NHS England claims it will be all-digital within the decade NHS England has once again pledged to improve the state of digital services to benefit patients and staff in its Long Term Plan, with a fully digital secondary care and access to digital consultations promised by 2024. The 136-page document (PDF), published at midday on 7 January, aims to provide clarity on the government's …
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Oh dear, its bad enough joining up small systems but I can't even imagine the size or number of NHS's current systems that they would want to join up.
I hope when they do join everything the same issues can be factored in, i.e where it is almost impossible to replace one bit of software with something else without screwing everything up or requiring a stupid amount of money to do.
Oh dear, its bad enough joining up small systems but I can't even imagine the size or number of NHS's current systems that they would want to join up.
It's the quality of the systems the worries me. I'd love ajoined up digital NHS - we'd catch up to where other countries were 20 years ago, but how is this to be secured? Given the impact the last skiddie breach had, and that the NHS seem unable to work simple things like a mop & bucket to clean the visible filth from the wards, I have very little faith that my most personal data could and woul be secured.
Cleaning, oh cleaning, 40 plus years ago my then employer spent a small fortune investigating cleaning and 'wet scrubbing' in an effort to remove problems from technical areas. Recently a trip to an emergency room showed the floor in a hospital to be 'varnished' with the remains of past patients fluids. Clearly the mop and bucket regime was not doing what you might hope to control the situation. A cruise ship had tighter infection control protocols then many hospitals currently achieve. As for medical protocols, my wife is supposed to have three weeks of radiotherapy, one set up scan and then treatment. So far four visits have secured 3 'one time' set up scans but only two therapeutic treatments, very considerable pain and one pain only (torture session?) with a failure to treat at all. I suggest training is a major issue that needs parallel attention to ensure that the increasing amount of technology is correctly employed. That along with eliminating FAX machines, eliminating hand written prescriptions and instructions might be a wise move*. Hand written, poorly coded instructions take orders of magnitude more time to process than correctly prepared electronic instructions, yet some princely medical staff refuse to use the superior (to their manual time wasting ways) electronic systems. They are 'too busy' to save time for patients, back office staff and even themselves.
*It resulted in one female patient being given erectile dysfunction cream for an eye condition causing considerable pain and additional treatment needs, hence costs.
*It resulted in one female patient being given erectile dysfunction cream for an eye condition causing considerable pain and additional treatment needs, hence costs.
You know what they say about Doctors handwriting....
But I have to question what kind of 'no questions asked' chemists didn't question the prescription vs. any application instructions/customers gender.
Not necessarily digital would have prevented this had the confusion been over similar packaging and inattentive pharmacy staff.
Being able to video chat with a GP, instead of waiting a week plus for an appointment, and having to travel there. I'm sold! But, will it ever happen? That's the question.
PS. This could also save a lot of time for GPs and prevent many missed appointments if it's done properly.
Done properly , it would be a boon and a great cost saving to the NHS.... sadly the contract will goto crapita.
Oh and the video call with your doc sounds great.. but you'll still have to face the wait until he can call you.... at his time..... and then some bright spark decides to out source your GP to somewhere else because its cheaper.....
"Probably to India as that is much cheaper than importing those Indian GPs."
Was just thinking this...
Prepare for the inevitable calls: (In heavy Indian accent) "Hello, my name Kevin and i offer you tech support...I mean talk you about health concern from N H S..."
We already offer video consultations at our practice, in addition to 4 methods of electronically sending us message (emailing and other methods).
The problem is that there aren't enough GPs to offer face to face appointments, and more are leaving due to the political situation.
Being able to video chat with a GP, instead of waiting a week plus for an appointment, and having to travel there. I'm sold! But, will it ever happen? That's the question.
It is great (I use PushDoctor after the NHS couldn't get me an appointment for 2 weeks for a problem serious enough to need antibiotics) but it is also limited. There's a whole raft of things they can't do very well over video link, but for simple prescriptions it works well.
What would work even better, is if we stopped the elderly using the GPs as some sort of social club. I've lost count of the number of times some old giffer has been making their next appointment on the way out form their last, while announcing to their cronies in the waiting area that they'll see them next week. A small charge for GP appointments could reduce the frequency of this sort of thing.
"What would work even better, is if we stopped the elderly using the GPs as some sort of social club. I've lost count of the number of times some old giffer has been making their next appointment on the way out form their last, while announcing to their cronies in the waiting area that they'll see them next week. A small charge for GP appointments could reduce the frequency of this sort of thing."
I was, literally, shocked when I read that.
You seriously think this is the main problem affecting GPs?
I was, literally, shocked when I read that.
You seriously think this is the main problem affecting GPs?
Why, do you literally not like opinions different to your own?
The main problem affecting my access to GPs is that GPs want to work office hours, when I'm in the office. The next biggest issue is getting an appointment at any time of day. Blocking others by persistently shceduling appointments for ailments that clearly stem only from old age, and for which the doctor has repeatedly stated he can do nothing, is a problem.
The only problem my GP doesn't have is funding. They seem to have enough of that to pay everyone six figure salaries.
