Can you go to a doctor anonymously?

[Judith]

I read in another place the following:

QUOTE:
FAMILY doctors have been told they must blow the whistle on patients who
defy their orders not to drive.

Under new guidelines, GPs will be able to raise the alarm and get
dangerous drivers off the roads without having to ask their patients for
permission.

...

http://www.dailyrecord.co.uk/news/scottish-news/gps-urged-report-patients-
not-6896361


My question is, can I go to a doctor without him or her knowing my
identity - is there any law broken if I assume another name and pay cash,
for instance.

Purely theoretical, you understand...

[Tim Watts]

Legalities aside, it would be hard with a regular GP as you have to
produce evidence of address etc to register.

A (possibly private) drop in centre might be possible to give an assumed
name...

[spuorg...@gowanhill.com]

On Saturday, 28 November 2015 18:19:15 UTC, Judith wrote:
> My question is, can I go to a doctor without him or her knowing my
> identity - is there any law broken if I assume another name and pay cash,
> for instance.
> Purely theoretical, you understand...

Purely hearsay as I've never been to one myself, you understand, but I believe from the television that it's possible to give a pseudonym at sexual health clinics.

Owain

[rasta....@gmail.com]

Don't you have to be registered at a practice to be seen?

[Roger Hayter]

At the moment, AFAIK, it is legal.[1] But any self-respecting police
state is going to make it illegal soon. There are already many reasons
that the state requires either by statute or through the
state-controlled regulatory body that doctors breach medical
confidentiality. You could not see a doctor under the NHS without him
being required to positively identify you, ostensibly for eligibility
reasons, but quite handy for general social control reasons.
\

The other thing is that without medical records it is going to be hard
for the more complex forms of medical care to be provided.

[1] There are a number of conditions that you might have (such as a
knife wound or a notifiable disease) which would mean the doctor was
legallly required to inform the authorities, who could presumably lie in
wait for you next time you attended.

--

Roger Hayter

[Roland Perry]

In message <ch9pic-...@squidward.sv.dionic.net>, at 18:48:44 on Sat,
28 Nov 2015, Tim Watts <tw_u...@dionic.net> remarked:

>Legalities aside, it would be hard with a regular GP as you have to
>produce evidence of address etc to register.

As an NHS patient presumably. What about being seen privately?

Drop-in centres see people living on the streets, but I don't know how
that maps onto those needing a referral to hospital.
--
Roland Perry

[Spud]

<spuorg...@gowanhill.com> wrote in message
news:e68450fe-a210-4bd9...@googlegroups.com...

I seem to recall, years ago when HIV was a new thing, if you went to a
clinic for a test you were advised to give a false name, to avoid problems
with Insurance forms or something.

J

[tim.....]

<rasta....@gmail.com> wrote in message
news:1513ac1f-5758-4782...@googlegroups.com...

Not if you turn up as a temporary patient

"registering" you to obtain your medical records is purely for your own
well-being.

If you insisted on being seen without that protection you might find a
doctor prepared to see you, but only on the basis that you lose any
protection for his not taking into account prior medical history

tim

[DerekF]

Surely they want your name and a list of your sexual
contacts?
Derek

[DerekF]

Could you go to a Walk in Clinic, give any name and pay cash?
Derek

[Jon Ribbens]

This is true. However I cannot immediately think of any obvious reason
why a sexual health doctor would want to ban someone from driving in
the first place.

[Janet]

In article <slrnn5m06j.1...@frosty.unequivocal.co.uk>,
jon+u...@unequivocal.co.uk says...

Patient is going blind and insane from tertiary syphilis.

Janet

[Janet]

In article <jRD6y.150783$KK.1...@fx29.iad>, lordp...@NOXgmail.com
says...

many regular users of walk-in STD clinics, probably never get round
to finding out the names of their sexual contacts.


Janet

[Jon Ribbens]

On 2015-11-29, DerekF <lordp...@NOXgmail.com> wrote:
> On 28/11/2015 22:07, spuorg...@gowanhill.com wrote:
>> On Saturday, 28 November 2015 18:19:15 UTC, Judith wrote:
>>> My question is, can I go to a doctor without him or her knowing my
>>> identity - is there any law broken if I assume another name and pay cash,
>>> for instance.
>>> Purely theoretical, you understand...
>>
>> Purely hearsay as I've never been to one myself, you understand,
>> but I believe from the television that it's possible to give a
>> pseudonym at sexual health clinics.
>

> Surely they want your name and a list of your sexual
> contacts?

They'll ask for *a* name, but you don't of course have to give your
real one. I don't think I've ever heard of them asking for a list of
sexual contacts (as opposed to asking the patient to speak to their
recent sexual contacts themselves).

[R. Mark Clayton]

On Saturday, 28 November 2015 18:19:15 UTC, Judith wrote:

You can seek treatment anonymously for certain conditions - e.g. sexually transmitted diseases [at a special clinic].

OTOH doctors do have a duty to notify the authorities of certain conditions, such as several infectious diseases and gunshot wounds.

[Jon Ribbens]

On 2015-11-29, Janet <nob...@home.org> wrote:
> In article <slrnn5m06j.1...@frosty.unequivocal.co.uk>,
> jon+u...@unequivocal.co.uk says...

>> This is true. However I cannot immediately think of any obvious reason
>> why a sexual health doctor would want to ban someone from driving in
>> the first place.
>
> Patient is going blind and insane from tertiary syphilis.

OK, yes, I did think of that, but it seemed rather unlikely that
someone who had refused seeing any doctor for many years would
suddenly decide to see a sexual health doctor for something that
would be unrelated to any recent sexual encounter.

[polygonum]

A temporary patient at a GP surgery may be asked to complete a GMS3
which includes many details such as name, address, NHS number and usual
GP/surgery. Failure to do so would likely result in questioning.

--
Rod

[spuorg...@gowanhill.com]

On Saturday, 28 November 2015 18:19:15 UTC, Judith wrote:

> FAMILY doctors have been told they must blow the whistle on patients who
> defy their orders not to drive.
> Under new guidelines, GPs will be able to raise the alarm and get
> dangerous drivers off the roads without having to ask their patients for
> permission.

I doubt GPs will bother reporting *everyone* who is unfit to drive. People who are concerned about losing their licence on medical grounds are more likely to tell their doctor they don't drive anyway.

Owain

[Roland Perry]

In message <33bad782-9e90-4387...@googlegroups.com>, at
10:32:17 on Sun, 29 Nov 2015, spuorg...@gowanhill.com remarked:

>On Saturday, 28 November 2015 18:19:15 UTC, someone not the usual

I expect we are mainly talking about pensioners who are both richer and
more medically propped up from day to day than in previous generations.

While that's to be applauded in general terms, I think rather too many
continue driving well beyond the point they are properly capable.
--
Roland Perry

[tim.....]

"polygonum" <rmoud...@vrod.co.uk> wrote in message
news:dc0qn2...@mid.individual.net...

Anecdotal evidence suggests that thousands of immigrants who have yet to
formalise their stay in the country register with a local GP (the profession
seem to think that the Hippocratic oath requires them to provide a service
to anyone in need, regardless of their status)

It can't be that hard

tim




>
> --
> Rod

[Nightjar <cpb]

On 29/11/2015 09:57, Roland Perry wrote:
> In message <ch9pic-...@squidward.sv.dionic.net>, at 18:48:44 on Sat,
> 28 Nov 2015, Tim Watts <tw_u...@dionic.net> remarked:
>
>> Legalities aside, it would be hard with a regular GP as you have to
>> produce evidence of address etc to register.
>

> As an NHS patient presumably. What about being seen privately?...

When I have been treated privately, I had first to be referred by my GP.


--
Colin Bignell

[Roland Perry]

In message <Do2dnc_23fQ-isHL...@giganews.com>, at 09:32:09
on Mon, 30 Nov 2015, "Nightjar <cpb" <"insert my surname
here>.me.uk"@serv4.dca1.giganews.com> remarked:

>>> Legalities aside, it would be hard with a regular GP as you have to
>>> produce evidence of address etc to register.
>>
>> As an NHS patient presumably. What about being seen privately?...
>
>When I have been treated privately, I had first to be referred by my
>GP.

I meant "see the GP privately". It's a bit old-fashioned now, but used
to be quite popular in order to get appointments quickly and out of 9-5
hours.
--
Roland Perry

[Roger Hayter]

Nightjar <cpb <"insert my surname here>.me.uk"@serv4.dca1.giganews.com>

wrote:

That rule is not enforced rigidly nowadays, especially if the consultant
is not in the NHS at all. But, in any case, there are private GPs
available who will always be available without referral.

--

Roger Hayter

[Brian Reay]

On 28/11/15 16:13, Judith wrote:

It could be done by giving false details, especially if the person
concerned, for example, had visited A&E. After all, they don't ask for
things like NHS or NI numbers from what I recall.

Likewise, if the person approached a doctor privately, as opposed to
under the NHS. The doctor would almost certainly has for a GP's name
etc. but any GP's name could be given. It wouldn't come to light things
were amiss until the doctor sent the usual follow up letter to the GP
named. I assume this is why private hospitals etc. request some proof of
ID, perhaps under the guise of asking for a credit card details to pay
for items not covered by, say, BUPA.

Of course, such behaviour, especially if applied to the example you
gave, is at best, reprehensible- as I am sure your agree.

