How the NHS Works, part 3 (Referrals)

Referrals

If your GP feels that your ailment requires more expert care, you may need to see a specialist, called a Consultant. Your GP will then need to refer you to a hospital, where consultants are based. The old-fashioned way of doing this was for your GP to write a letter to the consultant and request an appointment. The patient then waited to receive an appointment letter from the consultant’s office. Things are changing so that some appointments may be booked online by the GP or the patient. Waiting times to see consultants vary according to region and speciality. Current government guidelines (targets) are that it should take no longer than 6 weeks weeks to see a consultant for an initial consultation. The initial appointment almost never involves treatment. Government guidelines state that you should wait no longer than a further 18 weeks for the next appointment, when treatment begins.

It is very important to understand that under the NHS you cannot refer yourself to a consultant. That means if you wish to see a dermatologist because you have a minor skin rash, you will have to first go to your GP, ask for their help, and if they feel your condition is minor or does not require a specialist, you will not be allowed to see a dermatologist. It’s that simple. The NHS functions as a government-run HMO (Health Maintenance Organization) in that respect. Care is controlled by your GP, who acts as gatekeeper.

As far as targets go, once you have seen a consultant for your initial consultation within 6 weeks, one of that department’s targets is considered to have been met. Once you have had your second appointment within the next 18 weeks, another target has been met. If you require further treatment after that second appointment, my experience at my local hospital has been that I am put to the back of the waiting list again, which has meant a further 18-week wait. For patients with chronic conditions, this is not a viable option, as illustrated by this article which appeared on BBC News.

How the NHS Works, part 2 (Prescriptions)

Before I begin, let me re-iterate from my previous post that the following is based on my experience as a patient of the NHS and should not be taken as accurate!

Prescriptions

Prescriptions written by your GP may be filled at any pharmacy, and in my experience patients are not provided with free samples of drugs. Pharmacy hours tend to be quite short compared to pharmacies in the US, though that is slowly changing.

The cost of a prescription is currently £7.10, with exemptions given to people who meet certain guidelines or with certain conditions. The prescription charge seems reasonable compared to prescription charges in the US, but the caveat is that which drugs a GP may prescribe is decided by a body called NICE (the National Institute for Health and Clinical Excellence), and the list may exclude or limit drugs that are frequently prescribed in the US. Cost is a determining factor, with generics being preferred.

As an example, the only antibiotics I’ve been prescribed in over 10 years are: doxy- & tetracycline, amoxycillin & flucloxacillin, cipro and metronidazole. That’s it. And I’ve had a few infections that required antibiotics. Some of the newer antibiotics may be available on the NHS, but I’m guessing the guidelines recommend using less expensive generics where possible. (The argument for or against antibiotics is a separate issue.)

There has been quite a bit of press lately about certain drugs being unavailable under the NHS. The drugs are often very expensive drugs used to extend the lives of cancer patients. The reason NICE denies some drugs is because they do not offer value for money, as in this example.

Unfortunately, drug issues have led to public battles over mixed care (part NHS, part private), as some patients who voluntarily pay for for their own drugs are being denied further NHS treatment for their conditions. The practice of banning mixed care is currently under review.

Next, referrals.

How the NHS Works, part 1 (The Surgery)

One of the most common comments I hear when visiting the US is how great it must be to have good healthcare and how much fairer it would be if the US had something like the NHS. However, as I speak to people it becomes clear that most don’t understand how the NHS functions and what it’s like to seek treatment under the NHS. So I am putting forward my simplified view, as a patient, of how the NHS works. This is based only on my experience and limited understanding, so please don’t construe my account to be factually accurate!

The Surgery

When you move to an area, you are able to register with a general physician’s office (called a Surgery) in your area, if they are accepting patients. Surgeries often close their books to new registrations if they are oversubscribed, so you may not be able to register with the surgery closest to your house, nor with the most popular surgery. You can’t randomly choose a surgery, either. You must live within the surgery’s catchment area, similar to choosing a school within a specific school zone in the US.

Surgeries have varying financial structures. Some are set up as with financially invested partners, usually doctors at the surgery who have bought shares of the practice (as I understand it, please correct me if I’m wrong). Some are set up by the local Primary Care Trust (PCT), which is a broader body that oversees healthcare for a certain area. My surgery is a PCT surgery. The doctors and nurses are salaried rather than being shareholders.

The surgery is the first port of call for most minor ailments. Should you awake Tuesday morning with a sinus infection, you can ring your surgery and request an urgent appointment. You will normally be able to get an appointment within 48 hours, though you may have no choice over the doctor or nurse you see. If you prefer continuity of care from a specific doctor or nurse, you can sometimes request a bookable appointment days or weeks in advance, though in my experience these are more difficult to get.

