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When will covid end ? Please be nice and respectful to others


crazyfool1
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8 minutes ago, Barry Fish said:

People aren't even getting these telephone appointments.  I think you have your head in the sand on the realities.  Its not like people aren't speaking out about it. 

Yeah you're right. It's fucked. As we've been saying. People can't even get telephone appointments in some areas*. But that doesn't improve if you cut the amount of people GPs can consult in a given day with by 30% by going back to face-to-face appointments.

Does the quality of care drop? Yes. But like you said: 

Quote

Its hand to mouth organisation.  Its not one designed to have any more capacity than it needs.  It means during peaks of pressure we cancel elective surgery and so on and move around resources and only take in priority patients and queue the rest in ambulances or at home.

"Moving around resources" includes moving to telephone appointments for GPs: you drop the standard of care to increase capacity of care. You acknowledge that's how the NHS should work, but when they do it in a way you don't like, or that affects you, you get angry about it.

(*this is fucked bit, as if you're going to do mostly telephone consults, you may as well centralise it and spread the load - but then that was happening for first line stuff with NHS Direct until we cut it)

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24 minutes ago, DeanoL said:

Okay, yeah you're going to need to explain that one. We can argue the merits of phone versus face-to-face appointments all day, but the point of phone appointments (and the resulting reduction in the quality of care) has always been there in part to make things more efficient, not less.

I struggle to even get a telephone appointment at the moment. We just get fobbed off and told to try the walk in centre or phone 111. 
 

Have you ever tried to sit in a walk in centre waiting area for hours with a sick 1 year old? 

Edited by BobWillis2
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57 minutes ago, mcshed said:

How exactly when phone appointments are more efficient than in person ones will reverting to in person GPs suddenly fix all this?

I get that you find an in person consultation more reassuring and prefer them particularly where your kids are concerned.  There is a debate to be had about the quality of service some practices are giving over the phone but the idea that more in person appointments would help fix the NHS workload is for the birds. 

 

54 minutes ago, DeanoL said:

Okay, yeah you're going to need to explain that one. We can argue the merits of phone versus face-to-face appointments all day, but the point of phone appointments (and the resulting reduction in the quality of care) has always been there in part to make things more efficient, not less.

 

53 minutes ago, Barry Fish said:

Of course it won't "fix" it no matter how you feel on the issue.  Not going to discuss the above - you are welcome to your view point - I have mine.

What IS happening right now is people are trying to get appointments at their GPs - failing to do so - and then turning up at A&E.  That IS happening.  

Whatever you think is really going on at GP practices the number of people turning up at A&E due to lack of GP access is a reality.  

 

50 minutes ago, st dan said:

In many situations, they are pretty useless though to be fair. I recently had an ear infection, had a telephone appointment with my GP who flat out refused to give me antibiotics and told me to take drops etc. The pain became unbearable a few days later so I was forced to go to the (very busy) walk in centre, where I was assessed properly (looked down ear etc) and I was given a course of antibiotics which cleared it up in 3 days. The nurse I saw at the walk in was pretty critical of the whole system at the minute, as that really is the job of a GP.

I've got a ridiculous story around this:

Back in July the girlfriend has what looks like an infected insect bite on her back. It was on the site of a previous bite that had scarred over, but had been checked by the doctors a couple of years back. So it wasn't just a normal bite then into infection. 

It got worse so she called and had to send photos. The photos were the best I could do, but shit and didn't represent what it looked like at all. 

The words infected bite were used, misrepresentative pics were sent so antibiotics were given and she was told to go and enjoy Latitude fest. 

It kept getting worse despite these antibiotics, so leaving latitude early after it burst, two more doc phone appointments and 2 a and e trips followed because of concerns of worsening infection.

Final place tells her it's an abscess, that if it'd burst inwardly she'd have been in trouble (it burst outwardly) and gave her very strong antibiotics as the originals weren't ever going to touch it. It was drained there and fixed within days  

If the doc had seen her, it would've been identified as an abscess, she'd have got the antibiotics she needed, less work for the NHS overall, less stress, less risk of sepsis of course. Apparently the final diagnosis came from touching it, not just looking at it. 

