h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

I heard on BBC R2 this morning that some doctors ( presumably a group ) are thinking of charging £20 if they have to open their surgeries at weekends ,or in the evenings.

This is comparable to dentists who operate an 'on call' system to treat patients 'out of hours'. However in the case od dentists they need you to go to them because that is where the equipment is.

Why would GP's need to open the surgery? What is wrong with the old fashioned "home vist"?. Or is it an extension of the argument that locums or cover systems cannot treat you adequately without access to your NHS Computer Records.

And if that IS the case then why can't your GP get a decent laptop and wireles connection via his mobile so that he/she can consult at least your Practice Records from your bedside?

It sounds to me like too great a dependancy on the computer, or perhaps just a way of adding to their salary.

Novo

Perhaps they're just talking about extended surgery hours (beyond 'normal working hours') as opposed to emergency visits?

If they have to pay receptionists, nurses & pharmacists at a higher rate to be open weekends & evenings, then a charge does not seem unreasonable; £20 sounds a bit much.

There are awful stories of GPs refusing a home visit to people in dire circumstances - although I sometimes wonder why they didn't call an ambulance in some cases. It is much better use of their time if patients can get to the surgery, though & I bet there are plenty of calls for a home visit that aren't necessary.

My mum's a District Nurse with 25 years experience. One day in five, she is "On-Call". This means she works her normal 9 hour shift and then carries a pager. She can be called out at any point between 5pm and 9am the next day, and frequently is. She receives no extra payment for this and she earns just over £20k, a sight less than Doctors on a rumoured £100k.

I've been thinking about this today and I can't quite decide whether or not it's a good thing.

Doctors surgery's are more or less run during office hours, if you work during those hours and need to see the doctor, most people will need to time off work, be that a holiday, unpaid leave or a sickie (costing either the company you work for, or in some cases, yourself money). IF your doctor gave you the option to pay him/her to be seen out-of-hours you would not lose that day (or half days) pay.

On the other hand, why should you have to pay? Why can't there be a system at all doctors surgeries where they take time out (perhaps once a week) to do a late night surgery?

I suppose it would depend on what you need to see the doctor for and, if you had health insurance, would you be able to claim it back?

As a home-worker it doesn't really matter when my appointments are, but I can imagine when it would cost considerably more than £20 to take time off to get your warts removed.

OK, you've studied for 7 years (atleast). You've had all the fun of poking about the most unpleasant bits and bobs the human body has to offer. You start working for an unappreciative employing body who views you as a statistic. Heaven forfend you should ask for extra dough for extra work.

What kind of slackers are these doctors anyway? I can get a burger at 7:30pm why cant I get my bunions looked at then too? So what if they have families shouldnt a doctor care about saving my life or at the very least my poorly throat more than he cares about his own life?

And just because they are highly skilled and highly in demand worldwide do we have to pay them SOOOOO much more than we pay the people who flip burgers?

Those women doctors never look fashionable so why do they need Saturdays off? Its not like they go anywhere nice when they go shopping by the looks of things.




Honestly some people here make laugh. SWL you're mum took a job and she has her cross to bear I know what its like for a district nurse and I know the pay aint great for what they do and the skills they have but that is their problem not the doctors'. If you htink its unfair start a campaign but what's the point in just carping on about what other people get?



THe NHS is not an infinite resource. Ive helped care for two dying people and alongside charitites the NHS provided excellecnt support to my family in the home. What I came to understand was that some of those people who came out at 3am sometimes had got out of beds of their own, put that out of their mind and took care of the person in front of them who they did not know. Some of them would be driving back for a few minutes or hours of kip before the next call came.

Be happy that people come at all and if all you have to worry about right now is that some tweed and corduroy clad doctor is milking the system so he can upgrade his Benz then think yourself lucky that that's all you think about when you think of on call doctors.

one love

Blicky, historically I've agreed with you 99% of the time when arguing with SWL, but this time I have to say that a 20k pounnd salary for a nurse does seem criminal to me. I know US nurses make a good bit more than that - and that's with only 5-10 years experience.

