The GP service

On Friday I turned my attention again to the GP service. I have been working on this issue most of this Parliament, as there has been an increase in the number of complaints from people unable to obtain a  timely appointment to see the doctor. There have also been requests from doctors themselves for assistance with  more money and support to enable them to expand their practices and meet the extra demand.

I have been sympathetic and have taken these matters up with the government, as have other MPs. I was pleased this week to hear from the Health Secretary that considerably more money will be made available to the GP service over the next five years. Spending on GPs will now rise from £9.6bn this year to more than £12bn by 2020-21. This is  estimated to be a 14% rise above inflation, and will take the GP service to a 10% share of the NHS budget. This year funding increases by £322 m or 4.4%.

On top of this money will come a £500m national sustainability and transformation package  to support GPs. There are three smaller specialist funds totalling £112 m to help struggling practices and doctors under pressure. There will be measures and money to increase the numbers of GPs , adding more pharmacists to the service, helping train  more practice nurses and encourage others back to work, and training new physician assistants. There will also be a substantial £900 million capital investment programme.

It is quite clear there is a substantial increase in demand and workload. Some comes from a rising population.  In Wokingham substantial new housing development brings with it an obvious need for more surgery capacity. Nationally controlling migrant numbers better will make a contribution to managing increases in demand, which will be much easier to achieve if we leave the EU. Some of the increase in demand comes from people living longer, as the frail very elderly need more treatment. This is a  good development which just needs more medical care to be available. Some of the demand  increase comes from rising expectations of what doctors can achieve and help with. Locally I was told the average patient on a GP list has six consultations a year, with some users asking for as many as 50. Some need the appointments, but some are the worried well or could be treated by the practice nurse or pharmacist. GP practices are encouraged to experiment with  new ways of assessing patient need and booking the right appointment with the right person promptly.

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145 Comments

  1. Dame Rita Webb
    Posted May 1, 2016 at 5:37 am | Permalink

    Before the routine slagging off of the NHS commences perhaps the following should be considered as to why its hard to get an appointment? Could it be that some of the public themselves are part of the problem? I have written here before about general clinics sometimes only having a 50% turn up rate and presentations of ailments, that in times past, would have been sorted out by a mother/grandmother themselves e.g. bedwetting. However have a read of this as to how over indulgence of chocolate easter eggs recently overstrained A&E services in Middlesbrough http://www.theguardian.com/lifeandstyle/2016/mar/30/middlesbrough-a-and-e-flooded-easter-egg-overindulgers

    • Lifelogic
      Posted May 1, 2016 at 6:18 am | Permalink

      Indeed but if you just made patients pay £25 or something (perhaps even in advance of booking the appointment as a non returnable deposit) they would turn up and would have paid anyway. The no show rate is not helped by the huge delays in getting appointments either and by the poor way they run their booking systems, just sending out appointment letters rather than calling to make a (convenient to both parties) arrangement with the patient.

      Another sign of the NHS’s contempt for the patients. Take it or leave it mate we have your money already. Rather like all the other monopoly services that state delivers.

      • dame rita webb
        Posted May 1, 2016 at 2:58 pm | Permalink

        Rubbish. If the medics in the NHS do not give a toss then why do they do so much unpaid overtime?. Personally if I were the BMA I would stop the strikes and just tell the doctors to work their contracted hours. If they hold the patients in such contempt why should they bother otherwise?

        • Lifelogic
          Posted May 1, 2016 at 6:07 pm | Permalink

          There are indeed a lot of well meaning and hard working staff working in the NHS on the front line, it is the whole system, structure and administration that is rotten and does not work.

        • Richard1
          Posted May 1, 2016 at 6:10 pm | Permalink

          That attitude in itself illustrates the problem of a publicly funded monopoly. I can’t think of anyone I have ever come across in a professional job who doesn’t do “unpaid hours”. That’s what professionalism is about.

          • Jerry
            Posted May 2, 2016 at 6:48 am | Permalink

            @Richard1; @DRW was not complaining about doctors working ‘unpaid hours’, she was making a comment to @Lifelogic who thinks that doctors have “contempt” for their patients or do not care, then going on to say that rather than an all out strike it would be better to just work to contract. How does that illustrate the problem in your opinion, unless you are trying to suggest that private enterprise, with “professional jobs” do not suffer industrial disputes, work to rules and strikes?!

      • Jerry
        Posted May 1, 2016 at 4:16 pm | Permalink

        @LL; “if you just made patients pay £25 or something (perhaps even in advance of booking the appointment as a non returnable deposit”

        They would simply go to A&E, or wait so long before making an appointment to see a doctor for what – was then a minor illness but is now is a major illness requiring more powerful and costly drugs, if not admission to hospital. Not to mention the fact that these untreated people could quite possibly have been passing on their (perhaps highly infectious) illness to others for days, if not weeks or even months.

        How about just funding the NHS properly. like all (the then) major parties signed up to in their manifestos in 1945?…

        • Edward2
          Posted May 1, 2016 at 5:43 pm | Permalink

          What do you mean by “properly”
          Blair and Brown doubled funding for the NHS in the biggest increase in NHS funding ever
          The Coalition decided the NHS would be ringfenced against any spending cuts
          The current Govt have increased spending in real terms.
          Perhaps you could inform us what level of extra spending you feel is appropriate.
          Oh and where you would get this extra money from.

          • Bob
            Posted May 2, 2016 at 9:19 am | Permalink

            @Edward2

            “where you would get this extra money from?”

            TV Licence fees amount to abt £3.5 billion p.a., which is obviously far more than is needed to provide a bit of PSB, rubbishy bake off shows and reality TV.

            If the TV Licence revenue supported something worthwhile instead of funding political indoctrination and lucrative employment contracts I would reconsider paying for one.

        • Lifelogic
          Posted May 1, 2016 at 6:04 pm | Permalink

          Well of course you have charge at A&E too, businesses should be encouraging customers not rationing and inconveniencing them. Like it or not heath care is a business.

          • Jerry
            Posted May 2, 2016 at 7:31 am | Permalink

            @Edward2; There is a lot of middle management waste (accountant justifying their own jobs in the main), adding layers of costs that has been caused by the politician since the 1980s and the ‘internal market’ etc. very little of the extra money you mention ever reached the wards and front line services etc.

            “Oh and where you would get this extra money from.”

            How about from, cutting the middle management/accountants waste I’ve already mentioned, then cutting real waste in Whitehall (by abolishing a few complete departments for example, not to mention many a quango), and then -upon the Brexit- diverting the £9bn + saving into funding true front line NHS services – rather than giving a tax cut to a few?

            @LL; “Well of course you have charge at A&E too”

            I will repeat, that will just result in people not seeking treatment for possibly infectious illnesses, not to mention encourage a raise in ‘quack remedies’ that do nothing but cost the NHS even more later when trying to sort out the results of inappropriate treatments, if not cause the police more work investigating an unexplained death.

            “Like it or not heath care is a business.”

            Rubbish, Health/NHS is a service just like Police, Fire, Coast Guard, Social Services etc.

          • Edward2
            Posted May 2, 2016 at 3:59 pm | Permalink

            You might raise a few hundred million from your list Jerry
            The NHS eats billions with ease.

        • Hope
          Posted May 1, 2016 at 8:12 pm | Permalink

          Let us not forget Hunt told us not to go to A&E for non emergencies because appointments were not possible at GP surgeries. Hunt the did exactly what he told us not and took his child to A&E! The public services are overwhelmed because of Cameron’s mass immigration policy. Doctors can work 7 days a week it will not increase their number. Stop EU contributions and overseas aid,mwe could afford a few more doctors and nurses.nthe extra £1.7 billion Cameknron gave to the EU,bwhen he said he would not, could provide 60,000 extra nurses for life including their pensions. Instead he got nothing in return from the EU who spent it on whatever it wanted. If the UK left the EU it could tax and spend on the needs of this country and we could sack the politicos if they failed. EU elite we cannot influence or sack when they waste our taxes.

          • Jerry
            Posted May 2, 2016 at 7:37 am | Permalink

            @Hope; Let’s not forget that the (funding) problems of the NHS pre-existed the more recent migration you talk about – your ‘solution’ is like a doctor amputating the leg, rather than fixing a simple cracked bone!

          • Lifelogic
            Posted May 2, 2016 at 8:59 am | Permalink

            The problem is that it is often not clear what is or is not an emergency. Even the doctors at casualty get such judgements wrong quite often.

            I was sent away from casualty twice with appendicitis before they finally operated. A condition which was the second commonest cause of premature death in males, until routine operations for it.

    • Antisthenes
      Posted May 1, 2016 at 7:56 am | Permalink

      Yes indeed the patients are part of the problem but that is mostly because the service is free. When something is free there will always be plenty who will want it without real need. If it was not free but affordable as in France then if someone is suffering from a minor ailment they will think twice about attending for treatment.

