What IS causing the NHS crisis?

A friend was supposed to get a call from a GP at 6 and they still haven't called. How can it take them longer than it did in the surgery when there's no physical interaction?

Why are ambulances still backed up (why can't they lay on something else for non emergency transport??)?

It doesn't seem like just one thing, it seems like everyone has given up at once.

Ambulances have been a mess for years. No idea if it is widespread, but I know a few people from EU countries that are paramedics so presumably that has an impact if they have buggered off home. 

As for GP surgeries, perhaps more people that couldn't originally be arsed to go in are now getting phone appointments? Also I assume vaccination has an impact on capacity? 

I'm sure it's somehow the fault of the ungrateful unwashed masses, if we were to ask the esteemed Chimp. 

It’s multi-factorial. I’m quite interested in how much or little other roffers with relevant experience agree or disagree with me. 
 

1) Demand is unsustainable. The NHS is expected to do more and more as treatments and understanding of disease improves. At the same time patients have higher expectations and less deference (not a bad thing). Remember that the treatment for a heart attack into the 1980s was bed rest! Now it’s stents within minutes. 
 

2) The medicalisation of everyday life. This is a bit like 1 but regarding everything becoming a medical matter. This ranges from “get checked out” to the huge amount of shit life syndrome and social issues that burden GP. Someone feeling down after a breakup now needs “mental health support” rather than their mates getting them laid. 
 

3) Clinical staff per capita are insufficient. Yes we have more doctors than in 1990 but they’re doing more for more people. The move to common part time work (the result of a majority female workforce) has meant the FTE numbers aren’t that great. 
 

4) Lack of support staff. During the cuts after 2010 lots of support jobs were lost. This means clinical staff are wasting their time on admin and other duties that a clerical level person should be doing. 
 

5) Change in attitude from medicine as a vocation to just a job. Your Dr is now anyone in a white coat (metaphorical) and on a shift. There’s no real continuity of care nor do people seem as invested in their community (especially GPs who used to be an integral part of communities especially in small towns). 

Oh I forgot. 

11 years of Tory underinvestment. Khunts.

honestly tho the neck of the op’s question

eighteen bloody months of “why are doctors being such utter fannies about this deadly global pandemic we’re all living though, why don’t they just ignore it and all the cancer patients can get back their appointments, it’s only old fatties that die anyway”

and then the nhs collapses and it’s all “why is the nhs so awful - do you think maybe they’re all doing tiktoks instead of working”

Oh, another thing, GPs repeatedly "forgetting" to attach photos and files to hospital referrals and the hospitals not chasing so the patient gets fook all unless they phone to chase. And even then it's back to square one.

I think, honestly, the personalities of new doctors is a big part of both problems.

I think, honestly, the personalities of new doctors is a big part of both problems.

heh @ the negging of chimp so he pays you more attention tbf

Yes I actually agree with Clergs. I’m forever disappointed with the doctor profession in this country. It seems to be full of woketard snowflakes who’s rather do ticktoxs demanding people be muzzled than crack on and do some work. I work 6 days a week (sometimes 7) and don’t see why more can’t do the same. 

I don't know enough about him to know if he's like this but the doctors I know refuse to work beyond their hours and are generally pretty incensed by any suggestion that they are performing a service that should be done with some basic respect.

Dunno what’s it got to do with Chimp TBH. He always seems pretty hard working to me. He’s also not an NHS-worshiper and wants to make some money from the job so I’ve got (some) respect for him. 

ah Crypto! I HARD agree with you on the medicalisation of emotions. Mental health bandwagon gotta roll. I blame Matt Haig

+1 Crypto @ 1952.

Particularly around points 1 and 2 that demand is unsustainable and the medicalisation of everyday life.

I'm sure it's somehow the fault of the ungrateful unwashed masses, if we were to ask the esteemed Chimp. 
 

Not at all.

The answer is pretty obvious - massive demand and years of underinvestment. It’s finally coming to a head.

