NHS News

The following is something I have been thinking about for a while and decided it was time to put it on the blog. It’s not nearly as exciting as some of our other topics, but I think it’s relevant. So here goes:

I am very interested in what’s going on in the UK with their National Health Service for two reasons. I want to understand it better to be able to judge its role in “Doc Martin” and because I want to know how it compares to our health care in the US. I read the BBC News every day for many reasons and I’ve been collecting articles about the NHS. Before I lose track of all the articles, I wanted to post them and make some comments about them.

The way I propose to list these articles is not in chronological order, but in order of significance based on how their content affects health care and can be a reflection of what we see on DM.

The first article was published recently (Nov.) and refers to at risk GP surgeries. Ever since the “doctor’s friend” showed up in Portwenn, I’ve wondered how GPs are monitored. This article makes clear that there is a Care Quality Commission that is a watchdog that pays attention to how patients are treated. According to the article “the CQC look at whether surgeries are safe, effective, caring, responsive, and well-led.” Thus, Gavin Peters was properly looking into the GP in Portwenn following some complaints, and ME was performing all his duties correctly with the possible exception of the “caring” part. As they say in the article, “‘it is only when we inspect we can determine if a practice provides safe, high-quality and compassionate care,'” said CQC chief inspector of general practice Prof Steve Field.” Compassion is the question in ME’s surgery. It’s not clear if ME ever took that course Peters recommended. But it’s clear that caring and compassion are considered essential ingredients to good health care in UK. (Of course, I think we can all agree that those sentiments are important to good care here too. Not only do we prefer to be treated with compassion, but also there have been studies that demonstrate the value of compassionate care by doctors on the outcome of their treatment, e.g. http://www.psychologytoday.com/blog/the-joy-giving/201107/compassionate-medical-care-benefits-professionals-patients-students-and-3)

Another article notes a small number of GP practices have been getting complaints and the CQC has ranked all GP surgeries based on risk of providing poor care. And there has been an increase in complaints made about NHS care, according to this article. Then there is the concern that GPs may be missing diagnoses of lung cancer as a result of not having the proper tools. This article also blames patients for not seeking medical care in a timely fashion. I can imagine that how welcoming the GP is towards his/her patients would be a factor here. There is some tightrope line that must be walked between making sure patients who make appointments are the ones who have valid complaints and patients who need to be seen don’t neglect to come in. On the other hand, there is also a move to punish doctors more harshly for making mistakes, according to this article. In one case reported by the BBC, a doctor was sacked because of substandard care.

In a related article, there is a discussion of how many GPs will be retiring soon, leaving the remaining GPs to take care of more patients. In addition, there is a shortage of GPs entering the medical profession and this article mentions that the NHS needs to increase spending on training GPs and more GPs will need to be recruited. If ME decides to return to doing surgery, finding a new GP for Portwenn might not be so easy. Also, as an adjunct to the first article, the CQC may not have many options when it comes to demanding more compassion from Martin; they may just have to be content that he has so many of the other qualities.

Surgeons are not immune to oversight by the NHS and one article reports that they must publish their mortality rates or be sanctioned.

Not surprisingly, the NHS has some money problems and, according to this article increased funding is something that’s been requested. In October there was a strike by health care workers demanding more pay.

The systems of health care are quite different between the UK and US, yet UK is struggling with many of the same issues we have here in US. The show hasn’t done much with these problems, although I remember Pauline thinking she should get paid more because she was now a phlebotomist as well as a receptionist. Also, like the UK, the US is seeing a shortage of physicians and it’s a concern in terms of access to care, see this article for one. The other thing that we see in DM that is of interest is the procedure for registering with a GP in UK. The GP is usually associated with your postal code and the length of time you plan to be a resident in said location. The minimum stay is 3 months to qualify to register with a GP. New patients can be rejected if the GP is not accepting new patients. In US physicians may consider their practices full too and be unable to take on new patients, but there are no residency requirements. In DM there have been a few occasions when new patients have visited Dr. Ellingham to register, e.g. Julie, the Oakwoods, and it seems they have departed before being residents for 3 months. I’m not sure what actually would have happened with their registration.  All of the above provides some opportunity for a secondary storyline.

 

 

 

 

Originally posted 2014-12-13 13:02:47.

7 thoughts on “NHS News

  1. Santa Traugott

    NHS is having a lot of funding issues now, and some suspect that the Conservative government is privatizing it by stealth, which the Conservatives of course deny, as NHS, for all its faults, is still very popular.

    My daughter and her family have lived in England for 6 years now — she has had almost entirely positive experiences with NHS, with the exception of waiting quite a long time to see a specialist for one of her daughters.