      However I now contradict myself as the French noted for being a nation of hypochondriacs used to go to see more than one GP for the same ailment(not sure why maybe to double up on the medicine they were given or to see if they were given something different)until the government brought in compulsory registration the same as the NHS. Perhaps their healthcare is too affordable although slowly the French are transferring the burden of funding from the state to the individual. Recently it has gone from State 70% private insurance (optional) 30% to 65% / 35%.

      Provision is mixed private state most opt for private as the patient chooses and unlike the NHS they do not have armies of administrators and receptionists and practice nurses who I note only duplicate what the doctors subsequently have do all over again when you do get to see them.

      Throwing money at the NHS is not the answer until that money is used more productively. It will only go to back room services where so much of it goes now not to the front line where it should and where it goes in the French healthcare service.

      France spends considerably more on their healthcare than we do but as all healthcare requires considerable amounts of money taxes cannot on their own supply that money so we must move to the French system and make individuals contribute more. As for provision until we introduce competition then the only ones to benefit from the NHS will be the administrators and the like certainly not the patients. The NHS is a monopoly and as such it does not have to worry much about giving a decent service.

    • Hope
      Posted May 1, 2016 at 8:23 am | Permalink

      Cameron has demonstrated the lack of integrity in your manifesto. He dropped a pledge and changed a union bill for cash from the trade unions after making derogatory remarks about the Labour Party for doing the same! Cash for change of policy! You might also recall his comments about the dangers of corruption in lobbying! It goes to his lack of integrity and that’s you cannot believe a word he says. You need to sack him.

      Good piece by IDS in the papers. Both us and Gove’s article not getting the coverage they deserve. More challenges for debate required at this time. Cameron’s instinct is to run away as he did with Farage, Salmond and Miliband.

      • Hope
        Posted May 1, 2016 at 11:45 am | Permalink

        JR’s piece is once again flawed. The Health Secretary cannot make improvements that could cope with the mass immigration Cameron supports and is continuing to allow. Our public services are overwhelmed. Full stop. Stop pretending otherwise. In the past few weeks Cameron has been shown his lack of integrity, attack other for tax avoidance and squeezes every penny of tax from the middle classes. The continuous tax hikes while hiding his fortune off shore. Now he has sold manifesto pledge for cash to stay in the EU! Please show me I am wrong or not understood.

        We read today how the UK has given Mozambique £84 million a year which it spent on French built patrol boats! We read similar stories on a regular basis, corrupt regimes, £2 billion on Oxbridge consultants, £2 billion of Foreign Aid given to the EU to spend as it likes, and it likes wasting it on mating programmers for rare fish, dancing classes etc. Pensioners forced to sale their home to provide care, fuel poverty, food banks and life time of debt for English students while EU students are provided free tuition in our own universities! Green’s defence of Foreign Aid: it was in our manifesto which we were elected on! The same discredited manifesto that Cameron will disregard for cash even if it is for an organization that it is opposed to the values of his own party! There is no integrity left in such claims.

        Foreign Aid will reach £16 billion by 2020 while Cameron continues his mass immigration policy to rid our nation of our culture, identity and squeeze every penny of tax he can from the middle classes to pay for his stupid left wing ideology. I trust pensioners, strivers, workers and the prudent will vote leave and not vote for another Tory party. Cameron is for the left wing unions, feckless, welfare dependency, EU mass immigration, the social decay of our society and against democratic self- government.

        • Lifelogic
          Posted May 1, 2016 at 3:36 pm | Permalink

          The state sector cares not what it spends not what value it gets. It is not their money after all. For the best of all is if it spent on nice offices and the wages and pension of state sector bureaucrats, as indeed so much of it is.

          • Chris
            Posted May 1, 2016 at 6:57 pm | Permalink

            They also have to use up their quota of money by a certain time. Hence apparently the obscene rush to allocate money to almost any overseas aid project in the last financial year, regardless of its worth.

          • Hope
            Posted May 1, 2016 at 8:04 pm | Permalink

            Utter rubbish LL. The Inspection regimes of public services could change public sector spending if it chose. DfID over spenttits £12 billion budget to waste our taxes! I suspect terrified it would not hit its spending target.mit is. The tick in the box mentality created by govt and enforced by inspectors. The govt. is to blame.

        • M Davis
          Posted May 1, 2016 at 5:38 pm | Permalink

          Your comment got my blood boiling and if Remain get in, I will take out as much money as I can from my Bank Account, leaving the Direct Debits in place of course, as I can, and stash it wherever. I am so sick to death of this Government!

    • Bryan Harris
      Posted May 1, 2016 at 10:35 am | Permalink

      I agree that patients themselves could be a part of the problem – but in this politically correct world, people are afraid to take responsibility for themselves.

      It’s time people generally were educated effectively – rather than what passes for governmnet advice to avoid certain foods, do this or don’t do that – such advice confuses the whole scene and makes people more inclined to see a GP than to use their own initiative.

      There is a degree of mystery associated with the Human body, and we’ve come to rely on experts for everything else – let us demystify, a little, the way the body works, and what it needs. A better educated patient will respond better and take up less GP time.

      • hy
        Posted May 1, 2016 at 8:28 pm | Permalink

        Human physiology and pharmacology should be part of the A level Biology syllabus. It would be more useful than most of the other material taught on this course.

        • Bryan Harris
          Posted May 2, 2016 at 11:51 am | Permalink

          Agreed

    • Bob
      Posted May 1, 2016 at 10:48 am | Permalink

      “clinics sometimes only having a 50% turn up rate “

      I’ve never been to see the GP to find the doctors sitting around waiting for patients. Generally the waiting rooms are full and despite having an “appointment” time patients are still waiting for an hour or so before seeing the doctor. I would have thought therefore that any patient not turning up was doing every else a favour by reducing the pressure on the doctors by shortening the waiting times for patients who do turn up.

      • Bob
        Posted May 1, 2016 at 10:52 am | Permalink

        It’s also likely that after a 3 week wait for an appointment the patient has either recovered, gone to A&E or died.

        • Lifelogic
          Posted May 1, 2016 at 3:37 pm | Permalink

          Or gone elsewhere or forgotten about it.

      • hy
        Posted May 1, 2016 at 8:31 pm | Permalink

        The solution to non-attendance in many hospital out-patients is to double-book every appointment and book those with hospital transport into the earliest slots. What could go wrong?
        Many appointments with immigrant patients can take twice as long as they need a translator.

    • Denis Cooper
      Posted May 1, 2016 at 11:48 am | Permalink

      Well, I think the Guardian was “over-egging” that with its headline.

      In the body of the article:

      “There were several people with stomach problems because they had overindulged, whether on Easter eggs or other things over the Easter period.

      It’s difficult to give an exact number as we would have to go into the case notes of every patient who came in with symptoms of stomach problems, but several were telling staff they had eaten a lot and their symptoms were caused by that.”

      We know of several other reasons why A&E services are under strain, apart from the gluttonous over-consumption of Easter eggs.

      And this was from the “Comment is free but facts are sacred” newspaper!

    • Dennis
      Posted May 1, 2016 at 11:52 am | Permalink

      50% turn up rate? If only. I live 3 mins from my surgery and ask if there is a no show or cancellation I’ll come. This has never happened in 12 years.

      • dame rita webb
        Posted May 1, 2016 at 3:00 pm | Permalink

        Just to clarify that refers to a hospital clinic not a GPs surgery

    • acorn
      Posted May 2, 2016 at 7:29 am | Permalink

      Previously on John Redwood’s Diary.

      Posted November 17, 2013 at 2:54 pm | Permalink

      “Free at the point of use leads to abuse”. That will be the fifth time I have used that expression on this site. The first time was Sept 10, 2008. Can I refer the Rt Hon member to my for previous replies on this matter.

      The French, some while back, realised the problem and introduced co-payment and voluntary health insurance to top up the state financed statutory health insurance.

      The NHS costs about £2,200 per capita, a state run insurance scheme (not private sector insurance rip-offs), would cover, say, 95% of A&E and life threatening repairs. Gold plated hip joints would then be covered by, again, a state run top-up insurance option. “No-show” fees would be set to a level that reduced them by, say, 90%.

      You could do similar with Education. Across all education tiers (3 to 21 years of age), you are looking at an average of £6,500 per full time pupil /student year. A state run education credit card, could be used in any school, for full or part payment in the really posh schools.

      Everybody gets a bill and sees how much health and education costs. Education is well on its way to being privatised under the current government. NHS England will follow???

  2. Lifelogic
    Posted May 1, 2016 at 5:45 am | Permalink

    The contract that remunerates GP’s simply does not work. It encourages GPs to ration the appointments by back door methods or by making booking hard and inconvenient. Especially for those who are working and busy. It is the whole of the NHS that works like this. If a hospital casualty in London got a reputation for seeing you within minutes it would get overloaded so they always seem to take hours. We need to restrict the NHS to charge everyone something anyone from outside the UK should have insurance. We need to make sure the money follows the patient. If you can pay for a hair cut or a plumber why not a doctor?

