MemberlistThe Library Index  FAQFAQ   SearchSearch   RegisterRegister   ProfileProfile   Log in to check your private messagesLog in to check your private messages   Log inLog in 
The Tom Sawyer Principle (Politics)
Reply to topic Goto page Previous  1, 2, 3 ... 34, 35, 36 ... 44, 45, 46  Next
View previous topic :: View next topic  
Wile E. Coyote


In: Arizona
View user's profile
Reply with quote

But of course folks don't want a better than receptionist service as there will still be errors, folks want the certainty of seeing a doctor. About 10% of folks, after ringing 111 and being told they don't need an emergency service, will logically go straight down the A and E, the vast majority of those will then wait to see a doctor 3 hours later, to be told they don't need an emergency service, but heyho it pays to be certain. And this will be reinforced by family/friends who will all conclude that Uncle Stephen could have had meningitus, and has indeed certainly done the only sane thing. Still it's back to the GP for the heat rash.
Send private message
Mick Harper
Site Admin

In: London
View user's profile
Reply with quote

Why do you always get (hypothetically) uncaring GP receptionists. The answer is you want to see a GP but the GP has more important things to do. You cannot get an appointment.

Are you saying GP’s select uncaring receptionists as screening devices? That would be interesting, if true. The doctors would be committing various criminal offences, if true. But it would explain why incompetent receptionists hang around with exceptional longevity. One has been driving me mad for thirty years. [And note I've never had the courage to say anything about it because she is the gatekeeper and the GP would say, "Really? Nobody else has complained."]

So you dial 111. These days they give a very caring service, which normally starts with a discussion of your symptons, and ends when they discover that it is likely not life threatening, with advice to call your doctor's surgery. When you explain that this is tried, they email the doctor's surgery for you, asking them to get back to you as you do need to be seen. But this doesn't happen as the Surgerys does trust the 111 service, folks on 111 are not medically trained, they are using computers to pathway out how you should be triaged. The computer says it's a GP referral. The customer, after getting sick (as well as being sick) of no call back, will attend A and E. Where they face a long wait, a few meds and an instruction to attend a GP surgery.

Yes but patients would soon get wise to this and change their behaviour.

You don't fancy that? Clearly not, the unhelpful receptionist won't think it's important.

This is not my experience generally. Incompetent people tend to refer upwards more rather than less than they should (to protect their backs), not use their own initiative. Plus, they refer upwards in the least efficient manner possible.

The problem is you want to see a doctor. In actual fact this doctor is not going to cure you at all, he is going to check, like the medically untrained 111 service did with a computer, that you are not seriously ill and but also give some relief for symptoms. The good news is that you are by now feeling better, the relief (that is a relief) is not required.

Isn’t this what most of health provision is for?

You have a good large national organisation that is locally not agile. Of course we all know this. It's just we can't solve the problem, we can't flexibly adapt. We can build a Nightingale hospital, but can't fill the beds.

If you say so. Not that I can make out what you are saying.

A GP surgery in 2015 on average had something like 7200 patients, it now has 9700 patients. Most GPs want to work less hours, so receptionists on average have many more balls to juggle

No, more receptionists will be appointed. Doctors are paid per patient.

so they will stress out more and will drop them more often.

Clearly not. Though the more people manning a given desk (in dysfunctional organisations) the more scope there is for inefficiency.

GPs certainly don't see themselves as the problem. They can't see more people. It can't be the NHS, so it must be the fault of the government or the patients.

I thought you said they were seeing more patients (9,700) than before (7,200). So they're right, it is the fault of the government in either (a) not providing more GP's or (b) reducing the absolute numbers of patients.

The funny thing is that we actually have things that are really quite good at triage, much much better than GP receptionists, and they don't offend anybody.......they are called computers pathways that the 111 folks use.

More on this, please.

But of course folks don't want a better than receptionist service as there will still be errors, folks want the certainty of seeing a doctor. About 10% of folks, after ringing 111 and being told they don't need an emergency service, will logically go straight down the A and E, the vast majority of those will then wait to see a doctor 3 hours later, to be told they don't need an emergency service, but heyho it pays to be certain. And this will be reinforced by family/friends who will all conclude that Uncle Stephen could have had meningitus, and has indeed certainly done the only sane thing. Still it's back to the GP for the heat rash.

You have identified one of the problems. We have systems that take care of the vast number of complaints but we don’t know how to deal with the dangerous cases hidden among them because they are unidentifiable without professional intervention. And you haven’t assisted with the solution to this.
Send private message
Mick Harper
Site Admin

In: London
View user's profile
Reply with quote

Youth. I think that may be the key. Not that receptionists are necessarily young but if they have been there an over-long time, they were once.

