Financial Incentives to NHS-GP’s in the UK:

[kristina]

Today I was shocked to hear latest UK-news on the radio :
The UK government plans to pay the following financial incentive to NHS-GP’s :
 £ 55.00 extra earnings paid directly to every NHS-GP in the UK for every person/patient
whom the NHS-GP diagnoses with a mental dementia/the onset of a mental disease...
(... forget about whether a diagnosis made by a NHS-GP could be correct or incorrect ...
... or whether a diagnosis made by a GP needs to be confirmed by a specialist...).

... being as critical as usual, my first thought was, whether we can expect from now on a "mental epidemic disorder" in the UK...?

... Heaven help us all...

How does it work in other countries ?

[Sugarlump]

I expect everyone over 55 to be diagnosed in a rush!!!! That is ridiculous!
I want to know why I can't get an immediate appointment at my GP's for something pressing or get hold of a GP after hours but if I ring my vet I will be seen straight away and they offer a 24 hour service!

[kristina]

Hello sugarlump,
Welcome to the club! I can't make an appointment with "my" NHS-GP either...
In fact, I am glad to find out that I am not the only one having such difficulties,
because at one time I thought it "only happened to me" and was personal because of my rare diseases
and the thought made me very sad and almost depressed about my medical situation at one point...
But these days I meet more and more patients who can't get an appointment with their NHS-GP either,
supposedly because the NHS-GP are completely overworked and underpaid...
... and it makes me wonder what is actually going on?
Thanks from Kristina.

[noahvale]

*

[Sugarlump]

I'm not sure we really have non-NHS GP's in this country except in Harley Street, London for the super rich!
You can be a private patient of your NHS GP but that just doesn't seem right to say if you pay £80 I will see you today, otherwise three days away with all the other poor sods!
If I could take out private medical insurance I would, but once I was diagnosed with glomerulonephritus at 24, nobody would touch me for health or life insurance!

Once upon a time Doctors covered out of hours as well as drop in morning surgeries.
Nowdays if we want help out of hours we have to drive 20 miles to nearest A and E and wait 4/5 hours.

The British NHS wastes so much money on poor management, computer changes, fancy buildings with fancy artwork and lots of irrelevant stuff when at the end of the day all people
want is access to good Doctors and Nurses. I am sure if the whole service was better managed and they stopped privatising areas like the ambulance service, the catering and the cleaning
that we could have a better service overall.

The average GP in the UK earns £103,000 a year. That's 166,247 US dollars. That's a lot of dosh!

[jeannea]

Here in the US we do not have after hours service either really. I can call the number and a doctor will call me back. 99% of the time they say if you're truly concerned you need to go to the ER because we can't diagnose over the phone. I hardly ever call anymore. I just decide if I want to go to the ER.

[kristina]

I'm not sure we really have non-NHS GP's in this country except in Harley Street, London for the super rich!
You can be a private patient of your NHS GP but that just doesn't seem right to say if you pay £80 I will see you today, otherwise three days away with all the other poor sods!
If I could take out private medical insurance I would, but once I was diagnosed with glomerulonephritus at 24, nobody would touch me for health or life insurance!

Once upon a time Doctors covered out of hours as well as drop in morning surgeries.
Nowdays if we want help out of hours we have to drive 20 miles to nearest A and E and wait 4/5 hours.

The British NHS wastes so much money on poor management, computer changes, fancy buildings with fancy artwork and lots of irrelevant stuff when at the end of the day all people
want is access to good Doctors and Nurses. I am sure if the whole service was better managed and they stopped privatising areas like the ambulance service, the catering and the cleaning
that we could have a better service overall.

The average GP in the UK earns £103,000 a year. That's 166,247 US dollars. That's a lot of dosh!

Hello Sugarlump, like yourself I can't be insured by a private medical insurance or life-insurance either,
because of my very rare chronic diseases...

... Surprisingly, it has almost become a prejudice of the “old days” to connect Private Doctors in Harley Street
as the place for the “Super-Rich” to receive a special medical service...
If you go to Harley Street these days, you might notice that many patients who have come there for medical services
do not necessarily have money...In fact, many of them are very poor, financially speaking... 
... But they have saved money over time, cut down financially on many other things,
in an desperate attempt to receive proper health care, because they could not achieve a diagnosis
or a proper professional medical treatment from "ordinary" doctors and specialists on the NHS...

Many doctors in Harley Street Private Clinics happen to be the very best doctors and specialists in the UK
and they also provide an easy access to their private Health Services.
Many of them appear to be very caring doctors of “the old school”, who have lost faith with the NHS
and because of that they went to Harley Street in order to provide a proper Health Service for very desperate patients...