    I know someone who recently needed at gall bladder removal. Initially they were waiting on the NHS, but could not get any firm date for the operation. They eventually went to see a private specialist one morning, the scans were booked by the specialist that morning and done later that day. Then reviewed by the specialist that afternoon and the operation done two days later. The bladder was in very a bad state and necrotising. It could easily have burst and killed the patient at any stage. Who know when the NHS might finally have got round to doing the operation they certainly did not?

    The NHS is an absurd system and structure, it only works at all due to some well meaning and hard working people within it doing their very best. This despite the absurd system and the endless waiting list. Not to mention the endless expensive cover ups in the “Hillsborough mode” to avoid legal liability for negligence and prevent the truth being known. Also the manipulation and faking of waiting list to “meet” targets.

    The system can never work efficiently as structured. Once again Brexit will help hugely as we can insist on people for outside the UK paying in full for Heath and indeed university places too.

    • Lifelogic
      Posted May 1, 2016 at 3:40 pm | Permalink

      And we can take the best doctors and medical staff from all around the world and not just the EU.

    • Dame Rita Webb
      Posted May 1, 2016 at 7:33 pm | Permalink

      LL GPs get paid per patient that they have on the books (around a £100 per punter). Their pay is not related to how many appointments they do in a day. If you want to knock the NHS get your facts right first please. You are right however with regard to charging for an appointment. It works in Germany and I believe in Canada too. Once you have seen the doc you get the payment back via your insurance plan.

      • Lifelogic
        Posted May 2, 2016 at 3:55 am | Permalink

        I know this and there is nothing factually inaccurate in what I have said please read it again.

        Doctors and the heath providers in general should be paid by patients who are happy with the prompt and efficient service they have received. Not as now paid by governments and often incentivised to ration, delay treatment, meet artificial targets and inconvenience patients.

    • a-tracy
      Posted May 2, 2016 at 4:50 pm | Permalink

      LL ‘if you can pay for a haircut or a plumber then why not a doctor’

      Hold on a minute LL what are we paying our national insurance for, it doesn’t pay statutory sick pay anymore the employer pays it. It was never paid for plumbing or hairdressing! However I have extra insurance for plumbing, heating repairs and wouldn’t expect to pay twice.
      Our pensions are being slowly removed and reintroduced as NEST so the only thing left that NI funds of the 25.8% contribution (employees contribute) over the lel is supposed to be for healthcare. Now we pay for opticians, we pay for dentists, prescriptions, chiropodists, physio. We even pay £3 for 20 minutes parking to attend outpatients for a short test – we pay £8.40 per item for a prescription

  3. Jerry
    Posted May 1, 2016 at 6:07 am | Permalink

    Now do the same for both NHS Dentistry and Ophthalmology services….

  4. Lifelogic
    Posted May 1, 2016 at 6:10 am | Permalink

    The N…. H….. S…… was of course Cameron’s “priority in three letters”. This back in his hug a husky/hoody/cast iron/I am a EURO sceptic/low tax conservative at heart days. It has deteriorated hugely since and it was dire even back then. He seems to forgotten about it since.

    It really needs to start charging and to be broken up, it is hugely inefficient. It fails endlessly & kills thousands. The system encourages bureaucracy, huge delays and endless rationing rarely efficient treatment. The money needs directing to the people that are actually doing the things that help the patients.

    The best way to do this is to make the patients pay (unless they really cannot) and tax them less. Also give companies and individuals tax breaks to take insurance as we had under Mrs Thatcher. Not as now make them pay for the NHS through taxes, then for their own private insurance out of taxed income plus 9.5% IPT tax (thanks to tax borrow and piss down the drain Osborne) on top of this too.

    Consultant often even risk people’s lives by not telling patients the truth, that perhaps they need a certain urgent scan, treatment or operation urgently but will have a huge wait on the NHS. This when perhaps they could easily pay for these themselves anyway. I know someone who needed a back operation for severe back pain. He could easily have paid for it and had it a day or two later. But was just given a steroid injection that did not work (even that injection he had to wait a long time for). As a result he then developed a blood clot (from his sitting position to avoid the pain) and could then not have the operation for many months. He was thus in considerable pain for months until he finally was able to have the op privately which solved the problem an could have done so straight away and at far lower overall cost.

  5. Martyn G
    Posted May 1, 2016 at 6:14 am | Permalink

    Mine is a village of around 1300 houses, extremely well served by our GP practice – rarely can one cannot get an appointment on a day of one’s choice – and is surrounded on all sides by large greenfield sites. A B-class ‘rat-run’ road runs through the village and is a nightmare of traffic, cars and HGV at commuting times. Thanks to the government opening the door to development on Greenfield sites, outline planning applications have now been submitted by different developers to build 700 houses on three of the five fields, with another soon to follow for another 200 on a forth field, bringing the total to around 900 or more new houses.
    Admittedly at the outline planning stage many major considerations will be subject to detailed study downstream but it can hardly be imagined that the present commercial, medical, schooling and road infrastructure will be able to cope with a village almost doubled in size. Thanks, dear Conservative government, because if all applications are permitted, our village will be overwhelmed by influx of housing, people and traffic for which it is ill-fitted to sustain.

    • fedupsoutherner
      Posted May 1, 2016 at 2:59 pm | Permalink

      Martyn, please guide us as to which part of the country you reside in. When I move in the not too distant future I will steer well clear.

      • Martyn G
        Posted May 1, 2016 at 8:10 pm | Permalink

        About 10 miles south of Oxford and where the B4009 joins the A4074, once a royal ville, mentioned in Doomsday and once an important coach stop on the route from London to Oxford known as Bensington, my village is Benson. Wherein, as it happens, dwells our local MP from whom we have heard not a peep regarding building 100’s of houses on green field sites!

        • fedupsoutherner
          Posted May 1, 2016 at 10:00 pm | Permalink

          Martyn, disgusting. Just the same here. We contacted our MP (SNP) and have had no reply whatsoever. We had a letter from her secretary saying she would be in touch and that was 3 weeks ago. To date, zilch. Just what are we paying these people for? It would take an atomic bomb to get a peep from them.

  6. The Active Citizen
    Posted May 1, 2016 at 6:15 am | Permalink

    There is of course a demand and supply side to this issue, and there is also the nature of the demand. You mention all of these.

    Nature of demand:
    1. I welcome your thoughts on the increased use of practice nurses and other professionals to take the pressure off doctors. I won’t be the only one to have been frustrated to see people ahead of me in the queue who had little wrong with them. Doctors I know as friends have confirmed this trend.
    2. Can we please also apply this to A&E? There seems to be an absurd increase in the number of people who don’t seem to understand either words: ‘accident’ or ’emergency’.
    3. Doctors can increasingly do more for people, as medical innovations continue. Inevitably this means more treatable patients and more time on average with each of them. This requires ever more attention to operational efficiencies.

    Supply and demand:
    It’s infuriating to see the Government failing to mention the increased healthcare demand from a rapidly rising population due to immigration. The same was true the other day about school places – rapid growth in the number of migrant children wasn’t even mentioned.

    Can we please be open about the pressure which unlimited mass immigration has put on our public services in the last 15 years? The public aren’t fools, and get frustrated when government ministers deliberately side-step this issue.

    • Lifelogic
      Posted May 2, 2016 at 4:03 am | Permalink

      I do not think this government actually understand supply and demand or indeed logic and reason. They are mainly about lies, spin, irrational feeling and deceiving the public. They do not care if something actually works or not. The NHS is a very good example.

      Osborne even seems to think he can dictate higher wage levels by law, without killing thousands of jobs – either he is very stupid indeed or he does not care about the huge damage he inflicts because he thinks he will gain politically.

  7. Cheshire Girl
    Posted May 1, 2016 at 7:18 am | Permalink

    I’m not at all sure its just a question of money. There is a chronic shortage of GPs , many are planning to retire in the next five years, and it takes ten years to train new GPs. The Government always goes on about an ‘ageing population’ , while seemingly ignoring the fact that we have a growing population caused mainly by untrammelled immigration. Things will only get worse until we get a grip on this, but it suits the Government to pretend otherwise. There are other factors, but I believe this is the main one, and it is a big draw for others to come and use the services of our ‘International’ Health Service!

    • Lifelogic
      Posted May 1, 2016 at 10:46 am | Permalink

      It certainly does suit the Government to pretend otherwise. Why does it have to take 10 years to train a GP though?

      It really does not need to take anything like that long. If the systems and training were organised efficiently & sensibly and the medical unions were rather less protectionist?

