybe Nick is getting the HS2 money spent on him oop North. There's certainly little happening in Kent.
I saw a doctor was suspended for drinking wine whilst speaking to patients online and one reported him. They are taking the pee.

[Borchester]

Yes, why do the powers that be, including GPs themselves, not see any problem with non-medically qualified receptionists determining whether your medical condition is serious enough to actually need to see a doctor, and whether it is something that can wait for weeks or needs to be seen more urgently?

The practice gets paid by the number of patients, not the quacks, qualifications.

I only go to the doctor when they call me in, which they seem to do quite a lot lately. I suspect they get paid everytime they give me a shot.

You probably know this, but there is a Parkinson's support unit at:

Emmanuel Church
Compton Avenue
Mannamead
PL3 5BZ

08442 259839 (Parkinson's National Helpline 0808 800 0303)

[srb7677]

This seems to be a north / south divide issue, I have never had an issue getting an appointment to see a GP. I recently got diagnosed with AF, I very quickly got to see a heart specialist and yesterday had a Cardioversion, all through the NHS. The whole episode was fantastic from start to finish.

Before Covid it used to be like that down here in Plymouth. Not anymore.

[Nick]

I want to see more money spent at the grass roots level at doctor's surgeries. We need to get back to face to face appointments with proper GPs.
We don't want the receptionist diagnosing a urinary tract infection when we don't have one. We don't want a phone call from a "prescribing clinician".
We need to be able to see a doctor.
Get the online appointments back on the apps.

Spend some money on that, because mysteriously, excess deaths are still high.

This seems to be a north / south divide issue, I have never had an issue getting an appointment to see a GP. I recently got diagnosed with AF, I very quickly got to see a heart specialist and yesterday had a Cardioversion, all through the NHS. The whole episode was fantastic from start to finish. 

[srb7677]

I want to see more money spent at the grass roots level at doctor's surgeries. We need to get back to face to face appointments with proper GPs.
We don't want the receptionist diagnosing a urinary tract infection when we don't have one. We don't want a phone call from a "prescribing clinician".
We need to be able to see a doctor.
Get the online appointments back on the apps.

Spend some money on that, because mysteriously, excess deaths are still high.

Yes, why do the powers that be, including GPs themselves, not see any problem with non-medically qualified receptionists determining whether your medical condition is serious enough to actually need to see a doctor, and whether it is something that can wait for weeks or needs to be seen more urgently?

I mean the ludicrousness of this idea is glaring and must surely be costing lives. I mean imagine if we had a problem with our cars and the office secretary decided if it was bad enough to need a mechanic? Or if we had a legal problem and the bloody receptionist decided if our case warranted seeing a solicitor? Perhaps if we go to Accident and Emergency, the hospital porter should decide whether our condition is serious enough to warrant being seen by a medical professional?

At my surgery now the waiting room is almost empty, the doors to it permanently locked with no access unless the receptionist lets you in. The best you can get even if you are suffering a medical crisis is a call back in perhaps a couple of weeks time, at a time of their choosing. If you are supposed to be at work that day, tough. Employers are supposed to let staff have time off at the convenience of surgeries, whereas we used to be able to book an appointment that fitted in with work. And we used to be able to actually see a doctor within days, or get a same day guaranteed call back.

No wonder now so many people are overloading hospitals by rocking up at A&E. Because GP services have become so crap that they are next to useless if you require urgent attention.

Because of my Parkinsons Disease, my mental health has become more vulnerable and prone to sudden deteriorations into a crisis state. The last time this happened and I had to call in sick, and I contacted my surgery in a terrible state of anxiety and depression, I was told a GP would call me back 8 days later. What the actual F@@@? I could not afford to be off work for that long, and would have ended up being suicidal within a day or two if I did not immediately address it. Been there before. And so I had to make my own decisions re meds, taking a double dose of anxiety med for a couple of days which seemed to work. Other people I know have been forced to make similar decisions on their own for similar reasons.

Fortunately because of my condition, I now have access to a Parkinsons nurse at the local hospital, and he is also a mental health specialist. I am speaking to him this Friday and will discuss my meds with him. The fact that I keep getting periods of psychological difficulty but that a double dose of anxiety med always seems to bring me out of it, does tend to suggest that I need a higher dosage. But I have so little confidence in my surgery that I prefer to discuss this with the specialist. If I contact the surgery the frigging receptionist will end up deciding if I even need to be spoken to by a doctor at all, and if I do get to speak to one over the phone it will all too often be some locum I have never heard of who knows nothing about my history and is not a mental health specialist. And I'd have to wait for at least a week if not longer even for that.

GP surgeries need to be forced to start seeing patients again, which will immediately start taking some of the pressure off A&E. And will remove the need for patients to make their own decisions re meds, which has obvious potential risks.

[Barry]

I want to see more money spent at the grass roots level at doctor's surgeries. We need to get back to face to face appointments with proper GPs.
We don't want the receptionist diagnosing a urinary tract infection when we don't have one. We don't want a phone call from a "prescribing clinician".
We need to be able to see a doctor.
Get the online appointments back on the apps.

Spend some money on that, because mysteriously, excess deaths are still high.

[Borchester]

Blame Nick and Borchester, the truth seems to hurt them and neither know what debate is.

I am sorry Pappy. I did not realise that you expected the food at Land's End to be free.

I blame the Tories.

[Nick]

Again, you seem to be missing the point — China is a vast area with an authoritarian regime able to bulldoze through infrastructure schemes without regard for the environment or individuals lives.

Britain is a small, with the longest route, tip-to-tip, less than 1000 miles. Does it need to destroy hundreds of acres of established land and human and wildlife habitation and incur the cost of many miles of tunnelling for the sake of a prestige project and minutes off a journey?

Britain needs better and less costly rail links to build and use. HS2 doesn't appear to be the ideal example of the way to go. There are already mainlines running north-south. We've not been satisfactorily told why these can't be upgraded, and other much needed east-west routes built or improved...

You're missing my point Pat, I'm not saying it should be done, I'm asking why we don't have the wherewithal to achieve the project, it's not like we are a third world country 🤦 

[patman post]

China has high speed (300kph) lines all the way up the east coast. You can go from Guangzhou to Shanghai is 6 hours, a journey of 900 miles on a high speed train. Why do we find it so difficult to complete a section a third of the length? People just know if they get a government contract they can take the piss, and do.

Again, you seem to be missing the point — China is a vast area with an authoritarian regime able to bulldoze through infrastructure schemes without regard for the environment or individuals lives. 

Britain is a small, with the longest route, tip-to-tip, less than 1000 miles. Does it need to destroy hundreds of acres of established land and human and wildlife habitation and incur the cost of many miles of tunnelling for the sake of a prestige project and minutes off a journey?

Britain needs better and less costly rail links to build and use. HS2 doesn't appear to be the ideal example of the way to go. There are already mainlines running north-south. We've not been satisfactorily told why these can't be upgraded, and other much needed east-west routes built or improved...

[Nick]

You're trying to equate the pride in an equivalent route of a London Underground line with a French TGV. Both serve their different markets.

Nice to have projects to point at and be be proud of, but even better if they actually fulfil a useful purpose. I'm querying if the UK (with its difficult geography) actually needs the expense of HS2, when upgrading existing track and trains, and building east-west links, would vastly improve the infrastructure...

China has high speed (300kph) lines all the way up the east coast. You can go from Guangzhou to Shanghai is 6 hours, a journey of 900 miles on a high speed train. Why do we find it so difficult to complete a section a third of the length? People just know if they get a government contract they can take the piss, and do.