It’s definitely the case that younger doctors have more of a “my working day is finished, I’m off home now” attitude than the older generations. I would say that has a lot to do with how shit the job is and how low morale is. Being a clinical junior doctor in the NHS is genuinely a frequently awful experience.

It is quite funny how many people are all 😮 at the realisation that yeah all that moaning NHS staff have been doing for the past however long might actually eventually result in consequences 

I do agree with Crypto’s 19:52. Not the woketard stuff though, that’s just red meat for the base.

What Crypto said plus immigration of course.  Six million EU citizens alone has an impact on NHS capacity. 

The Australian system for GPs is a million times better. GPs are paid by the govt per consultation and can choose to charge patients over and above the basic tariff. There are surgeries everywhere, a mix of those that are completely free and those where you pay a modest top up and I’ve never had to wait more than 2 hours for an appointment. 
 

the NHS needs to move away from everything being 100% free. 

Chimp at 21 25

older docs now - goodwill well truly empty now also

The answer is pretty obvious - massive demand and years of underinvestment. It’s finally coming to a head.

We were told there were 3m EU immigrants.  Turned out there were at least 6m.  No government can plan healthcare if they have no idea how many people are here.  The UK government of course has to take some of the blame for not keeping track of how many were coming and going, but this is difficult when you have free movement. 

the NHS needs to move away from everything being 100% free. 

This.  Free at the point of use doesn't work anymore.  As a more philosophical point, we have to stop treating the NHS as a sacred cow.  Politicians are too shit scared to suggest proper reform because of the idiotic quasi religious status of the NHS. 

None of which would have mattered if we had kept ahead of demand…oh…

None of which would have mattered if we had kept ahead of demand…oh…

How do you keep ahead of demand if you have no idea what demand is?

Should we just keep shovelling more and more money into the gaping yaw of the NHS indefinitely? 

Free at the point of use doesn't work anymore. As a more philosophical point, we have to stop treating the NHS as a sacred cow. 

Total dickhead. Literally a head shaped like a dick with ball chin. Be gone.

How do you keep ahead of demand if you have no idea what demand is?
 

Come on. You don’t need to know precisely how many immigrants there are to know what the demand on the NHS is. You can easily deduce the latter by looking at things like how many patients are turning up to hospital seeking treatment. It’s a different set of figures.

Come on. You don’t need to know precisely how many immigrants there are to know what the demand on the NHS is. You can easily deduce the latter by looking at things like how many patients are turning up to hospital seeking treatment. It’s a different set of figures.

Let me get this straight, you think that the fact that there were TWICE as many EU immigrants alone as we though there were did not complicate planning for NHS provision? 

"Precisely" is doing a lot of work in your post.  

Total dickhead. Literally a head shaped like a dick with ball chin.

You only have one ball?

You need to see a GP... good luck getting an appointment.

I personally don’t givvafvck about whether “we should just keep shovelling more and more money into the gaping yaw of the NHS indefinitely”. Do it or don’t, I don’t care. I’ll just keep turning up to work and doing my job, for which there will be demand whatever happens. The fate of the system is not my problem and the public will get what they voted for.

Let me get this straight, you think that the fact that there were TWICE as many EU immigrants alone as we though there were did not complicate planning for NHS provision? 
 

Let me get this straight. You think that the government has to know how many immigrants are present in the country to know how many people are arriving at hospitals and GP surgeries requiring treatment?

I think the existence of 3 MILLION more immigrants (at least) than we expected has a major impact on planning the provision of public services, yes.  You can pretend not to agree with this to "win" an argument on the internet if you like. 

You only have one ball?

You need to see a GP... good luck getting an appointment.

Your comebacks are so bad you must have more kids than Boris.

Anyway, it doesn’t matter at all to what I originally said which is that excess demand and underinvestment is the problem. You were the one who decided to bring up immigrants. I don’t know or care if it’s the fault of the immigrants.

Immigrants must have something to do with demand surely?

Keep deliberately missing the point if it makes you feel better though. 

“The point” seems to be that you badly want to talk about immigrants whereas I don’t share your enthusiasm.