      • hefner
        Posted May 1, 2016 at 4:20 pm | Permalink

        http://www.topuniversities.com > Medicine. compares the training for GP practitioner in the USA, Canada, Australia and the UK.
        All these countries require around 9-10 years of studies, training, internships before being given the right to be a GP.

        So another uninformed statement from our lovely LifeWhat’sThat.

        • Lifelogic
          Posted May 2, 2016 at 4:20 am | Permalink

          Just because other countries do something too does not invalidate anything I said. Doctors unions are perhaps strong there too. Doctors do go directly into being the first line at casualty departments after all, which is often far more challenging than being a GP though you hopefully have better back up.

          You could train people directly to be GP’s in far less than 10 years. Large quantities of things currently done by GPs could be done by specialist nurses anyway with suitable back up as needed.

          Indeed all the things I or my children have ever seen a GP for in my 50 odd years could have been done by perfectly well by decent specialist nurses.

          Indeed when the new junior doctors take over each year early each August, A&E death rates increase by about six per cent apparently. Something the NHS seem perfectly happy to accept.

          A price worth paying it seems, perhaps as they are not the ones paying it.

      • Qubus
        Posted May 1, 2016 at 5:28 pm | Permalink

        Surely, it’s five years from start to qualification. Where exactly does the other five come from for a GP?

        • hy
          Posted May 1, 2016 at 8:35 pm | Permalink

          5 year degree course + 5 years training (combinations of paediatrics, gynaecology, psychiatry, general medicine, public health, etc, etc)

          • Qubus
            Posted May 2, 2016 at 11:34 am | Permalink

            I would have expected that to be in the first five years.

    • Denis Cooper
      Posted May 1, 2016 at 12:04 pm | Permalink

      Not just a “growing population”, but an “unpredictably growing population”.

      It’s difficult to predict future requirements without having such unexpectedly large numbers of people suddenly turning up, and if the government wants to maintain a pretence that it isn’t really happening then that makes it even worse.

      • fedupsoutherner
        Posted May 1, 2016 at 3:05 pm | Permalink

        Agree Denis. You can see where the immigration numbers are high by the amount of time people have to wait to see their doctor. For the most part it would seem to be the south that is most affected. Let’s also remember a large number of people cannot get to see a dentist for the same reason. Too many people! Luckily, even though we are missing a lot of things like good broadband speeds, a BT service that actually delivers, rotten roads with pot holes you could drown in, wind farms galore, MSP’s/MP’s who don’t do anything when you write to them, Nicola Sturgeon and Alex Salmond we are fortunate that our service from our GP’s is very good. I feel this is because the population is fairly low (not surprising when you look at the list of things that are wrong) and we have hardly any immigration.

  8. Ex-expat Colin
    Posted May 1, 2016 at 7:23 am | Permalink

    Some of us select the nurse practitioner. Just cannot imagine why that would be? Anyway, its a swift procedure and that person can grab a doctor PDQ if a problem is above pay grade.

    The rest of it is to do with too many patients for too small a business. And its the term business that irks me immediately. Some GPS have a peculiar attitude, so I don’t get sick quite so often I find? GPs as I recall from the 50’s onward and including military(MOs) have had strange attitudes. The Godly status does not really work with me. However, thank you for your efforts.

    • hy
      Posted May 1, 2016 at 8:39 pm | Permalink

      Select the nurse practitioner if you have something basic or protocol-driven but poor at undifferentiated stuff.

  9. CHRISTOPHER HOUSTON
    Posted May 1, 2016 at 7:48 am | Permalink

    Has Mr Osborne done any more long-term projections for the economy in or out of the EU? I’m thinking of the age distribution of the UK population.
    In 2011 83.6% were under the age of 65 years of age.

    The Remainians, though they never ever mention it now, used to say that the massive influx of young immigrants and their children and potential children were necessary to pay for the 16.6% of people on pensions and also for the existing OAPs’ increased need of medical services, care homes, care in the community, drugs, transport and whatnot.

    OK who is going to pay and HOW for the 300,000 net per annum immigrants when they get to 65? plus 20,000 Syrians AND 3,000 Syrian unaccompanied children. Oh and the tiny matter of the existing population of the UK now under the age of 65 who so often get missed out of statistics, concentrated as they are for some reason on migrants and their requirements?
    Then there is the need of pensioners in the EU from where our new young migrants have originated. Who is going to pay their pensions, their medical fees ( assuming they have some kind of medical service in a few years time )? Could it be the UK will be required to find the money? “It’s only fair”, I can hear the Corbynistas saying.
    So, again, has Mr Osborne a cunning plan? Does he need to import a migrant with an abacus or can he figure it out himself?

    • miami.mode
      Posted May 1, 2016 at 4:11 pm | Permalink

      CH. In the financial world it would be considered a Ponzi scheme, which is illegal.

      Perish the thought that we may think of our top politicians as “here today, gone tomorrow” as Robin Day put to John Nott prior to him walking out of an interview, which can be seen on YouTube.

    • Qubus
      Posted May 1, 2016 at 5:32 pm | Permalink

      Unless I am mistaken, even immigrants age! So, aren’t we storing up problems for the country in a next generation?

      • M Davis
        Posted May 1, 2016 at 5:51 pm | Permalink

        Unfortunately, Government Politicians don’t think that far ahead!

        • Lifelogic
          Posted May 2, 2016 at 4:26 am | Permalink

          A week is a long time in politics, the professional career politicians (in the Cameron, Osborne mode) almost never care about anything beyond the next election.

      • JoeSoap
        Posted May 1, 2016 at 6:31 pm | Permalink

        No
        You import more

  10. Richard1
    Posted May 1, 2016 at 8:10 am | Permalink

    This service needs to be deregulated and privatised. It should be possible to see a doctor in the same way as it’s possible to see a dentist or an optician. There was a move a few years ago to establish drop in centres for minor ailments which opened long hours and where appointments weren’t needed. But these seem to have closed – doubtless the bureaucratic backside covering mentality dictated that people can only be seen by the particular practice where they are registered – which, there being no choice, they obviously have to do at the convenience of the practice not at their own.

    The total prohibition on any politician from raising the possibility of running the NHS in any way other than as a state monopoly on quasi-soviet lines damages the nations health and doubtless wastes huge amounts of money.

    • Jerry
      Posted May 1, 2016 at 9:24 am | Permalink

      Richard1; “This service needs to be deregulated and privatised. It should be possible to see a doctor in the same way as it’s possible to see a dentist or an optician.”

      You mean wait 4 months for treatment, unless of course what you really mean is have a USA style health system….

      Suggest that for either the Tory or UKIP manifesto in 2020, worse still, the current government enact such a policy without a manifesto mandate and Mr Corbyn will be striding up Downing Street, not so much a ‘new dawn’ but back to the future – 1945 style, with the same sort of landslide.

      • libertarian
        Posted May 1, 2016 at 3:13 pm | Permalink

        Jerry

        Yes, because of course there are only two ways of delivering health services, the NHS or the US system……. not….. How come waiting times in France and Germany ( both with same size populations roughly) are almost non existent ?

        In France you can turn up at a GP surgery without an appointment & still expect to be seen within an hour.

        In the UK even with an appointment time, you can STILL be kept waiting for an hour or so past the allotted time.

        In Some parts of Sweden & Denmark patients are charged for missing appointments.

        • Jerry
          Posted May 2, 2016 at 7:48 am | Permalink

          @libertarian; Yes and you need additional health insurance in those European countries, much as you do in the USA, unlike the NHS that is based on need and not what the patient could afford (at the time of taking out their health care insurance).

          • libertarian
            Posted May 2, 2016 at 5:55 pm | Permalink

            Jerry

            Not true, and even if it was So what? The French and German model are FAR superior to NHS. Yes you have to pay small amounts ( which is refundable) . Try Singapores system then, my point is there are very different ways of organising health provision Jerry, health provision “free” at the point of service than being run by the government in one giant top down mega organisation

      • Edward2
        Posted May 1, 2016 at 3:36 pm | Permalink

        Whenever I have paid for medical treatment I have seen a doctor within a day or two
        You should assert yourself more Jerry.

        • Jerry
          Posted May 2, 2016 at 7:53 am | Permalink

          @Edward2; When ever I have used private medical insurance or paid directly myself I have been seen within the hour (certainly the same day), you should assert yourself more Edward!..

          But that is not the point, we are talking here about the NHS, how it should be funded and its scope, based on the patients need or how deep their pockets are.

      • Richard1
        Posted May 1, 2016 at 6:18 pm | Permalink

        I think people are increasingly aware that the NHS is far from providing the ‘best in the world’ service which it is obligatory for politicians to claim for it & that there are many other countries with mixed systems – including most other countries in Europe – which have better healthcare outcomes, lower waiting times and lower costs. We should also remember that the reported cost of the NHS is hugely understated. What is the ‘cost’ of the doctors strike, which would be inconceivable in a mixed system? What’s the cost of longer waiting times or higher death rates?