A parallel would be someone changing their name, even via a deed poll,
and then denying a criminal record. It happens but could be illegal.

[Janet]

In article <vJnkYZMw...@perry.co.uk>, rol...@perry.co.uk says...

At my GP practice, any patient who calls in the morning with urgent
need to be seen, will be fitted in to that morning's surgery.

or if they are too frail elderly or ill to attend the surgery (but not
an emergency requiring an ambulance) they will get a GP home visit
during that day. In either case you have to accept whichever Dr is
available (it might be your own Dr, or another practice member).

Janet.

[Roland Perry]

In message <n3hlnn$qfd$1...@dont-email.me>, at 14:18:47 on Mon, 30 Nov
2015, Brian Reay <no...@m.com> remarked:

>I assume this is why private hospitals etc. request some proof of ID,
>perhaps under the guise of asking for a credit card details to pay for
>items not covered by, say, BUPA.

Are private hospitals not to be allowed reasonable credit control
procedures? The treatments they seek payment for are not going to be
cheap, and guarantee of payment up front seems fair enough.
--
Roland Perry

[Paul Cummins]

In article <n3hlnn$qfd$1...@dont-email.me>, no...@m.com (Brian Reay) wrote:

> A parallel would be someone changing their name, even via a deed
> poll, and then denying a criminal record. It happens but could be
> illegal.

I;d be interested to now under what circumstances you think this would be
illegal, if not done for a fraudulent purpose.

Anyone is entitled to use any name they please, and no-one s obliged to
disclose a criminal record to just any Tom, Dick or Harry who happens to
ask. In fact no-one is required to disclose a criminal record at all.

Only if you are asked, lawfully, to disclose it and you lie do you commit
an offence. You don't even commit an offence by failing to reply.

So on what basis would your hypothetical scenario be illegal, in your
mind?

--
Paul Cummins - Always a NetHead
Wasting Bandwidth since 1981
Please Help us dispose of unwanted virtual currency:
Bitcoin: 1LzAJBqzoaEudhsZ14W7YrdYSmLZ5m1seZ

[Roland Perry]

In message <MPG.30c673e...@news.individual.net>, at 14:56:15 on
Mon, 30 Nov 2015, Janet <nob...@home.org> remarked:

>> >>> Legalities aside, it would be hard with a regular GP as you have to
>> >>> produce evidence of address etc to register.
>> >>
>> >> As an NHS patient presumably. What about being seen privately?...
>> >
>> >When I have been treated privately, I had first to be referred by my
>> >GP.
>>
>> I meant "see the GP privately". It's a bit old-fashioned now, but used
>> to be quite popular in order to get appointments quickly and out of 9-5
>> hours.
>
> At my GP practice, any patient who calls in the morning with urgent
>need to be seen, will be fitted in to that morning's surgery.

That's rather different to having a 9-5 job in a town 20 miles away and
wanting to get a non-urgent (but still necessary) appointment either in
the evening or with less than a three week wait.

> or if they are too frail elderly or ill to attend the surgery (but not
>an emergency requiring an ambulance) they will get a GP home visit
>during that day. In either case you have to accept whichever Dr is
>available (it might be your own Dr, or another practice member).

Clearly, if there are numerous doctors it's unlikely yours will be on
that duty, the day you call.
--
Roland Perry

[Rob Morley]

Wouldn't help - you'd still be lying when you answered "Have you been
tested for HIV?".

[Rob Morley]

On Mon, 30 Nov 2015 14:56:15 -0000
Janet <nob...@home.org> wrote:

> At my GP practice, any patient who calls in the morning with urgent
> need to be seen, will be fitted in to that morning's surgery.
>

Mine too. But if I'm festering in bed with dreaded lurgy I'll not manage
to phone anyone at 08:00. :-(

[Brian Reay]

As companies like BUPA tend to pre-authorise payment for treatment, the
Hospitals etc. know they will get paid. Certainly in the cases I'm
thinking of, it was clear the credit card was part of the ID process and
to recover the cost of things like newspapers etc. As it happens, even
where there were such nominal extras they didn't bother charging.

In fact the payment process always seemed remarkably straight forward.
While I am a believer in the NHS, they could certainly learn a lot about
administrative efficiency from the private sector.

[tim.....]

"Nightjar <cpb....@serv4.dca1.giganews.com>" <"insert my surname here>
wrote in message news:Do2dnc_23fQ-isHL...@giganews.com...

I'm looking at going to a private consultant

The advice is that it is best to be referred by your GP (particularly if
expecting your health insurance to pay) but not absolutely necessary (if
paying the bill yourself)

tim

[Roger Hayter]

Roland Perry <rol...@perry.co.uk> wrote:

> In message <MPG.30c673e...@news.individual.net>, at 14:56:15 on
> Mon, 30 Nov 2015, Janet <nob...@home.org> remarked:
>
> >> >>> Legalities aside, it would be hard with a regular GP as you have to
> >> >>> produce evidence of address etc to register.
> >> >>
> >> >> As an NHS patient presumably. What about being seen privately?...
> >> >
> >> >When I have been treated privately, I had first to be referred by my
> >> >GP.
> >>
> >> I meant "see the GP privately". It's a bit old-fashioned now, but used
> >> to be quite popular in order to get appointments quickly and out of 9-5
> >> hours.
> >
> > At my GP practice, any patient who calls in the morning with urgent
> >need to be seen, will be fitted in to that morning's surgery.
>
> That's rather different to having a 9-5 job in a town 20 miles away and
> wanting to get a non-urgent (but still necessary) appointment either in
> the evening or with less than a three week wait.

Indeed. Why should the NHS want to meet that need? It is a crazy
misuse of a scarce commodity we are all paying for. Consider what it
might cost to obtain the services of plumber or solicitor or a car
workshop in the evening or on Sunday and it becomes obvious that this
should be a private service.

>
> > or if they are too frail elderly or ill to attend the surgery (but not
> >an emergency requiring an ambulance) they will get a GP home visit
> >during that day. In either case you have to accept whichever Dr is
> >available (it might be your own Dr, or another practice member).
>
> Clearly, if there are numerous doctors it's unlikely yours will be on
> that duty, the day you call.


--

Roger Hayter

[Graham Murray]

Rob Morley <nos...@ntlworld.com> writes:

> Wouldn't help - you'd still be lying when you answered "Have you been
> tested for HIV?".

Would you always know? When the Doctor sends you to the phlebotomist, do
you know what tests the lab will be performing on your blood sample?

[Mark Goodge]

On Mon, 30 Nov 2015 22:38:42 +0000, Roger Hayter put finger to keyboard and
typed:

>Roland Perry <rol...@perry.co.uk> wrote:
>
>> That's rather different to having a 9-5 job in a town 20 miles away and
>> wanting to get a non-urgent (but still necessary) appointment either in
>> the evening or with less than a three week wait.
>
>Indeed. Why should the NHS want to meet that need? It is a crazy
>misuse of a scarce commodity we are all paying for. Consider what it
>might cost to obtain the services of plumber or solicitor or a car
>workshop in the evening or on Sunday and it becomes obvious that this
>should be a private service.

The argument is that the NHS should not discriminate between its users on
the basis of their occupation. Someone who can't get to a surgery during
normal opening hours has just as much right to non-urgent treatment as
someone who can.

Mark
--
Insert random witticism here
http://www.markgoodge.com

[Roland Perry]

In message <1meq0t0.1elfwpq1vetvg8N%ro...@hayter.org>, at 22:38:42 on
Mon, 30 Nov 2015, Roger Hayter <ro...@hayter.org> remarked:

>> > At my GP practice, any patient who calls in the morning with urgent
>> >need to be seen, will be fitted in to that morning's surgery.
>>
>> That's rather different to having a 9-5 job in a town 20 miles away and
>> wanting to get a non-urgent (but still necessary) appointment either in
>> the evening or with less than a three week wait.
>
>Indeed. Why should the NHS want to meet that need? It is a crazy
>misuse of a scarce commodity we are all paying for.

You are assuming that the person requiring the appointment isn't also a
scarce resource, who has to take half a day off work in order to fit
into the NHS's view of the world.

We could throw examples back and forth all day, but how about a sixth
form school teacher whose class is a couple of months off taking their
A-levels?
--
Roland Perry

[Roland Perry]

In message <n3iffv$8ft$1...@dont-email.me>, at 21:38:23 on Mon, 30 Nov

2015, Brian Reay <no...@m.com> remarked:

>>> I assume this is why private hospitals etc. request some proof of ID,
>>> perhaps under the guise of asking for a credit card details to pay for
>>> items not covered by, say, BUPA.
>>
>> Are private hospitals not to be allowed reasonable credit control
>> procedures? The treatments they seek payment for are not going to be
>> cheap, and guarantee of payment up front seems fair enough.
>
>As companies like BUPA tend to pre-authorise payment for treatment, the
>Hospitals etc. know they will get paid. Certainly in the cases I'm
>thinking of, it was clear the credit card was part of the ID process
>and to recover the cost of things like newspapers etc. As it happens,
>even where there were such nominal extras they didn't bother charging.

When I went to see a BUPA consultant he suggested I have a scan, and as
it was the early evening and they had a scanner on the premises, it was
done immediately. But in that timescale it wasn't possible to get BUPA
to authorise it, so they took some CC details just in case.

