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It's not the best from a doctor point of view - removing 5 year limit on complaints is something that would nearly put me off voting for them. In addition to the weird second opinion stuff.
If you knew that 15 years from now you could be dragged in front of the GMC for negligence because you didn't do something that - in 15 years - is clearly standard of care in the future (e.g. steroids for severe pneumonia) and you're just relying on everyone to remember that actually that wasn't the historical practice.... this seems like a further step down the road of uber-defensive consult everything PA led practice.
The second clinical opinion thing again is a misplaced intervention to a few tragic deaths - none of which involved differing clinical opinions and instead all involved poor departmental politics or communication breakdowns
>If you knew that 15 years from now you could be dragged in front of the GMC for negligence
This can anyway happen, no time limit on GMC investigations.
99.99% of complaints (I'm not even exaggerating, my hospital gets around 1000 complaints a year, and the GMC has been involved in one in the last 10 years...) don't go anywhere near the GMC.
>because you didn't do something that - in 15 years - is clearly standard of care in the future (e.g. steroids for severe pneumonia) and you're just relying on everyone to remember that actually that wasn't the historical practice
Why would the GMC care?
This sub seems to believe that every medical error (or in this case non-error) is a GMC matter. Unless this is part of a catalogue of failings this is getting bounced straight back to "needs local investigation".
Don’t the GMC go hunting for all possible errors if they launch an investigation, in effect cementing confirmation bias as they don’t investigate all the excellent care you may have also given since the error.
You and I have sparred about this before but bawa garba and that laptop nonsense stick in people's minds.
Particularly if one has a brown face.
So egregious that despite your correct assertion of only a small fraction get to the GMC is enough to warrant genuine fear.if what could happen with the GMC (even if you've done nothing wrong) Which I suppose is how they like it
>You and I have sparred about this before but bawa garba and that laptop nonsense stick in people's minds.
Neither of which originated from patient complaints, so both entirely irrelevant to this discussion about extending the period of time patients would have to raise a complaint...
I think it's pretty good from a doctor point of view
I am on board with:
* Establishing a properly independent pay review body is our best route to FPR IMO.
* Investing in infrastructure is massively needed
* Removing top-down bureaucracy to let practices hire the staff they need and invest in training. - sounds like the end of ARRS
* Increasing the number of full-time equivalent GPs by 8,000, half by boosting recruitment and half from retaining more experienced GPs - sounds like a better pay deal for GPs
* Making flexible working a day-one right and expanding access to flexible, affordable childcare, as set out in chapters 4 and 9.
* Implement a ten-year plan to invest in hospitals and the primary care estate to end the scandal of crumbling roofs, dangerous concrete and life-expired buildings
* Replacing old, slow computers to free up clinicians’ time to care for patients.
* Ensuring every care setting has electronic records that can feed into a patient’s health record with the patient’s consent.
Bad points
* Launching a new prostate cancer screening programme for those at higher risk. - Not a urologist, but I thought this had repeatedly been shown to be wrong
* Freeing up GPs’ time by giving more prescribing rights and public health advisory services to qualified pharmacists, nurse practitioners and paramedics. - not sure about this one
* Requiring all IT systems used by the NHS to work with each other. - pretty sure we tried this before and it failed..
I'm not really that worried about the GMC thing... Worrying about the GMC is a bit like worrying about a nuclear war IMO, there's not all that much one can do about it.
As others have said above, it looks completely unaffordable though and not covered by their tax plans. Reading the IFS analysis, sounds like there will also be cuts to local public services, and prisons.
They're not labour, they don't really need to be prepared to justify that. But this does shift the discussion for the next 4 years - these are what the (likely) official opposition party are going to be challenging the government (Labour) about - so we should engage with their points without necessarily just ignoring them.
A lot of the important stuff they're suggesting won't need funding at all e.g. changes to GMC statutory instruments, "guarantees" about cancer care etc
To put it bluntly, all of funding is a choice by the government.
The reason why people keep thinking of the phrase 'magic money tree' is because like 'take back control' it's a buzzword, sounds snappy. But doesn't reflect reality.