        • Jerry
          Posted May 2, 2016 at 8:16 am | Permalink

          When comparing health care costs no one compares the ‘back room’ administration of the services, people mention other (European) countries and their mixed-funding methods but then fail to mention that taxes are higher to start with, that the local GP has far more autonomy over the commissioning or further treatments etc. Much of the waste in the NHS is not due to the way it is funded nor the failings of GP practises (and the other patient facing parts) but the utter failing of politicians and their imposed top-down middle management structures – many of these failings have been present since the NHS was created but far to many others, and now perhaps the majority, are much more recent problems caused by the ‘internal market’ structuyres and the modern Trusts.

          • libertarian
            Posted May 2, 2016 at 2:21 pm | Permalink

            Jerry

            AT LAST !!! You are finally beginning to understand, praise be. Most of us have been saying all along its THE STRUCTURE and top down management of the NHS which is wrong and causing it to be the massive failure that it is.

          • Jerry
            Posted May 2, 2016 at 7:59 pm | Permalink

            @libertarianl; No one has EVER said otherwise, other than NHS middle management and accountants perhaps! You also seem to forget that the failed structure everyone is talking about has been influenced by your beloved “market forces” for the past 35 odd years, we need more of the 1945 spirit than that of 1985 or 2015…

          • Richard1
            Posted May 2, 2016 at 8:34 pm | Permalink

            The problem is exactly that – it is a government monopoly not a service which survives and prospers by serving its customers. Switzerland has a much better health service and much lower taxes. France provides a better health service with lower spending. The conclusion is inescapable – the post-war govt monopoly model has failed.

          • libertarian
            Posted May 3, 2016 at 10:56 am | Permalink

            Jerry

            There is NO market forces in the NHS, half privatisation, govt internal markets yes. Free markets no. I actually dont have a problem with tax payer funded health care, I have a problem with government run health provision.

            The wholly private GP system works very well for the most part. Hospitals should be run on the same basis

    • Bob
      Posted May 1, 2016 at 10:35 am | Permalink

      @Richard1
      If there were a private GP network, the usual suspects would be complaining about inequality, because it would only be available to people who could afford to pay for it.
      The inevitable extension would be that the NHS would be required to provide access to these private GPs, and voilà the GP service would be effectively privatised, and the NHS would be on the way to becoming a nationalised health insurance scheme rather than a healthcare provider.

      Under such a scheme I expect that IVF, cosmetic surgery and many self inflicted conditions would not be covered without payment of enhanced premiums or excess contributions from claimants. I could also envisage that the cost of attending road accidents would be recovered from motor insurance companies, thereby increasing the cost of motor insurance.

      • libertarian
        Posted May 1, 2016 at 3:15 pm | Permalink

        Bob

        The UK GP service is and always has been private. All GP surgeries and GP’s are private companies/partnerships/self employed. They get paid tax payers money to treat patients.

      • Jerry
        Posted May 1, 2016 at 4:28 pm | Permalink

        @Bob; “If there were a private GP network,”

        There is, it’s called private medical insurance…

        …oh hang-on, those companies do not do the 24/7 A&E and GP services, just the easy and profitable stuff! Perhaps they should be made by law to offer a full service to those who chose to buy such a product – NHS problem sorted, or would these commercial companies just divest themselves of their UK operations?

        • Edward2
          Posted May 1, 2016 at 5:48 pm | Permalink

          If you go to private hospitals or clinics or private GPs near me you can pay money and be seen quickly
          Whatever your problem.

          • Jerry
            Posted May 2, 2016 at 8:20 am | Permalink

            @Edward2; Does your private hospital offer a GP Home visits service (out of hours or otherwise), does it offer an A&E service – I suspect not…

          • Edward2
            Posted May 2, 2016 at 1:58 pm | Permalink

            Getting an out of hours home service visit on the NHS is a rare accomplishment.
            Virtually impossible where I live
            True that proper A and E is an NHS excellence
            But the vast majority of patients in A and E waiting rooms are there with minor illnesses and injuries.

          • Jerry
            Posted May 2, 2016 at 8:04 pm | Permalink

            Edward2; “Getting an out of hours home service visit on the NHS is a rare accomplishment.”

            It is now and has been for the last 20 years at least [1], but it wasn’t so 40 years ago – so what changed?

            [1] thus we can ignore the protests of people like @Hope who blame recent mass-migration

        • libertarian
          Posted May 1, 2016 at 7:54 pm | Permalink

          Jerry

          Wrong again, do join us in the 21st century.

          There are now many private A&E services , ALL GP’s have always been private and where I live we have leading neurosurgery ,Cadiology, Gynaecology surgery hospitals and a dedicated oncology hospital. All totally private and offering leading edge specialist and difficult surgery. They offer tertiary and intensive care.

          The cardiac team at this PRIVATE hospital recently won the coveted Laing Buisson Nursing Practice Award.

          The private hospitals are state of the art and are NOT owned by health insurance companies but by the consultants, Doctors and staff. The do accept payment from health insurance but they also offer pay as you go services.

          Jerry its no longer 1948 mate

          • Jerry
            Posted May 2, 2016 at 8:45 am | Permalink

            @libertarian; “There are now many private A&E services”

            So what hospital will those having taken out such private health care insurance be taken to after they fall ill and have become unresponsive, I bet they’ll be taken to an NHS A&E hospital – at least in the first instance and until responsive and/or next of kin are present. Or are you really suggesting that the ambulance crew will be looking in peoples pockets to see if the patient has a private health care insurance with A&E cover and which private hospital they should be taken to?!

            Once again @libertarian you try and fudge the issue by comparing apples and pears.

            “Jerry its no longer 1948 mate”

            Strange you say that because if it were the NHS would still be properly funded and would not have become the political football it has since 1951 (when Gaitskell imposed prescription charges on dental care and spectacles due to the cost of the Korean war).

          • libertarian
            Posted May 2, 2016 at 6:02 pm | Permalink

            Jerry

            I suggest you do some research chap. You are talking drivel. If you want a private A&E then you call the private ambulance service that goes with it. If you are going to try to argue something I suggest you find out how it works first

            No fudge here you made a statement that is factually and totally incorrect.

            You said private hospitals dont undertake difficult work. You are WRONG and thats what I pointed out not apples and pears fact v lazy opinion of yours

            Its also a fact that there were more hospitals in the UK PRIOR to 1948 and the NHS than theres ever been since….. Oh !

        • Lifelogic
          Posted May 2, 2016 at 4:37 am | Permalink

          The reason there are not many alternative to the NHS in some areas is entirely the fault of the NHS system. It you tax people & then provide a virtual monopoly “free” at the point of use service then others, who do have to charge, will find obviously find it very hard to compete. They get pushed out by the government system you cannot blame them for it.

          Without the NHS there would be plenty of GP and health options, just are there are in veterinary services, and you could see them straight away without delay.

          • Jerry
            Posted May 2, 2016 at 9:00 am | Permalink

            @LL; Fine, so that’s the well healed and those with at least an average incomes without pre-existing conditions taken care of in your (and @libertarian’s) utopia of privatised health care, but what about the vast majority of people, even a 50% cut in their income tax bills will not provide the funds to pay for private health care insurance, and indeed many people do not even pay income tax – 50% off zero is a zero gain…

            “Without the NHS there would be plenty of GP and health options, just are there are in veterinary services, and you could see them straight away without delay.”

            The same problems would be faced by the veterinary services if there were as many animals wanting to be treated, and needing to be treated, as there are humans each day using the NHS!

    • Anonymous
      Posted May 1, 2016 at 11:15 am | Permalink

      Will that include a reduction in our tax, Richard 1 ?

      • Anonymous
        Posted May 1, 2016 at 2:55 pm | Permalink

        I mean, Richard, you’ve got to be fair on people.

        If they are to pay for their own health insurance then where are they going to find the money for it if they are being taxed for a service they no longer recieve ?

        • Richard1
          Posted May 1, 2016 at 6:14 pm | Permalink

          I don’t think it will fly politically to give a tax credit for private healthcare. But I have no doubt people would be happy to pay £25 to see a doctor at their convenience. People who can’t afford it could get refunded. In France this system means better healthcare, no waiting and lower cost of healthcare to the economy.

        • Edward2
          Posted May 1, 2016 at 7:56 pm | Permalink

          Bit like education services when you decide to send your children to a fee paying private school?

          • Jerry
            Posted May 2, 2016 at 9:10 am | Permalink

            @Edward2 et al; It is like any service that one chooses not to use, or would prefer not to contribute towards, for example (not that I agree with their ideals but) if those not wishing to use the NHS or state education should get a tax refund should members of CND not also receive a tax refund for the amount they would otherwise contribute to the MOD budget – if not why not?.

