Whos failing?

1505helen said:

I have admit to only skimming this thread but you all seem to be making some excellent points.

My daughter was basically dismissed by the GP when she presented with classic type 1 symptoms and BG level of 22.5. If she'd been referred to the hospital at this point on Tuesday it would have saved the NHS the cost of a visit to the minor injuries unit, followed by appointment with the practice nurse who then sent us to A&E. She was then admitted as an emergency case with ketone levels of 3.1 spent the night and following day in hospital taking up a bed on a drip being closely monitored. The diabetic team we were referred to the next day were appalled. If she'd been referred on Tuesday it would have saved the NHS a fortune!

Will the GP be picking up the bill now she's under the care of the hospital? If so was this his motivation for sending her away on Tuesday with the advice to avoid sugar and make an appointment with the practice nurse (earliest appointment was 10 days later!) she would have been in a coma by then if she lived alone!

The hospital team were excellent gave her 3 sets of all the equipment and meds one to keep here one to keep at her dads and one to carry around! We are so lucky in that respect when I see others struggling to get hold of just one, I suspect the GP won't like the prescription I handed in yesterday which covered meds needles and 2types of strips for the monitor more money from his budget.

Can't fault the hospital but the GP? Can't post what I think of him as I'd probably be banned!

Phew! Well if anyone reads this rant to the end well done and thanks for keeping with me I just needed to get it off my chest! I suspect as Arnie would say 'I'll be back!'

Helen

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Well done for posting Helen, have seen your daughter recently online, I hope all is going well with her now :thumbup:

Its not a rant Helen,its all too fimiliar, my 2 1/2 grandaughter was on the critial list when finally diagnosed with Type 1 Diabetes, the stupid, stupid doctor in A & E sent her home with a suspected viral infection,even though my daughter told the A& E doctor that she went to her GP and said could my GD get an urine test because GD could be having diabetes symptoms, a simnple finger prick test would of found out what was going on, but the next night she was rushed to hospital and put in the High dependancy unit critically ill, fighting for her life with tubes coming out and an oxygen mask on her face, because her breathing was so bad..........one of the worse things in my life,I'll never forget it , can't post what I actually thinkofthisdctoctor,that would be two of us banned, yep, I needed to get that off my chest also.

Have a good weekend

All the best RRB

Patient goes to GP feeling tired, can't eat, headache. GP sends a blood test for anaemia. Mrs Yorks see that the patient is not anaemic but reads the notes and, on seeing that the patient has jst returned from a trip to India, tests for malaria. There it is, that little tell tale dot in a blood cell, a malarial parasite. Informs GP whose reaction is not, 'I should have thought of that, afterall, I wrote it down in the notes'. No, GP's reaction is ''Oh Goody, I've never had one of those before'.

Some GPs gather all the info and try and diagnose and then test to confirm the diagnosis. Others test for this and, if negative, test for that and, if negative test for something else. This can be an expensive approach, not to mention time consuming for the patient. They are the Charlie Brown motor parts fitters who keep swapping parts out until the thing works again. It's tick box healthcare. It is replacing diagnostic skill with a semi skilled process. It's one reason why so many pills are prescribed. Just hope they mask the problem.

Some may find this paper of interest:

Frequently Asked Questions on Paediatric Diabetes Best Practice Tariff
http://www.google.co.uk/url?sa=t&rct=j& ... 2k&cad=rja

In particular, the introduction:

Background
Standards of paediatric diabetes care vary quite widely across the UK. Compared with many
European countries, outcomes in the UK are poor - in the 2009-2010 National Paediatric Diabetes
Audit, less than 15% of children and young people achieved an HbA1C below 7.5%, compared
with over 50% of children in Germany in the same period. In 2010, only 10% of children and young
people (CYP) with diabetes in Germany had an HbA1C > 9.5%, compared with over 40% in the
UK.

An RCPCH survey in 2008 estimated that there were 23,000 CYP under 18 with diabetes in
England. This is an estimate as we do not, as yet, have any robust way of collecting this data and
relied on individual clinicians reporting how many patients they had in their clinic. It does, however,
mean that we have the fourth largest paediatric diabetes population in the world. It also means that
there is potentially an enormous burden on the NHS and the economy as a whole in the long-term,
dealing with the complications of this cohort of young people.

We simply do not approach things properly in this country. All too often, the attitude is complacent and the matter is dealt with in a routine manner as if it is trivial, or your own fault.

@Yorksman: "like giving surgeries incentives to have healthier patients who will cost less in the long run" is a polictical line. It's just spin and has nothing to do with the reality.