>In fact the payment process always seemed remarkably straight forward.
>While I am a believer in the NHS, they could certainly learn a lot
>about administrative efficiency from the private sector.

I've just been written to regarding a routine annual appointment which
the hospital has had to "change". To five minutes later. Given that they
typically run half an hour late, I really don't see the need for them to
have done that.
--
Roland Perry

[Roger Hayter]

With respect, and I realise that you are not claiming it as your own,
that is an absurd argument. "Discrimination" for perfectly good
reasons is not wrong, and occupation is not a protected characteristic.
And if the NHS is not allowed to do routine work in routine hours why
should the passport office or HMRC be allowed to do so?

--

Roger Hayter

[Roger Hayter]

Well firstly the NHS is not such a bottomless pit of wealth that it can
be used to subsidise other industries, even publically owned ones; and,
secondly, why can't he go to the doctor between the end of the school
day and the end of the surgery's day; thirdly, most GPs have had one
late evening a week for years, can't the customers put themselves out to
get to that?




--

Roger Hayter

[Sara Merriman]

In article <1mer0bp.13d5j8n2nz9ymN%ro...@hayter.org>, Roger Hayter

Of course, if they can get an appointment to it. Isn't that where we
came in?

--
Armagedon is tiny

[Roland Perry]

In message <1mer0bp.13d5j8n2nz9ymN%ro...@hayter.org>, at 11:31:48 on
Tue, 1 Dec 2015, Roger Hayter <ro...@hayter.org> remarked:

>> >> > At my GP practice, any patient who calls in the morning with urgent
>> >> >need to be seen, will be fitted in to that morning's surgery.
>> >>
>> >> That's rather different to having a 9-5 job in a town 20 miles away and
>> >> wanting to get a non-urgent (but still necessary) appointment either in
>> >> the evening or with less than a three week wait.
>> >
>> >Indeed. Why should the NHS want to meet that need? It is a crazy
>> >misuse of a scarce commodity we are all paying for.
>>
>> You are assuming that the person requiring the appointment isn't also a
>> scarce resource, who has to take half a day off work in order to fit
>> into the NHS's view of the world.
>>
>> We could throw examples back and forth all day, but how about a sixth
>> form school teacher whose class is a couple of months off taking their
>> A-levels?
>
>Well firstly the NHS is not such a bottomless pit of wealth that it can
>be used to subsidise other industries, even publically owned ones;

Perhaps they could save some money by only operating the ambulance
service 9-5?

>and, secondly, why can't he go to the doctor between the end of the
>school day and the end of the surgery's day; thirdly, most GPs have
>had one late evening a week for years, can't the customers put
>themselves out to get to that?

Those two come under the "three week wait" - to find an appointment
available which meets those timing criteria.
--
Roland Perry

[Roland Perry]

In message <1mequax.bvcto760zdguN%ro...@hayter.org>, at 11:01:11 on Tue,

1 Dec 2015, Roger Hayter <ro...@hayter.org> remarked:

>> The argument is that the NHS should not discriminate between its users on
>> the basis of their occupation. Someone who can't get to a surgery during
>> normal opening hours has just as much right to non-urgent treatment as
>> someone who can.
>

>With respect, and I realise that you are not claiming it as your own,
>that is an absurd argument. "Discrimination" for perfectly good
>reasons is not wrong, and occupation is not a protected characteristic.
>And if the NHS is not allowed to do routine work in routine hours why
>should the passport office or HMRC be allowed to do so?

Because people can't choose when they want to be ill. They can choose
when to fill in a tax return.
--
Roland Perry

[Roland Perry]

In message <n3jope$vd$1...@dont-email.me>, at 09:20:46 on Tue, 1 Dec 2015,
Brian Reay <no...@m.com> remarked:
>Likewise making use of the facilities in hospitals outside 9 to 5, Mon. to
>Fri. makes a lot of sense. Having an MRI machine sitting idle 2 days a week
>is criminal. Ditto anything else which tends to prove a bottle neck.

One of the things they started doing at QMC, Nottingham, was booking
appointments at all times/days in the X-ray facility of the A&E. The
hospital is big enough to have X-ray there, as well as the bigger
radiology department. It has to be available 24x7.

Obviously, if there's a lot of people arriving in A&E needing an X-ray,
you'd have to wait.
--
Roland Perry

[Roger Hayter]

If they are actually ill enough to need to see a doctor urgently then
they aren't likely to be going to work. So they might as well be seen
at the optimal time for the system.


--

Roger Hayter

[Roger Hayter]

Roland Perry <rol...@perry.co.uk> wrote:

> In message <1mer0bp.13d5j8n2nz9ymN%ro...@hayter.org>, at 11:31:48 on
> Tue, 1 Dec 2015, Roger Hayter <ro...@hayter.org> remarked:
>
> >> >> > At my GP practice, any patient who calls in the morning with urgent
> >> >> >need to be seen, will be fitted in to that morning's surgery.
> >> >>
> >> >> That's rather different to having a 9-5 job in a town 20 miles away and
> >> >> wanting to get a non-urgent (but still necessary) appointment either in
> >> >> the evening or with less than a three week wait.
> >> >
> >> >Indeed. Why should the NHS want to meet that need? It is a crazy
> >> >misuse of a scarce commodity we are all paying for.
> >>
> >> You are assuming that the person requiring the appointment isn't also a
> >> scarce resource, who has to take half a day off work in order to fit
> >> into the NHS's view of the world.
> >>
> >> We could throw examples back and forth all day, but how about a sixth
> >> form school teacher whose class is a couple of months off taking their
> >> A-levels?
> >
> >Well firstly the NHS is not such a bottomless pit of wealth that it can
> >be used to subsidise other industries, even publically owned ones;
>
> Perhaps they could save some money by only operating the ambulance
> service 9-5?

The remarkably large part of it which is a subsidised taxi system for
the elderly, disabled or poor does actually do that.

>
> >and, secondly, why can't he go to the doctor between the end of the
> >school day and the end of the surgery's day; thirdly, most GPs have
> >had one late evening a week for years, can't the customers put
> >themselves out to get to that?
>
> Those two come under the "three week wait" - to find an appointment
> available which meets those timing criteria.

Maybe it would be easier to find prompt appointments if we didn't try to
make the system double its hours of routine work with no added funding.
It would also help if people did not go to the doctor for totally
inappropriate reasons, a behaviour which is becoming more common as the
years pass, for some reason.


--

Roger Hayter

[Roland Perry]

In message <1mer3j2.14fv8l81yx84fmN%ro...@hayter.org>, at 13:02:27 on

Tue, 1 Dec 2015, Roger Hayter <ro...@hayter.org> remarked:

>> >and, secondly, why can't he go to the doctor between the end of the
>> >school day and the end of the surgery's day; thirdly, most GPs have
>> >had one late evening a week for years, can't the customers put
>> >themselves out to get to that?
>>
>> Those two come under the "three week wait" - to find an appointment
>> available which meets those timing criteria.
>
>Maybe it would be easier to find prompt appointments if we didn't try to
>make the system double its hours of routine work with no added funding.

They are doubling GP opening hours? And obviously if you increase the
hours a surgery is open, you reduce the number of staff at any one time.

>It would also help if people did not go to the doctor for totally
>inappropriate reasons, a behaviour which is becoming more common as the
>years pass, for some reason.

Any cites for that.
--
Roland Perry

[Roland Perry]

In message <1mer3fk.qcz1wevjzyr1N%ro...@hayter.org>, at 13:02:26 on Tue,

1 Dec 2015, Roger Hayter <ro...@hayter.org> remarked:

>> >> The argument is that the NHS should not discriminate between its users on
>> >> the basis of their occupation. Someone who can't get to a surgery during
>> >> normal opening hours has just as much right to non-urgent treatment as
>> >> someone who can.
>> >
>> >With respect, and I realise that you are not claiming it as your own,
>> >that is an absurd argument. "Discrimination" for perfectly good
>> >reasons is not wrong, and occupation is not a protected characteristic.
>> >And if the NHS is not allowed to do routine work in routine hours why
>> >should the passport office or HMRC be allowed to do so?
>>
>> Because people can't choose when they want to be ill. They can choose
>> when to fill in a tax return.
>
>If they are actually ill enough to need to see a doctor urgently then
>they aren't likely to be going to work. So they might as well be seen
>at the optimal time for the system.

Did you miss the "non-urgent" above?
--
Roland Perry

[Rob Morley]

That's a good point - I don't think it gets included in a regular full
bloodworks (because it's always accompanied by counselling?) but it may.

[Paul Cummins]

In article <P5kskl8+...@perry.co.uk>, rol...@perry.co.uk (Roland

Perry) wrote:

> >and, secondly, why can't he go to the doctor between the end of
> the >school day and the end of the surgery's day; thirdly, most
> GPs have >had one late evening a week for years, can't the
> customers put >themselves out to get to that?
>
> Those two come under the "three week wait" - to find an appointment
> available which meets those timing criteria.

As an asthmatic, I once needed an urgent appointment with my doctor, then
in Lewisham in the 1990's.

I was told that I could have an urgent appointment in 15 days.

I then pointed out I was asthmatic, so perhaps an emergency appointment
instead? 11 days time...

I went to A&E.

[the Omrud]

I think that routine blood donation (which is always tested for HIV,
IIRC) is specifically mentioned as not requiring disclosure when
answering this question.

