Wouldn’t this joyously change things?

In Oz at the moment. One of the great things here is freedom of choice on GP’s.

Call your GP for an urgent appointment: Too busy to see you? Call another one or fire up the app and ask “Who around here has free appointments?”. The GP you see is the one that gets the money from Medicare, the one who was too busy misses out.

It’s funny how easy it can be to see a GP when they are incentivised to actually see patients

Now do the same with every specialist, every hospital, every penumbran service like MRIs etc and we’d have solved the system pretty much.

19 thoughts on “Wouldn’t this joyously change things?”

  1. My specialist does work like that – bulk selling his services to the NHS – but the GP is still the gatekeeper. The main reason I refused to let them sign my treatment off as “completed” as I would have to go all the way back to the start when my problem flared up again.

  2. Almost got that at the moment (ish).

    My GP is so busy/understaffed that at the moment you have to call up at 8am in the morning, wait 30 mins on hold, to then be told a GP from the extended access service will call you back at some point that day because the normal GPs are too busy.

    ‘Minor’ downsides are that if you phone too late they’ll tell you to try again just after lunch, and if you want to book ahead for whatever reason (commuting to work, child care responsibilities, not being allowed to take personal calls at work, illness making it hard to get up for 8, difficulty affording 30 min phone call etc they aren’t interested). Not sure if that is better or worse than the old online system of you could only get an appointment in 3 weeks

  3. NHS MRIs:

    Buy top end, gold plated machines for hospitals, then run the whole thing 9 to 5.

    In countries with more private competition, they sweat the machines. Run it 12-15 hours per day with multiple shifts. More variety of machines, so if a cheaper machine will do the job, you use that.

    Greed, for want of a better word… works.

  4. This system treats you – the person requiring the service – as a customer. For that reason alone, it’ll never be implemented by the NHS.

  5. @BoM4… then run the whole thing 9 to 5

    …for a goodish percentage of patients who don’t even bother to turn up. Last time I had an MRI I was seen and finished before my actual appointment time arrived because the two patients before me hadn’t shown.

    I can only assume that because they see the service as “free” and consider it valueless.

  6. BoM4

    “9-5 MRI”

    Tried to have that conversation with medic friends over 20 years ago (when 18 month MRI waiting lists). Realised just how institutionalised (broken) the mindset is. It needs Building Back Better ……

  7. Baron J
    Sometimes one is given NHS appointments one doesn’t ask for. I’ve had this, constantly receiving an appointment that I didn’t ask for or needed and cancelling, asking to be taken off of the list. In the end I realised that the only way to break the cycle was simply not to turn up and they cancelled me as a “punishment”.

    A few years ago I had to have treatment in Vienna. They gave me a list of around 20 MRI scanners that I could visit, the cost was regulated at 100 Reichsmarks. I found one 10 minutes limp away, phoned and was magnetised the next day. Insurance companies in Austria these days try to ration scans, because it got a bit out of hand with scans for the most minor stuff. It is usually an 8am-8pm service.

  8. Bloke in North Korea (Germany province)

    This is how it is done in North Korea (Germany Province) but so few doctors are now given the chits that allow them to bill “public” health insurers it’s getting increasingly hard to find any doctor, despite constantly increasing premiums.

    “In countries with more private competition, they sweat the machines. Run it 12-15 hours per day with multiple shifts.”

    I know at least one NHS hospital in England that did this, I worked there, and got multiple scans there at times that suited me (i.e. not slap bang in the middle of the work day), but it was >20 years ago. I think (hope at least) the days when MRs were bought from charitable proceeds purely for bragging rights are gone. Machines are also used for emergencies at night when you aren’t going to persuade many customers to come in.

    Here there’s no GP gatekeeping system for specialists (unless they work in a hospital rather than own practice because that’s different for some inexplicable reason), at least it isn’t mandatory. Got an X-problem, go find whichever local street has all the X-quacks, and ask at each reception until someone can fit you in today (and if they take the downtrodden publicly insured, of course, though you can often tell from the reception area…)

    It helps to be pushy, but sick people aren’t always up to being pushy.

    The waiting thing is never going to disappear, but there has to be a better way to fast-track the time-poor.

  9. Bloke in North Dorset


    NHS MRIs:

    Buy top end, gold plated machines for hospitals, then run the whole thing 9 to 5.

    About 15 years ago I had to have shock wave lithotripsy for kidney stones. Fortunately I could go private but the procedures (it took 6 visits) were carried out at Reading NHS hospital in the evenings, my latest appointment was 8pm, I don’t know if that was the last time. It was a way of getting the machine quicker.

    I was told, but haven’t verified, that Dorchester Hospital MRI scanner is also used by the private sector in the evenings.

  10. But if we implement such a system, or use the MRI machines efficiently as per another commenter, when are all the doctors and nurses going to find the time to make tick tock videos?

  11. @ Baron Jackfield
    … who don’t even bother to turn up because they have already died or recovered.
    Anecdata – a couple of years ago I tore (70-odd%) my “rectus femoris” and my physiotherapist, who is a sports injury specialist, told me to register it with the NHS in case I needed an operation, so I ‘phoned my GP’s surgery – earliest appointment available for *me* a week later, Dr swiftly decided to refer me to a specialist, first appointment was more than three weeks later; specialist wrote a snotty letter to my GP saying, in effect, “why send him to me – we cannot do anything for him” omitting the important word “now” since the damage *was* treatable at the time that I ‘phoned the surgery.
    The previous tear was healed because it was treated promptly (privately); this time after two-and-a-bit-years of gently increasing work and several £k of physiotherapy my rectus femoris is still barely 50% of its previous strength.
    My physio quit the NHS because he couldn’t stand watching them fail his patients time after time.
    My elder son has ordered me never to do the Long Jump again but the more important lesson I have learned is not to *rely on* the NHS, however much I think that the concept is desirable.

  12. Bloke in North Korea (Germany Province)

    I think the lesson of that is if the choice is between urgent but “elective” surgery and irreparable disability, get yourself carted off in an ambulance to
    A&E rather than talk to GP later. Of course it is always easy to be wise after the event.

    I wrote, and deleted (because too personal) a lengthy post on getting needed care. Tldr, find a surgery that takes students/trainees and volunteer to be seen by them. Insist on it
    You get the best of all worlds, with kid docs who haven’t yet had all the ideals and enthusiasm kicked out of them, and they will still ask a superior when not sure.

    Same if you end up in hospital. Become the ward darling by letting all student docs and nurses learn from you. Having 20 people look at your results beats having 1 person do it, no matter how high up the food chain the 1 is.

  13. In the NHS where reward is based on length of service and grade not merit, and staff are paid anyway irrespective of patient throughput, where budgets are fixed – there is no incentive to do more work for the same pay, or to treat more patients which deplete the budget more quickly.

  14. I phoned our local World-Renowned Teaching Hospital a few months back to discuss an appointment. The boy on the phone helpfully pointed out that I had a second appointment that week. That was the first I’d heard of it. How many missed appointments have never been reported to the patient?

  15. @BiNK(GP)
    Same if you end up in hospital. Become the ward darling by letting all student docs and nurses learn from you. Having 20 people look at your results beats having 1 person do it, no matter how high up the food chain the 1 is.

    Good tip. But if I ever (hope not!) need surgery, I’d rather be under the knife of someone who’s done the procedure scores of times than someone newly qualified.

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