    I have wondered if a plot twist or a way to end the series is the NHS consolidating Portwenn’s surgery with Wadebridge, or Delabole, and Martin having to leave — will Louisa go with him..? Yes, in the end, just as Rachel didn’t go off to England and returned to Ross, would be my bet.

  2. kjacobson@mindspring.com Post author

    Oh boy! Do I hear an echo? We could argue all day about whether private or public run health care is the best way to deliver the best service to the greatest number of people. I sure hope the Conservatives in UK have been paying attention to what’s been going on here. Also to economists and what they say about reducing public spending too much.

    Many public service jobs are done by people who are dedicated to the performance regardless of pay, but it’s a bit risky to count on that. In DM they’ve done a good job of balancing an excellent doctor who cares about his patients and doing the job right, living in a modest home, while driving a luxury car and dressing in nicely pressed dress shirts, suits and ties. The fact that some of his habits are self imposed and reflect his London origins complicates whether his life style is mostly due to his higher pay or his family/obsessive background. I think the general perspective of him is that he considers himself better than most others, either because of his knowledge or because of their ignorance (or both). They also see him as having more money and more autonomy over his schedule. We definitely see resentment among the villagers, but it’s sometimes hard to tell if it’s due to his attitude or his standard of living (or both).

  3. kjacobson@mindspring.com Post author

    Here’s another interesting tidbit: “In a clinical assessment that could have implications for the United States, Britain’s National Institute for Health and Care Excellence has concluded that it is safer for healthy women with uncomplicated pregnancies to give birth under the supervision of midwives than in a hospital maternity ward run by doctors. The reason: Doctors are much more likely than midwives to use interventions like forceps deliveries, spinal anesthesia and cesarean sections — procedures that carry risks of infection and surgical accidents.

    The guidance applies to healthy women who are considered at low risk for complications because they have had no previous complicated birth, they are expected to deliver a single baby at full term and their baby is presenting head first. These mothers and their babies fared better with midwives than with doctors in almost all settings, except for first-time mothers delivering at home.”

    This would obviously not have applied to Louisa, but it says something about the midwife movement and its new found support in UK.

  4. Linda D.

    Interesting comments on the NHS! We in Canada operate a bit differently.

    The Federal Government and Provincial Governments both fund health care but doctors and clinics are regulated mainly by the provinces in which they are located. Doctors are well “policed” by The College of Physicians and Surgeons.

    There is a lot of concern about rapidly rising health care costs though and this may result in individual doctors being audited in similar ways to Britain. We have universal health care in Canada and those who can, pay a fee while low income people do not. With the advent of many new tests, treatments and drugs, as well as the coming of age of “internet trained physicians” who insist on tests etc., the costs are on the rise. This puts pressure on the political coffers. Everyone wants more and larger hospitals, the latest and greatest diagnostic equipment, to recruit the best and brightest doctors, and to have a reduction in wait lists nursing home beds, and surgeries etc. But, the rub is that there are so many other demands on tax dollars that there is never enough to fill all needs. And, NO ONE EVER WANTS TO SEE TAXES RISE!

    Another concern is that young docs coming out don’t want to be family doctors, especially in rural Canada because demands on their time are often so great. There are communities who may not even1 general practicioner and if they have a hospital at all, it might be closed at times for lack of staff! The do have trained midwives in Canada and are training nurse practioners who can diagnose and prescribe medicines in certain cases. they can order x-rays and set bones too.

    Our doctors in clinics (surgeries), may indeed have some over-sight, but none that I am aware of. If someone reports misconduct or malpractice, the situation is rapidly dealt with by the College. Doctors can be suspended for periods of time,, lose privileges all together or receive fines. If the act is criminal, the matter comes before the courts.

    Sounds like many countries are having similar issues. Maybe we need to move to Norway where everyone pays 60% tax but where all health care, and higher education etc. is FREE!

  5. kjacobson@mindspring.com Post author

    It’s interesting to learn about how our different health care systems operate. In the US we definitely have committees in each state that deal with misconduct and complaints. There is a Medical Board that assesses complaints and recommends actions. What I’ve never been aware of is any group that regularly visits individual practices to determine whether the physician should be required to make any changes. I think everything happens here based on specific complaints received.

    Anyway, I do think we all have a lot of similar issues when it comes to medical care and nurse practitioners are taking on more and more of the routine duties of medical practice because there aren’t enough family practice doctors being trained and available for all the places they are needed.

    I saw a couple of other BBC articles that I wanted to mention. The first one is important because it speaks to delays in emergency treatment. It seems that there is a lot of monitoring and that would be a sign that they are concerned about the delivery of medical care. The second shows there is still quite a bit of unhappiness regarding pay.

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