--
David

[Paul Rudin]

agree2...@spam.vlaad.co.uk (Paul Cummins) writes:

> In article <P5kskl8+...@perry.co.uk>, rol...@perry.co.uk (Roland
> Perry) wrote:
>
>> >and, secondly, why can't he go to the doctor between the end of
>> the >school day and the end of the surgery's day; thirdly, most
>> GPs have >had one late evening a week for years, can't the
>> customers put >themselves out to get to that?
>>
>> Those two come under the "three week wait" - to find an appointment
>> available which meets those timing criteria.
>
> As an asthmatic, I once needed an urgent appointment with my doctor, then
> in Lewisham in the 1990's.
>
> I was told that I could have an urgent appointment in 15 days.
>
> I then pointed out I was asthmatic, so perhaps an emergency appointment
> instead? 11 days time...
>
> I went to A&E.

JOOI, isn't A&E intended for emergencies? If so, then isn't this the way
it's suppose to work?

There are obvious difficulties with people effectively being able to
queue jump by self-declaring their need for an appointment to be
urgent. Some would abuse such a system and others just have odd ideas
about what should count as urgent.

[Roger Hayter]

No but I read the "people cant't choose when they want to be ill", and
noted that you appear to be contradicting yourself.


--

Roger Hayter

[tim.....]

"Brian Reay" <no...@m.com> wrote in message
news:n3jope$vd$1...@dont-email.me...

> Roger Hayter <ro...@hayter.org> wrote:
>> Roland Perry <rol...@perry.co.uk> wrote:
>>
>>> In message <MPG.30c673e...@news.individual.net>, at 14:56:15 on
>>> Mon, 30 Nov 2015, Janet <nob...@home.org> remarked:
>>>
>>>>>>>> Legalities aside, it would be hard with a regular GP as you have to
>>>>>>>> produce evidence of address etc to register.
>>>>>>>
>>>>>>> As an NHS patient presumably. What about being seen privately?...
>>>>>>
>>>>>> When I have been treated privately, I had first to be referred by my
>>>>>> GP.
>>>>>
>>>>> I meant "see the GP privately". It's a bit old-fashioned now, but used
>>>>> to be quite popular in order to get appointments quickly and out of
>>>>> 9-5
>>>>> hours.
>>>>
>>>> At my GP practice, any patient who calls in the morning with urgent
>>>> need to be seen, will be fitted in to that morning's surgery.
>>>
>>> That's rather different to having a 9-5 job in a town 20 miles away and
>>> wanting to get a non-urgent (but still necessary) appointment either in
>>> the evening or with less than a three week wait.
>>
>> Indeed. Why should the NHS want to meet that need? It is a crazy
>> misuse of a scarce commodity we are all paying for.
>>
>>
>

> Not really, if someone uses a 'drop in' service it frees up his GP,
> possibly to deal with a more serious problem for another patient or avoids
> inappropriate use of A&E. Plus, some things are easier to treat if dealt
> with early.

>
> Likewise making use of the facilities in hospitals outside 9 to 5, Mon. to
> Fri. makes a lot of sense.

min runs its "machines" 8-8

Dunno about weekends

tim

[tim.....]

"Roland Perry" <rol...@perry.co.uk> wrote in message
news:HZsusP8c...@perry.co.uk...

But this isn't about people who are ill

it's about people wanting to arrange routine appointments outside of core
hours

Roger is right

It's an absurd want to pander too

tim

[tim.....]

"Roger Hayter" <ro...@hayter.org> wrote in message
news:1mer0bp.13d5j8n2nz9ymN%ro...@hayter.org...

Mine doesn't

It doesn't even have the 5:30(+) pm appointments that my previous one did

tim

[Mark Goodge]

On Tue, 1 Dec 2015 11:01:11 +0000, Roger Hayter put finger to keyboard and

It is partly my argument, and I don't think it's entirely absurd.
Discrimination on the basis of occupation may be legal for commercial
organisations, because they are in competition with each other and the
prospective customer has the option of taking his business elsewhere. But
public services which are free at point of use should, as far as is
practical, ensure that they are equally accessible to everyone.

Obviously, there are practical limits, and I don't think that routine NHS
appointments should be available 24x7. But I can talk to HMRC 8am to 8pm on
weekdays and 8am to 4pm on Saturdays. My local library is open six days a
week, on two of which it is open to 7pm. The council leisure centre is open
seven days a week, and on most days it's open to 10:30pm.

I think that level of extended opening is reasonable to expect for a
publicly-funded service. For GP surgeries, Saturdays and at least one
evening a week are, I think, a bare minimum.

The real underlying problem, of course, is the massive structural flaw at
the heart of the NHS, which was completely unforseen by its founders,
failed to be addressed as soon as it became apparent and is now pretty much
politically impossible to deal with. That is, a combination of the fact
that new drugs and new equipment are almost always more expensive than
those they replace and an aging population (itself a by-product of improved
medical treatment) means that the cost of running the NHS can only ever
increase.

In the long run, that's unsustainable. But the longer it's left without
being tackled, the harder to tackle it will get. Since any form of
price-rationing is considered polically unacceptable, we use
convenience-rationing as a substitute. And that is getting harder and
harder to justify to an increasingly sceptical public.

[Roland Perry]

In message <1merfxv.jr2pm51f94esyN%ro...@hayter.org>, at 18:34:56 on

Perhaps you think all illness needs urgent treatment - but that's not
the case. And even the NHS thinks so too: typical three month waits to
se a consultant, three weeks to see a GP.
--
Roland Perry

[Roland Perry]

In message <n3kppl$1rt$1...@dont-email.me>, at 18:46:28 on Tue, 1 Dec 2015,
tim..... <tims_n...@yahoo.co.uk> remarked:

>>>And if the NHS is not allowed to do routine work in routine hours why
>>>should the passport office or HMRC be allowed to do so?
>>
>> Because people can't choose when they want to be ill.
>
>But this isn't about people who are ill
>
>it's about people wanting to arrange routine appointments outside of
>core hours

No, it's about whose time is more valuable: ten minutes with a GP or
someone having to take half a day off work because the NHS won't
schedule those ten minutes at a time which avoids them having to take
half a day off work.

And if they are a teacher that could be over 100 student-hours of lost
learning.

>Roger is right
>
>It's an absurd want to pander too

It's a balance, which the NHS has yet to get right.
--
Roland Perry

[Roger Hayter]

Roland Perry <rol...@perry.co.uk> wrote:

> In message <n3kppl$1rt$1...@dont-email.me>, at 18:46:28 on Tue, 1 Dec 2015,
> tim..... <tims_n...@yahoo.co.uk> remarked:
>
> >>>And if the NHS is not allowed to do routine work in routine hours why
> >>>should the passport office or HMRC be allowed to do so?
> >>
> >> Because people can't choose when they want to be ill.
> >
> >But this isn't about people who are ill
> >
> >it's about people wanting to arrange routine appointments outside of
> >core hours
>
> No, it's about whose time is more valuable: ten minutes with a GP or
> someone having to take half a day off work because the NHS won't
> schedule those ten minutes at a time which avoids them having to take
> half a day off work.

If your time is that valuable you can afford to go private. The NHS
should not be subsidising others at its own excess cost.

>
> And if they are a teacher that could be over 100 student-hours of lost
> learning.

Teachers are a terribly bad example, you know, I should think they could
often get away at four o'clock if they had to!

>
> >Roger is right
> >
> >It's an absurd want to pander too
>
> It's a balance, which the NHS has yet to get right.

The NHS should provide appropriately prompt appointments. It is up to
the patient to be available.


--

Roger Hayter

[Roland Perry]

In message <1mesqzz.1e9g7qdpqu6o2N%ro...@hayter.org>, at 09:53:02 on
Wed, 2 Dec 2015, Roger Hayter <ro...@hayter.org> remarked:

>>it's about whose time is more valuable: ten minutes with a GP or
>> someone having to take half a day off work because the NHS won't
>> schedule those ten minutes at a time which avoids them having to take
>> half a day off work.
>
>If your time is that valuable you can afford to go private.

Might work for the self-employed, but not for an ordinary employee.

>The NHS should not be subsidising others at its own excess cost.

It should not be causing others massive excess costs for the simply lack
of a rota system - which of itself should not increase NHS costs.

>> And if they are a teacher that could be over 100 student-hours of lost
>> learning.
>
>Teachers are a terribly bad example, you know, I should think they could
>often get away at four o'clock if they had to!

Which (along with other employees doing the same thing) creates
unbalanced demand through the day, and hence longer waiting lists.

>> >Roger is right
>> >
>> >It's an absurd want to pander too
>>
>> It's a balance, which the NHS has yet to get right.
>
>The NHS should provide appropriately prompt appointments.

Except they don't.

>It is up to the patient to be available.

Which is precisely the arrogant attitude from the medical profession
that people most object to.
--
Roland Perry

[Janet]

In article <6F9h7nHa...@perry.co.uk>, rol...@perry.co.uk says...

