The definition of naive

[Howyoudoin]

I've been quite fortunate in my life, in that most of the visits that i've had to make to a hospital were as a visitor rather than a patient.

However, just recently, i've had to have some tests done and yesterday I returned to the hospital to get the results. The doctor and I discussed two of the three test results but the third had not arrived, despite me being told it would be ready and taking time off work.

"So", said the Doctor, summing up, " we'll have to book another appointment for you to come in."

"Oh", said I, a bit surprised and disappointed. "OK, well I guess I could speak to work again and come in at the end of the week or the start of next week?"

"Ha ha", said the Doctor, "I'm afraid it doesn't work like that. We are one of the most efficient hospitals in the NHS but there is still at least two weeks waiting list. Have a word with one of the receptionists outside."

"OK . . . .", I thought, trying to process Christmas holidays and how many more 'half days' I am able to take. "Do you have any appointments at lunchtime?", I said.

"My afternoon shift starts at 1.30pm". "And after work?", said I. "My last appointment is at 4pm." "Ah, that's no good then. Anything in the morning?"

"My morning appointments are for my private patients."

Stunned silence that probably only lasted 5 seconds.

"And is there much of a waiting list if I went private?"

"I could see you tomorrow."

OK, thank you Doctor, I said, leaving the room and then spending longer (about 15 mins) with the receptionist outside trying to get an 'NHS' appointment to come back. Eventually . . . she returned from a back room. "Doctor X has a 2.30pm appointment available on Monday 9 December. Other than that we're into the New Year i'm afraid." "And that's it?". "That's it." Guess i'll have to book that then.

Conclusion

What a shocking waste of my time and the Doctor's/Other Patients' time. Why could they not contact me to say that they were still waiting for some test results to come back and that i'd need to rearrange the appointment?

And the whole seeing Private Patients in the morning and NHS in the afternoon left a nasty taste in my mouth. I've already paid for care haven't I?

But as said in the title of this thread, i'm naive about such matters and those unfortunate enough to know the system better have probably known the above for donkeys years.

HYD

[Lootman]

" the whole seeing Private Patients in the morning and NHS in the afternoon left a nasty taste in my mouth. I've already paid for care haven't I?"

I don't use the NHS much but twice in the last year or so I have visited my GP with an issue. On both occasions she suggested seeing a specialist and, on both occasions, I was told to see a NHS specialist would take between 8 and 12 weeks.

I asked about a private consultation instead and, in both cases, I could be seen that week.

The NHS is OK as a free gateway but in practice you're better off paying for quick specialist care. As with any system that is "free", demand greatly outstrips supply. It's a structural problem.

[scotia]

Regrettably there is a feedback loop in action here. If a patient is concerned at waiting (and I fully understand why) and decides to go private, then the NHS becomes a poorer choice. There are only a finite number of consultants, and going private doesn't increase their number or the average waiting time - it simply jumps you up the ladder, and de-facto drops NHS patients down the ladder. I'm not arguing against those who decide to jump up waiting lists - I suspect I would do it if I felt my health was at risk. Fortunately my NHS experiences with waiting times have, so far, been acceptable.

[Lootman]

There are only a finite number of consultants, and going private doesn't increase their number or the average waiting time - it simply jumps you up the ladder, and de-facto drops NHS patients down the ladder.

Not entirely. If you ask a NHS GP about the possibility of seeing a specialist privately then the GP can only advise on specialists that work at least partly within the NHS. In that sense, yes, in theory you are depriving another NHS patient of that slot. Although even then I suspect that the specialist has set hours for both private and NHS, so not really.

But there is also a pool of private-only specialists and your GP won't or can't mention them. By seeing one of those you are not depriving another NHS patient of anything.

[scotia]

But there is also a pool of private-only specialists and your GP won't or can't mention them. By seeing one of those you are not depriving another NHS patient of anything.

But if the private-only specialists had no private patients, would they starve, or would they offer their services to the NHS?

[Howyoudoin]

I haven't had enough time to investigate this properly since this occurred yesterday but it definitely makes me feel uneasy to think of a Doctor treating a certain set of 'clients' in a luxury room and all others in a poorly maintained room next door.

In my game this would raise all sorts of TCF and Conflicts of Interest issues but clearly it's par for the course in the NHS game.

HYD

[Lootman]

But there is also a pool of private-only specialists and your GP won't or can't mention them. By seeing one of those you are not depriving another NHS patient of anything.

But if the private-only specialists had no private patients, would they starve, or would they offer their services to the NHS?

They'd probably emigrate.

Not to turn this into a politics discussion, but I think part of the problem is that the private sector can't attain critical mass in the UK because the competition is free. And yet a vibrant private sector could relieve a lot of the load on the NHS. And would attract more UK students to study medicine and also more doctors from overseas.

If Labour implements free broadband for all you will see the same effect. The private providers won't be able to compete with "free" and then we will end up with a monopoly service that is straining to provide, and all the competition will vanish.

[Howyoudoin]

But there is also a pool of private-only specialists and your GP won't or can't mention them. By seeing one of those you are not depriving another NHS patient of anything.