          • Edward2
            Posted May 2, 2016 at 2:02 pm | Permalink

            It’s a strange analogy
            I don’t mind paying twice for private health and schooling and it releases a little capacity to the State systems.
            It would be fair to allow those who do so a tax break but I don’t think it will happen any time soon.

          • Bob
            Posted May 2, 2016 at 3:15 pm | Permalink

            @Jerry

            “should members of CND not also receive a tax refund for the amount they would otherwise contribute to the MOD budget – if not why not?”

            If they could prove they had paid for alternative nuclear deterrence the they would be entitled to a tax break on the amount paid.

          • Jerry
            Posted May 2, 2016 at 8:22 pm | Permalink

            @Bob; Rubbish, all they would need to prove is that they do not need or use such a deterrent, in the same way as an adult with or without children would just need to prove that they have no need to fund the Dept. of Education.

            CND, in the 1980s actually took this principle to the High Court for a ruling (some of their members were withholding a proportion of their income tax at the time, If I recall correctly), the court ruled that due taxes have to be paid in full, regardless of the tax payers needs for the services paid for.

          • Bob
            Posted May 3, 2016 at 10:18 pm | Permalink

            @Jerry
            Don’t get too excited, I was just suggesting how things could be if you decided to opt out of state provision, following on from your comment.

            Just replace the word “would be entitled” with “could be…”

  11. Nigel
    Posted May 1, 2016 at 8:16 am | Permalink

    I make two points:

    1) I saw a report saying that during the recent Junior Doctors’ strike, A+E departments were unusually empty. This suggests that many people use A+E as a substitute for seeing a GP. When it can take a couple of weeks to get an appointment to see your GP, this is not surprising, but it needs to be addressed.

    2) My local pharmacist has a petition running against the impending closure of some local pharmacies by the NHS service. I find this difficult to understand, as JR points out, the local pharmacist can often make a GP visit unnecessary.

    • Leslie Singleton
      Posted May 1, 2016 at 1:19 pm | Permalink

      Dear Nigel–Totally agree that a Pharmacy attached to the Surgery is a jolly good idea. I am lucky because that’s what I have but (best I understand) that is because I live in the country and Surgeries in towns do not or perhaps may not (never quite understood this) have Pharmacies attached. Not only is it infinitely more convenient (or in some cases even possible with depleted bus services) for especially the elderly to be able to pick up prescriptions at the Surgery but I for one very often present myself to the Pharmacist, who is invariably willing to give immediate advice, before trying to see a Doctor. It is true that often the Pharmacist will just say, You need to see a Doctor, but that is no hardship if the Pharmacy is at the Surgery and even if the Pharmacist does say, See a Doctor, he or she can be of help deciding whether it is an “Emergency” or not when seeking to make an appointment with the Doctors’ Reception. And often the Pharmacist can put your mind at rest with just some OTC remedy. I vote for bigger Surgeries with (as mine) half a dozen Doctors, doing stuff like Minor Ops (so no need to go to the Hospital), plus a fully stocked Pharmacy.

      • fedupsoutherner
        Posted May 1, 2016 at 3:08 pm | Permalink

        Leslie, we have the same thing plus 5 beds in a ward for people who don’t have a serious condition, physiotherapy, X-ray facilities, podiatry, and nurses. Nothing to complain about. We only have 3 main doctors and a couple of locums. To be fair, the only thing that could be wrong is that we often cannot get to see our own doctor or the doctor of our choice but can normally see someone. It would see our doctors only work 3 full days at the surgery each and other times do private work elsewhere.

    • a-tracy
      Posted May 2, 2016 at 5:09 pm | Permalink

      Nigel, local GP practices were also quiet those two days of the strike but boy the service was under strain on the Friday before a close down bank holiday weekend and I’d guess A&E had similar problems as people held on, some dangerously so.

      Pharmacies attached to GP practices in my experience give a poor and often rude service, ignoring people, long queues, giving generic drugs rather than that specified by the GP just some examples. I always take my business elsewhere, the problem is too many people just put up with the poor service and this closes down better more patient responsive pharmacies a distance away! Then we all lose out.

  12. Lifelogic
    Posted May 1, 2016 at 8:24 am | Permalink

    What a dire choice for London next week. The Corbyn proposer, Islamic, lefty lawyer and ex-chairman of the civil liberties pressure group Liberty and a rich boy deluded eco-nut. Is this really the best the main parties can come up with?

    It seems certain to go to Labour, what a foolish choice Cameron made with his rich boy lefty eco-nut. Cameron ability to choose the right people is dire. He fires people like Owen Patterson and employs just dire dross or token women, other tokens or “tv celebs”.

    • Lifelogic
      Posted May 1, 2016 at 8:36 am | Permalink

      Perhaps his most damaging choice was to have Osborne as chancellor when he has not got a clue.

      But Lord Patton, C Huhne, A Soubry, E Davey, D Laws, A Rudd, Ken Clark, Greg Clark, M Fallon, Hammond, Goldsmith, Tony Hall, Baron Hall of Birkenhead, Baroness Warsi and almost all as dire.

    • fedupsoutherner
      Posted May 1, 2016 at 3:10 pm | Permalink

      Lifelogic, it’s a bit like our choice of major parties also. None of the 3 main parties are really what we would expect. The Conservative party has lost the plot and looks more like a coalition of Green/Libdim/Labour everyday.

      • Lifelogic
        Posted May 1, 2016 at 6:15 pm | Permalink

        Indeed Cameron’s “Tories” are nearly all fake Green, Libdem/Labour light, fake PC, BBC think, anti-democratic, open door migration, tax borrow and tip down the drain, EUphiles. Plus they inflict on us the total economic incompetence of wage controls, IHT ratter, pension mugger, landlord & tenant thief, tax increasing and tax complexity increasing Osborne.

  13. Bert Young
    Posted May 1, 2016 at 9:37 am | Permalink

    I am extremely fortunate where I live ( South Oxfordshire ) because my nearby medical practice is superb – staffed and run by dedicated effective professionals who make appointments on the same day if requested . Recently the local planning authority indicated a building expansion programme involving something like another 2000 houses , naturally everyone was concerned what the effect would be on the medical practice and the local school . When questioned the medical practice indicated they would hire another doctor , however the education authority said the local school was adequate ( class sizes are already in excess of 35 pupils )!, nothing was indicated at all on the local traffic congestion issues .

    The strain that is being imposed on communities through increasing population numbers are exposing just how fragile our support and communication facilities are ; the result is increasing frustration with those who allow these sort of things to happen . Old age numbers are one thing but , we can and should prevent the problems associated with unwanted migrants .

    Central Government is at fault ; they do little to control our borders , they allow others to dictate what we can and cannot do , they allocate resources to the wrong priorities , they do not listen to the electorate , they put their own personal ambitions above those of the public they are supposed to represent – the list is endless ; the way I read it we should scrap the lot and go back to some grass roots individuals who can and will put the needs of this country first .

  14. miami.mode
    Posted May 1, 2016 at 9:55 am | Permalink

    To some patients and users, while ever the NHS ostensibly costs them nothing, that’s exactly the value they will put on it.

    I’ve no idea how other European countries run their health services, but I do not read of them being continually in crisis and in fact whenever I’ve come across people who have had to use their services I’ve not heard any complaints except that sometimes a payment is involved if an EHIC card is insufficient.

    Surely we should study how other countries run their health services, and if we find that successful services involve part government funding and part payment rather than “free at the point of delivery”, then that is the model we should adopt.

  15. David Ashton
    Posted May 1, 2016 at 10:07 am | Permalink

    Anything which is free is abused. I believe we should pay a fee of £25 to visit our GP, and £40 to visit A&E. We should also have to pay for our meals when staying in hospital. The former would reduce demand, as there are many time wasters (I know because unfortunately my mother was one of the worst offenders). The cash from the food charge should be ring fenced to improve on the current dreadful fayre served up at hospitals. It may appear harsh but I genuinely believe this is the only way to bring sanity to our health services.

  16. William Long
    Posted May 1, 2016 at 10:49 am | Permalink

    I find it very interesting that people are prepared to pay through the nose for medical help for their animals but for some reason think there is something sinful about paying for their own healthcare. Our vet’s waiting areas is always at least as full as that at the GP’s surgery and they do not suffer much from people failing to turn up. Likewise, at the dentist where many go privately one actually gets a text message or telephone call the day before asking one to confirm one will attend. Why cannot the dental situation be replicated in the medical NHS whereby those that can afford to pay, and those that cannot get a nearly free service?

    • Lifelogic
      Posted May 1, 2016 at 6:16 pm | Permalink

      Indeed have you ever had much problem finding a vet to give you an appointment?

    • a-tracy
      Posted May 2, 2016 at 5:13 pm | Permalink

      William, I don’t pay compulsory national insurance for pets, if I did I’d expect pets to be covered for the insurance that’s paid. If people don’t pay pet insurance they have to pay vet fees from their savings or don’t keep pets you have a choice.