>
> In message <n3kppl$1rt$1...@dont-email.me>, at 18:46:28 on Tue, 1 Dec 2015,
> tim..... <tims_n...@yahoo.co.uk> remarked:
>
> >>>And if the NHS is not allowed to do routine work in routine hours why
> >>>should the passport office or HMRC be allowed to do so?
> >>
> >> Because people can't choose when they want to be ill.
> >
> >But this isn't about people who are ill
> >
> >it's about people wanting to arrange routine appointments outside of
> >core hours
>
> No, it's about whose time is more valuable: ten minutes with a GP or
> someone having to take half a day off work because the NHS won't
> schedule those ten minutes at a time which avoids them having to take
> half a day off work.
>
> And if they are a teacher that could be over 100 student-hours of lost
> learning.

School classes are normally finished by 3.30, or 4 pm at the latest,
and marking, admin and lesson prep time can be adjusted.

So why would a teacher have to "take a half day off work" to see their
GP?

Janet

[Roland Perry]

In message <MPG.30c911b...@news.individual.net>, at 14:34:00 on
Wed, 2 Dec 2015, Janet <nob...@home.org> remarked:

> School classes are normally finished by 3.30, or 4 pm at the latest,
>and marking, admin and lesson prep time can be adjusted.
>
> So why would a teacher have to "take a half day off work" to see their
>GP?

Because they have to travel between school/doctor/school and with the
appointment running typically 20 minutes late they'll have to get
themselves signed-out from school for a full half-day (I don't think you
can get time-off in smaller chunks).

If they belong to one of those surgeries that *only* does "appointments
for today, and you must phone at 8.30am" then it's a bit of a lottery,
and most teachers will have to be in school by then. They have to take
the risk of the day off, and hope an appointment is agreed.

I didn't mention this before because it muddies the difference between
urgent and non-urgent appointments; so I'm assuming that at least some
people use a surgery where appointments-in-the-future are allowed. My GP
does, and also accepts telephone-triage applications for a small number
of on-the-day urgent appointments.

Some colleagues of mine in the private sector told me they had to take a
whole day off if there was any sort of medical appointment booked (we
were specifically discussing dentistry) - even if it would only have
meant being absent for a couple of hours. Such was the granularity
imposed by the HR department.
--
Roland Perry

[Janet]

In article <dXGIPtj2...@perry.co.uk>, rol...@perry.co.uk says...

>
> In message <MPG.30c911b...@news.individual.net>, at 14:34:00 on
> Wed, 2 Dec 2015, Janet <nob...@home.org> remarked:
>
> > School classes are normally finished by 3.30, or 4 pm at the latest,
> >and marking, admin and lesson prep time can be adjusted.
> >
> > So why would a teacher have to "take a half day off work" to see their
> >GP?
>
> Because they have to travel between school/doctor/school and with the
> appointment running typically 20 minutes late they'll have to get
> themselves signed-out from school for a full half-day (I don't think you
> can get time-off in smaller chunks).

Or get a late afternoon appointment, after pupils have gone home, then
there's no need to return to school after it.

Janet.

[Roland Perry]

In message <MPG.30c951d...@news.individual.net>, at 19:08:02 on

Wed, 2 Dec 2015, Janet <nob...@home.org> remarked:
>> > School classes are normally finished by 3.30, or 4 pm at the latest,
>> >and marking, admin and lesson prep time can be adjusted.
>> >
>> > So why would a teacher have to "take a half day off work" to see their
>> >GP?
>>
>> Because they have to travel between school/doctor/school and with the
>> appointment running typically 20 minutes late they'll have to get
>> themselves signed-out from school for a full half-day (I don't think you
>> can get time-off in smaller chunks).
>
> Or get a late afternoon appointment, after pupils have gone home, then
>there's no need to return to school after it.

Which is a slot that's going to be more congested and so take longer to
get an appointment.
--
Roland Perry

[Roger Hayter]

But when a plumber or a builder or a banker or a solicitor says the same
it is just ordinary commercial common sense? Something is wrong here
somewhere, and I think it is people's attitude to the NHS.


I think if a GP is personally working about 50 to 60 hours a week, as
most GP partners are, and is asked to work an extra 10 hours, for no
extra money, finding this burdensome is *very* far from "arrogant".




--

Roger Hayter

[Roland Perry]

In message <1metia6.eyuw401rrmlwkN%ro...@hayter.org>, at 19:48:50 on

Wed, 2 Dec 2015, Roger Hayter <ro...@hayter.org> remarked:

>> >> >It's an absurd want to pander too
>> >>
>> >> It's a balance, which the NHS has yet to get right.
>> >
>> >The NHS should provide appropriately prompt appointments.
>>
>> Except they don't.
>>
>> >It is up to the patient to be available.
>>
>> Which is precisely the arrogant attitude from the medical profession
>> that people most object to.
>
>But when a plumber or a builder or a banker or a solicitor says the same
>it is just ordinary commercial common sense? Something is wrong here
>somewhere, and I think it is people's attitude to the NHS.

What's wrong is the perception that going to the GP is something which
can be put off and arranged when the person requiring the appointment
has several hours to spare.

Bankers and solicitors don't routinely run half an hour late, and
bankers at least operate on Saturdays now.

>I think if a GP is personally working about 50 to 60 hours a week, as
>most GP partners are, and is asked to work an extra 10 hours, for no
>extra money, finding this burdensome is *very* far from "arrogant".

I'm not asking any individual to work more hours, but to schedule their
time better, and actually offer patients a choice of times. Some GPs do
that (for 9-5) reasonably well, but hospitals generally offer
appointments at random times on a "take it or leave it" basis, and are
very bad at informing patients how long the visit is likely to take.
Hence the need to take off much longer from work.
--
Roland Perry

[tim.....]

"Roland Perry" <rol...@perry.co.uk> wrote in message

news:dXGIPtj2...@perry.co.uk...

> In message <MPG.30c911b...@news.individual.net>, at 14:34:00 on
> Wed, 2 Dec 2015, Janet <nob...@home.org> remarked:
>
>> School classes are normally finished by 3.30, or 4 pm at the latest,
>>and marking, admin and lesson prep time can be adjusted.
>>
>> So why would a teacher have to "take a half day off work" to see their
>>GP?
>
> Because they have to travel between school/doctor/school and with the
> appointment running typically 20 minutes late they'll have to get
> themselves signed-out from school for a full half-day (I don't think you
> can get time-off in smaller chunks).
>
> If they belong to one of those surgeries that *only* does "appointments
> for today, and you must phone at 8.30am" then it's a bit of a lottery,

well that's a different argument

for which the solution is:

change your flipping doctor

tim

[Roland Perry]

In message <n3nkn1$544$1...@dont-email.me>, at 20:38:08 on Wed, 2 Dec 2015,
tim..... <tims_n...@yahoo.co.uk> remarked:

>> If they belong to one of those surgeries that *only* does
>>"appointments for today, and you must phone at 8.30am" then it's a
>>bit of a lottery,
>
>well that's a different argument
>
>for which the solution is:
>
>change your flipping doctor

Easier said than done. I have often been registered with the only doctor
in the small town or village, and today in a mid-sized town there are
only two surgeries, the other inconveniently further away (more than
sensible walking distance). Luckily the one I'm registered with doesn't
have that particular policy.
--
Roland Perry

[Graham Murray]

Roland Perry <rol...@perry.co.uk> writes:

> I'm not asking any individual to work more hours, but to schedule
> their time better, and actually offer patients a choice of times. Some
> GPs do that (for 9-5) reasonably well, but hospitals generally offer
> appointments at random times on a "take it or leave it" basis, and are
> very bad at informing patients how long the visit is likely to
> take. Hence the need to take off much longer from work.

At least hospitals seem better now than they used to be[1] - having all
morning appointments at the same the time, similarly with the afternoon
ones. Then running so late that if you turned up at the stated time for
an afternoon appointment, you would sometimes see the consultant leave
for lunch having only just finished the morning clinic.

[1] I am thinking here of about 50 years ago when both myself and my
sister were (for different reasons) regular visitors to hospital
outpatient clinics.

[Janet]

In article <Ega+CKuF...@perry.co.uk>, rol...@perry.co.uk says...

> hospitals generally offer
> appointments at random times on a "take it or leave it" basis, and are
> very bad at informing patients how long the visit is likely to take.
> Hence the need to take off much longer from work.

That's the exact opposite of our experience over many years and half a
dozen hospitals. Every appointment letter states wte "if this time is
inconvenient please call this number to change your appointment" , which
we almost always have to do and it's changed cheerfully followed by a
new letter confirming the new time.

IME, appointments for outpatient investigations or procedures,
invariably include a leaflet telling you what to expect and how long
you'll be at the hospital.

Janet.

[Roland Perry]

In message <MPG.30c9a61...@news.individual.net>, at 01:07:05 on
Thu, 3 Dec 2015, Janet <nob...@home.org> remarked:

>> hospitals generally offer
>> appointments at random times on a "take it or leave it" basis, and are
>> very bad at informing patients how long the visit is likely to take.
>> Hence the need to take off much longer from work.
>
> That's the exact opposite of our experience over many years and half a
>dozen hospitals. Every appointment letter states wte "if this time is
>inconvenient please call this number to change your appointment" , which
>we almost always have to do and it's changed cheerfully followed by a
>new letter confirming the new time.

I wonder if you are attending more popular clinics - the routine one I
go to is only done on Tuesday mornings, for example.

> IME, appointments for outpatient investigations or procedures,
>invariably include a leaflet telling you what to expect and how long
>you'll be at the hospital.