But if the private-only specialists had no private patients, would they starve, or would they offer their services to the NHS?

They'd probably emigrate.

Not to turn this into a politics discussion, but I think part of the problem is that the private sector can't attain critical mass in the UK because the competition is free. And yet a vibrant private sector could relieve a lot of the load on the NHS. And would attract more UK students to study medicine and also more doctors from overseas.

If Labour implements free broadband for all you will see the same effect. The private providers won't be able to compete with "free" and then we will end up with a monopoly service that is straining to provide, and all the competition will vanish.

To use my own example if free broadband is only available at certain times of the day and the service is not as fast or reliable as the 'on all day' private provider, then the latter will find enough clients, to be sure.

HYD

[Alaric]

To use my own example if free broadband is only available at certain times of the day and the service is not as fast or reliable as the 'on all day' private provider, then the latter will find enough clients, to be sure.

You wonder about a "National Broadband service", were it ever to exist. It might be an easy target for government cutbacks. Restricted access for non-essential services perhaps, so you had to pay extra, possibly to the private sector, for streaming films. Actually the private sector does this now, in a manner of speaking. Netflix for example charges more for streaming at the highest definition.

[Watis]

I think we should abandon the pretence that the NHS is free. It's costing all of us taxpayers a considerable amount every year - we just don't know how much. If we knew the cost, we might be less happy to tolerate its inefficiencies.

And, as HYD suggests, a free broadband service would result in a poorer service with no clear path for the redress of any failings or opportunity to switch to another, better, provider. So, if my broadband stops working, will I be added to a waiting list of other users with broadband issues? No doubt that waiting list will have a 'target', such as: we aim to fix your problem within four weeks.

Watis

[zico]

I haven't had enough time to investigate this properly since this occurred yesterday but it definitely makes me feel uneasy to think of a Doctor treating a certain set of 'clients' in a luxury room and all others in a poorly maintained room next door.

Usually with this sort of thing, you'll be seeing exactly the same person in exactly the same room, but by going privately you see them the next day instead of waiting 6 weeks or longer. I'd guess the private consultant fee would be about £150, so depending on the potential urgency of the tests, it's probably worth seeing them privately. Your workplace may cover the costs of this, depending on your scheme.

To your more general point, the NHS can be (and often is) shockingly disorganised. I recently took my elderly (80+) father to have large moles removed from his head - the GP had seen them and booked him in for the appointment at a hospital 20 minutes drive away. The doctor at the hospital took one look at the moles and said she couldn't do them because he needed first to put ointment on them to soften them. She gave him a prescription to present to the hospital dispensary. They didn't have it in stock, said they didn't know when they'd have it, and they didn't have a number he could ring to check if it was in stock. They suggested he ask his own GP, so he did but the GP refused to prescribe the ointment, saying he needed to return to the hospital to get it.

[Howyoudoin]

I'd guess the private consultant fee would be about £150, so depending on the potential urgency of the tests, it's probably worth seeing them privately..

Consultancy fee, yes.

But the cost of surgery, if required?

£6,500.

HYD

[bungeejumper]

To your more general point, the NHS can be (and often is) shockingly disorganised.

In my experience, the private sector is hardly better....

Last year I had a minor cancer scare, insofar as these things are ever minor. (They're not, obviously.) The NHS found the problem, removed the offender immediately, and told me it would take eight to ten weeks before they could do the follow-up scans that would confirm whether or not they'd killed the beast. Not very surprisingly, I coughed up a couple of hundred quid to have a couple of much quicker scans done at a very highly-regarded local private hospital.

The private hospital screwed up just about everything in sight. They booked me an appointment on a bank holiday, and then had to phone me back to say that sorry, they'd have to cancel because nobody would be there. They conducted the first scan, but they told me they couldn't do the second scan because the NHS hospital had left a metal clip inside me. (Perfectly true, but the NHS uses titanium clips that don't mess up an MRI machine. You'd have thought the private squad would have known that, wouldn't you? Apparently not all private clinics use titanium, though.... )

And then, at long last, the results. Oh god, the nail-chewing wait for the results. After three bloody weeks, the private hospital still hadn't sent my NHS surgeon their findings. The reason, apparently, was either that they'd lost my record, or that the person who worked the fax machine was away. (Oh yes, hospitals are the biggest users of fax technology in the UK. May I ask exactly why?)

The news, when it came, was good, I'm glad to say. There was the smallest scintilla of doubt during a subsequent NHS scan, and they sent me straight up to the foremost specialist on my side of the country - the man who wrote many of the pathology textbooks, as it turned out. He was excellent, and pleasant, and he confirmed that all was well with me and that the beast was dead.

Score: NHS three (minus one). Private sector one, minus three.

BJ

[didds]

well I learned something yesterday....


Person S has a family GP in the town they grew up in

S then moved away to university - many uni courses these days are effectively for 7 months per calendar year (including several weeks break at xmas and easter). The other 5 months of the year S may well be back in the home town.

S cannot have a GP in the home town [HT] (where S may be for 7 months of the year) AND a GP in the uni town [UT} (where S may be 5 months of the year). S may ONLY have the ONE GP anyway.