  17. Bryan Harris
    Posted May 1, 2016 at 10:52 am | Permalink

    John – Always good to see funds targetted at specific needs.

    You mentioned that GP’s would be encouraged to find ways to improvise. This is a subject I’ve commented on to my own MP and his response was encouraging.

    A lot more could be done to treat people quickly and directly at GP surgeries, rather than having multiple GP visits and arranging hospital vists which are rarely convenient.
    The GP should surround himself with skilled practitioners, like Osteopaths, herbalists, Shiatsu specialists, homeopathy and accupuncturists….ETC.
    The GP would direct people to a specialist working in the same building – it would be his diagnosis of treatment, and he would keep an eye on progress.

    All too often people are given drugs rather than an exact physical treatment, and we all know of the huge expense that drugs cost the NHS – A different apprach is required here to get to the root cause of physical problems and use local resources to treat, rather than clogging up hospitals with outpatients needing blood tests and so on.

    Let’s put some emphasis on building up GP practices and making treatment as local and varied/specific as patients require – let’s break the huge dependency on repeat prescriptions…. let’s do more to cure people.

    .

    • Lifelogic
      Posted May 1, 2016 at 6:18 pm | Permalink

      Indeed in the short time they give you all they can usually do is give you some tablets and tell you to go away and try them.

    • hy
      Posted May 1, 2016 at 8:44 pm | Permalink

      “The GP should surround himself with skilled practitioners, like Osteopaths, herbalists, Shiatsu specialists, homeopathy and accupuncturists….ETC.”

      GPs should have nothing to do with most of the quacks on this list

      • Lifelogic
        Posted May 2, 2016 at 9:09 am | Permalink

        Indeed and it is an outrage that tax payers cash & the NHS fund these, as is encouraged by Prince Charles and several MPs.

      • Bryan Harris
        Posted May 2, 2016 at 11:55 am | Permalink

        hy – how dare you address trained professionals in that way

        Open your eyes and don’t be so blinded by what the establishment tells you – there are other options etc ed

  18. Dennis
    Posted May 1, 2016 at 11:56 am | Permalink

    “Some comes from a rising population”

    So where are the policies to reduce UK population to 10-15 million? Oh right, no thought for the future – who cares?

    • Anonymous
      Posted May 1, 2016 at 5:32 pm | Permalink

      Set to increase hugely – 127 million people to join the EU soon … Turkey, Macedonia, Bosnia, Ukraine…

      • fedupsoutherner
        Posted May 1, 2016 at 9:53 pm | Permalink

        I am always amazed at the number of people who don’t realise that these countries are joining the EU soon. John, Vote Leave needs to make sure they are aware of these facts.

  19. CHRISTOPHER HOUSTON
    Posted May 1, 2016 at 12:20 pm | Permalink

    “Doctors of the World” recently indicated there are health fears (untreated TB for example ) because 40% of refugees in the UK are being refused registration by GPs because they failed to produce ID, address, and 13% because of their “immigration status” adding that for what they call “primary healthcare” it is not necessary for such IDs and justifications.

    I’m not sure what is meant by “Primary Healthcare”..is it the provision of a sticking plaster on a slight abrasion with a nurse saying in 42 different languages “there, there, it’ll be all ok” or, free drugs, hospitalisation and to take out that nagging heart-valve.

    Whatever the case, the government continues to allow people into our country with contagious diseases; leaves it to doctors working for charities to seek out those carriers of disease and to give them “Primary Healthcare”

    Therefore the projected future funding of GPs cannot be adequate based on those 40% of refugees who hopefully will in future be treated.

    Of interest is how Doctors of the World know that all the wandering unregistered refugees without ID, admittable address, and basic honesty have somehow found them to produce the statistics. Do wandering refugees have the names and addresses of “Doctors of the World ” tattooed somewhere on their anatomy in 42 different languages and a map in the same number of languages? Probably not.

    The government is in a mess.

    *One wonders why there appear to be so many doctors wandering about the world quite willing to work for a chip butty, a mug of tea, a joss stick with a sleeping bag for a bedroom yet when they stay at home all they can do is jig up and down on a picket line chanting mindlessly about wanting and needing more pay.
    We should all renounce our British and European citizenship, contract TB or some other contagious disease and join hands with the junior doctors on the picket lines. They may just work.

  20. Ken Moore
    Posted May 1, 2016 at 12:55 pm | Permalink

    When I was a child I had one GP who served a very large area with just his wife assisting as the practice nurse from his own adapted private home. He always seemed to have more time to chat and didn’t just stare into his computer screen throughout the consultation. He knew the area and the local people well.
    It was very much better having one doctor who I knew and trusted rather than taking pot luck and hoping that the doctor was one of those I knew and trusted….
    He was available 24 hrs a day 7 days a week despite being paid a good deal less than today’s doctors. He would routinely visit sick patients in their own homes without complaint – he recognised he had a vocation not a job.
    It’s not all about money……..it’s about too many people on a crowded island and public service that has lost sight of it’s primary purpose – to serve the public… not itself.

    • Qubus
      Posted May 1, 2016 at 5:41 pm | Permalink

      Quite right. When I was a lad, we had a GP who was totally reliable. As I remember, he made house calls every day. He really knew his patients too; when he was driving past in the street, he would stop his car and ask me how I was going on at school. Iniltially, he was a one-man practice, who also mixed his own prescriptions. OK, medicine has moved on since then, but not that much.

  21. Denis Cooper
    Posted May 1, 2016 at 1:04 pm | Permalink

    From the Sunday Telegraph:

    “Doctors in training”

    “SIR – Any form of industrial action demeans the medical profession. However, the treatment of junior doctors over many years has been deplorable. They are trainees, and the service should not depend on them. It ought not to matter if they withdraw emergency cover – but it does.

    The worst influence on the quality of training has been the European Working Time Directive, which forced hospitals to impose shift patterns such that junior doctors spend too little time with their trainers. It also disrupted continuity of care for patients.

    I have no sympathy for strikers, but much with the plight of this generation of young doctors.

    David Nunn FRCS
    Port Isaac, Cornwall”

    That’s the same Working Time Directive which somehow got overlooked when our Prime Minister was compiling his list of “demands” for EU “reform”, along with some other items the pursuit of which might have weakened Labour party support for his campaign to keep us locked in the EU:

    http://www.telegraph.co.uk/news/newstopics/eureferendum/12054269/How-many-EU-demands-has-David-Cameron-dropped-since-he-became-Tory-leader.html

    How far back should I go?

    Back to the Major government’s opposition to the EU proposal in 1993 – opposition which was effectively neutralised by the ECJ deciding that it was a matter for Qualified Majority Voting and the UK had no veto?

    http://www.eurofound.europa.eu/observatories/eurwork/articles/working-conditions/government-acts-on-eu-working-time-directive

    Or just to the continued opposition 16 years later, which was written into the manifesto at the time of the 2009 elections for the EU parliament?

    Or even just to January 2012?

    Column 746 here:

    http://www.publications.parliament.uk/pa/cm201212/cmhansrd/cm120118/debtext/120118-0001.htm

    “The Health and Business Secretaries are committed to revising the directive at EU level to give the NHS the flexibility it needs to deliver the best and safest service to patients. We will work urgently to bring that about.”

  22. turbo terrier
    Posted May 1, 2016 at 1:20 pm | Permalink

    GP practices are encouraged to experiment with new ways of assessing patient need and booking the right appointment with the right person promptly.

    If GP practices operated like an A&E unit with a Triage nurse in place to vet every patient before being passed onto the doctor checking blood pressure, weight etc eventually you arrive at the obvious. Patients have to start looking after themselves and those who are obese, smokers, drug addicts with these pre consultation checks can be told over the last x number of months you have done nothing to help yourself, please close the door on the way out. On the rare occasions I visit my local surgery it always seem to the same old people sitting in the wasting room.

  23. Ian Wragg
    Posted May 1, 2016 at 1:46 pm | Permalink

    Why are GP’s threatened with legal action if they don’t register illegals or asylum seekers.
    General Practice is a business funded by the taxpayers. The same rules should be applied to them as any other business. Why should we fund their pension scheme.
    They ought to make their minds up if they are NHS employees or self employed.
    A small fee should be payable each appointment which would reduce demand

    • Qubus
      Posted May 1, 2016 at 2:37 pm | Permalink

      The GP service in the UK leaves a great deal to be desired.

      If I want an appointment with my GP in two weeks’ time, I can simply go online and book one. No problem. However, if I need an appointment within the next two days, I need to go and queue outside the surgery at 7.45am along with all the other supplicants. It simply isn’t good enough.

      I think that we have to realise that health spending is a bottomless pit; in addition, anything that is free at the point of demand will be abused; it is time to bring in a small fee for visiting one’s GP. We pay through the nose for dental care, and the worst that can happen there is that one’s teeth drop out. What is the objection to a fee for visiting a GP? There could be a safety net for the patients on benefits etc. and the dental surgeries seem to cope with the administration perfectly well.