That's patchy; often it's only "we may ask for more tests to be done, so
be prepared to stay a while" (or words to that effect).
--
Roland Perry

[Roger Hayter]

The answer to hospital appointments is blindingly simple: just pay for
twice[1] as many consultants so that they can run a civilised
appointment system and not have to rely on various types of trainee and
substitute to get through the relentless tide of referrals. Say 5p on
income tax, something like that.

[1] Ball park figure, but seen in places that have a thriving on-demand
system.


--

Roger Hayter

[Roland Perry]

In message <1metlu4.1mpyg9i1h78a7tN%ro...@hayter.org>, at 01:18:05 on
Thu, 3 Dec 2015, Roger Hayter <ro...@hayter.org> remarked:

>> I'm not asking any individual to work more hours, but to schedule their
>> time better, and actually offer patients a choice of times. Some GPs do
>> that (for 9-5) reasonably well, but hospitals generally offer
>> appointments at random times on a "take it or leave it" basis, and are
>> very bad at informing patients how long the visit is likely to take.
>> Hence the need to take off much longer from work.
>
>The answer to hospital appointments is blindingly simple: just pay for
>twice[1] as many consultants so that they can run a civilised
>appointment system and not have to rely on various types of trainee and
>substitute to get through the relentless tide of referrals.

You still fail to address the fundamental issue that you don't need more
staff, you just need to spread them (thinner) over more slots in the
day, so that the public isn't needlessly inconvenienced so much.

Of course there are still many efficiencies to put in place, which will
save both hospital and patients time; but that's a slightly different
debate.

--
Roland Perry

[Adam Funk]

On 2015-12-02, Roger Hayter wrote:

> Roland Perry <rol...@perry.co.uk> wrote:
>
>> In message <n3kppl$1rt$1...@dont-email.me>, at 18:46:28 on Tue, 1 Dec 2015,
>> tim..... <tims_n...@yahoo.co.uk> remarked:
>>
>> >>>And if the NHS is not allowed to do routine work in routine hours why
>> >>>should the passport office or HMRC be allowed to do so?
>> >>
>> >> Because people can't choose when they want to be ill.
>> >
>> >But this isn't about people who are ill
>> >
>> >it's about people wanting to arrange routine appointments outside of
>> >core hours
>>
>> No, it's about whose time is more valuable: ten minutes with a GP or
>> someone having to take half a day off work because the NHS won't
>> schedule those ten minutes at a time which avoids them having to take
>> half a day off work.
>
>
> If your time is that valuable you can afford to go private. The NHS
> should not be subsidising others at its own excess cost.

It's not necessarily about your time being valuable, but about having
control over it; people with low-paying employment are likely to have
inflexible employers.

[Janet]

In article <6vxBx4BW...@perry.co.uk>, rol...@perry.co.uk says...

>
> In message <1metlu4.1mpyg9i1h78a7tN%ro...@hayter.org>, at 01:18:05 on
> Thu, 3 Dec 2015, Roger Hayter <ro...@hayter.org> remarked:
> >> I'm not asking any individual to work more hours, but to schedule their
> >> time better, and actually offer patients a choice of times. Some GPs do
> >> that (for 9-5) reasonably well, but hospitals generally offer
> >> appointments at random times on a "take it or leave it" basis, and are
> >> very bad at informing patients how long the visit is likely to take.
> >> Hence the need to take off much longer from work.
> >
> >The answer to hospital appointments is blindingly simple: just pay for
> >twice[1] as many consultants so that they can run a civilised
> >appointment system and not have to rely on various types of trainee and
> >substitute to get through the relentless tide of referrals.
>
> You still fail to address the fundamental issue that you don't need more
> staff, you just need to spread them (thinner) over more slots in the
> day, so that the public isn't needlessly inconvenienced so much.

If you spread one consultant thinner over more slots in the day, so
that he spends his entire working day doing outpatient appointments,
what do you suppose will happen to his inpatients at the same hospital?
When does that consultant do ward rounds, work in theatre, supervise and
train the other doctors in his team, attend departmental meetings, and
write up the reports on all his inpatients, outpatients, etc?

Janet.





Janet

[Janet]

In article <xfODNL7Wr$XWF...@perry.co.uk>, rol...@perry.co.uk says...

>
> In message <MPG.30c9a61...@news.individual.net>, at 01:07:05 on
> Thu, 3 Dec 2015, Janet <nob...@home.org> remarked:
>
> >> hospitals generally offer
> >> appointments at random times on a "take it or leave it" basis, and are
> >> very bad at informing patients how long the visit is likely to take.
> >> Hence the need to take off much longer from work.
> >
> > That's the exact opposite of our experience over many years and half a
> >dozen hospitals. Every appointment letter states wte "if this time is
> >inconvenient please call this number to change your appointment" , which
> >we almost always have to do and it's changed cheerfully followed by a
> >new letter confirming the new time.
>
> I wonder if you are attending more popular clinics - the routine one I
> go to is only done on Tuesday mornings, for example.

Most consultants and departments we attend seem to have have a
regular day of the week for outpatient appointments and procedures. In
other words, of ones we've attended for years, each specialty
appointment's OP clinic generally happens on the same day of the week
each time.

Janet.

[Roland Perry]

In message <MPG.30ca590...@news.individual.net>, at 13:50:26 on
Thu, 3 Dec 2015, Janet <nob...@home.org> remarked:

>>
>> You still fail to address the fundamental issue that you don't need more
>> staff, you just need to spread them (thinner) over more slots in the
>> day, so that the public isn't needlessly inconvenienced so much.
>
> If you spread one consultant thinner over more slots in the day, so
>that he spends his entire working day doing outpatient appointments,
>what do you suppose will happen to his inpatients at the same hospital?

On one hand there's rarely just one inpatient-focussed consultant
available in a hospital (what happens to "their" inpatients when they go
on holiday).

On the other hand many consultants don't have any inpatients to deal
with. The most extreme I've encountered is one who, from a series of
appointments and rescheduling, I'm convinced was working at that
particular large hospital only half a day a month.

>When does that consultant do ward rounds, work in theatre,

Not every consultant is a surgeon, nor do they have to personally
administer or supervise the treatment. If an oncologist prescribes a
regime of daily chemotherapy it's done entirely by nursing staff and the
consultant won't see the patient again for weeks, if not months.

>supervise and train the other doctors in his team, attend departmental
>meetings, and write up the reports on all his inpatients, outpatients,
>etc?

In the same percentage of their weekly hours as now. All that changes is
their outpatient-clinic-hours are spread over more of the week.
--
Roland Perry

[Roland Perry]

In message <MPG.30ca605...@news.individual.net>, at 14:21:47 on

Thu, 3 Dec 2015, Janet <nob...@home.org> remarked:

>> I wonder if you are attending more popular clinics - the routine one I
>> go to is only done on Tuesday mornings, for example.
>
> Most consultants and departments we attend seem to have have a
>regular day of the week for outpatient appointments and procedures. In
>other words, of ones we've attended for years, each specialty
>appointment's OP clinic generally happens on the same day of the week
>each time.

But as a teacher I couldn't ask for a late afternoon appointment at the
clinic I attend, because they only do it on Tuesday mornings.
--
Roland Perry

[Serena Blanchflower]

If the clinic is so specialised (or, in other words, is in such low
demand) that it only needs to be run on one morning per week, it's
unlikely that they would ever be able to justify running clinics at
several different times of the week.

If the condition was one which largely affected people of working age,
they might well choose to run it in the evenings, or at a weekend, if
the hospital was running routine clinics at those times. If, on the
other hand, the bulk of the patients were elderly, and retired, they
could well choose to keep running it on a weekday morning.

--
Best wishes, Serena
The human race has one really effective weapon, and that is laughter.
(Mark Twain)

[Serena Blanchflower]

On 03/12/2015 10:01, Roland Perry wrote:
> In message <1metlu4.1mpyg9i1h78a7tN%ro...@hayter.org>, at 01:18:05 on
> Thu, 3 Dec 2015, Roger Hayter <ro...@hayter.org> remarked:
>>> I'm not asking any individual to work more hours, but to schedule their
>>> time better, and actually offer patients a choice of times. Some GPs do
>>> that (for 9-5) reasonably well, but hospitals generally offer
>>> appointments at random times on a "take it or leave it" basis, and are
>>> very bad at informing patients how long the visit is likely to take.
>>> Hence the need to take off much longer from work.
>>
>> The answer to hospital appointments is blindingly simple: just pay for
>> twice[1] as many consultants so that they can run a civilised
>> appointment system and not have to rely on various types of trainee and
>> substitute to get through the relentless tide of referrals.
>
> You still fail to address the fundamental issue that you don't need more
> staff, you just need to spread them (thinner) over more slots in the
> day, so that the public isn't needlessly inconvenienced so much.

That's not entirely true. You'll also need to have receptionists and
admin support working to cover the longer hours and their numbers are
more likely to be based on the number of hours the practice / clinic is
open, rather than on the number of doctors on duty at any one time.


--
Best wishes, Serena
The difference between theory and practice is that in theory there is no
difference between them: in practice there usually is.(Arnold Kraakman)

[tim.....]

"Roland Perry" <rol...@perry.co.uk> wrote in message

news:Ega+CKuF...@perry.co.uk...

