Archive for January, 2018

Managing the Acutely Well.

Posted on January 31, 2018. Filed under: Apply topically, Journal from behind the desk... |

Patients grumble they can’t get an appointment, then they spend 5 minutes of their 10 minute appointment moaning how difficult it is to get an appointment, having rang up this morning and got an appointment. When they eventually tell me why they have come… some of them are actually ill, but a vast majority are acutely well.

If less well patients came to see me, there would be more readily available appointments.

The patients moan: “The NHS is in crisis” – because the Daily Mail told them it was.

The NHS is in crisis – it has been for as long as I have worked within it (not a reflection on me hopefully). Is it due to government under funding??? Well you could throw a few zillion pounds at it, and watch it get swallowed up quite happily, more funds would be good. However it is a case of; “look after the pennies and the pounds will look after themselves”… or at least; “look after the hundreds and the thousands will look after themselves”.

What’s my point?? Dross. I have sat in clinic today and seen several patients who really DID NOT have any sensible reason to be in my room. Someone who thought they were getting a cough . Someone who had a rash 3 days ago and it had now disappeared. Also around the holidays (Easter, Summer, Christmas or any other event, (the neighbours cousins cats wedding)) patients come in and say….”I wouldn’t normally have come for something so trivial, but I’m going away tomorrow!” The fact you are going away rarely changes my clinic decision making. Either you presently have something that needs treating or you don’t. I don’t have a crystal ball and there is no such thing as Santaclausacillin, despite my previous suggestion.

Back in 2014 it was estimated that a single 11.7 minute trip to the GP costs the NHS £45 and a 15 minute appointment with your nurse in a GP practice costs £13.​ (The 2013 Units Health and Social Care report): Now as a Nurse Practitioner I’m sure I’m somewhere between the two. So for every acutely well patient I’ve seen today the NHS has spent let’s say £30 on seeing someone who didn’t need to be seen. Multiple that by the amount of dross patients I’ve seen (and today that is about 20) that’s £600. Multiple that by the thousands of other clinicians seeing dross today and the cost is going to be pretty high. Multiple that by 5 days a week and we could surely afford to bail out a few struggling areas of the NHS.

So why do the acutely well keep on coming? Because they can. Because they live with the attitude that the NHS is free! They’ve already paid for it with there tax. They are “entitled”.

If only these people could see that “yes” they are entitled to use it if they need to, but it cost them (the tax payer) money that could be better spent on the acutely ill rather than wasted on the “just in case” visits.

If you add in the patients who come to get a”free” prescription, for a readily available over the counter drug, the price goes up more. One prescription from your GP costs £41.35 – which makes the whole “don’t want to pay for a 49p pack of paracetamol when I get “free” prescriptions” argument pretty lame. I just want to shout “It’s your NHS’s money your spending!”

Why can’t some patients just take responsibility for how they use their NHS?

If patients used the NHS when they NEEDED to, rather than felt they were entitled to and thought of it as an investment when they didn’t go for trivial nothingness, the NHS would be in a much safer place, with more money in reserve.

OK and relax.


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