We try not to think how bad it could've gone and while we took the wrong decision to go to a  festival, it was cleared twice by doctors. Problem is now we don't trust them over the phone for stuff like this

Edited by efcfanwirral
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25 minutes ago, fraybentos1 said:

Dunno what ur GP is like but I phoned up for a phone appointment and was told I couldn’t get one for over 3 weeks. It can’t get less efficient than that. 

Err, yeah it can. 6 weeks? 12 weeks? Just because things are really bad doesn't mean they can't get worse.

But when people are saying the NHS is overwhelmed, this is all what they mean.

I'm impressed by the cognitive dissonance on here from people that are saying we definitely don't need any restrictions and it'll all be fine and the NHS will cope, then they complain when they can't get a doctor's appointment.

People saying the NHS just needs to prioritise and it'll be fine, then get confused when the NHS ceases to prioritise them or their kids.

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3 minutes ago, DeanoL said:

Err, yeah it can. 6 weeks? 12 weeks? Just because things are really bad doesn't mean they can't get worse.

But when people are saying the NHS is overwhelmed, this is all what they mean.

I'm impressed by the cognitive dissonance on here from people that are saying we definitely don't need any restrictions and it'll all be fine and the NHS will cope, then they complain when they can't get a doctor's appointment.

People saying the NHS just needs to prioritise and it'll be fine, then get confused when the NHS ceases to prioritise them or their kids.

Oh I'm consistent.  I don't want restrictions to be used as a way for the NHS to get waiting lists down. If it means a rougher winter, then we have a rough winter. But it's not a wartime emergency situation, and if there are issues with waiting time, the govt need to get their finger out and sort it out.

Edited by zahidf
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12 minutes ago, efcfanwirral said:

I've got a ridiculous story around this:

Back in July the girlfriend has what looks like an infected insect bite on her back. It was on the site of a previous bite that had scarred over, but had been checked by the doctors a couple of years back. So it wasn't just a normal bite then into infection. 

It got worse so she called and had to send photos. The photos were the best I could do, but shit and didn't represent what it looked like at all. 

The words infected bite were used, misrepresentative pics were sent so antibiotics were given and she was told to go and enjoy Latitude fest. 

It kept getting worse despite these antibiotics, so leaving latitude early after it burst, two more doc phone appointments and 2 a and e trips followed because of concerns of worsening infection.

Final place tells her it's an abscess, that if it'd burst inwardly she'd have been in trouble (it burst outwardly) and gave her very strong antibiotics as the originals weren't ever going to touch it. It was drained there and fixed within days  

If the doc had seen her, it would've been identified as an abscess, she'd have got the antibiotics she needed, less work for the NHS overall, less stress, less risk of sepsis of course. Apparently the final diagnosis came from touching it, not just looking at it. 

We try not to think how bad it could've gone and while we took the wrong decision to go to a  festival, it was cleared twice by doctors. Problem is now we don't trust them over the phone for stuff like this

That's horrible mate - glad it worked out okay. There are definitely cases where the telephone consult thing doesn't work and fails patients, leading them needing to use more NHS resource than they would have otherwise. This definitely happens, and it's important to say that's one of the consequences of reducing quality of care in this way.

But overall, it's more efficient, because the savings outweigh the costs. Which is horrible when the "cost" is you or someone close to you but it's what we've been doing this entire pandemic in order to allow the NHS to cope (and what many here were advocating).

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6 minutes ago, DeanoL said:

Err, yeah it can. 6 weeks? 12 weeks? Just because things are really bad doesn't mean they can't get worse.

But when people are saying the NHS is overwhelmed, this is all what they mean.

I'm impressed by the cognitive dissonance on here from people that are saying we definitely don't need any restrictions and it'll all be fine and the NHS will cope, then they complain when they can't get a doctor's appointment.

People saying the NHS just needs to prioritise and it'll be fine, then get confused when the NHS ceases to prioritise them or their kids.