S _can_ transfer from the HT to a UT GP, but then needs to transfer back again each time they move - which keeping things simple (ignoring vacations/breaks) is lets say once in each direction per academic year. However if there is any ongoing treatment eg mental health, that treatment cannot be transferred and once the HT GP is moved to UT GP (assuming UT and HT are not under the same NHS trust anyway presumably) the queue to access the non-GP treatment starts again.

The reality is then that if HT was Penzance and UT was Newcastle On Tyne, any follow up treatment/GP visits even would require a circa 500 mile and 8 hour trip to achieve. I appreciate this is an extreme, but it highlights a not totally impossible scenario.

Who knew? I do NOW!

didds

PS I can see that the 3 month/whatever wait to access services post GP move may be to prevent systemic abuse but at least in the case of students there are obvious checks that can be made to substantiate a case.

[sg31]

I understood that if you went private for a consultation all subsequent treatment for that problem had to be private. Does anyone know if this was ever the case and if so does it still apply.

I really don't know much about these things so could easily have misunderstood.

[bungeejumper]

S cannot have a GP in the home town [HT] (where S may be for 7 months of the year) AND a GP in the uni town [UT} (where S may be 5 months of the year). S may ONLY have the ONE GP anyway.

Things must have changed. When I was at university (late 60s/early 70s), the university had its own GPs/opticians/dentists, whose job it was to look after me when I was at college, but not when I was back at home. That seemed like a sensible set-up, since I was "ordinarily resident" in my home town, where my parents were paying the rates and so forth.

The same applied when I studied in Berlin. The German university's medics sewed up my wounds and fixed my broken teeth (seriously!!) on the clear understanding that this was happening in the strictly temporary context of my studenthood. It's not clear what would have happened if I'd been gravely crocked up by a dread disease or a major accident, especially since Britain wasn't in the EU at that time and I had no statutory rights to European benefits. But I'm pretty sure that they were insured to cover me.

BJ

[bungeejumper]

I understood that if you went private for a consultation all subsequent treatment for that problem had to be private. Does anyone know if this was ever the case and if so does it still apply.

Many years ago, I queue-jumped during a cholesterol investigation when my GP wrote me a private consultation note with an eminent specialist. For which I paid, obviously. Once I had his expert opinion, I was back to the NHS for treatment, which covered me from there on. Guess who my specialist at the NHS hospital turned out to be?

BJ

[Gaggsy]

I've had a few tests recently and definitely notice a disconnect between GP and hospital.

Similar to HYD and Zico's stories, I took time from work for an appointment with a specialist at the hospital who was extremely off-hand with me and moaned that he didn't have the results of the ultrasound test that I'd had done a few weeks previously. It was as if it was my fault and I was wasting his time. Rifling through his disorganised notes he then found the letter from my GP. He told me the ultrasound was too vague for this sort of thing and I'd have to come back for a CT scan. Now, surely he could have figured that out without calling me in to sit in front of him like a lemon and waste half a day of my time.

On the positive side, after the CT scan, they called my by phone and told me all was well and they were discharging me back to my GP. They could have done that with the first appointment.

I was also in for a gastroscopy recently. The sedative didn't work (canula not done properly in my opinion) and I couldn't finish the procedure. So I have to return again in 6 weeks time. In the meantime, the hospital prescribed some drugs that I have to take for the 6 week period, but only gave a prescription for 2 weeks which I picked up from the hospital dispensary. Go get the rest from your GP. So, another visit to the GP.
The hospital had prescribed, amongst other things, 300mg of ranitidine daily. My GP pointed out that this has been withdrawn and couldn't be obtained anymore. She had to call the hospital pharmacy to find out what was going on. We decided to ignore the ranitidine and just take the other stuff.

Honestly, it makes you wonder.

One turn for the better in recent years is the use of telephone appointments in certain circumstances. This certainly helps working people save time. I'm for it as long it's used appropriately.

[Watis]

I understood that if you went private for a consultation all subsequent treatment for that problem had to be private. Does anyone know if this was ever the case and if so does it still apply.

I really don't know much about these things so could easily have misunderstood.

This is similar to a friend's experience.

Their child had a hearing issue that would likely need grommets to fix.

They asked about going private and were told that, while they could have a private consultation to confirm the need for grommets, if they wanted to have the grommets fitted under the NHS, they would have to undergo a second consultation on the NHS!

What a waste of resources that duplication would have been!

Watis

[tjh290633]

I'd guess the private consultant fee would be about £150, so depending on the potential urgency of the tests, it's probably worth seeing them privately..

Consultancy fee, yes.

But the cost of surgery, if required?

£6,500.

HYD

My wife was told by our GP to contact a local private clinic, in order to have a facial mole removed. She booked a consultation and was surprised that removal of the mole was done there and then.

Total cost £250, plus the parking meter outside. They did a biopsy as a matter of course, the result being negative. We were there less than an hour, which included waiting for the local anaesthetic to take effect.

It can be done, and the NHS could work in a similar way.

TJH