Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Wonderful!
- Sarah J Bedford (15 February 2008)
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Out of hours Access
- paul michael schenk (18 February 2008)
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...but shouldn't we do something about it.
- Anthony T O'Brien (18 February 2008)
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Re: Out of hours Access
- Martinus J Brugman (20 February 2008)
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Better medical practice
- GEORGE Y CALDWELL, SINGAPORE 259858. (20 February 2008)
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Re: Out of hours Access
- GEORGE Y CALDWELL, SINGAPORE 259858. (20 February 2008)
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Re: Out of hours Access - other professional groups
- Lesley E Bacon (20 February 2008)
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Disguising the truth
- Roger M Goss (20 February 2008)
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Re: Out of hours Access
- M Valerie Hesketh (20 February 2008)
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The fallacy of consumer choice
- Oliver C Boney (24 February 2008)
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Sarah J Bedford, GP Principal Village Practice Armthorpe Dn3 2DB
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Absolutely wonderful letter Iona, the Health Service cannot be run on a 24hr basis providing what patients want, when they want, without HUGE investment and Government sense. I will happily clone myself so that my patients can see me at all hours of the day and night and will also expect all of myselves to be adequately remunerated for giving them that privilege. I wonder if Mr Brown will respond? Competing interests: None declared |
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paul michael schenk, Full time GP Clays Practice Roche Cornwall PL26 8JF
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With regard to access does anyone know of any similar professional group who offer routine work out of hours ? -we already work till 630pm Monday to Friday ! In addition what happens if you open up the surgery till 8pm - you will be seen as being 'open for business 'ie any patients including those with perceived 'urgent problems ' will arrive and be expected to be seen by the only Doctor trying to carry out the proposed late evening routine booked surgery. Finally one model doesnt not fit all ie what urban areas need may well be different to semi-rural / rural areas. Competing interests: None declared |
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Anthony T O'Brien, GP Principle Wyndham House Surgery, Silverton, Devon TQ13 9LQ
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As Iona Heath eloquently and intelligently illustrates the Prime Minister is building his Health Care Policy on weak foundations. The medical profession has until now been slow to point out the flaws in politicians’ thinking. This is because Access, Screening and Choice all have broad public appeal and are difficult to oppose. However they are based on superficial non-evidence based arguments. We have a professional duty to point this out. However since the Government is unwilling to listen to reasoned debate we must enter the political arena. The future of the NHS is in jeopardy. What would happen if doctors were asked to give a Vote of Confidence in this current Government’s ability to manage the NHS? The result might bring everyone (politicians, doctors and the public) back into the real world to address the real issues. Competing interests: None declared |
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Martinus J Brugman, General Practitioner King George Surgery,135 High Street, Stevenage SG1 3HT
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I would suggest that any emergency patients should either be directed to the OOH centre or be seen with a bill sent to the PCT, who, after all, are responsible for OOH care. Competing interests: None declared |
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GEORGE Y CALDWELL, GENERAL PRACTITIONER 31 BALMORAL PARK, #18-33, SINGAPORE 259858.
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Free the General Practitioner from all these Management Controls and unnatural "targets".. Pay him his Fee for the work he has done. Then his Surgery will open for the convenience of his patients and at weekends. He will be willing to go on night-calls, for the Extra Fee. He will be willing to do those Minor Operations in his own Surgery, for a fair Fee. He will do the Domiciliary Midwifery, for that extra Fee. Let him select the Specialist of his choice for his patients and have no lottery over whom will serve him. The Receptionists of the NHS have a tight grip on its progress. Introduce a plastic Medical Card that has encrypted all the relevant patient's past record. One swipe of it will pay the doctor for his Consultation and the rest. Competing interests: None declared |
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GEORGE Y CALDWELL, GENERAL PRACTITIONER 31 BALMORAL PARK, #18-33,, SINGAPORE 259858.
