poor internal management: agree, most clinicians started work in the nhs to help patients, they have evolved to do management, and is almost the thing that happens when you been around a long time. so often not due to good planning.
poor patient communication? not sure what you mean here. most of the complaints I get is because patients do not get what they think they need eg MRI, Xray ect.
Indeed, but what about the complaints you don’t get, but which still exist? Throughout nearly all parts of the NHS, the system of dealing with appointments is a complete and wasteful shambles. This is particularly acute with GP practices, the area in which doctors could have the highest level of control. Appointments are often not communicated properly, it is either virtually impossible to get a timely appointment without pretending everything is an emergency. Receptionists or booking staff are generally obstructive, frequently rude and nearly always unprofessional. Large numbers of appointments are missed (as frequently as not by the NHS as the patient, but usually misrecorded), some - for expensive operations - are never communicated to the patient at all, or directed to inappropriate staff.
Another dangerous area of poor communication is that test and imaging results and consultants’ reports more often than not disappear into a black hole and the doctors who are supposed to review them in a timely manner frequently never even see them without patient intervention. Some staff have informed me that XXX person, hospital or entity NEVER reads their reports, so they provide them directly to patients. Certainly this has been our family’s experience over long periods in different regions, with conditions as severe as cancer, brain tumours, child epilepsy, anaphylaxis, spinal cord operations, heart disease and so on.
listening is required by both parties in a conversation.
It certainly is. And the very clear message is that doctors point blank refuse to contemplate the reality that the NHS system is not the optimal way to deliver healthcare. The conversation in the UK is constrained by the absurd pre-condition that the NHS is the only acceptable system for delivering healthcare, and that every other developed country in the world is operating a dangerous and far-right wing system that endangers patients and staff. That needs to be dropped. Doctors are collectively at fault in this through electing representatives who hold such views. You’re all intelligent people, so why does the conversation from that side need to be so ideological, dismissive of patient experience and frankly blinkered about the outside world?
Patients should get appropriate care including MRI ect. Appropriate is the key. We do far to much imaging, and this causes waiting lists, plus increased costs.
And for other patients, far too little imaging is done. On the whole, imaging equipment, and much other stuff, could be used far more efficiently. There is no sound reason why expensive equipment like MRI scanners are not used 24/7 instead of perhaps 10/6. From the patient’s perspective, actually the NHS does far too little imaging, testing, and analysis which is why GP demand is so high, and is a large component of why people are driven to private healthcare.
We should be running the NHS by evidence based practice.
Are we doing that? Or are we operating on probability-based practice?
I do acknowledge that other countries image everything. Is this due to worries about litigation and protective medicine or is it evidence based?
Indeed. But do we contend that NHS doctors are better than foreign (or, for that matter, private UK) doctors? I suspect that would not be a tenable line of argument. Litigation is a massive cost, and one that ideally ought not to exist at a significant level, but it only arises where the approach taken was probably wrong. Given that, then it leads to the conclusion that more imaging (and I think testing?) would be preferable. Personally, I struggle to see how one could operate an evidence-based method without collecting the full portfolio of evidence.
Bad staff behaviour: That must be me on a Saturday night out? not really sure what your saying again. I would hope that you would not think all staff working for the NHS behave badly. yes it happens, long shifts, no lunch, no down time or sometimes just a bad day. What I get feed up with is patients behaving badly. The entitlement for things that have no benefit to their management.
Low productivity: lets look at why there are fewer GP's, too stressful a job, lack of time, high demand, high risk of missing something.
Let us also look at the other side of that coin. Three out of four of those factors are also to a very significant degree consequences of inefficiency.
I am not sure if I could be significantly more productive in my roles. I rarely have spaces in my clinics, I keep imaging to patients that clinically require them. I could reduce a few onward referral to secondary care when not needed, but all that happens is the patient complains or makes appointment with another practitioner and the another practitioner till we all get worn down and refer on. Then they see the consultant who says nothing to do here and the patient starts the cycle once again.
That is a major source of waste in itself. The large majority of patients acting in that way are actually ill, or dying.
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I guess you have not used the NHS for sometime, or been luck to get a gp appointment or not wait in A+E, or wait for a bed, or investigation or even been able to leave hospital as there is no where for well patients to go.
I hope that’s not what you’d call an evidence-based guess, because sadly it is very wrong.
There is unlikely to be a consensuses on how to run , manage and provide health care. I believe free for all at point of access. but very sad that we as a whole have let the NHS get to this state.
Indeed, but by delegitising any rational discussion or analysis of a way forward, what else would anyone with a remotely scientific education expect? We are where the medical lobby insisted on being. We are not where patients or voters wanted to be. Blaming politicians or taxpayers is not an acceptable course.
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