Which is why I said the pay aint great. My other point was that it was'nt the doctors' fault. Which it isnt. Mentioning the two side by side gives the mpression that it might be and I just wanted to disagree with that sentiment.

I'm unsure. The amount they get and the work they have to do, I don't think we'd have any nurses at all without their decent motives.

Becoming a doctor requires a lot of skill and dedication*, and they have a difficult, responsible job once they get there. But they already get properly rewarded for that, nurses don't. Hmm. I think it the NHS had decided that evening sessions are important, then it should budget for them. If they're not important enough to be part of the budget, then scrap them. That's how it works, doesn't it?

I'm very unsure about making people pay for any NHS treatment. There's a reason its supposed to be free at point of service. If the government feels that some people can afford to pay a bit more for their treatment to fund this measure, then surely that should be done through a higher bracket income tax adjustment? Its better to be honest and hit people in the pocket just once for the amount you're intending to take.

So basically TS for the nurses and "c'mon the doctors" eh Blicky?

It used to be the case that District Nurses had to do one "on call" a month. But under re-organisation a few years back, this was changed to one every five days - along with a pay freeze.

At the same re-organisation, Drs moved to pool resources with group practices and effectively cut their working week and got a whacking pay rise as a further sweetener.

Given that most, (but not all) Drs work in group practices now, what's wrong with a shift system? Maybe one of them could come in to work a couple of hours later in the morning and stay on for a couple of hours extra at night? Hardly a radical proposal. In fact, why don't they join the 21st Century and operate a triple shift system and have a Dr available 24/7?

If anyone is being treated as a statistic in the NHS, it certainly ain't the GPs.

In fact Blicky, it's becoming more and more apparent that you just post "black" to my "white".

What section of society has the poorest health?
- The socially disadvantaged and the poor.

It follows that these are the people most likely to need a Doctor's attention at any time of the day or night, yet these are the very people you would like to see pay for the priviledge of receiving what their taxes have already paid for. These are the people likely to be working longer hours who will be more likely to be docked wages for any time off and who are least likely to have any health insurance. A double whammy then for the poor. They lose wages and have to pay fees. £20 for someone on minimum wage is around 12% of their take home pay, against 6% from someone on the national average of £24k.

And, BTW, your comment about nurses having their cross to bear could equally well be applied to Doctors.

if you need to see a doctor and your employer is funny about it you can either hang on to your job, or you can go to the doc in some cases.

And yep, I'm one who doesn't go to the doc unless I'm nearly dead on my feet mostly because of my employer's attitude.

If I have to lose half a day's pay or pay 20 quid? That's fine as long as 20 quid isn't your half day's pay... or more.

Frankly I think that doctors could be a little more flexible with their working hours. Here it's a complete nightmare if you need to see a doctor on Wednesday afternoon or Friday afternoon because they don't work then. (Where I work we have an out of hours practice, which is open outside of GP hours. We don't pay any extra for it and it is a fantastic service that I use mostly for sick Gruesomes)

Other people earning a lot less than 100k have to be a heck of a lot more flexible with their working hours, which causes havoc if they have childcare or other such things to organise. And although doctors are fantastic and, IMO, worth that money - the people who are operating call centres, working in banks, selling stuff etc etc are actually keeping an economy going to be able for society to afford those doctors. So a little bit more flexibility to keep us all well enough to line the capitalists pockets would be nice (after all, all our bosses can afford private healthcare)

"In fact Blicky, it's becoming more and more apparent that you just post "black" to my "white"."

That's hilarious! I've been thinking the same thing about you SWL. Weren't you just arguing *against* the first law of thermodyamics with me?

"So basically TS for the nurses and "c'mon the doctors" eh Blicky?

Far from it. No one else has drawn that conclusion from what I said why you have is beyond me.

"It used to be the case that District Nurses had to do one "on call" a month. But under re-organisation a few years back, this was changed to one every five days - along with a pay freeze.