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Very often one worked out at ships through the night returning for a quick breakfast and then straight off to a distant early Morning Clinic at 7.30 am.. No moaning. No claims for "time-off"! One night on Full call and a second on back-up call. In that busy practice one got paid one's share and well for the work done. And it was satisfactory and fun. Since the very inception of the "socialistic" NHS there has been too much groaning and moaning because of the lack of satisfaction and financial appreciaton for that experience, by night or at weekends. The G.P. has been exploited from the beginning and diddled out of his real earnings. A Salary is degrading to a Professional man. A return to Private Practice is imperative and payment by the National Health Insurance for each item of service. Competing interests: None declared |
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Lesley E Bacon, Consultant in Sexual and Reproductive Health Lewisham PCT, SE8 4BG
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Yes, I do know of a similar professional group offering out of hours services. Family planning has done always done so, working evenings and (increasingly) weekends. Who would be happy to take time off work to get their pills ( or, worse, get their chlamydia treated)? Competing interests: Consultant in Sexual and Reproductive Health |
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Roger M Goss, Co-director Patient Concern
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Iona Heath, BMJ 2008;336:360 (16 February) illustrates the deliberately deceptive language used in medicine. Treatment doesn’t save lives. It defers death. Withholding or withdrawing artificial nutrition and hydration doesn’t only attempt to relieve suffering. It kills the patient. No outcry over euthanasia. Doctors have made the decision - so that’s alright! If patients plead for death, the medical establishment deplores requisite change in the law. Resuscitation doesn’t simply attempt to defer death. It risks leaving patients in a vegetable-like state. Removing organs from a beating heart patient doesn’t only mean that another patient(s) live longer. It kills the donor. Presuming consent without having consent does not legitimise organ removal. It inevitably means organs will get removed from patients who did not want this. Opting out requires an objection and many may be unaware of the need to object, be unable to do so, not get around to doing so or consider the legal obligation morally unjustified. Medical ethics is so often a contradictory concept only espoused by medical and legal folk and described in the recent Organ Donation Taskforce report as ‘current ethical norms’. Now there’s a give-away. Competing interests: None declared |
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M Valerie Hesketh, Midwifery Team Leader Maidstone & Tunbridge Welss NHS Trust ME16 9QQ
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Yes we midwives provide care out of hours 24/7. We can be called to home births of course and in my trust we are regularly called to work in the hospital after a full day of clinics and visits. I do not recommend this as safe practice. We would like to improve access to midwifery services for women but find we are restricted by surgeries closing at 6pm. Not all GPs would be on duty out of hours - a minimum service -either until 7-8pm or Saturday mornings 9-12 could be covered by a rota. Competing interests: None declared |
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Oliver C Boney, Senior Resident Medical Officer Intensive Care, Prince of Wales Hospital, Sydney
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Dr Heath’s letter addresses one of the most fundamental flaws in NHS policy today, namely the doctrine of ‘consumer choice’. NHS reform appears to be based largely on the misguided assumption that being able to choose your doctor, your hospital, and even the treatment you receive, is unquestionably a good thing. Informed choice is a clear force for patient empowerment; uninformed choice – choice for choice’s sake, almost – is a political gimmick. The instant gratification of consumer culture has led us to believe that we can have whatever we want, whenever and wherever we want it. Such an attitude is fine when uninformed consumer choices have only minor consequences (that dodgy Friday night kebab that wreaked gastrointestinal havoc the next day, or the Hawaiian shirt that my girlfriend refuses to be seen with me in…) However, Mr Brown clearly wishes society to adopt such an approach to its consumption of healthcare: ‘a time to suit you, with the clinician of your choice, in the setting and environment which meets your needs’. This culture is dangerous on two counts. One, it fosters unrealistic expectations of instant access to tailor-made healthcare – which, as Dr Heath argues, the finite resources and manpower of the NHS are in no way able to deliver. Two, it creates the illusion of empowering patients, yet allows them to make uninformed decisions about potentially life- threatening treatments. In an age where medical information has never been more freely available, but is largely unregulated and frequently inaccurate, patients should be encouraged to seek their doctor’s advice to ensure they have access to, and can understand the implications of, accurate information to help them arrive at an informed decision. You might choose a cinema to catch the latest disaster movie because it’s showing at a convenient time, it’s nearby, and the popcorn’s a cut above the average. Selecting a hospital to have your CABG because it’s close to home, the cardiologist was nice, and they can squeeze you in before that week in Spain you’ve been looking forward to, might just turn your operation into a disaster movie. The rhetoric of patient empowerment needs to be grounded in patient autonomy informed by medical expertise, not consumer convenience. Mr Brown should know better than to encourage a culture of choice based on convenience rather than on informed, evidence- based decision making. Competing interests: None declared |
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