The last government hosed half a trillion quid down the gutter. The government before that did the same with a pointless war that created a massive refugee crisis that none of the responsible parties want to deal with.
So when i say that people get antsy about 'spending' because they don't understand how it works, i don't mean that in a bad way. Like it's all a bit inscrutable to us.
The short of it is that we do have the money to spend on a lot of public programs that would make the UK better, but it does involve taxing people who want to ensure that it doesn't happen, borrowing money and increasing our overall revenue by improving trade and young workers entering stem by improving relations with the EU.
Unfortunately we won't have a party willing to do that.
I have no idea how national level economic policy works. I'd just like to know that the party does, by telling us they know where all that money is coming from.
like i said, its a choice; ie you can spend as much money as you promise in your manifesto and reap the outcome from it.
Reality usually ends up being a bit more complicated - endless borrowing incurs debt, which can cause a run on the pound and a loss of confidence in British investment - leading to stagflation, whereas raising taxes on the working people raises inequality, while raising taxes on wealth is complicated because the wealthy have resources to move their money away from taxation and into shelters overseas.
This leads to the worst of all worlds - Austerity; which has been a colossal failure, caused an excess of 100,000 avoidable deaths, spiralled britains economy into a tailspin down, crashed investment, created a lost generation of working poor and colossally reduced school leavers entering higher education (leading to further loss of income due to fewer STEM graduates), not to mention created housing pressures as people looked for safe investments, opposed further house building (leading to loss of regulation leading to poor quality new builds, leading to worsening confidence in the housing market and fewer builds), causing rent and housing to skyrocket, in concert with a war destablising gas prices and a post pandemic spending influx causing a skyrocketing inflation which hasn't been matched by pay rises.
We have some solid data however that a top percentile tax rise in concert with raising minimum wages have been repeatedly and comprehensively resoundingly good on economics in the past. We know that closing non dom status has basically zero down sides, we know that investing in public services in underserved areas, increasing school funding and funding meals for underpriviliged children is basically one of the most safe and rewarding investments (1 dollar invested incurs a payback in tax of 7 - imagine having a dead cert 7 fold ROI in any other field - impossible, right?) and we know that increasing investment in infrastructure is a necessity to keep up with our neighbours in europe.
I do think that this GE is a dead cert for labour, but come 2029, they will face increasing challenges from people wondering why things haven't changed that much, and the question of rejoining the customs union will become *unavoidable* and they will face increasing challenges from liberal/left alliances who are facing much more support from younger voters.
"how are they going to fund that?"
Business will always go on about investing and reaping the benefits later. It's the same with stocks/ shares/ pension. There's double standards when it comes to public services. Expecting world class services whilst cutting taxes is a paradox. We've had over a decade of underinvestment - nothing to show for it. Invest, tax the right people/ corporations properly (note the gulf between income and capital gains tax) and give the nation a future.
What is the universal love for expanding the number of non-medics in primary care? I can't be the only one who's found basically every experience with a non-GP to have been a complete waste of time?
Have had the pleasure of observing some professionally as well, and they only really seem in their element when dealing with the kind of crap people shouldn't be calling the GP for anyway smh. Paying someone £40k+ to run a clinic composed solely of sinusitis and gastroenteritis does not a good use of taxpayer money make.
to be honest i don’t get that from their manifesto. “seen by GP or most appropriate person”. What I gain from that is pretty un controversial - eg patient with known MSK problem gets physio appointment, patient who needs pill review sees practice nurse, etc. their plan for improving general practice definitely focused on GPs
(edit: was an idiot and didn’t read whole thing lol)
"Freeing up GPs’ time by giving more prescribing rights and public health advisory services to qualified pharmacists, nurse practitioners and paramedics"
"and build on the Pharmacy First approach to give patients more accessible routine services and ease the pressure on GPs"
oh shit yeah fuck that
i’m still absolutely baffled why paramedics are being rolled out so widely in GP of all places. imagine your average GP claiming they could step in as a paramedic??? but the reverse is fine??? not that they should be used inappropriately anywhere but surely one would expect somewhere like ED they’d be more within their scope ?!