Blah blah blah, what has this got to do in anything but a tenuous and tangental way to do with out of hours pay for doctors?

"At the same re-organisation, Drs moved to pool resources with group practices and effectively cut their working week and got a whacking pay rise as a further sweetener.

Ah, your almost making sense here...then you go and spoil it...

"Given that most, (but not all) Drs work in group practices now, what's wrong with a shift system? Maybe one of them could come in to work a couple of hours later in the morning and stay on for a couple of hours extra at night? Hardly a radical proposal. In fact, why don't they join the 21st Century and operate a triple shift system and have a Dr available 24/7?

There working practices and pay are in a huge way reliant on the scarcity of the service they provide. They can keep archaic practices because they are so talented and skilled. hwereas those whithout comparable skills have to be at their masters beck and call a lot more often. FYI information there are places where you can get doctored 24/7 they are called hospitals, big stone and concrete places and as it happens small brick built places called your home too.

Out of hours surgeries in local practices that's a different matter and what the doctors are saying is; "If you want us in their and away from our golf club/family more often you have to pay us more pounds".



"If anyone is being treated as a statistic in the NHS, it certainly ain't the GPs.

Oh look more aimless bleating. They are being treated as a diagnosing comodity by a government, who for the best reasons, want more coverage of this important service. Your personal gripe about nurses and thier treatment does not alter this fact one jot or tittle. Try to understand that if I kick you eght times and Arnie 80 times I would still have kicked you 8 times, do you see?



"In fact Blicky, it's becoming more and more apparent that you just post "black" to my "white".

No I tell you you're wrong when you're wrong, that this happens a lot regardless of what it suggests to you is actually just about you being wrong.



"What section of society has the poorest health?
- The socially disadvantaged and the poor.

Hey yyou got something right for a change, I'll go round giving you a pat on the back like this everytime you get something right if you'd like me to be that condescedning just ask, I'll do it for you!




"It follows that these are the people most likely to need a Doctor's attention at any time of the day or night, yet these are the very people you would like to see pay for the priviledge of receiving what their taxes have already paid for. These are the people likely to be working longer hours who will be more likely to be docked wages for any time off and who are least likely to have any health insurance. A double whammy then for the poor. They lose wages and have to pay fees. £20 for someone on minimum wage is around 12% of their take home pay, against 6% from someone on the national average of £24k."

Stop right there mister! Who said we already pay for the out of hours care that doctors are holding out on? We as the consumer and the governmnet as the negotiator did a deal for a certain level of cover. Now we want more. The doctors have replied with their pay demand for the extra service.

What you say seems to suggest that Ive exprssed a wish for those least able to afford it to pay a an individual top-up fee for out of hours appointments when I have said no such thing. This is a short thread you can easily cut and paste or link to the post where I said such a thing or just admit you're wrong.



"And, BTW, your comment about nurses having their cross to bear could equally well be applied to Doctors."

Two things right in one post. Roll out the barrels. Yes the doctors and the nurses situations while being linked are seperate with neither being entirely dependant on the other.

one love

Nobody is asking for extra service. Consumers are actually being offered a lesser service for which they are expected to pay.

Since the instigation of the NHS, GP's offered an out of hours home call service. I'm sure we all have stories of GP's arriving at 3 in the morning to deal with a patient.

However, this has been gradually eroded.

Firstly by bringing in NHS 24 - where a telephone operator decided if you were sick enough to be passed onto a nurse, who decided if you were sick enough for a Dr to be called.

Now, Doctors are saying they will charge for out of hours consultations - not at your bedside, but at their surgery. So, they are effectively charging for a lesser version of a service they always provided. Nothing whatsoever with getting extra dough for extra work.

The NHS was supposed to be free at point of delivery. This is an erosion of that principle and further, as I have explained previously, it will adversely affect those who can least afford it.

Are you seriously trying to make a case for people on six figure salaries to be paid more for doing less at the expense of the poor?