Can you not see the knock on effect that GP’s playing hide and seek is causing? 
 

Doctors surgery tells x people to go to the walk in centre, walk in centre gets busy so people try A&E instead, A&E gets busy taking up precious time, recourses and beds, ambulances get stuck outside hospitals waiting for these resources and beds to come free, people at home are now waiting far too long for ambulances to arrive, their urgent problem gets far worse and their subsequent hospital stay increases as a result causing an even bigger bed shortage. 


EDIT: and as the story above shows, people are not getting the correct diagnoses over the phone and their problems worsen leading to potentially taking up hospital bed space unnecessarily. 


 

 

Edited by BobWillis2
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3 minutes ago, zahidf said:

Oh I'm consistent.  I don't want restrictions to be used as a way for the NHS to get waiting lists down. If it means a rougher winter, then we have a rough winter. But it's not a wartime emergency situation, and if there are issues with waiting time, the govt need to get their finger out and sort it out.

It's 9 years to train new GPs. So we're in for a fair few hard winters. There's no easy way to sort a resource problem like this.

Just now, BobWillis2 said:

Can you not see the knock on effect that GP’s playing hide and seek is causing? 
 

Doctors surgery tells x people to go to the walk in centre, walk in centre gets busy so people try A&E instead, A&E gets busy taking up precious time, recourses and beds, ambulances get stuck outside hospitals waiting for these resources and beds to come free, people at home are now waiting far too long for ambulances to arrive, their urgent problem gets far worse and their subsequent hospital stay increases as a result causing an even bigger bed shortage. 

GPs are not "playing hide a seek" - they're seeing as many people as they can. It's just there's more people and fewer GPs. Do you really thing GPs have just suddenly stopped giving a fuck and are enjoying some lazy days? 

Look at the problem the other way: some GPs always did this - they refer people to walk-in centres, they tell you to go to A&E and A&E sorts you out. But they can't now because hospitals are busy with all the extra COVID patients. The system falls over.

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33 minutes ago, DeanoL said:

While that didn't happen, what did happen was people who had heart attacks putting off or not going to A&E in the first place because of COVID. 50% fewer people went in with heart attack symptoms than normal during the first wave. https://www.escardio.org/The-ESC/Press-Office/Press-releases/worse-outcomes-observed-after-heart-attacks-during-pandemic-compared-to-previous

I don’t know what to say to someone who doesn’t bother getting their heart attack seen to out of dear of catching a pretty much bog standard respiratory virus.

 

Definition of a Darwin Award and a complete inability to assess risk. 

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26 minutes ago, DeanoL said:

Err, yeah it can. 6 weeks? 12 weeks? Just because things are really bad doesn't mean they can't get worse.

But when people are saying the NHS is overwhelmed, this is all what they mean.

I'm impressed by the cognitive dissonance on here from people that are saying we definitely don't need any restrictions and it'll all be fine and the NHS will cope, then they complain when they can't get a doctor's appointment.

People saying the NHS just needs to prioritise and it'll be fine, then get confused when the NHS ceases to prioritise them or their kids.

Might as well just not exist at that point is it was months to get a phone appointment.

every year we are told the nhs is about to collapse. Not accepting restrictions every winter and thankfully it seems the gov isn’t either 

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1 minute ago, fraybentos1 said:

Might as well just not exist at that point is it was months to get a phone appointment.

every year we are told the nhs is about to collapse.

What is "collapse"? Is waiting 3 weeks for an appointment not already "collapse" ?

It's not going to blink out of existence. Boris isn't going to come out and go "I've got to level with you, the NHS is massively over-subscribed so we're just going to stop it as of tomorrow".

The NHS won't collapse, it'll fall apart slowly. The quality of care will drop (hello telephone appointments instead of in-person ones). The time for appointments will increase (hello "I was told the earliest appointment is in three weeks time"). Waiting lists will go up. And all these will keep getting worse until, as you say, it may as well not exist.

The collapse of the NHS will be a whimper, not a bang.