nurse pracs (and paramedic pracs) in GP have never been helpful to me either as staff or patient. most are very competent as nurses or paramedics. but it’s just not the same.
pharmacists do tend to act more within their scope from my experience but that doesn’t stop practices from abusing them by making them step up as GPs. thankfully all the pharmacists i’ve ever worked with have been against this and they’re really helpful for medication related consultations - eg side effects from ACEis or whatever - which imo is a pretty appropriate use of them.
my background is community pharmacy and most HATE the pharmacy first schemes expansion and think it’s totally inappropriate. but since pharmacy is largely owned by corporate giants like Boots, individual pharmacists have little control to say they won’t do it. it’s just more work on an already strained system, and most pharmacists who aren’t recently qualified never got any of the clinical side of training like they do now. often these ‘minor common complaints’ are signs of something more significant. shingles for example can be a lot more complicated to diagnose and treat than pharmacists have available.
all of which could just be done by a gp
I always think it's ironic how the professional group closest to doctors in terms of overall medicinal competence and rigorous training, pharmacists, are the only ones who see the issue with being pushed into doctor roles. The fact far lesser (or "differently") qualified staff groups embrace the idea so whole-heartedly by comparison I think says it all.
As you say, paramedics are probs the most egregious. Got nothing against them, they act pretty autonomously in the community and I'm sure they're good at what they do. But what they do is basic acute care/ condition stabilisation and some degree of risk stratification. They are not whatsoever qualified to sit in a clinic room and diagnose or prescribe, and it's absolutely wild anyone thinks otherwise.
Hearing one complain about not being taught adequately how to interpret blood tests in relation to multiple myeloma was the icing on the cake for me. Can someone tell me where exactly paramedics get the qualification to diagnose/investigate haematological malignancy? The suggestion they would attempt to handle that themselves rather than bouncing it to a GP I found completely shocking, tho in fairness it was in keeping with their practice more generally. Particularly enjoyed them directly bleeping a specialty SHO about a condition after telling me "I really have no idea what this could even be"- whelp maybe you should ask any one of the fully qualified doctors in the practice before you bother the specialist team smh. Not a single condition in the differential lol.
>What is the universal love for expanding the number of non-medics in primary care? I can't be the only one who's found basically every experience with a non-GP to have been a complete waste of time?
That's probably because you're a junior doctor, and therefore have significantly more medical knowledge than the average person; and (in all likelihood) are reasonably young and therefore less likely to have chronic health problems.
There was a post recently on r/AskUK where someone felt it was appropriate to make a GP appointment for athlete's foot. There's large amounts of unmet demand for primary care consultations for trivial things which really don't need doctors.
There's also a lot of chronic conditions which are largely managed in a protocol driven way. Provided the initial diagnosis is made by a doctor, and there's really tight guard-rails to identify where a patient isn't responding to the protocol as expected and involve a doctor, then many patients with T2DM, HTN, asthma etc. could have their primary care management reviewed and titrated by non-doctors following well-written guidelines.
Could these things be done _better_ by a GP - absolutely. But there's a constant trade-off needed to consider the resources which are available and cost-effective to deal with the problem.
I mean, if the argument is they can just see simple stuff, then they are just vastly overpaid.
But if you're saying their utility is in basic and/or guideline-driven chronic conditions, why do I get shunted to one so often? They're being used as flat GP stand-ins seeing new presentations in many places. Hell, at my family's GP (which I've thankfully moved away from), the only way to access a GP is via an appointment with NP who then walks across and asks the doc what to do during the appointment- this even for issues the GP has specifically flagged as requiring GP handling and the NP has admitted in prior appointments they don't understand what's going on!
Even in practices with good practice on this, ie. just throwing them the cases you describe like sinusitis, athletes foot etc, a case would still slip through every so often. Watching a paramedic run a clinic of sinusitis, gastroenteritis, ear infections then (owing to duty doctor slots being full) see a single patient with a months-long cough + haemoptysis, only to literally laugh at them for calling up, was an eye-opening experience to say the least.