We can start with stereotypes since they can, to a point, be trusted. We have the flibbertigibbet and the lady bountiful, the young and the old. Which one is going to give us the runaround and which is going to 'care for us'? The clue is in the names. Notice that I have already excluded men, both old and young. Anyone ever seen a male receptionist in a doctor's surgery? Clearly, GP's believe in the stereotype -- or men do. But why would doctors prefer flibbertigibbets to lady bountifuls? This is contra-indicated because the whole operation is supposed be 'caring'. An NHS reception desk does not demand youth in the way that being the human interface at an ad agency would.

Let's assume doctors don't care one way or another and it is down to 'churn'. That is lady bountifuls retire or get dispatched by other forms of natural wastage whereas flibbertigibbets would be off at the first chance they got to front an ad agency. Unless they are incompetent in which case they will soon be back at another doctor's surgery (or manning the phone lines at utilities or dealing with the public at town halls).

Not bad. Rather distasteful, so that's another good sign since AE says distasteful conclusions are seldom arrived at. It doesn't make them true but even so...
Send private message
Mick Harper
Site Admin

In: London
View user's profile
Reply with quote

Let us consider it the other way round. We (the patients) cause them (receptionists) to become ornery. This is a well-known syndrome. I remember the husband of a friend of mine becoming a raving fascist after spending a couple of years as an immigration officer. (He's all right now.) We are, after all, terrible whingers when it comes to our own health.

This would be taken care of by internal processes in properly run organisations but that's one thing doctors' surgeries can never be. They are run by doctors who, whatever else they may be, are not by nature Organisation & Methods enthusiasts. They recognise this and appoint practice managers. And who are they? Promoted receptionists of course!
Send private message
Wile E. Coyote


In: Arizona
View user's profile
Reply with quote

I am starting to think that we need to do away with all GP surgeries, receptionists and GPs. They are really just primary triage centres, which we can now do better (quicker) using 111. These practices and buildings and technology are really from a bygone age. These folks are simply walling themselves into these dilapidated buildings with ancient technology.

Sorry, they most go. What we need is shiny local clinics with a few beds, where our younger doctors, who are both good all rounders but also have a specialism, are surrounded by modern technology. They are also mobile, if 111 says home vist off they go.

It's the end for the receptionist. If folks don't like their 111 traige, they can pay for a consultation with a local specialist. If they are seriously ill we refund.
Send private message
Mick Harper
Site Admin

In: London
View user's profile
Reply with quote

Germane to all this is yesterday's settlement of the health strikes. Whenever you hear the phrase "efficiency savings" you know everybody is saving face. Both sides have climbed down (in my judgement, more the unions than the government on this one, but it's a close run thing). Nor can Kirsty's earnest question, "Could a winter of thousands of lost appointments have been avoided?" be answered in the affirmative. You have to have strikes before you can have climb downs.

If they are identifiable, efficiency savings would already have been made. If you set out to identify new ones you will find that it is simply a question of getting present workers to do more and you will get a dusty answer in such a heavily unionised workplace as the NHS. No matter how Spanish the practices are, there will need to be strikes before reforms can be adopted (or resisted). Occasionally the solution is to make patients do more but that gets even dustier answers. They certainly will from me.

It could mean changes in structure and objectives but since nothing has altered since 1948, this can be discounted in the case of the NHS. Apart from the constant re-organisations that amount to ... er ... re-organisations. Can you imagine Tesco talking about 'efficiency savings'? No. What you will hear is "Tesco are shedding x thousand staff by natural wastage and redundancy payments as they re-assess etc etc." It's a completely standard procedure of properly functioning organisations.

Also beware of references to 'front line staff'. Like an army, there are very few front line people in a health service. Plus, they have found, in every army only a small percentage of front line troops ever engage the enemy. Ah, now, armies... there's a case in point.
Send private message
Mick Harper
Site Admin

In: London
View user's profile
Reply with quote

Wiley's strictures were certainly borne out by my subsequent adventures. To get through to the surgery one now has to listen to a long message urging you to go elsewhere, replete with lots of www's. If they were on our side, it would be 'Press One to hear alternatives'. But anyway after listening to this for a bit and queuing for a bit

"I was told to ring you for the results of my blood tests." Click, click, whirr, whirr.
"They all came back negative."
"Thanks. Bye."
"No, wait, the doctor wants to speak to you about one of them."
"OK."
"Ring any day at either 8 am or 1.30 pm to make an appointment." I suppose she could have done it there and then but anyway, this morning, after the message and the queue
"I'm ringing to arrange an appointment with the doctor to discuss the results of a blood test."
"Next Wednesday week, anytime between 8.30 and midday."