I can assure you, my words are not political at all. I have seen from the inside that giving surgeries incentives works. What I would argue and this goes back to the question, "Whos failing?", is that it is not just the NHS or indeed politicians. The patients fail too and because of this increase the spend. One of the aims of the incentives is make sure the surgeries are contacting people who miss clinics, as there are a large number of diabetics (other groups too) who do so, and to make sure they have done all they can in getting those people in for check ups etc. However, you can't help people who don't want to be helped. What you do end up doing, however, is picking up the tab when they have serious complications.

"like giving surgeries incentives to have healthier patients who will cost less in the long run" is exactly the sort of hyperbole a politician would come out with, or a hospital administrator, or manager or any other person who wishes to appear to have a controlling influence, plan or idea. It's just a mantra.

The NHS is not a single hierarchical structure where specific outcomes can be determined by individual decisions or group policies. It is an almalgamation of disparate and, often, self governing special interest groups, professional bodies, professional associations and councils, often quite separate from the employer, different tiers of local accountibility, different legal statuses, different constitutions, separate business associations and interests and trade unions. There is no single lever that can be pulled which will put the train on a different track. When one group pulls one lever, most of the others pull their own levers to compensate or to protect their own interest. That's how target driven cultures work. Giving a GP surgery an incentive is as you write, only one part of the picture. It is not a solution in itself. How to incentivise the entire NHS is something that has proven elusive. Squeezing budgets, internal markets, GP led services, patient choice and so on have all been tried and have all failed. Today's headlines about NHS fat cats typifies the empire building that is typical and which wastes so much money.

My wife works in a system designed by one of these managers which will only function if no memeber of staff is ever sick and no member of staff ever takes a holiday and, in the eventuality of either, the solution is 'sort it out yourselves'. For this wonderful system said manager got a £100,000 bonus, took 9 months sick leave and retired on a enhanced service pension. 17 fully qualified members of staff have since left and only 4 unqualified members of staff have been recruited to replace them. Current management has now to rely on using unqualified staff to work unsupervised and have invented a new management term, 'remote supervision', whatever that means. When people at one hospital refuse to sign off the work of those unqualified people in a remote hospital, they are simply threatened, 'if you don't, you can be replaced'.

Incentivising GP surgeries does nothing to sort out this sorry state of affairs.

I agree with the picture you've painted and this is the world we live in..........unfortunately!

No, incentivising GP surgeries cannot ever be expected to sort out all of the problems. If, however, and using diabetes as an example, it can prevent complications arising by having more people regularly checked (feet, eyes etc) then money can be saved.

Sadly I blame evolution and Leonard Cohen can say it better than me:

"Things are going to slide, slide in all directions
Won't be nothing
Nothing you can measure anymore
The blizzard, the blizzard of the world
has crossed the threshold
and it has overturned
the order of the soul "

It is the NHS.
I recieved some info on diabetes when i was diagnosed aged 5 and then nothing until i was 27!!!
At no point were the risks of prolongued high sugars spelled out to me. I spent my life trying to avoid low sugars as i thought it could lead to a coma.
I stayed on the diabetic ward at the QMC nottingham a couple of years ago following a stomach prob. I had to specifically demand to manage my own insulin (on a previous day i was put on an insulin drip and was left to hypo). I notified a nurse everytime i had a jab. But when i required an extra correction dose te nurse said i wasnt allowed as id already had my daily allowance of insulin!
What the hell!

Economics is about quarterly repayments and governments only last 5 years, so the powers that be will never look at the long term issues.
The drug companies make trillions every year from sick people. It is in there interest to keep us sick. Which is why we only have expensive treatments and no cures.

We live in a day and age where money is more important than lives and quality of life.

In spite of what you say about the NHS, try living in Spain.

My doctor has appointments from 8.30am but somedays doesn't turn up until after 10.00am. Last week my wife waited 2 and a half hours before she saw the doctor.

Money is short so I now have to pay a contribution towards my prescriptions that were free.

My doctor has a computer but every time I see her I have to tell her what medication I am on. Expence is not an issue, if I need medication I get it, irrespective of price.

I went to see her one day and she went into her briefcase (pre-computer days 2 years ago) and pulled out a piece of paper and told me it was time for me to have a blood test. I had it and my PSA was higher than it should have been (as well as my suger level). End result was prostate cancer which was cleared within 6 months. after 39 radiotherapy sessions.

How to get your blood sugar down - go on the Slimming World diet. It worked wonders for me.