If you happen to be – for example – in end stage kidney failure, you can make an appointment in Harley Street today,
have an instant check-up of your blood for Creatinine, Urea, Potassium and Sodium straight away, 
wait for one or two hours in a comfortable waiting room, get your blood-test-result instantly and go home.

Such a service can be invaluable for ESRF-patients, who need to urgently continue with a certain vegetarian diet,
drink a certain amount of daily water-intake etc. in an effort to keep off dialysis for as long as possible...
Having instant blood-results from Harley Street on the same day, these ESRF-patients can figure out instantly (with the help of the Internet),
whether they need to refine their diet any further the same day (with the help of the Internet),
or whether they are still alright for the moment...

[Sugarlump]

That's interesting kristina (I have alsways assumed they would be well out of my price range)
You know it can be a fortnight before i get my blood tests back, which is crazy. The blood lab's have the results the same day that you would think in this digital age we would be able to access our results on our computer
I understand some hospitals did introduce this.
You cannot make corrections to your diet r regime if you are not aware of changes. Two weeks could be two long if you have high potassium.

[noahvale]

^

[kristina]

I agree with you, Sugarlump! To wait a fortnight (or in my case almost 4 weeks) and eventually get the results of a recent blood-test
from a NHS-GP/doctor, is much too long for any ESRF-patient to wait... and life is much too short to take such enormous risks!
... It is much better and much healthier, to give oneself a real fair survival chance instead...

...  I mention this, because all my neighbours who became seriously unwell and were in urgent need of medical care died shortly after,
whenever they made the fatal mistake to rely only on NHS-GP's and NHS-doctors...

It is interesting what you say, noahvale... .but I am not sure that it is really necessary for NHS-doctors to pay “malpractice insurance fees”?
After all, it is practically impossible for any UK-patient to prove malpractice of a malpracticing NHS-GP/doctor...
...even if the NHS-patient can prove it with valid documents...

The patient would need to locate a NHS-doctor in the UK who is prepared to diagnose the malpractice of one of their colleagues
(which is practically impossible, because many NHS-GP's/doctors belong to the same clubs...).
...Adding to that, the patient would have to locate a solicitor/lawyer, who is prepared to take on such a case
(pretty impossible again, because many solicitors belong to the same or similar clubs as doctors do) ...
... and then the patient would need on top of it all “oodles of money” to pay the astronomical fees of a solicitor/lawyer etc...
... and that is practically impossible, because being chronically sick and unwell is extremely expensive here in the UK as well...

I don't know the precise details about this noahvale, but I am not sure that 37.5% of their income is being paid by NHS-GP's to the government...?
(I have already come across NHS-GP's/doctors who could hardly speak English)...
In my experience, many NHS-GP's and doctors are becoming extremely well off financially after a very short time, whilst working as NHS-GP/doctors...
... to my knowledge NHS-GP/s and NHS-doctors in the UK are being trained by the NHS (courtesy of the UK-tax-payer)...
... and I might be wrong, but I should be very surprised if NHS-GP's and NHS doctors have to repay any money to anyone for their medical studies?...

[PrimeTimer]

I'm in the USA. I want any doctor I have to see to be well-compensated. I want them to have the incentive to treat me well, very well. Research and education are not cheap and shouldn't be...

[noahvale]

*

[Sugarlump]

Doctors don't pay anymore tax than anyone else on same salary bracket.
The average wage in Suffolk, UK is £22,000 so I don't think they are doing too badly.
Whilst I do agree Doctors should be paid a reasonable salary what about nurses? Their average salary is £23,000 and they are on the frontline.
I think they deserve a lot more. Better wages attract better candidates to the vocation.

[kristina]

I am sorry to say noahvale, that I know the papers you have put here to be read...
...many of them are regarded here in the UK as “clever PR-papers”, because their content and promise is often not connected
to the grim reality of many NHS-patients...
... Unfortunately it is not uncommon that NHS-patients are being discriminated against by NHS-GP’s and NHS doctors,
especially NHS-patients who suffer from a rare chronic disease or elderly patients who have no family-members to assist them and stand up for them...
... For example, in one of the papers it says that “Our whole ethos is focused on putting your needs first...”
I really wish there could be such an ethos and I do wish there could be such a priority... towards NHS-patients  ... as well...

I agree with you Sugarlump. Many NHS-nurses are medically extremely well educated
and take their time for the medical needs of NHS patients...
...Many NHS-nurses also make time to explain medical matters to NHS-patient s
and even bother to understand the NHS-patient...in many cases...
... Unfortunately many NHS-nurses are not getting well paid and that is a pity,
 because I have met NHS-nurses who were really dedicated to help and assist NHS-patients ...
.... but unfortunately I have not yet had the good luck to come across a NHS-GP
who is really dedicated to the medical welfare of NHS-patients...