Maybe immigrants were the cause or maybe it was poor planning for some other reason. Don’t care, doesn’t make a difference now.

No doubt that massive immigration has contributed to the excess demand although as chimp says it doesn’t matter now: Brexit has solved it and we are where we are with the population we now have. 

In GP, part of the problem is more work being pushed onto GPs by specialists, increasing understaffing, plus delays in hospital treatment meaning patients being managed with worsening conditions etc. Plus aging population. Mental health services completely swamped and GPs managing a lot of that too.

Demand is infinite. Plus (and this is my interpretation rather than from my GP spouse) there are on the one hand fairly seriously ill people whose conditions need managing, on the other those coming in with trivial complaints that should be solved via google (best shower gel for sensitive skin, how to manage a cold, minor scrapes etc) and I imagine there's a risk of being so frustrated and swamped with the latter that there's a risk of dismissing patients with concerns that need to be taken more seriously.

Free at the point of use doesn't work anymore.

jesus this is disappointing 

hope this isn’t the post-brexit worldview we’re heading toward (though fear it might be)

awful

What is so awful about people who can afford it being asked to e.g. pay a few quid to see a GP?

Why is everything so damned black and white on here.  "Free at the point of use doesn't work any more" does not imply that absolutely everything should be privatised or that nothing should be free unless you are being deliberately obtuse or trying to be as uncharitable as possible.

 

People should pay £5 deposit for appointments, which is retained if they miss it.

NHS should tell anyone with Type 2 diabetes that it's not really a medical condition, more a lifestyle choice, so we aren't treating it.

No doctor should be permitted to do any private work until they have done 40 hours per week on the NHS.

There, sorted it.

Certainly a good start SJH.  I think those who can afford it (e.g. most people who already have to pay for prescriptions) should just be charged a small amount £5-15 for an appointment.  We should also of course check that people are actually entitled to NHS treatment.

We also need to do something about alcohol abuse too which is an enormous drain on NHS resources.  Not sure what the answer is there though, but the amount of money wasted on alcoholics who aren't going to stop drinking must be huge.

Obviously sack anyone with "diversity" or "equality" in their job title too. 

Personally I'd just like to see an ID card system linked to residency/citizenship. No ID = no service.

 

Then they'd just stop in France. 

No doctor should be permitted to do any private work until they have done 40 hours per week on the NHS.
 

This is already the case.

You actually need to work 10% over the minimum contract for the NHS and THEN they’ll think about letting you do some private work. Don’t worry lads the NHS gets its pound of flesh. Consultants doing too much private practice is not the cause of the current problems.

Cheers NC. So how is it that you can wait x time to see the specialist on the NHS, but if you pay, you can see the same bloke pretty much immediately?

Because the private practice isn’t as busy as the NHS practice? You’re not in a massive queue when you see him privately.

an ID card system linked to residency/citizenship

Not sure why the reference to "citizenship" here means. There's no entitlement to free NHS treatment on the basis of British citizenship, although in practice many non-resident British citizens living in, for example, Dubai, treat the NHS as a back-up healthcare system. And NHS administrators will query the residence status of visible ethnic minority service users much more quickly than those who present as white British...

Most economic asylum seekers pass through France principally because of the NHS entitlement, that’s what I was getting at.

The fact that the French provide healthcare anyway is irrelevant - it’s the perception. We’re seen as lax, so people take the piss.

Genuinely puzzled at the fact that NHS doctor appt must be free but NHS dentist appt has a charge. If they can do it for dentists why not for doctors? Seems a fairly easy and affordable way to bring some cash in quickly. Only for initial appt (not follow up, specialist or hospital appointments) and only for those who pay for dental appointments (I.e. not children, pregnant women, those on benefits). Would this be outrageous?

The state of the NHS dental service (or rather lack of service most places) is exactly why moving away from free at the point of delivery is so dangerous. You end up with a really sh1t service being delivered for free with the better off paying for a top up to get a better service. The end result of that is the sh1t free service gets worse and worse because nobody with any influence gives a fvck about it. It's a bit like comprehensive schools in that respect...