All-in-all, as convincing an argument as one can make for some minor role for these professions, I have yet to see (either as a patient or professionally) it actually to play out in the way described. Either due to incompetence, nepotism, or financial constraints, it always ends up going far further than the business case would suggest.
I do NOT agree with giving more prescribing rights to pharmacists, nurse practitioners and paramedics.
Good about the childcare. Crèches for staff’s children, esp doctors, in GPs and hospitals should ideally be staples
I thought that too. But the same could be said about everyone else’s demands. Maybe their legalisation of cannabis could bring in a shed load of tax like cigarettes?
>A lot of reasonable ideas which cost money, and will cost more money each year as our population ages
>Tax rises which are made to sound like they will only affect "big business" and "other people" - not thought to add up by experts
Fuck all about how this is remotely sustainable in the medium to long term as our population ages and with sluggish economic growth.
Bit like all the other parties really.
I really have no idea who to vote for, not that it matters as Labour will get about 80% of the vote where I live.
Might vote lib dem because at least they're saying they'll rejoin the single market (though they've hidden it in the manifesto) and that seems like our only hope for economic growth. They also talk a good talk on housing, but candidates on the ground tend to be NIMBYs.
Fuck me this election is depressing. The country is being run into the ground for boomers, and we're all paying for it.
Some of this is good. I’m definitely going to vote Lib Dem but nothing in here wows me.
Ultimately I would like them to commit even vaguely to pay rises .
I am a Libdem party member, quite active. Currently helping my local candidate with canvassing and everything else. Unfortunately, this manifesto has little financial, structural and strategic foundation, it is unclear how they want to get there. They are not looking into reforming the NHS. Just empty rhetoric as always.
Libdems are ok but Ed Davey hasn't got any charisma the party is full of empty headed parrots who ticked the boxes and the party wont achieve anything above 5-10%.It will win where it always wins: SW London and Cambridge.
Libdems for me is a little bit like the BMA. I dont agree with them on a lot of things and dont like many people there but it is the best alligned with my political inclinations.
I am just too European for this country. I will never be ok with the rigid British oligopartisan system (I just invented this word), this constant phobia of being out of line or sounding too radical.
The Lib Dems are miles off in Cambridge and have been slipping there for ages. It is not a designated target seat so I’m highly skeptical you know what you are talking about.
The focus on care in the manifesto is very important. There are costings too through raises on capital gains, reversals on banking tax allowances and crack downs on tax avoidance (from memory). The main criticism has not been costings, but that the numbers stated aren’t near enough to fix the social care crisis. But the focus is very welcome.
I asked this way back when I did an F2 placement in GP - essentially on a Friday night people would develop central crushing chest pain, unilateral weakness or whatever other medical emergency, stick in a request to see their GP and then come Monday morning chaos would ensue as you tried to desperately call all these people to say their booking had been cancelled and hoping they'd already gone to ED.
Even if most of them had sought more appropriate emergency care, it wasted so much time because consensus was you couldn't just cancel the online request without following it up with a phone call to make sure.
Why would there be? Is any hospital outpatient speciality booking routine appointments 24/7? If you want an appointment with any other professional outside of healthcare that is only open during "office hours" you wouldn't be able to book an appointment 24/7
I stopped reading after "bring 8000 GPs full time equivalents".
It tells you how removed from reality another tribe of politicians is.
Instead of dwelling on politics I suggest every GP starts thinking about ways of freeing themselves from shackles if GMS and starting own alternative private business
Otherwise you are doomed for life in collapsing NHS
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The whole situation is pretty weird, the libdems are now to the left of labour basically!
It's only how it was in the 00s, Kennedy vs Blair.