[noahvale]

*

[jeannea]

In every country these days, you must either fight for yourself or have someone to fight for you. I was recently being pushed off by office staff and I had to push back to get the care I needed. I believe this happens everywhere. You can accept what help they offer or push for the help you need. I feel very bad for some I saw at dialysis. Old people in nursing homes with many problems who seemed alone. I am lucky I can still fight and I have family. This is not unique to NHS.

I think that NHS and US physicians are being asked, like almost all professions, to do more with less resources. There are bad doctors of course. But I suspect most of them want to help their patients. Most want to be good doctors. Finding the best doctor is a two way street. You both have to communicate and cooperate.

[kristina]

Hello noahvale, it cannot be backed up because it is a well protected taboo... despite lots of documented evidence... 
...and...  unless you are unlucky – like I was and many other NHS-patients are  -  and experience it for yourself,
you may not even comprehend what I am talking about...
... But: If you really need to know: why not come here and experience it for yourself?

...There is no need to insult each other about “constant conspiratorial statements”  or  “dementia and uraemia disorders” as you try to indicate...
... and I sincerely do hope that we continue to be well mannered here ?

I agree with you jeannea. That sort of thing might happen everywhere and is possible everywhere...
The only reason why I can become upset about it is because it is in very bad taste, when a medically trained, studied and experienced NHS-doctor
misuses such a wonderful humanitarian institution – like the NHS was from the very start –
and misuses such a humanitarian institution with vulnerable NHS-patients for their own misguided purposes ...

[kristina]

I am sorry to say noahvale, that I know the papers you have put here to be read...
...many of them are regarded here in the UK as “clever PR-papers”, because their content and promise is often not connected
to the grim reality of many NHS-patients...
..

Please back up anything that I have posted to be "clever PR papers."  Are the links that I included wrong that med students do have to pay for med school or the income brackets I linked to are not correct?  Wouldn't it be better to show me my errors as opposed to making constant conspiratorial statements?   But then again, many with only 5% renal function experience dementia and cognitive disorders, common effects of inadequately treated uremia toxicity.

P.S. I do understand what you mean and I certainly should give it my consideration,
but I have been working very hard to prepare for my exam which is going to take place at the end of November 2014
and I shall give it my very best to pass this exam and get it done and over with...
If my kidney function has deteriorated so badly that it would influence my thinking in a negative way ... 
... that would be very bad luck indeed, but I shall try my very best on the day all the same ...
... I don't think I would be able to concentrate or even  think about taking this exam at the end of November,
if I would have gone already through this complete psychological upheaval of starting  with dialysis...
I shall think about starting dialysis or whatever after my exam... and hopefully I shall have a good chance with the exam ...
... I am pretty determined to make it ...
.

[obsidianom]

I generally stay out of political discussions here and focus on medical aspects etc. But I beleive I am the only actually still practicing physician on this site. I am older and only work part time these days but I have been in the medical "business" over 25 years now. I am self employed which is rare these days as almost all the docs around are now working for the hospitals. So I still run my own business, pay my own expenses and over head etc. More than 50% of what I bring goes to pay the over head expenses. Medicine is a very hard business these days. We work harder for less money and more paperwork and govt. regulation . Many older docs in my area are quitting due to this.
I love treating patients. Its a joy for me to actually help someone feel better. But for every minute of patient contact , I have to deal with the same amount of time in paper work . It wears me out. I could do so much more for my patients if the time could be spent just treating them. I dont know much about the UK.
I do know that here in the US I had to go to college 4 years, 4 years of med school, then 2 years of residency (which is now 3 or more for all). That cost a fortune and dont forget the lost income during those 10 years. While I was in school collecting debt, others were working and getting paid.
I addition I am never really "off duty'. I am available by phone 24 /7.   My patients can get me 7 days per week . I have to arrange for coverage by the doc. I share the office with when I would be away. ( I dont travel now due to my wifes dialysis, but for years I did ). So I cant just forget the office when I come home. When I did surgery (for my first 18 years) I had to be available for any complications that arose after. That was very stressful. I had many late night calls.
Medicine is a very rewarding career but it is not easy. I am glad I am at the end of my career. It was far easier in the past.