When people talk about how much better health care provision is in other countries that have more of a blended offering/state insurance system what they generally mean is how much better health care is for middle class people. 

That said I do think anyone who isn't on benefits should be charged a modest deposit for appointments which they then lose if they no show. The flip side should be an equivalent payment from the GP surgery if your appointment is cancelled on short notice or there is a wait of more than (say) 45 minutes past your appointment time when you get there. 

Not sure the dentist model is brilliant - loads of poor to middle income people don’t ever go to the dentist for check ups because they are so expensive. 

Ditto for opticians. People don’t go unless it gets sufficiently bad that their life enjoyment is impaired. 

Apologies for banging on about this, but if a consultant sees you privately having done a full week's work, is there not an argument that:

1. He is now overworked or tired, and you don't want him poking things in you at that stage, or

2. He has more to give the NHS, so they should sweat that asset more, or

3. All this talk of overworked doctors in the NHS is bollocks because they do their lists and then step out and work in the goldmine anyway?

Problem is if you made consultants give up their private practice sideline quite a lot of really good ones would go entirely private/move abroad unless you paid them a lot more.  5 minutes on google suggests the top of the scale for an NHS consultant is about GBP110k a year. Reality is that is simply not enough for a highly skilled professional 'on top of their game' in London or the South East. Nothing like it. 

I hate to bang on about Dubai but a good mate of mine is an A&E consultant out here earning double that tax free (and he works in a government hospital). 

SJH, you are starting from the position that the NHS has an entitlement to all the useful labour of the consultant. This isn’t the case under the present contract.

As DDS says, private practice allows NHS consultants to make up for the pretty disappointing wage available in the public system.

Quite a lot of consultants don’t even do any private practice at all, either because their specialties aren’t suitable for it or they don’t live in the right area for it or they simply can’t be bothered with it.

Also PP isn’t always as well remunerated as it was. The insurers have really put the screws on it and rates haven’t kept up with the expenses of running a private practice. 
 

A full time NHS consultant contract is 40hrs. Lots of people are on well above that for the NHS simply because there is so much work to do and they aren’t doing private work. £100k for a highly skilled professional just isn’t enough. 

I’m by no means an expert on this. I hardly ever use my GP, but when I do, it seems totally unnecessary. For example 2 years ago asked for a prescription for some slightly stronger acne cream than you can get across the counter. Why did I need a GP to say I could have that? Then recently I wanted to have my private health insurer pay for me to have my ears syringed privately and they wanted a “GP referral” before they would agree to it. Why? That is just wasting my GP’s time they could spend treating somebody actually ill instead of somebody who just needs some minor predictable maintenance.

So that's not the solution then.....OK.

My gut instinct is that the NHS has expanded to treat all conceivable problems pretty much regardless of cost.or outcome. 

I appreciate that is a massive simplification of one part of a massively complicated puzzle, but the NHS is a giant maw requiring ever greater quantities of cash to try to settle its insatiable appetite. Even if we devoted the entire UK budget to it we wouldn't solve it, not least because we haven't locally trained enough staff.

But I do not understand why we don't now consider rationing treatments where the benefit or prognosis is unclear,  or permit conpayments if you want the latest and snazziest treatment.

And why is IVF free? There is no right to have a child,  and some people chose not to. The underlying infertility problem is usually not life threatening or.life limiting to the relevant parent. 

Sorry, getting a little ranty. I fear for the system, and it is an untouchable shibboleth that now cannot be treated objectively. 

We already ration treatments where the benefit or prognosis is unclear, the body that carries this out is called NICE and they make the news every so often due to disputes over whether they will or will not fund some hugely expensive drug for an emotive patient group. You are right though that probably in future the NHS will offer far fewer treatments in general - it will become a life/limb preservation service rather than a general provider of healthcare and people will have to go elsewhere for other healthcare needs. That will involve payment.