So it couldn't have been that serious.
Send private message
Mick Harper
Site Admin

In: London
View user's profile
Reply with quote

"The axing of the BBC Singers is a blatant act of vandalism" Newsnight

I should think so too, they've been going ninety-nine years. What's this country coming to when the BBC can go round abolishing something nobody's ever heard of? Its senses?
Send private message
Mick Harper
Site Admin

In: London
View user's profile
Reply with quote

India's Leader of the Opposition has had to forfeit his seat in parliament because he's been given a two-year sentence for saying nasty things about Narendra Modi. Rishi Sunak was asked whether he was considering the same tactic here. "Not bloody likely," he said. "Without Starmer Labour will win by a landslide."
Send private message
Mick Harper
Site Admin

In: London
View user's profile
Reply with quote

We do it so much better in the west. A sex worker, Ms Stormy Daniels, will be keeping Donald Trump out of the 2024 presidential election. Not for having sex with her, not for paying hush money because of having sex with her, but for not reporting it as a campaign contribution. Be in no doubt, I will not be voting for someone who is so slipshod with their paperwork.

I shall instead be voting for the 2024 liberal candidate. They are with one voice accusing Mr Trump of insurrection because, in a tweet, he urged his supporters to demonstrate in protest about the Stormy case. And quite right too because our Supreme Court laid down in Marbury vs Madison ex parte Daniels

"Thou shalt be guilty of the capital crime of seeking to overthrow the government of the United States if aiding and abetting the waving of placards outside any federal building in downtown Manhattan."
Send private message
Wile E. Coyote


In: Arizona
View user's profile
Reply with quote

I know she is attractive, but it would be cheaper to redecorate your flat in Downing Street, stick your head back, and look at the wallpaper, rather than pay Stormy rates. Mind you, the Audit Commision would still probably complain it wasn't value for money. No pleasing some people.
Send private message
Mick Harper
Site Admin

In: London
View user's profile
Reply with quote

I don't believe Ms Daniels' scale of charges has ever been made a matter of public record so perhaps you could give us your general experiences as to what constitutes 'cheap'. Apply a £1 to $1.20 exchange rate or as applicable.

We know all about the expense of decent wallpaper thanks to Peter Hall's efforts on behalf of Sandersens's so you can leave that.
Send private message
Mick Harper
Site Admin

In: London
View user's profile
Reply with quote

How can England's universities survive?
The government's laissez-faire approach has imperiled the whole system.
Time for a radical rethink.
Glen O'Hara Guardian

I was hopeful this heralded the end and universities could finally go the way of the monasteries into oblivion (or heritage) but it turned out what the Guardian means by radical is re-imposing the pre-George Osborne policy of restricting student numbers at top universities so non-top ones can keep their arts departments going.

Apparently, arts courses are so cheap to run that top universities -- with what amounts to an infinite supply of applicants -- have been expanding them exponentially. There was the prospect that half the cohort would be studying Eng Lit at Oxbridge colleges. I use the word 'studying' in its widest sense.

Mick Harper in THOBR wrote:
First-year English Literature students are too callow, maybe too cowed, to question why they should be required to study Beowulf but since it is the only bit of hard work the poor dears will undertake during undergraduate careers spent reading books and then discussing them (which the rest of us do without demanding a degree for it) they would do well not to make a fuss.
Send private message
Grant



View user's profile
Reply with quote

We keep being told there’s a shortage of workers in the UK, but no-one links the shortage with the three million people aged between 16 and 21 who are loafing
Send private message
Mick Harper
Site Admin

In: London
View user's profile
Reply with quote

I absolutely agree. And throw in their teachers and the support apparat with the three million. (If a large hole in the ground is not available.) I'm the last person in the world to advocate a worker ant society so I don't object to people staying out of the workforce as long as they can. What I do object to is the sheer pointlessness of what they actually achieve in those years.

We should demand informed consent for our loafers not bend our backs telling them it's essential if they want to get on in life.
Send private message
Display posts from previous:   
Reply to topic Goto page Previous  1, 2, 3 ... 34, 35, 36 ... 44, 45, 46  Next

Jump to:  
Page 35 of 46

MemberlistThe Library Index  FAQFAQ   SearchSearch   RegisterRegister   ProfileProfile   Log in to check your private messagesLog in to check your private messages   Log inLog in 


Powered by phpBB © 2001, 2005 phpBB Group