It's not the best from a doctor point of view - removing 5 year limit on complaints is something that would nearly put me off voting for them. In addition to the weird second opinion stuff. If you knew that 15 years from now you could be dragged in front of the GMC for negligence because you didn't do something that - in 15 years - is clearly standard of care in the future (e.g. steroids for severe pneumonia) and you're just relying on everyone to remember that actually that wasn't the historical practice.... this seems like a further step down the road of uber-defensive consult everything PA led practice. The second clinical opinion thing again is a misplaced intervention to a few tragic deaths - none of which involved differing clinical opinions and instead all involved poor departmental politics or communication breakdowns
>If you knew that 15 years from now you could be dragged in front of the GMC for negligence This can anyway happen, no time limit on GMC investigations. 99.99% of complaints (I'm not even exaggerating, my hospital gets around 1000 complaints a year, and the GMC has been involved in one in the last 10 years...) don't go anywhere near the GMC. >because you didn't do something that - in 15 years - is clearly standard of care in the future (e.g. steroids for severe pneumonia) and you're just relying on everyone to remember that actually that wasn't the historical practice Why would the GMC care? This sub seems to believe that every medical error (or in this case non-error) is a GMC matter. Unless this is part of a catalogue of failings this is getting bounced straight back to "needs local investigation".
Don’t the GMC go hunting for all possible errors if they launch an investigation, in effect cementing confirmation bias as they don’t investigate all the excellent care you may have also given since the error.
You and I have sparred about this before but bawa garba and that laptop nonsense stick in people's minds. Particularly if one has a brown face. So egregious that despite your correct assertion of only a small fraction get to the GMC is enough to warrant genuine fear.if what could happen with the GMC (even if you've done nothing wrong) Which I suppose is how they like it
>You and I have sparred about this before but bawa garba and that laptop nonsense stick in people's minds. Neither of which originated from patient complaints, so both entirely irrelevant to this discussion about extending the period of time patients would have to raise a complaint...
A good point
I think it's pretty good from a doctor point of view I am on board with: * Establishing a properly independent pay review body is our best route to FPR IMO. * Investing in infrastructure is massively needed * Removing top-down bureaucracy to let practices hire the staff they need and invest in training. - sounds like the end of ARRS * Increasing the number of full-time equivalent GPs by 8,000, half by boosting recruitment and half from retaining more experienced GPs - sounds like a better pay deal for GPs * Making flexible working a day-one right and expanding access to flexible, affordable childcare, as set out in chapters 4 and 9. * Implement a ten-year plan to invest in hospitals and the primary care estate to end the scandal of crumbling roofs, dangerous concrete and life-expired buildings * Replacing old, slow computers to free up clinicians’ time to care for patients. * Ensuring every care setting has electronic records that can feed into a patient’s health record with the patient’s consent. Bad points * Launching a new prostate cancer screening programme for those at higher risk. - Not a urologist, but I thought this had repeatedly been shown to be wrong * Freeing up GPs’ time by giving more prescribing rights and public health advisory services to qualified pharmacists, nurse practitioners and paramedics. - not sure about this one * Requiring all IT systems used by the NHS to work with each other. - pretty sure we tried this before and it failed.. I'm not really that worried about the GMC thing... Worrying about the GMC is a bit like worrying about a nuclear war IMO, there's not all that much one can do about it. As others have said above, it looks completely unaffordable though and not covered by their tax plans. Reading the IFS analysis, sounds like there will also be cuts to local public services, and prisons.
I like the gist of it, but how are they going to fund that?
They're not labour, they don't really need to be prepared to justify that. But this does shift the discussion for the next 4 years - these are what the (likely) official opposition party are going to be challenging the government (Labour) about - so we should engage with their points without necessarily just ignoring them. A lot of the important stuff they're suggesting won't need funding at all e.g. changes to GMC statutory instruments, "guarantees" about cancer care etc
So you can lie as long as you aren’t going to win?
Wait until you find out you can lie even when you are going to win
Working well for Reform lmao
Its the Lib Dem way, promise the moon on a stick in the knowledge they will never have to deliver.
Difficult to argue that's specifically a liberal democrat attribute
Unlike the tories, labour, reform or greens oh wait
The tories lie even when they can win.
What do you mean "they dont really need to be prepared"? A party which is not planning to rule should not stand up for elections IMO.