Some people are living in a fantasy world where the reason they can't get an appointment is something that could be easily fixed if doctors just tried harder or the NHS just operated in a different way. 

And I agree, we can't be having restrictions on our lives just to protect the NHS from being overstretched. But you've got to understand, that means the NHS will be overstretched and what that means is it's possible you can't see a doctor when you want to

Honestly it's like Brexit all over again. "We want rid of freedom of movement" "Okay, done." "Wait, why can't I live in France 6 months a year any more".

"No lockdowns just to protect the NHS" "Okay, done" "Wait why can't I see a GP?"

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What's the basis on which it's currently only 50yo's and above that are getting boosters? Is there strong evidence that the benefit of moving that to 30yo+ is of minimal advantage?

I have no idea where this stands from a vaccine stock POV but if the stock is there this makes more sense than hitting the restrictions button surely?

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I work in community health and think people are over simplifying things. Some of my patients can easily get a home visit from a GP while others struggle for a phone review. Some have great GPs and some have average ones. This was no different before Covid.

As a health care professional a move from face to face worries me as there is the potential to miss so much over the phone. The vast majority of patients want to be seen face to face and appreciate the service. What worries me is some (by no means a majority) health professionals are now using covid to continue with changes that benefit themselves reduced travel, saving on childcare when it's to the detriment of the patient. We sometimes now struggle to get staff in to do face to face or train students as it doesn't fit their new routine.

When the needs of the patients overlap with the want of the professional then that's great, telephone and video has its place. However the needs of the patient should always come first, accepting finances will effect what is possible.

 

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1 hour ago, DeanoL said:

That's horrible mate - glad it worked out okay. There are definitely cases where the telephone consult thing doesn't work and fails patients, leading them needing to use more NHS resource than they would have otherwise. This definitely happens, and it's important to say that's one of the consequences of reducing quality of care in this way.

But overall, it's more efficient, because the savings outweigh the costs. Which is horrible when the "cost" is you or someone close to you but it's what we've been doing this entire pandemic in order to allow the NHS to cope (and what many here were advocating).

Oh absolutely a middle ground needs to be found, i just don't think they've quite got there yet. And obviously people having to wait weeks for appointments is unacceptable. We've been lucky in that we at least always get same day ones. 

Anything that might potentially need in person visual or touch diagnosis should be seen in person but there are plenty of things that don't need it- for example I got antibiotics for clear tonsillitis last year in a 5 minute phone call- I'd had it before, it looked and felt the same and I picked them up an hour later.

Balance would be nice, but I feel covid fear is going to take over in winter again and in person is going to reduce even more, lengthening the waiting lists 

Edited by efcfanwirral
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23 minutes ago, JoeyT said:

What's the basis on which it's currently only 50yo's and above that are getting boosters? Is there strong evidence that the benefit of moving that to 30yo+ is of minimal advantage?

I have no idea where this stands from a vaccine stock POV but if the stock is there this makes more sense than hitting the restrictions button surely?

It's just capacity to jab isn't it? Enough vaccines but they need people to jab them in. Better to prioritise with age

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24 minutes ago, JoeyT said:

What's the basis on which it's currently only 50yo's and above that are getting boosters? Is there strong evidence that the benefit of moving that to 30yo+ is of minimal advantage?

I have no idea where this stands from a vaccine stock POV but if the stock is there this makes more sense than hitting the restrictions button surely?

Because nobody can get a booster until 6 months after their second dose so opening it up to 30+ is going to change nothing yet as most won’t have had their second dose until June/July/August. 

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19 minutes ago, pink_triangle said:

I work in community health and think people are over simplifying things. Some of my patients can easily get a home visit from a GP while others struggle for a phone review. Some have great GPs and some have average ones. This was no different before Covid.

As a health care professional a move from face to face worries me as there is the potential to miss so much over the phone.

I think a combined system would work best but it's a big move away from local GPs. You have a GP call centre that's national, through which all initial appointments are done. You develop an app so these can be video calls where the patient is comfortable with that. Then if you need examination you're passed on to your local GP to be seen, preferably the same day. But if you don't it's done over the phone. 

