Nhs...

the bottom line its not the NHS that is the problem ...

its crap managers and a lack of funding…………………sounds familiar?

 

As health technologies become more refined and complicated, they inevitably get more expensive. If it exists and you need it, you're going to want it and expect it. That's only normal. But it implies ever increasing funding, especially with an aging population which need looking after longer as different bits of them wear out.

Your post does imply that managers are just sponging parasites who do nothing useful. There's bound to be some wastage, but no doubt most of them are trying to do their best, as they do in most companies or organisations.

 

But do they add to the bottom line ?

I think it is good that the NHS is losing it's sacred cow status.

 

Spoken like a true market economist! The NHS isn't a business, it's a service. Managers aren't meant to be "adding to the bottom line", they're meant to be ensuring the best quality service they can provide for the money they are given to play with.

 

I was using 'bottom line' in its wider sense, equally I could have said 'quality of outcome', which for the NHS is lower than most of the rest of Europe in key areas such as heart disease and cancer treatment.

 

I was working for a consultant and he told me the managers view of the nhs is that it would all run smoothly if it wasn't for the bloody patients.

 

job would be great without the public………...

 

It's too easy to get into arguments about individual words in this area. For instance, a GP practice provides a service, but it is a business too.

 

Indeed it is. A GP practice gets a certain amount of money per patient and what they don't spend on the patients they get to keep; it becomes profit. Yet another conflict of interest

 

I agree. Good point.

 

I don't see a huge problem with the basic concept that GPs are paid on the basis of the number of patients, and that they have to run their business without losing money. It's difficult to see how this could be changed, short of an even more communistic approach, whereby all the practices would have to be nationalised (no doubt that was considered when the NHS was set up). Perhaps there could be some mandate as to how much must be spent per patient (within the practice - I think referrals to hospital are cost-neutral to a practice, although I may be wrong), but yet more NHS admin would then be needed. I guess some complex system could be devised where each practice would have to return a proportion of its profits to HMG (but then all the GPs would have to have fixed salaries, so we're back to a form of nationalisation...).

We certainly need to have adequate competition between GP practices, in the sense that patients need to be able to switch to another practice reasonably easily if they feel that they will get a better service by doing so - just as one is free to choose between motor dealers/garages. But what troubles me more, when I think of GPs and potential "conflict of interest", is the frequent inclusion of a dispensary within a practice - clearly GPs have to take many things into account when writing prescriptions, but it seems unfortunate that for each one written and dispensed by the same practice, one can see a possible financial incentive.

 

But there is no getting away from it - they are businesses. They do not belong to the state.

Larger practices have "practice managers" who run the business, and pretty tough people they can be - I know, because I have crossed swords with one when the practice which did provide my local surgery (1/2 mile away) decided to close it (with the permission of the local NHS hierachy). I was not able to influence the decision.

Fortunately there is competition, so I was not left only with the option of going to their main surgery 4 miles away, but was free to switch to another practice 2 miles away. I'm not talking about having to tolerate a practice that does an inadequate job from a medical point of view, but the fact that I want to be able to choose a practice, as I can between Sainsburys or Tesco (both are perfectly acceptable) or indeed LIDL... I'll bet that the East German state provided reasonable healthcare, probably with no choice whatsoever (except for senior party members), but I'm glad I never had to live there.

 

Whether there is or is not competition between businesses is an entirely different issue from whether there is a conflict of interest within a business. Let us not confuse the two.

 

At the risk of harking back to the "good old days"….

When I was a kid, the GP in the village would come and visit me when I was sufficiently ill in bed. He'd come in the day - you didn't need an appointment weeks in advance. And if he wasn't on, there was another GP who was.

I assume this now sounds ludicrously quaint.

My great aunt, like her father, was a GP in Northumberland. She used to visit patients on horseback.

 

How can the NHS / GP service be a business FFS?

Are there shareholders? Are there Profit and Loss forecasts? Are patients 'Customers'? Does the NHS pay Corporation Tax? In fact, has it been incorporated? Is it VAT registered?..........or is it a Partnership (with whom?) or a Sole Proprietorship (Who??)

A Police Force (note Force, not Service) not far from me advertised nationally for a Business Development Manager - WTF for?

And Local Authorities and their effing Chief Executives and the 'Cabinet' etc.........Chief Executive my arse.....Jumped up Town Clerks is wot they are.......

 

My great aunt, like her father, had huge mutton shop sideburns and moustache...........

She was vet then?

Or you mean she was on horseback?