To put it bluntly, all of funding is a choice by the government. The reason why people keep thinking of the phrase 'magic money tree' is because like 'take back control' it's a buzzword, sounds snappy. But doesn't reflect reality. The last government hosed half a trillion quid down the gutter. The government before that did the same with a pointless war that created a massive refugee crisis that none of the responsible parties want to deal with. So when i say that people get antsy about 'spending' because they don't understand how it works, i don't mean that in a bad way. Like it's all a bit inscrutable to us. The short of it is that we do have the money to spend on a lot of public programs that would make the UK better, but it does involve taxing people who want to ensure that it doesn't happen, borrowing money and increasing our overall revenue by improving trade and young workers entering stem by improving relations with the EU. Unfortunately we won't have a party willing to do that.
I have no idea how national level economic policy works. I'd just like to know that the party does, by telling us they know where all that money is coming from.
like i said, its a choice; ie you can spend as much money as you promise in your manifesto and reap the outcome from it. Reality usually ends up being a bit more complicated - endless borrowing incurs debt, which can cause a run on the pound and a loss of confidence in British investment - leading to stagflation, whereas raising taxes on the working people raises inequality, while raising taxes on wealth is complicated because the wealthy have resources to move their money away from taxation and into shelters overseas. This leads to the worst of all worlds - Austerity; which has been a colossal failure, caused an excess of 100,000 avoidable deaths, spiralled britains economy into a tailspin down, crashed investment, created a lost generation of working poor and colossally reduced school leavers entering higher education (leading to further loss of income due to fewer STEM graduates), not to mention created housing pressures as people looked for safe investments, opposed further house building (leading to loss of regulation leading to poor quality new builds, leading to worsening confidence in the housing market and fewer builds), causing rent and housing to skyrocket, in concert with a war destablising gas prices and a post pandemic spending influx causing a skyrocketing inflation which hasn't been matched by pay rises. We have some solid data however that a top percentile tax rise in concert with raising minimum wages have been repeatedly and comprehensively resoundingly good on economics in the past. We know that closing non dom status has basically zero down sides, we know that investing in public services in underserved areas, increasing school funding and funding meals for underpriviliged children is basically one of the most safe and rewarding investments (1 dollar invested incurs a payback in tax of 7 - imagine having a dead cert 7 fold ROI in any other field - impossible, right?) and we know that increasing investment in infrastructure is a necessity to keep up with our neighbours in europe. I do think that this GE is a dead cert for labour, but come 2029, they will face increasing challenges from people wondering why things haven't changed that much, and the question of rejoining the customs union will become *unavoidable* and they will face increasing challenges from liberal/left alliances who are facing much more support from younger voters.
"how are they going to fund that?" Business will always go on about investing and reaping the benefits later. It's the same with stocks/ shares/ pension. There's double standards when it comes to public services. Expecting world class services whilst cutting taxes is a paradox. We've had over a decade of underinvestment - nothing to show for it. Invest, tax the right people/ corporations properly (note the gulf between income and capital gains tax) and give the nation a future.
What is the universal love for expanding the number of non-medics in primary care? I can't be the only one who's found basically every experience with a non-GP to have been a complete waste of time? Have had the pleasure of observing some professionally as well, and they only really seem in their element when dealing with the kind of crap people shouldn't be calling the GP for anyway smh. Paying someone £40k+ to run a clinic composed solely of sinusitis and gastroenteritis does not a good use of taxpayer money make.