Look like it or not the doctors cut a deal.

They are being asked for services outside that deal. I think they should be paid for services outside that deal. The government has expressed that it wants more doctoring at more hours.

I have said consisitently people should be paid for the owrk they do. I have not said *who* should pay doctors for the extra work people would like them to do.

I think that if people want out of hours surgeries they should pay for them preferably through the NHS but if not then its peoples own money let them choose.

Its not easy to get to see a doctor but that's ife for you if it were impossible Id agree there is a pressing problem but we cant go throwing money at every single problem some people encounter.

There is a tremendous variance in the way GPs work.

For example I can get to see a doctor within 24 hours at my surgery - not always the doctor I'd like to see - but a doctor.

At other surgeries people are being asked to book 3 days in advance.

The governments attempts to set parameters around GP service have led to GPs (in some practices) moving their availability to the fartherest edges of the parameters, and so service is degraded. Other surgeries have taken on the spirit of what the government was trying to do.

I've been faced with a locum at 3:00 AM who didn't know my children, and who I couldn't understand, and ended up making a trip to the big concrete building. (Good job I did) Nowadays there is a centralised surgery available out of hours, where I can talk to a doctor over the phone - and if required I can go down and see them.

I'm afraid the service you get nowadays depends on your location.

That's true. Some surgeries do offer either an early start or an evening consultation but are closed part of the day. Many have some sort of weekend opening for emergency consultations.
In some areas it might be possible to change your doctor to one who does offer the sort of hours you want.
We shouldn't forget that GPs are also doing daytime house calls & specialist clinics.

As has been said, someone's got to pay for the service, somehow. Is it fairer to pay through taxes for a basic service & then cough up a bit more for tailoring it to your convenience, or should we all pay more via taxes to ensure convenience for everyone?

it's a toughie all right

I'd hardly say that an evening surgery once or twice a week was tailoring things to the convenience of the average working person whose hours don't allow visits during usual surgery times, though.

Gosh I remember the days when I used to get het up over this stuff.

I seem to remember this proposal which I read about was an idea one doctor had at a BMA conference which has got out of hand. I don't really think that there was much support - not even on the Doctors.net GPs' forum.

The idea isn't to charge for emergency care but to charge for 'non urgent' visits 'out of hours'. Eg if you can't get an asthma check up during the day you can get one out of hours.

Personanally I think it's a stupid idea, but anyway, that's all it was an idea, proposed by, well one or two members at a meeting, I don't think it was ever offical BMA policy.

Home visits incidently did have never ever been for non-urgent care. Oh and in the time it takes for one home visit you could see four patients in your surgery.

My GPs surgery is great - they start at 8.30 am and finish at 6.30 pm so the majority of people can work in an appointment. But it is down to the individual surgery when they choose to open, though I think there are some basic rules.

You can usually get seen the same day. Different surgerys have different systems, so I guess in a few years time as patient choice gets off the ground people will choose to be with a sugery with appointments that suit them.

Mind you I am now offically on the 'hospital medicine training programme' *stares at offer letter again' so I'm sure I will soon be GP bashing like the rest of you.

When some GP contracts were renegotiated in 2003 (to take effect in 2004) they agreed to provide surgery hours between 08.30 and 18.30 Monday to Friday but they also had the option to opt out of providing out-of-hours cover. The provision of out-of-hours cover now lies in the hands of the Primary Care Trusts (PCTs). Some GPs didn't opt out and still provide this cover but many, and I can't say that I blame them, did opt out.

It is also worth noting that GPs have always been 'private' as it were; in 1948, many agreed to contract their services to the new NHS but they were not directly employed by the NHS. This is still essentially the case. Think of it in this way; your PCT is responsible for providing accessible, free-at-the-point-of-access primary care. In order to provide this service, your PCT contracts various GPs to run surgeries that you can visit.

I'm not saying that the system works but it isn't that much different from how it has ever been- we just have more transparency these days.

Van