> In message <1metia6.eyuw401rrmlwkN%ro...@hayter.org>, at 19:48:50 on Wed,
> 2 Dec 2015, Roger Hayter <ro...@hayter.org> remarked:
>
>>> >> >It's an absurd want to pander too
>>> >>
>>> >> It's a balance, which the NHS has yet to get right.
>>> >
>>> >The NHS should provide appropriately prompt appointments.
>>>
>>> Except they don't.
>>>
>>> >It is up to the patient to be available.
>>>
>>> Which is precisely the arrogant attitude from the medical profession
>>> that people most object to.
>>
>>But when a plumber or a builder or a banker or a solicitor says the same
>>it is just ordinary commercial common sense? Something is wrong here
>>somewhere, and I think it is people's attitude to the NHS.
>
> What's wrong is the perception that going to the GP is something which can
> be put off and arranged when the person requiring the appointment has
> several hours to spare.

because the others are commercial service operated for a fee paid for by the
user on a (more or less) pro rate basis based upon use

the NHS is paid for out our taxes and is free at the point of deliverer for
individuals to use and abuse (or not) as they see fit (and have the balls to
do so)

tim

[tim.....]

"Roland Perry" <rol...@perry.co.uk> wrote in message

news:x5GjE9JL...@perry.co.uk...

> In message <MPG.30ca590...@news.individual.net>, at 13:50:26 on
> Thu, 3 Dec 2015, Janet <nob...@home.org> remarked:
>
>>>
>>> You still fail to address the fundamental issue that you don't need more
>>> staff, you just need to spread them (thinner) over more slots in the
>>> day, so that the public isn't needlessly inconvenienced so much.
>>
>> If you spread one consultant thinner over more slots in the day, so
>>that he spends his entire working day doing outpatient appointments,
>>what do you suppose will happen to his inpatients at the same hospital?
>
> On one hand there's rarely just one inpatient-focussed consultant
> available in a hospital (what happens to "their" inpatients when they go
> on holiday).

you get seen by the "locum registrar" as I did on my last but one visit

tim

[Vir Campestris]

On 02/12/2015 08:24, Roland Perry wrote:
> No, it's about whose time is more valuable: ten minutes with a GP or
> someone having to take half a day off work because the NHS won't
> schedule those ten minutes at a time which avoids them having to take
> half a day off work.

I once took a half day off work, and took my son out of school to meet
the surgeon before an op. to remove a suspicious mole. After we'd hung
around for half an hour I was wondering. At an hour I was getting cross.
After two hours I was kicking up a fuss, and they finally deigned to
check. Turned out (1) he wasn't coming that day and (2) he didn't need
to see us in advance for such a minor op.

Andy

[Mark Goodge]

On Thu, 3 Dec 2015 01:18:05 +0000, Roger Hayter put finger to keyboard and
typed:

5p on income tax is a lot. It's £850 a year for someone on the average
salary. That's more than a typical annual BUPA policy. It would make more
sense to try and reduce the burden on the NHS by encouraging those who can
afford to go private to do so.

Mark
--
Insert random witticism here
http://www.markgoodge.com

[Roger Hayter]

That is very annoying, but it is clearly a culpable systems failure of
the most unacceptable sort rather than a limitation of the service
offered.


--

Roger Hayter

[Roger Hayter]

Unfortunately that is unlikely to help a great deal. Those who can
afford to go private rarely have major health needs. And if they start
to have significant needs they can no longer afford to go private. That
applies to the insured, whose premiums will rapidly become unaffordable
or insurance unavailable. It may not apply to the stupendously rich,
but there aren't that many of those.


--

Roger Hayter

[Roger Hayter]

Unfortunately (apart from a few bizarre edge cases) if you have an
urgent need you won't be working. And there is a 24 hour emergency
service. If you are still working it isn't that urgent. And if the
GPs were not flooded by people phoning up the out of hours service at 2
am for free condoms, or demanding an emergency appointment because they
have a cold then the necessary appointment within a week or two would be
generally avaiable. Then please compare with the plumber, and work out
why it isn't sensible to demand an out of hours appointment for a
routine matter.

As you say, people wouldn't make demands for an out of hours convenience
service if they had to pay what it actually costs.





--

Roger Hayter

[Mark Goodge]

On Fri, 4 Dec 2015 00:09:00 +0000, Roger Hayter put finger to keyboard and
typed:

>

>As you say, people wouldn't make demands for an out of hours convenience
>service if they had to pay what it actually costs.

So maybe the solution is to charge for non-emergency care.

The NHS suffers from the effects of two unavoidable truisms:

1. Any service that is free at point of delivery will be abused.

2. Any service that is a monopoly, or effective monopoly, will end up being
organised primarily for the convience of the provider rather than the user.

Dealing with these is hard. Very hard. Solving the first requires
motivating or compelling a change in user behaviour. Dealing with the
second requires motivating or compelling a change in staff behaviour.
Compelling, in either case, is going to be unpopular and risk the
introduction of unintended, but potentially serious, consequences. So the
only practical answer is to find some way of motivating the desired
changes.

[Roland Perry]

In message <FICdnbzcP7REy_3L...@brightview.co.uk>, at
14:51:07 on Thu, 3 Dec 2015, Serena Blanchflower
<nos...@blanchflower.me.uk> remarked:

>>>> I wonder if you are attending more popular clinics - the routine one I
>>>> go to is only done on Tuesday mornings, for example.
>>>
>>> Most consultants and departments we attend seem to have have a
>>> regular day of the week for outpatient appointments and procedures. In
>>> other words, of ones we've attended for years, each specialty
>>> appointment's OP clinic generally happens on the same day of the week
>>> each time.
>>
>> But as a teacher I couldn't ask for a late afternoon appointment at the
>> clinic I attend, because they only do it on Tuesday mornings.
>
>If the clinic is so specialised (or, in other words, is in such low
>demand) that it only needs to be run on one morning per week, it's
>unlikely that they would ever be able to justify running clinics at
>several different times of the week.

This particular one has typically three consultants in parallel, so if
it didn't clash with other duties they could run it for more hours on
that one day. I am sympathetic to them choosing to do it only on one
day, because the surgeons will be in the operating theatre all day, some
other days of the week. (While a different set of them run a slightly
different outpatients clinic).

>If the condition was one which largely affected people of working age,
>they might well choose to run it in the evenings, or at a weekend, if
>the hospital was running routine clinics at those times. If, on the
>other hand, the bulk of the patients were elderly, and retired, they
>could well choose to keep running it on a weekday morning.

Because the elderly and retired have nothing better to do with their
time than sit in hospital waiting rooms?
--
Roland Perry

[Roland Perry]

In message <n3q7lf$6n4$1...@dont-email.me>, at 20:13:50 on Thu, 3 Dec 2015,
tim..... <tims_n...@yahoo.co.uk> remarked:

>> On one hand there's rarely just one inpatient-focussed consultant
>>available in a hospital (what happens to "their" inpatients when they
>>go on holiday).
>
>you get seen by the "locum registrar" as I did on my last but one visit

There's a concept of "...or one of their team" where I go.
--
Roland Perry

[Roland Perry]

In message <b5d16bdvskpkffgp0...@news.markshouse.net>, at
21:36:08 on Thu, 3 Dec 2015, Mark Goodge
<use...@listmail.good-stuff.co.uk> remarked:

>5p on income tax is a lot. It's £850 a year for someone on the average
>salary.

The NHS budget is 96bn and there are 28m income tax payers, which is
almost £3500 each (if that were the only funding source).

>That's more than a typical annual BUPA policy.

Although BUPA doesn't cover everything, of course.

>It would make more sense to try and reduce the burden on the NHS by
>encouraging those who can afford to go private to do so.

That's pretty much what happens with dentistry.
--
Roland Perry

[Serena Blanchflower]

On 04/12/2015 12:20, Roland Perry wrote:
> In message <FICdnbzcP7REy_3L...@brightview.co.uk>, at
> 14:51:07 on Thu, 3 Dec 2015, Serena Blanchflower
> <nos...@blanchflower.me.uk> remarked:
>

>> If the condition was one which largely affected people of working age,
>> they might well choose to run it in the evenings, or at a weekend, if
>> the hospital was running routine clinics at those times. If, on the
>> other hand, the bulk of the patients were elderly, and retired, they
>> could well choose to keep running it on a weekday morning.
>
> Because the elderly and retired have nothing better to do with their
> time than sit in hospital waiting rooms?

I don't think any of this would make any significant difference to how
long anyone needed to sit around in hospital waiting rooms. It's about
when the people affected would find it easier to get there.

Inevitably, there will be some people who find mornings best, others who
would choose afternoons, while others would want evening appointments.
People of working age may be more likely to want evening appointments,
while retired people may, in general, be happier with daytime ones.