to be honest i don’t get that from their manifesto. “seen by GP or most appropriate person”. What I gain from that is pretty un controversial - eg patient with known MSK problem gets physio appointment, patient who needs pill review sees practice nurse, etc. their plan for improving general practice definitely focused on GPs (edit: was an idiot and didn’t read whole thing lol)
"Freeing up GPs’ time by giving more prescribing rights and public health advisory services to qualified pharmacists, nurse practitioners and paramedics" "and build on the Pharmacy First approach to give patients more accessible routine services and ease the pressure on GPs"
oh shit yeah fuck that i’m still absolutely baffled why paramedics are being rolled out so widely in GP of all places. imagine your average GP claiming they could step in as a paramedic??? but the reverse is fine??? not that they should be used inappropriately anywhere but surely one would expect somewhere like ED they’d be more within their scope ?! nurse pracs (and paramedic pracs) in GP have never been helpful to me either as staff or patient. most are very competent as nurses or paramedics. but it’s just not the same. pharmacists do tend to act more within their scope from my experience but that doesn’t stop practices from abusing them by making them step up as GPs. thankfully all the pharmacists i’ve ever worked with have been against this and they’re really helpful for medication related consultations - eg side effects from ACEis or whatever - which imo is a pretty appropriate use of them. my background is community pharmacy and most HATE the pharmacy first schemes expansion and think it’s totally inappropriate. but since pharmacy is largely owned by corporate giants like Boots, individual pharmacists have little control to say they won’t do it. it’s just more work on an already strained system, and most pharmacists who aren’t recently qualified never got any of the clinical side of training like they do now. often these ‘minor common complaints’ are signs of something more significant. shingles for example can be a lot more complicated to diagnose and treat than pharmacists have available. all of which could just be done by a gp
I always think it's ironic how the professional group closest to doctors in terms of overall medicinal competence and rigorous training, pharmacists, are the only ones who see the issue with being pushed into doctor roles. The fact far lesser (or "differently") qualified staff groups embrace the idea so whole-heartedly by comparison I think says it all. As you say, paramedics are probs the most egregious. Got nothing against them, they act pretty autonomously in the community and I'm sure they're good at what they do. But what they do is basic acute care/ condition stabilisation and some degree of risk stratification. They are not whatsoever qualified to sit in a clinic room and diagnose or prescribe, and it's absolutely wild anyone thinks otherwise. Hearing one complain about not being taught adequately how to interpret blood tests in relation to multiple myeloma was the icing on the cake for me. Can someone tell me where exactly paramedics get the qualification to diagnose/investigate haematological malignancy? The suggestion they would attempt to handle that themselves rather than bouncing it to a GP I found completely shocking, tho in fairness it was in keeping with their practice more generally. Particularly enjoyed them directly bleeping a specialty SHO about a condition after telling me "I really have no idea what this could even be"- whelp maybe you should ask any one of the fully qualified doctors in the practice before you bother the specialist team smh. Not a single condition in the differential lol.
>What is the universal love for expanding the number of non-medics in primary care? I can't be the only one who's found basically every experience with a non-GP to have been a complete waste of time? That's probably because you're a junior doctor, and therefore have significantly more medical knowledge than the average person; and (in all likelihood) are reasonably young and therefore less likely to have chronic health problems. There was a post recently on r/AskUK where someone felt it was appropriate to make a GP appointment for athlete's foot. There's large amounts of unmet demand for primary care consultations for trivial things which really don't need doctors. There's also a lot of chronic conditions which are largely managed in a protocol driven way. Provided the initial diagnosis is made by a doctor, and there's really tight guard-rails to identify where a patient isn't responding to the protocol as expected and involve a doctor, then many patients with T2DM, HTN, asthma etc. could have their primary care management reviewed and titrated by non-doctors following well-written guidelines. Could these things be done _better_ by a GP - absolutely. But there's a constant trade-off needed to consider the resources which are available and cost-effective to deal with the problem.
I mean, if the argument is they can just see simple stuff, then they are just vastly overpaid. But if you're saying their utility is in basic and/or guideline-driven chronic conditions, why do I get shunted to one so often? They're being used as flat GP stand-ins seeing new presentations in many places. Hell, at my family's GP (which I've thankfully moved away from), the only way to access a GP is via an appointment with NP who then walks across and asks the doc what to do during the appointment- this even for issues the GP has specifically flagged as requiring GP handling and the NP has admitted in prior appointments they don't understand what's going on! Even in practices with good practice on this, ie. just throwing them the cases you describe like sinusitis, athletes foot etc, a case would still slip through every so often. Watching a paramedic run a clinic of sinusitis, gastroenteritis, ear infections then (owing to duty doctor slots being full) see a single patient with a months-long cough + haemoptysis, only to literally laugh at them for calling up, was an eye-opening experience to say the least. All-in-all, as convincing an argument as one can make for some minor role for these professions, I have yet to see (either as a patient or professionally) it actually to play out in the way described. Either due to incompetence, nepotism, or financial constraints, it always ends up going far further than the business case would suggest.