      Incidentally, I thought that the behaviour of Mr Cameron regarding the pronunciation of N. Farage’s name during PMQs on Wednesday was totally pathetic. Not the sort of behaviour I expect from a Prime Minister, rather that of a ten-year-old in the school playground.

      • Bob
        Posted May 1, 2016 at 3:04 pm | Permalink

        Nigel Farage has invited Mr Cameron to a public debate about the Brexit referendum.

        The PM will not accept the invitation because he’s too busy making up silly scare stories to frighten the voters who for years have been subjected to conditioning through misinformation and so are now unable to understand the real issues because their minds have been focused on cell phone roaming charges,

        The last thing Mr Cameron wants is for Nigel to expose him on TV the way he did to Nick Clegg.

        • fedupsoutherner
          Posted May 1, 2016 at 9:51 pm | Permalink

          Bob, Well, that’s exactly what we do need. Cameron needs a head to head with Farage so that the people vote out.

    • Jerry
      Posted May 2, 2016 at 9:47 am | Permalink

      Ian Wragg; “Why are GP’s threatened with legal action if they don’t register illegals or asylum seekers.”

      Because such people could pose a real public health problem perhaps?

      @Qubus; Well yes if treatment is free at the point of Want, rather than Need

      There is the same problem with all the similar services, people abuse the 999 services in the same way as they abuse NHS GPs, all this is not helped by politically correct language/terminology now being used. Calling everything an emergency or disaster – thus the Fire Brigade gets called out because a cat has become stuck between two walls or in a drain – well it is an ’emergency’ to the owner of the cat, someone calls for an ambulance or goes to A&E because they have cut their finger but are just need basic first aid – well it’s an emergency to the owner of the finger.. someone calls 999 and ask the Police to attend the local Chinese takeaway because the caller has been given a No. 4 when they are sure they ordered a No. 14, the former being that much more money with accusations of criminality thus flowing – well it;’s an emergency to them as they want their dinner…

  24. Denis Cooper
    Posted May 1, 2016 at 2:13 pm | Permalink

    Off-topic, I see that Ed Vaizey is threatening us with the reimposition of mobile phone roaming charges if we dare to defy his boss and vote to leave the EU.

    I’m not sure exactly how that would work, whether it would be Mr Vaizey ordering operators based in the UK that they must charge their British customers through the nose if they use their phones in France, or it would be the French government issuing such as order to the operators in France because they really don’t like us and would much prefer that we didn’t visit France and spend our money there.

    I also note that Mr Vaizey is giving his boss a lot of the credit for getting the EU to pass EU laws on this, when according to Richard North it’s been less pressure from Cameron within the EU and more pressure from international bodies outside the EU, and rather than being an EU initiative the EU has actually been dragging its feet on this:

    http://www.eureferendum.com/blogview.aspx?blogno=86008

    Of course this false government propaganda would have less traction in the referendum campaign if it was known that the preferred Leave option would be to stay in the EEA after we had left the EU, as least for an interim period.

  25. Denis Cooper
    Posted May 1, 2016 at 2:21 pm | Permalink

    Incidentally we went to see the new “Jungle Book”, and during the trailers before the film my attention wandered and I briefly thought one was for “Brexit: The Movie”, but it turned out to be for “X-men: The Apocalypse”.

    • Bob
      Posted May 1, 2016 at 3:07 pm | Permalink

      @Denis Cooper
      Are the BBC going to broadcast the Brexit movie or would it be against the”rules”?

      • Denis Cooper
        Posted May 1, 2016 at 6:27 pm | Permalink

        I shouldn’t think so!

        At least, not until they do a retrospective of the referendum.

  26. matthu
    Posted May 1, 2016 at 2:33 pm | Permalink

    These walk-in centres are a complete waste of time.

    When I was recently advised by my GP’s receptionist that I might prefer to visit a medical drop-in centre, I duly went in to Reading and was told that the wait would be 4 hours.

    When I inquired what would happen if I needed to be served with a prescription, I was told that I would need to be referred back to my GP!

    • Bob
      Posted May 1, 2016 at 3:13 pm | Permalink

      @Matthu
      The drop in centres have doctors who can prescribe medication.

      Sounds like you were misinformed, which doesn’t surprise me as some of the admin staff seem barely literate (their level of intellect can often be ascertained on an inverse proportion to the number of tattoos and facial piercings).

      • Lifelogic
        Posted May 1, 2016 at 6:23 pm | Permalink

        This can indeed a good rule of thumb, not that one would want to be too “judgemental” or “discriminating” of course.

  27. sm
    Posted May 1, 2016 at 4:22 pm | Permalink

    Regarding the NHS and all its highways and byways, I will repeat myself:

    We must consider what we would put in its place AND how it would be funded if the current clapped-out model did not exist.

    As it is, governments of all shades keep adding go-faster stripes, new seat covers and a different kind of fuel in the hope that their 1948 Morris Minor will work well enough to be one of the front-runners at a Formula 1 Grand Prix race.

    I’m neither a doctor nor a racing driver, but I know that the formula doesn’t work.

  28. Edward2
    Posted May 1, 2016 at 5:59 pm | Permalink

    We should allow employers to provide private health insurance cover for staff.
    I would encourage this process by making it tax deductable for both employer and employee.
    This would help reduce pressure on the overstreched NHS.

    • a-tracy
      Posted May 2, 2016 at 8:18 pm | Permalink

      As well as paying 13.8% employers NI, 3% NEST, full SSP and SSP Holiday pay?
      Then when you close down all of these legitimate SMEs you’ll be left with all self employment with no terms whatsoever!

  29. Anonymous
    Posted May 1, 2016 at 6:57 pm | Permalink

    Off topic please.

    Nicola Sturgeon keeps banging on about Scotland thinks this and Scotland thinks that.

    The Scots decided to be British in their referendum.

    • fedupsoutherner
      Posted May 1, 2016 at 9:46 pm | Permalink

      Anonymous, Sturgeon thinks and says that she speaks for Scotland. I can assure her, she doesn’t. There are many that don’t like what they stand for and want out of the EU. Who does she think she is? She has forgotten that more people wanted to stay British than just belong to Scotland. Bout time she realised this.

  30. Northern mountaineer
    Posted May 1, 2016 at 8:19 pm | Permalink

    One only has to walk around any of my local market towns in the Lake District to see why the NHS is blocked by excess numbers of sick people. For sure there are many fit and healthy who take their health responsibly.
    BUT!!
    So many fat, unhealthy, old way before their time, shuffling along with sticks, twenty years younger than many of us, hopelessly overfed on rubbish food, no exercise, no self-pride, the only upside for the NHS is that the life expectancy figures will very soon take a nose-dive, because many of the younger generations are equally unhealthy and do not exercise or eat real food either.

  31. Lindsay McDougall
    Posted May 3, 2016 at 1:24 am | Permalink

    How can keeping people alive beyond their natural term be described as a ‘good development’? And if the medical profession are determined to do it, why is HM government obliged to finance it?

    Why are so many elderly people in hospital when it is widely known that a suitable combination of home visits comes at a quarter of the price of hospital stays? There is no need for central government to finance home vists or meddle with them. Just let local councils put up council tax.

    Two very good mottos:
    (1) For central government: Mind you own business
    (2) And for the NHS: Thou shalt not kill, but shouldst not strive, officiously to keep alive.

  32. Iain Gill
    Posted May 3, 2016 at 9:34 pm | Permalink

    John,

    I think you made a massive mistake with this post. You have swallowed the acceptance of the NHS of the political and journalistic bubble in this country. Real people think its rubbish, the web forums I read of normal people are completely disgusted with all aspects of the NHS from top to bottom and want to see it replaced with a system from the best of the rest of the world. As for GP’s why cannot we have the system used in New Zealand, Belgium, or Italy? in all those countries I have been able to see a GP immediately for a very modest fee. Indeed in our big cities I can see a private GP immediately for about 30 quid.

    The people they should be looking after are the people who never go to the docs who are walking around with high blood pressure and who could have their life expectancy significantly increased with simple cheap treatment. etc

  33. Iain gill
    Posted May 4, 2016 at 5:53 am | Permalink

    Indeed we should allow private gp’s to write NHS proscriptions and refer to NHS consultants just like private dentists can, and free up competition.

  • About John Redwood


    John Redwood won a free place at Kent College, Canterbury, and graduated from Magdalen College Oxford. He is a Distinguished fellow of All Souls, Oxford. A businessman by background, he has set up an investment management business, was both executive and non executive chairman of a quoted industrial PLC, and chaired a manufacturing company with factories in Birmingham, Chicago, India and China. He is the MP for Wokingham, first elected in 1987.

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