[PrimeTimer]

I generally stay out of political discussions here and focus on medical aspects etc. But I believe I am the only actually still practicing physician on this site. I am older and only work part time these days but I have been in the medical "business" over 25 years now. I am self employed which is rare these days as almost all the docs around are now working for the hospitals. So I still run my own business, pay my own expenses and over head etc. More than 50% of what I bring goes to pay the over head expenses. Medicine is a very hard business these days. We work harder for less money and more paperwork and govt. regulation . Many older docs in my area are quitting due to this.
I love treating patients. Its a joy for me to actually help someone feel better. But for every minute of patient contact , I have to deal with the same amount of time in paper work . It wears me out. I could do so much more for my patients if the time could be spent just treating them. I dont know much about the UK.
I do know that here in the US I had to go to college 4 years, 4 years of med school, then 2 years of residency (which is now 3 or more for all). That cost a fortune and dont forget the lost income during those 10 years. While I was in school collecting debt, others were working and getting paid.
I addition I am never really "off duty'. I am available by phone 24 /7.   My patients can get me 7 days per week . I have to arrange for coverage by the doc. I share the office with when I would be away. ( I dont travel now due to my wifes dialysis, but for years I did ). So I cant just forget the office when I come home. When I did surgery (for my first 18 years) I had to be available for any complications that arose after. That was very stressful. I had many late night calls.
Medicine is a very rewarding career but it is not easy. I am glad I am at the end of my career. It was far easier in the past.

Your patients must love having you for their doctor. Not too many around like you anymore...I grew up in a small harbor town in the Pacific Northwest that was so small at the time, the farm animal Vetenarian served as the town doctor. And he made housecalls. If he thought it serious enough that you needed hospitalization, he'd tell you to go to the nearest hospital, which was 23 miles away. Otherwise, he made housecalls to check on us and keep us well. Meanwhile, I've had the same Internal Med doc for over 20 years now (thankfully) but I've noticed the paperwork they drown him in. He's busy, busy, busy and I wonder how he keeps updated. It's obviously quite a balancing act he is performing in order to see his patients, which is why I am so glad he's still my doctor. He always makes time to explain what the problem is and what he going to treat it with and why, he is very thorough, he just has to do it more in a rush now and I think he hates that. Makes me want to yell "Hey, this doctor over here is trying to help a patient!"

[kristina]

I generally stay out of political discussions here and focus on medical aspects etc. But I beleive I am the only actually still practicing physician on this site. I am older and only work part time these days but I have been in the medical "business" over 25 years now. I am self employed which is rare these days as almost all the docs around are now working for the hospitals. So I still run my own business, pay my own expenses and over head etc. More than 50% of what I bring goes to pay the over head expenses. Medicine is a very hard business these days. We work harder for less money and more paperwork and govt. regulation . Many older docs in my area are quitting due to this.
I love treating patients. Its a joy for me to actually help someone feel better. But for every minute of patient contact , I have to deal with the same amount of time in paper work . It wears me out. I could do so much more for my patients if the time could be spent just treating them. I dont know much about the UK.
I do know that here in the US I had to go to college 4 years, 4 years of med school, then 2 years of residency (which is now 3 or more for all). That cost a fortune and dont forget the lost income during those 10 years. While I was in school collecting debt, others were working and getting paid.
I addition I am never really "off duty'. I am available by phone 24 /7.   My patients can get me 7 days per week . I have to arrange for coverage by the doc. I share the office with when I would be away. ( I dont travel now due to my wifes dialysis, but for years I did ). So I cant just forget the office when I come home. When I did surgery (for my first 18 years) I had to be available for any complications that arose after. That was very stressful. I had many late night calls.
Medicine is a very rewarding career but it is not easy. I am glad I am at the end of my career. It was far easier in the past.

It is so good to read your input, obsidianom.
You sound just like my (private) dentist whom I have consulted for almost 30 years twice every year and who sadly retires next year.
He also loves being a dentist and he worked almost as a dental pioneer by making sure not to inflict any pain on his dental patients.
I am very grateful that he gave me a real break for almost 30 years and I am very sad that he retires next year.
He was considered to be one of the best dentists in the UK and he always studied the health history of every patient in detail.
He knows everything about my diseases and allergies and he taught me how to avoid any dental problems and dental mishaps despite these diseases. In all the years I consulted with him I had never any problems with my teeth despite suffering from regular SLE/MCTD-flare-ups.
These diseases can affect the teeth of a patient very badly, but with the help of my dentist I could manage to avoid such dental problems...
My dentist always gave me the right medical/dental advice how to avoid any dental and even medical problems,
in fact, he taught me how to avoid any dental mishaps and he was quite pleased how well I managed to look after my teeth over the years...
As you can imagine, my husband and I followed our dentist wherever he moved anywhere in England,
even after he first semi-retired and we made sure to consult with him every six months about our teeth for almost 30 years without any problems.
It is wonderful and so good to come across medics like yourself and this very special dentist!