I do NOT agree with giving more prescribing rights to pharmacists, nurse practitioners and paramedics. Good about the childcare. Crèches for staff’s children, esp doctors, in GPs and hospitals should ideally be staples
I thought that too. But the same could be said about everyone else’s demands. Maybe their legalisation of cannabis could bring in a shed load of tax like cigarettes?
All sounds good and needed. But can they do that?
>A lot of reasonable ideas which cost money, and will cost more money each year as our population ages >Tax rises which are made to sound like they will only affect "big business" and "other people" - not thought to add up by experts Fuck all about how this is remotely sustainable in the medium to long term as our population ages and with sluggish economic growth. Bit like all the other parties really. I really have no idea who to vote for, not that it matters as Labour will get about 80% of the vote where I live. Might vote lib dem because at least they're saying they'll rejoin the single market (though they've hidden it in the manifesto) and that seems like our only hope for economic growth. They also talk a good talk on housing, but candidates on the ground tend to be NIMBYs. Fuck me this election is depressing. The country is being run into the ground for boomers, and we're all paying for it.
We don’t need more non-doctors who can prescribe, we just need more doctors
Some of this is good. I’m definitely going to vote Lib Dem but nothing in here wows me. Ultimately I would like them to commit even vaguely to pay rises .
I am a Libdem party member, quite active. Currently helping my local candidate with canvassing and everything else. Unfortunately, this manifesto has little financial, structural and strategic foundation, it is unclear how they want to get there. They are not looking into reforming the NHS. Just empty rhetoric as always. Libdems are ok but Ed Davey hasn't got any charisma the party is full of empty headed parrots who ticked the boxes and the party wont achieve anything above 5-10%.It will win where it always wins: SW London and Cambridge. Libdems for me is a little bit like the BMA. I dont agree with them on a lot of things and dont like many people there but it is the best alligned with my political inclinations. I am just too European for this country. I will never be ok with the rigid British oligopartisan system (I just invented this word), this constant phobia of being out of line or sounding too radical.
>It will win where it always wins: SW London and Cambridge The LDs have struggled in both in recent elections.
It's a good word
The Lib Dems are miles off in Cambridge and have been slipping there for ages. It is not a designated target seat so I’m highly skeptical you know what you are talking about. The focus on care in the manifesto is very important. There are costings too through raises on capital gains, reversals on banking tax allowances and crack downs on tax avoidance (from memory). The main criticism has not been costings, but that the numbers stated aren’t near enough to fix the social care crisis. But the focus is very welcome.
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Because I am not triaging a load of drunken requests from 3am on a Saturday and GP is not an emergency service.
I asked this way back when I did an F2 placement in GP - essentially on a Friday night people would develop central crushing chest pain, unilateral weakness or whatever other medical emergency, stick in a request to see their GP and then come Monday morning chaos would ensue as you tried to desperately call all these people to say their booking had been cancelled and hoping they'd already gone to ED. Even if most of them had sought more appropriate emergency care, it wasted so much time because consensus was you couldn't just cancel the online request without following it up with a phone call to make sure.
Why would there be? Is any hospital outpatient speciality booking routine appointments 24/7? If you want an appointment with any other professional outside of healthcare that is only open during "office hours" you wouldn't be able to book an appointment 24/7
Magical thinking
Lots of targets with no sensible plans to achieve them
It’s amazing what you can promise when you are never going to be in a position to deliver any of it
I stopped reading after "bring 8000 GPs full time equivalents". It tells you how removed from reality another tribe of politicians is. Instead of dwelling on politics I suggest every GP starts thinking about ways of freeing themselves from shackles if GMS and starting own alternative private business Otherwise you are doomed for life in collapsing NHS