"The main problem affecting my access to GPs is that GPs want to work office hours,"
... modern GPs want a career and not a vocation. My father was a GP of the original NHS type which meant in his 2 partner country practice he was on call every other night and every other weekend covering an area up to 10-15 miles away. They had an ex-US army Jeep and then a Landrover to deal with getting to remote farms in winter weather (though even that wasn't also enough and at least once he ended up walking through snow drifts up a farm lane). And at that time surgeries were evenings from 4 or 5pm until the waiting room was empty.
As someone with a neighbour who's a GP - Yes. OAP use GPs as some sort ofsocialclub cum attention seeking.
Not all of them but enough to waste 50% of his time.
Any old person with a chronic condition needs to be seeign a speecialist.
A simple £20 apointment charge would solve this. It would also reduce demand for GPs by 50%, resulting in mass layoffs, which is why the BMA is so keen on 'free a tthe point of use' healthcare i.e. make work.
I am having a hard time just dumping the problem on the older generation. I get that lonliness is a big problem and that in a lot of cases seeing the GP is a way of actually seeing someone that, at least, is their job to care about you.
But this:
"A simple £20 apointment charge would solve this. It would also reduce demand for GPs by 50%, resulting in mass layoffs, which is why the BMA is so keen on 'free a tthe point of use' healthcare i.e. make work."
Is so cynical that I want to know if this is really the case, or an opinion, probably shared I guess, of a disgruntled GP who is under a heavy workload.
It would also keep people away who don't actually have £20 (or £2) available. This is what the NHS was created to stop. Before it, you had the choice of spending money you didn't have or seeing what happened next - like dying.
“No society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means.”
It would also keep people away who don't actually have £20 (or £2) available.
Ok, so offer a better system to prevent the elderly using the GP as a social club and let's discuss it, because what you have now is very much the case that people with nothing wrong with them other than loneliness are blocking those of us that are actually ill and do need to see a GP from doing so.
No healthcare system can pretend it is universal or effective when well people prevent a sick person seeing a doctor because they're bored.
Any old person with a chronic condition needs to be seeing a specialist.
Rubbish. Hospital appointments are in just as short supply as GP appointments. They need to see specialists occasionally, but for monitoring long-term problems the GP is best placed. Much will be done by a practice nurse, anyway. And good luck with monitoring bloods online!
You've got this the wrong way round. The GP practice (which is a private contractor, not a part of the NHS) gets paid per registered patient, not per appointment. They will only allow the giffer to make another appointment next week if it is actually needed. Once the giffer is coming regularly every week for his check-up, *of course* he is going to get friendly with the other patients.
They will only allow the giffer to make another appointment next week if it is actually needed.
Self evidently untrue as there is no cure for old age. Routinely making an appointment on your way out of your last one because you are bored is selfish to the point of criminality.
> The GP practice (which is a private contractor, not a part of the NHS) gets paid per registered patient, not per appointment.
This is one part that I'm a little surprised about - not that this has been the arrangement since the NHS was established, but that nothing has been done by successive governments to alter the arrangement, like set up NHS GP practices where the GP's are employees of the NHS - just like Junior doctors etc.
The only substantive reason (other than it being a change to established practice) I can see that this hasn't happened is because the current arrangement is cheaper...
All that can be done online is a history and visual examination [and the latter will be sub-optimal]. No palpation of the lump or tender area. No ophthalmoscopic exam of the eyes. No dip test of urine, and no blood tests - have to make another appt for that, probably at the hospital.
And it won't take less time for the GP who will get more info from the patient in 10 mins face-to-face than in an online consultation.
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The aim is to reduce the pressure on GPs, and increase the time they can spend on face-to-face appointments with people who do come to the clinic.
Ah, great.
GPs already have to bother with a multitude of EPR systems, various types of scanners, etc.
Adding more paper to a trashcan fire doesn't take it out.
What technology will they use for that ? Will it be secure, ie not like Skype that sends everything via MS servers (& thus to the NSA) ?
What platforms will they support: MS Windows PCs, Linux PC, Apple laptops, Android, iPhone, ... ? I doubt that they will do them all.
"went to see a doctor the other day, he was more interested in tapping away in the computer than dealing with me."
^THIS!^
I remember a time when a doctors best asset was their ability to listen to the patient.
I believe what we are seeing is that with the advancement of technology that allows medical facilities to become more streamlined that physicians are now seeing more patients in a single workday.
These medical professionals now have to document their interactions with their patients while the patient is still in the room so that the physician is ready for the next patient waiting in the assembly line.
Older physicians seem to have a harder time "multi-tasking" and do sometimes seem distracted, diverting their attention away from actual patient.
Sadly, it is these older physicians that probably had a higher success rate of diagnosing a patient due their ability to interact and listen to their patients.
Older physicians seem to have a harder time "multi-tasking" and do sometimes seem distracted, diverting their attention away from actual patient.
And there was I, thinking it was younglings who get distracted with their digital toys, diverting their attention from whatever it is that needs to be done.
On the whole there's a lot to be said for making sure stuff is recorded, whether in writing or otherwise.