One of the worst things we did was scrapping NHS Direct, when you could actually talk to a qualified nurse 24-hours a day. That would have been ideal but instead now we've got the useless 111 service.

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8 minutes ago, DeanoL said:

I think a combined system would work best but it's a big move away from local GPs. You have a GP call centre that's national, through which all initial appointments are done. You develop an app so these can be video calls where the patient is comfortable with that. Then if you need examination you're passed on to your local GP to be seen, preferably the same day. But if you don't it's done over the phone. 

One of the worst things we did was scrapping NHS Direct, when you could actually talk to a qualified nurse 24-hours a day. That would have been ideal but instead now we've got the useless 111 service.

There definitely needs to be an overhaul to the GP system. 
If we could bypass the militant receptionists and take it to a national system that works I’m all for it. 
There’s been many occasions in the past where I’ve sat waiting for over half an hour at the doctors surgery and only been in the doctors room for a minute or two and a telephone appointment would have been far more convenient for everyone, and on the flip side getting a face to face appointment at my doctors surgery has been next to impossible since March 2020 and now I can’t even get past the receptionist to speak to a doctor on the phone. 

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32 minutes ago, zahidf said:

It's just capacity to jab isn't it? Enough vaccines but they need people to jab them in. Better to prioritise with age

Yep my sister runs a vaccine centre … no shortage of vaccine … just a shortage of people available to jab and administer all of it … along with the volunteers who were available because of furlough previously … some clinics have unfortunately been cancelled … along with some covid related sickness 

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2 hours ago, DeanoL said:

Yeah you're right. It's fucked. As we've been saying. People can't even get telephone appointments in some areas*. But that doesn't improve if you cut the amount of people GPs can consult in a given day with by 30% by going back to face-to-face appointments.

Does the quality of care drop? Yes. But like you said: 

"Moving around resources" includes moving to telephone appointments for GPs: you drop the standard of care to increase capacity of care. You acknowledge that's how the NHS should work, but when they do it in a way you don't like, or that affects you, you get angry about it.

(*this is fucked bit, as if you're going to do mostly telephone consults, you may as well centralise it and spread the load - but then that was happening for first line stuff with NHS Direct until we cut it)

GPs stopped taking face to face appointments because they was scared of getting covid when we didn't have a vaccine.  Don't re-write history...  

It had fuck all to do with efficiency etc...  

Now we have the vaccine we seem to have reason after reason why they can't go back to what they are very well paid to do.  And GPs are VERY well paid.  
 

Edited by Barry Fish
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1 minute ago, Barry Fish said:

GPs stop taking face to face appointments because they was scared of getting covid when we didn't have a vaccine.  Don't re-write history...  

That's true (I mean, not "scared" but it was to prevent spread) and at that point it was "fine" as demand was down anyway. But demand is up now because of the backlog and lack of GPs. And many GP surgeries had already been moving to phone-first consultations pre-COVID (my partner's at her old place had already) to boost capacity. So it's a mix of both.

I dunno man. I've found today quite frustrating. There's people on here I've spent 18 months disagreeing with on COVID. People saying we overreacted, saying people die anyway, saying it's almost entirely old people, or those with pre-existing conditions, or those unvaccinated that are dieing from COVID. That wasn't our experience, and I was never happy with the position of saying "it's just bad luck for them, people die, that's life". But I got their point. I respected their point. People die, your number comes up, shit happens, can't save everyone. It's a pretty ruthless viewpoint but I get it. We can't all put our lives on hold to save everyone. Sure.

And now many of those self-same people are complaining they can't get doctor's appointments for themselves or their family. And suddenly that's a big deal. 

We had family and friends pass from COVID, in one case someone our age (late 30s) with no pre-existing conditions. And in the case of my partner's father, it was at least partly down to NHS overcrowding. He didn't have COVID when he went in to get the emergency operation. And that's part of what's informed my personal view on this whole thing. 

It's so much harder to say "ah well, people die, the overall numbers are low" when it's your own family and friends that can't get the care they need. 

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