--
Best wishes, Serena
Save the Earth - It's our only source of chocolate

[Roland Perry]

In message <n3q7fi$5uf$1...@dont-email.me>, at 20:10:42 on Thu, 3 Dec 2015,
tim..... <tims_n...@yahoo.co.uk> remarked:

>> What's wrong is the perception that going to the GP is something
>>which can be put off and arranged when the person requiring the
>>appointment has several hours to spare.
>
>because the others are commercial service operated for a fee paid for
>by the user on a (more or less) pro rate basis based upon use
>
>the NHS is paid for out our taxes and is free at the point of deliverer
>for individuals to use and abuse (or not) as they see fit (and have the
>balls to do so)

It's nothing to do with the source of funding. The police are publicly
funded but you can still walk into a police station on demand (although
to be fair they will sometimes send you away and tell you to make an
appointment).
--
Roland Perry

[Roland Perry]

In message <1mevncx.1siky3d1u9dn7lN%ro...@hayter.org>, at 00:09:11 on
Fri, 4 Dec 2015, Roger Hayter <ro...@hayter.org> remarked:

>Vir Campestris <vir.cam...@invalid.invalid> wrote:
>
>> On 02/12/2015 08:24, Roland Perry wrote:
>> > No, it's about whose time is more valuable: ten minutes with a GP or
>> > someone having to take half a day off work because the NHS won't
>> > schedule those ten minutes at a time which avoids them having to take
>> > half a day off work.
>>
>> I once took a half day off work, and took my son out of school to meet
>> the surgeon before an op. to remove a suspicious mole. After we'd hung
>> around for half an hour I was wondering. At an hour I was getting cross.
>> After two hours I was kicking up a fuss, and they finally deigned to
>> check. Turned out (1) he wasn't coming that day and (2) he didn't need
>> to see us in advance for such a minor op.
>

>That is very annoying, but it is clearly a culpable systems failure of
>the most unacceptable sort rather than a limitation of the service
>offered.

That's one thing my routine clinic gets right - they have a whiteboard
on which they write the names of the consultants-du-jour, and
sporadically how many minutes late they are running. So if he wasn't
going to turn up the receptionists would probably have noticed.

Last time I was there I had one of the first appointments and the
consultant waved at me across the waiting room on his way to his room.

At Addenbrookes they have a more hi-tech solution: a TV screen with the
list of consultants (interspersed with various public information
messages) and a much more real-time display of how late they are
running.
--
Roland Perry

[Roland Perry]

In message <Opedndx5VepG0f3L...@brightview.co.uk>, at
14:08:30 on Thu, 3 Dec 2015, Serena Blanchflower
<nos...@blanchflower.me.uk> remarked:

>>>> I'm not asking any individual to work more hours, but to schedule their
>>>> time better, and actually offer patients a choice of times. Some GPs do
>>>> that (for 9-5) reasonably well, but hospitals generally offer
>>>> appointments at random times on a "take it or leave it" basis, and are
>>>> very bad at informing patients how long the visit is likely to take.
>>>> Hence the need to take off much longer from work.
>>>
>>> The answer to hospital appointments is blindingly simple: just pay for
>>> twice[1] as many consultants so that they can run a civilised
>>> appointment system and not have to rely on various types of trainee and
>>> substitute to get through the relentless tide of referrals.
>>
>> You still fail to address the fundamental issue that you don't need more
>> staff, you just need to spread them (thinner) over more slots in the
>> day, so that the public isn't needlessly inconvenienced so much.
>
>That's not entirely true. You'll also need to have receptionists and
>admin support working to cover the longer hours and their numbers are
>more likely to be based on the number of hours the practice / clinic is
>open, rather than on the number of doctors on duty at any one time.

As with the consultants, don't assume there's just one of each per
clinic. Where I go, there are usually five receptionists[1] dealing with
typically three simultaneous clinics in different parts of the "wing".

[1] They spend most of their sorting out the notes and handing them out
at the right time to the nurses who fuss over each consultant,
rather than just keeping a list of who has turned up.
--
Roland Perry

[Mark Goodge]

On Fri, 4 Dec 2015 12:39:28 +0000, Roland Perry put finger to keyboard and
typed:

I walked into a police station at 3am once to report a crime in progress,
only to be told by the police officer I spoke to that he couldn't leave the
building to investigate at the time as he was the only one there and had a
prisoner in the cells. But he'd let the regional control room know and they
might send a car round if one was in the area.

[tim.....]

"Roland Perry" <rol...@perry.co.uk> wrote in message

news:MqfcQP2v...@perry.co.uk...

> In message <1mevncx.1siky3d1u9dn7lN%ro...@hayter.org>, at 00:09:11 on Fri,
> 4 Dec 2015, Roger Hayter <ro...@hayter.org> remarked:
>>Vir Campestris <vir.cam...@invalid.invalid> wrote:
>>
>>> On 02/12/2015 08:24, Roland Perry wrote:
>>> > No, it's about whose time is more valuable: ten minutes with a GP or
>>> > someone having to take half a day off work because the NHS won't
>>> > schedule those ten minutes at a time which avoids them having to take
>>> > half a day off work.
>>>
>>> I once took a half day off work, and took my son out of school to meet
>>> the surgeon before an op. to remove a suspicious mole. After we'd hung
>>> around for half an hour I was wondering. At an hour I was getting cross.
>>> After two hours I was kicking up a fuss, and they finally deigned to
>>> check. Turned out (1) he wasn't coming that day and (2) he didn't need
>>> to see us in advance for such a minor op.
>>
>>That is very annoying, but it is clearly a culpable systems failure of
>>the most unacceptable sort rather than a limitation of the service
>>offered.
>
> That's one thing my routine clinic gets right - they have a whiteboard on
> which they write the names of the consultants-du-jour, and sporadically
> how many minutes late they are running. So if he wasn't going to turn up
> the receptionists would probably have noticed.
>
> Last time I was there I had one of the first appointments and the
> consultant waved at me across the waiting room on his way to his room.

You're lucky

>From my recent dozen or so visits to the hospital (more than one condition)
I have see a consultant, just once.

Every other time it's been the junior assistant underling and due to the HNS
practice of rotating junior doctors through different discipline every 6
months, never the same junior assist underling

The idea that I might see the same person often enough that they recognise
me just doesn't compute

tim

[Roland Perry]

In message <0of36b1arkqgjcu1l...@news.markshouse.net>, at
16:29:44 on Fri, 4 Dec 2015, Mark Goodge
<use...@listmail.good-stuff.co.uk> remarked:

>>The police are publicly funded but you can still walk into a police
>>station on demand (although to be fair they will sometimes send you
>>away and tell you to make an appointment).
>
>I walked into a police station at 3am once to report a crime in progress,
>only to be told by the police officer I spoke to that he couldn't leave the
>building to investigate at the time as he was the only one there and had a
>prisoner in the cells. But he'd let the regional control room know and they
>might send a car round if one was in the area.

The incident I had in mind was in the middle of a weekday, at what I
understand to be the biggest police station in the county concerned.
--
Roland Perry

[Roland Perry]

In message <n3sfl3$q2r$1...@dont-email.me>, at 16:42:26 on Fri, 4 Dec 2015,
tim..... <tims_n...@yahoo.co.uk> remarked:

>> Last time I was there I had one of the first appointments and the
>>consultant waved at me across the waiting room on his way to his room.
>
>You're lucky

Or unlucky, to have had to see him so many times.

>>From my recent dozen or so visits to the hospital (more than one
>>condition)
>I have see a consultant, just once.

I've seen a real consultant at perhaps three-quarters of various visits
for various things (across the whole family). But it didn't get started
until I was approaching 50 - been falling apart ever since then.

>Every other time it's been the junior assistant underling and due to
>the HNS practice of rotating junior doctors through different
>discipline every 6 months, never the same junior assist underling

That would be a predictable consequence.

>The idea that I might see the same person often enough that they
>recognise me just doesn't compute

I've not been counting, but it must be at least 25 times by now.

It's a bit like barmen in the pub - some of them look straight through
you even if you've been in there every day for a year. Others recognise
and greet you even if you've been away for months.
--
Roland Perry

[tim.....]

"Roland Perry" <rol...@perry.co.uk> wrote in message

news:WQ06uFNA...@perry.co.uk...

> In message <n3sfl3$q2r$1...@dont-email.me>, at 16:42:26 on Fri, 4 Dec 2015,
> tim..... <tims_n...@yahoo.co.uk> remarked:
>
>>> Last time I was there I had one of the first appointments and the
>>> consultant waved at me across the waiting room on his way to his room.
>>
>>You're lucky
>
> Or unlucky, to have had to see him so many times.

On my next trip to Orthopaedics I shall be up to 9 visits for a simple knee
arthroscopy (not including the Op itself).

(I wont mention the other clinic, it's more personal)

>>>From my recent dozen or so visits to the hospital (more than one
>>>condition)
>>I have see a consultant, just once.
>
> I've seen a real consultant at perhaps three-quarters of various visits
> for various things (across the whole family). But it didn't get started
> until I was approaching 50 - been falling apart ever since then.

I had nothing wrong with me until they called me in for my "well man's
assessment", now the drugs that I have to take to cure the things that they
decided was wrong with me make me worse than before I went

(The knee accident occurring at the same time was a coincidence)

>>Every other time it's been the junior assistant underling and due to the
>>HNS practice of rotating junior doctors through different discipline every
>>6 months, never the same junior assist underling
>
> That would be a predictable consequence.
>
>>The idea that I might see the same person often enough that they recognise
>>me just doesn't compute
>
> I've not been counting, but it must be at least 25 times by now.
>
> It's a bit like barmen in the pub - some of them look straight through you
> even if you've been in there every day for a year. Others recognise and
> greet you even if you've been away for months.

My "team" for the last 9 months go to the local Weatherspoons for a team
lunch every Wednesday.

We usually get served by the same person, and every week, when I ask for my
free drink to a be a "half" (so I don't fall asleep in the afternoon) he
explains how he has to put it through as a pint for it to be "free" - It's
clear why it is that he works in a pub!

tim