My mother had a penicillin allergy but in her 80s she forgot. It didn't matter too much as her GP knew about it. But then the GP retired and it wasn't in her notes. Possibly a coincidence but she had a fatal stroke not long after being prescribed penicillin.
Entering stuff and checking on past history inevitably takes attention but it's essential if the GP isn't to have to carry everything in their head. Perhaps the answer is to make sure systems fit into the doctors' work as effectively and unobtrusively as possible.
He was probably taking notes while you told him your symptoms. That's what my GP does and I've never had a problem with him providing a good diagnosis. Would you rather he'd scribbled notes in a pad and then entered them on the computer later, causing a delay before seeing the next patient?
My surgery uses the Evergreen app, which is brilliant for when you go to see a consultant and they don't have your records to hand. Want blood results? Just show them in the app.
"he was more interested in tapping away in the computer than dealing with me"
As a cynic, he was probably tapping away in the computer to see if dealing with you would help him or the practice meet their (bonus) targets. (I have relatives who are GPs and as a result have had it explained how one of the major roles of the "practice manager" is to ensure that all bonuses etc are maximized - that's why when the Blair government rejigged the way GPs worked then they were a bit shocked to find that almost all the incentive targets were met meaning it all cost significantly more than they'd assumed)
As someone who has worked for over 30 years as a GP, let me say that telephone consultations only work for (at best) 50% of consultations. We tried it all.... search on-line for "Doctor First" to see how it might happen. Half of the consultations need an examination, so you lose time on the phone / Skype and then do the normal consultation. Being too available caused consultation figures to rocket ( hello doctor, I've got shampoo in my eyes, what can I do? ) and we lost an experienced GP for 6 months with stress.
Increasing litigation means that no doctor wants to take a risk, so the fail-safe is to examine patients to at least put yourself in a position to make a diagnosis which is defensible in court /coroner's court.
"Conversely do not use a defibrillator on a pc."
I once used a PC as a defib (well I passed the mains across my heart via both arms), luckily I was in my early 20s at the time and was able to shake it off. On the other hand I was in my early 20s and stupid enough to not treat electricity with due respect.
>Any recommendations for managing both?
Get the med degree then use the computing skills and contacts to get an IT related job in the medical supply industry (eg. Pharma). If you feel the need, get yourself a computing masters -although, given the work habits of junior doctors, you might find an MBA less stressful and more remunerative...
We work with the NHS Discovery project and currently have transformers for TPP, Cerner, Emis, and others to convert their records into FHIR format (which works well for tracking a single patient) then from there into different relational DBs for different subscribers. So far we've gone live with the Frailty API for calls to 111 in our client areas.
https://discoverydataservice.org/Content/Home.htm
If they just paid nurses a decent wage, made the environment in which they have to operate better, and made it so that GP surgeries couldn't make it as hard as they could to book appointments, everyone would be happy.
But no. Throw technology and money - which doesn't grow on trees for nurses but does for the DUP - at something that sounds good BUT WILL NEVER EVER HAPPEN because CRAPITA.
30k after a few years
£30k isn't enough to deal with bed ridden people, having to pull them up to change their bedding, or administer chemotherapy to people who are terminal, or to provide end of life care. Especially when you consider an MP gets £80k, 6 week holidays and can merrily fuck off for 3 weeks over Christmas while they country's in crisis.
But yeah, I'd love to live with you if you think £30k is enough for that.
well id love to be on 30k.
the MP example is obviously , well , we'd all like MP terms conditions and hoilidays. You forgot to mention the expenses scamming as well :)
Good description of what nurses do - accurate - I wouldnt want to do it.
But minimum wage staff in care homes and hospices haveto do that for half the money.
I lot of people work very hard for a lot less, and a lot of people work just as hard in different areas for 30k.
I've not had a huge amount of exposure to the NHS over the years, which i suppose is more luck than judgement, but when my Wife was pregnant with our son it really amazed me just how old fashioned the NHS was...
Anyone who's had a kid will remember the reams of paper, forms, booklets, you need to have with you at all times from about 7 months on. Why the hell this could not be done electronically is beyond me...it's not that hard, is it??
The "Red Book" is one of the things they are planning on replacing with online system. While it could be done online, given the amount of people who like to see the Red Book I'd imagine it will be tricky. In addition to pre and post natal care, we've used them to demonstrate up to date immunisations for Nurseries and Child Care, including at Kids Clubs abroad.
Hate to say it but for harassed parents and others, I think the Red Book is probably a very good and robust system.
"Hate to say it but for harassed parents and others, I think the Red Book is probably a very good and robust system."
Quite agree, and when our second son was born while I was working in the US we didn't get a "red book" ... but as my sister is a GP she was able to get one for us (though its actually green) - especially useful as he started his immunisations on the US timetable which is completely different to the UK so having a record of what he'd already had and when was vital!
What is also needed is a review of processes, as some are madness.
At my GP ‘surgery’ neither the doctor or nurses - that is fully qualified medical professionals - take blood samples and you have to book a separate appointment at the nearby hospital blood clinic with all it’s time and cost of parking.
Madness for 1min go take a blood sample they could send off in bulk for all patients needing it that day
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