The concept that the NHS is a giant maw with an insatiable appetite doesn’t reflect anything in particular about the NHS but simply the fact that modern healthcare is a very expensive good. That is the case everywhere. It’s very visible in the UK because the state takes on almost all the cost.

Interesting just how many people feel able to make very dogmatic statements from a position of partial (or even total) ignorance.

I have two siblings (plus a brother-in-law) and my dad in general practice and a wife who's a hospital consultant, who, together with their doctor friends, often talk about what they think is going on.

All I can say with some confidence, having been privy to those conversations, is:

  • The whole thing is a complex system, which also interfaces with other complex systems (for example, social care, social services, the police, the court system, the benefits system) - stresses and strains in any part of that system, or in any interfacing system, have significant ripple effects.
  • Precisely where people place the blame seems to be significantly driven by their political views. And the interesting thing is, they're probably all right, to some extent (but not when they point to x, y or z as the only or main problem).
  • There are no simple fixes* and anyone who believes or pretends otherwise is either a fool or a fraud.  (*There may be some relatively simple ameliorations - but not systemic fixes.)
  • Yes, some more recent entrants to the medical professions seem less resilient than those with longer service, and yes, some (even many) doctors have, for a variety of reasons (but mostly getting kicked in various ways for many years), adopted much more of a work-to-rule approach, but...
  • ...doctors (and other medical professionals) should be a long way back in the blame queue for the current troubles, after politicians, managers and us, the users and abusers of the service.  Plus, of course, y'know, Covid and an ageing population, which, whilst they could perhaps be better handled, aren't really anyone's fault.

But NICE don't always get to do that, do they. Wasn't that  cancer fund specifically designed to run roughshod over NICE QALY assessments so people with cancer could live a few extra weeks, only delaying but not avoiding the inevitable?

God, I sound really callous now.

I think the relative increase in the cost of healthcare as compared to other goods is an example of Baumol’s cost disease.

But NICE don't always get to do that, do they. Wasn't that  cancer fund specifically designed to run roughshod over NICE QALY assessments so people with cancer could live a few extra weeks, only delaying but not avoiding the inevitable?
 

Essentially yes

In GP, part of the problem is more work being pushed onto GPs by specialists, increasing understaffing, plus delays in hospital treatment meaning patients being managed with worsening conditions etc. 

I find this interesting. 

My wife and her colleagues (specialists) would say that a lot of the problem is more work being pushed onto them (often via people inappropriately / desperately visiting A&E, but also often because of GPs not being able to effectively triage conditions which could be managed at GP-level). 

When they say this, they're not blaming the GPs (in our area there's an acute and well-acknowledged shortage of GPs, and the simple fvckwittery / impatience of the general public is probably a factor too) - just stating that the proportion of their workload which involves managing things which could and should be treated via primary care has increased significantly in recent years (and especially recent months).

It seems that perhaps one part of the problem is the wrong type of workload in the wrong place, with insufficient capacity in the system to get on top of that and reallocate / reorganise.

Thank you for your patience NC.

I am hoping that somebody will invent a Star Trek/Prometheus analyser that cures as it scans....solve a lot of problems.

Medicine probably has even worse productivity now than in prior times. Think of an amputation for example. 3 minutes max on a Napoleonic battlefield. How long do you slackers take nowadays, with your fancy infection control and anaesthetic bollox?

I think there should be a bit more rationing and support for GPs especially when trying to avoid admitting patients. During COVID many GPs tried to do care plans for their most frail patients who would be unlikely to benefit from hospitalisation. This was really sensible and everyone would benefit from it. However, the media then the government and regulators started to attack those GPs for “killing vulnerable people”. What incentive is there now for a GP to do anything but send the patient in? 
 

I’ve said before but it should be very difficult to get into hospital from a nursing home. Clearly there will be exceptions but most patients there are in the last 18 months or so of life - bringing them into hospital isn’t sensible. In the past a doubly incontinent dementia sufferer would have been allowed to die comfortably at their care home, with a GP who knew their case keeping them like that. Now they’re rushed into to A&E by ambulance and given drips and all sorts just to keep them going occupying a hospital bed for weeks as they deteriorate and the home refuses to have them back. 

Medicine probably has even worse productivity now than in prior times. Think of an amputation for example. 3 minutes max on a Napoleonic battlefield. How long do you slackers take nowadays, with your fancy infection control and anaesthetic bollox?
 

Heh! I think there is a lot to this. A few decades ago a surgical trainee would just start cracking on taking bits out from very early in training, while a very junior anaesthetist did the gassing. Bosses might not even be in the building. More procedures, more patients died, more acceptance of medical error. Medicolegally and culturally that is no longer possible.

In my experience, the hospitals are ruthless in throwing those people out with a cursory occupational health report which fails to acknowledge the double incontinence or need for lifting. 
In France, people love a pharmacist; our pharmacist is bloody brilliant and in every way more knowledgeable and helpful than the GPs. He should always be the first port of call and he would remove 80% of the pointless GO visits far more quickly but people object to having to pay for over the counter meds when they can get a free scrip for them. Removing all scrips for OTC medicines except foe the most needy would be a start. And more excellent pharmacists 

@Crypto (your 09.16 post) - rare that I get to say this about one of your posts, but I fully agree.  Them's harsh truths, but truths nonetheless.

Would I feel the same way if it was my dad in the nursing home / on the care plan?  Well, probably yes, the guy's a dick.  (Kidding. Mostly.)  But it is an emotive subject for those in the thick of it - doesn't make what you say any less true though.

Definitely what Crypto said about elderly patients in care homes. Unless their pain can't be managed adequately at the care home they should stay there in most cases. Particularly if they have advanced dementia.  

Totally agree Crypto. Acceptance of death and dying seems to have gone backwards - some families seem shocked to learn that their 80-90+ relative will die. I’m sure this wasn’t the case in years past.

When my grandmother had a massive stroke, she was semi comatose but responsive to stimuli, and actively refusing a naso gastric tube. The consultant took my mother and I in, and started blathering on about this and that. I rudely cut across him and said "is she now on the Liverpool  care pathway", and I think he was surprised that I knew about it, but also relieved that I was being pragmatic. Of course, that left me having to explain it to my poor old mum.

I'm all for consultants doing private work, but the portion of NHS work that you need to do before you can start seeing PP's cannot be terribly demanding. Mr Don does 12 patient sessions a week (FT Is 10, I believe) and that still leaves a weekday free for private work and occasionally a morning clinic on a Saturday. PP is booming since the NHS fell over, although anecdotally most patients are furious with their GP by the time they get to see an oncologist, whether private or NHS. Many more patients flogging the family silver/42 inch telly to be seen promptly. 

I suspect it is the loss of public confidence because of some pretty variable and occasionally diabolical standards of care at GP level that caused people to rail against the attempts to impose DNR's mentioned in Crypto's 09.16. If the GP who you can't even get to see or speak to suddenly wants to slap a DNR on your elderly relative, your first reaction is probably not to assume s/he has their best interests at heart. Something has gone very rotten in primary care. 

I’ve just been in a hospital pharmacy and had to tell three different people I needed to pay and i hadn’t been charged for my prescription. 
 

I wonder how many people just declare they don’t pay for prescriptions and what happens when that’s false. I know you are supposed to get a £100 fine but I really can’t imagine that is happening often. 

The first time I was ever asked “Do you pay for prescriptions?” I was a 26 year old qualified solicitor. My genuine internal thought was “I don’t know? I never have”. Said yes and have paid ever since and I’m certain the SRA would have done me had I ever taken one for free.

I'm all for consultants doing private work, but the portion of NHS work that you need to do before you can start seeing PP's cannot be terribly demanding.
 

You need to do 11 PAs. As I said, this is 10% more than the standard contract. Whether this is “terribly demanding” or not isn’t the point.

DNR has taken on a peculiar status in the public imagination. Some seem to regard CPR as a big “save life” button that doctors can either press if they’re good or kind, or not bother if they’re lazy and bad. Obviously this isn’t the case. For most older people, resuscitation after cardiac arrest will not have a good outcome. DNR is the correct choice for these patients.

We don’t have media controversies over other potentially life-saving treatments that are routinely denied. For example, I don’t think I’ve ever successfully referred an elderly patient with an intracranial bleed for neurosurgery. Only the choice of whether or not to perform CPR seems to attract so much scrutiny.

I genuinely don’t understand the obsession people have with people wanting to stay alive.  
 

Tap me out by 80 and I’ll be very happy. Have seen the children grow up etc etc. 
 

Ditto if something happens suddenly and my expected outcome is poor - turn me off - my husband knows this. 
 

My sister (one of the doctors) insists that if she makes it to 80, she's going to throw a big party then kill herself the next day.

Not sure how, but she managed to make that all sound very positive and uplifting.

Popular media does portray CPR as a big 'save life' button though and it's a relatively common trope in the cheaper end of medical drama that the good (usually young and good looking) doctor who just won't give up after the jaded fvcker has said 'enough' saves the day and the pretty young mum (or whoever) pops back into life.

You just don't have the one where they got the 90 year old's heart beating again but had broken a couple of ribs in the process and he just got 3 weeks of agony out of it before he died. 

You're right DDS, media portrayals probably do have a lot to do with it.

I think it's generally the family rather than the patient who are obsessed with keeping the elderly alive isn't it.

It's very hard emotionally to get passed that.  After my grandmother died my grandfather (who had cared 24/7 for about 6 or 7 years while she declined) clearly had just had enough and wanted to die. He was't senile. He just didn't really see the point of keeping going (and was probably absolutely exhausted). He basically just let himself decline after that.  Stopped exercising every day as he had previously, ate cold food out of tins if you didn't watch him etc. The doctors said he was depressed (which he probably was to be fair) but he was also 83.  Anyway. He went into a care home and would routinely say he was happy to call it quits and looking forward to it. Everyone told him to stop being so silly (as they do).  Eventually he did become senile and then it got really miserable for him.  Even so, the instinct to fight to get him care to keep him alive was strong in all of us I think.  

It sort of is the point though Chimp. Is it even a 40 hour week? I doubt it. Isn't it reasonable to expect a full working week from the highest paid hcp's in the NHS? I don't like the idea of "sweating the assets" as a PP wrote upthread, but there are millions on waiting lists so expecting them to pull a 5-day week for the NHS doesn't seem too outrageous.

The scarcity of NHS provision is of course making the obvious conflict of interest a bit trickier to ignore. 

Probably an unfair tangent of this thread, but I'm genuinely interested in the views of our resident doctors on this: what's the wider medical profession's view of Dr Tess Lawrie (the British doctor advocating that the Covid vaccine roll-out be stopped in favour of treatment with Ivermectin)?

At what point does something like that become a GMC matter?

Less dramatically, we have a couple of doctor friends (from earlier in my wife's career) who make scientifically dubious (and sometimes outright false) claims in support of their non-NHS careers. 

One (a GI surgeon) has written a book about veganism, and is all over the socials (and in some cases the relatively-MSM) with claims about the benefits of veganism - some of which are supported by science, but others of which are, to put it charitably, wildly optimistic.

The other (a GP) has some bullsh1t "holistic" private practice where she promotes things like honey to cure cancer (that's not consciously a real example, but it could well be).

If I, a d1ckhead with no medical training and making no claims to be medically qualified, threw around such theories to flog my business, that would be morally reprehensible, but not (I think) an abuse of trust or position.  Where doctors are trading on their doctorliness, is that more problematic?

Does it matter if it is a 40 hour week? They are being paid to do X. You can't turn round and say right now it's X+20% or whatever without paying them more. 

Should the model be different and they work completely full time (and probably get paid a fair bit more). Maybe.  But its a whole other discussion and people would need time to transition/wind up their other responsibilities etc.