The purpose of the surgery is to offer care when needed, and due to budget constraints the focus tends to be oriented toward treating rather than preventing. I have never been offered a physical exam. Nor have I been asked to come in for a follow-up appointment unless my problem has failed to clear up. There are exceptions, of course. Some conditions are targeted by the NHS and will be followed more closely. A patient with asthma, for example, might be asked to come in once a year to make sure their medications are working properly. Patients with diabetics are also monitored more closely, as well as those with cancer or heart problems.

Next, prescriptions.

Little pleasures

We’ve not been the healthiest of people lately, resulting in more than a couple of visits to our local medical walk-in centre (or doc-in-the-box, as I like to call it). Today the centre was more crowded than usual, so when Mister went in, he was less than happy. But they got him in and out quickly, and just in time to see a beautiful, whopping great caterpillar trying to go in the door as Mister was coming out (maybe the poor caterpillar wasn’t feeling up to par?).

Apparently the little guy (the caterpillar, that is) caused a bit of a stir at the centre. Some kind soul rescued him from the automatic door and footfalls of the ill and injured and placed him on a small grassy area adjacent to the centre. Mister came home full of life, excited at having seen such a fantastic beast. He tried to identify the species online but couldn’t narrow the selection beyond three, so he bundled me into the car and we went to see if it was still hanging around.

To our surprise, the caterpillar was happily going in circles beneath one of the nurses’ cars in the parking lot! We waited patiently as he wound his way around and around, up and back, until he finally decided to try to climb one of her front tyres. Then Mister gently lifted him off the ground and let me snap a few photos before placing him on the trunk of a nearby ash tree, which as it turns out is the favourite food of this species. It seemed only fair to try to repay the chubby guy for giving us a little lift.

In the end we identified the little chap as a Sphinx Ligustri, which is commonly known as a Privet Hawk moth.

Why you should always question “scientific fact”

Things are not always as they appear! Question that which is presented as “fact.” Read on.

Ban Dihydrogen Monoxide! The Invisible Killer

Dihydrogen monoxide is colorless, odorless, tasteless, and kills uncounted thousands of people every year. Most of these deaths are caused by accidental inhalation of DHMO, but the dangers of dihydrogen monoxide do not end there. Prolonged exposure to its solid form causes severe tissue damage. Symptoms of DHMO ingestion can include excessive sweating and urination, and possibly a bloated feeling, nausea, vomiting and body electrolyte imbalance. For those who have become dependent, DHMO withdrawal means certain death.

Dihydrogen monoxide:

CONTAMINATION IS REACHING EPIDEMIC PROPORTIONS!
Quantities of dihydrogen monoxide have been found in almost every stream, lake, and reservoir in America today. The pollution is global, and the contaminant has even been found in Antarctic ice. In the midwest alone DHMO has caused millions of dollars of property damage.

Despite the danger, dihydrogen monoxide is often used:

Companies dump waste DHMO into rivers and the ocean, and nothing can be done to stop them because this practice is still legal. The impact on wildlife is extreme, and we cannot afford to ignore it any longer!

THE HORROR MUST BE STOPPED!

The American government has refused to ban the production, distribution, or use of this damaging chemical due to its “importance to the economic health of this nation.” In fact, the navy and other military organizations are conducting experiments with DHMO, and designing multi-billion dollar devices to control and utilize it during warfare situations. Hundreds of military research facilities receive tons of it through a highly sophisticated underground distribution network. Many store large quantities for later use.

IT’S NOT TOO LATE!

Act NOW to prevent further contamination. Find out more about this dangerous chemical. What you don’t know can hurt you and others throughout the world.

(Source: http://www.snopes.com/science/dhmo.asp)

Evolution?

In the beginning God covered the earth with broccoli, cauliflower, and spinach, green, yellow, and red vegetables of all kinds; so Man and Woman would live long and healthy lives.

Then using God’s bountiful gifts, Satan created Dairy Queen and Ice Cream parlours. And Satan said, “You want hot fudge with that?” And Man said, “Yes!” and Woman said, “I’ll have another with sprinkles.” And lo they gained 10 pounds.

And God created the healthful yogurt that Woman might keep the figure that Man found so fair.

And Satan brought forth white flour from the wheat, and sugar from the cane, and combined them. And Woman went from size 2 to size 14.

So God said, “Try my fresh green salad.”

And Satan presented crumbled Bleu Cheese dressing and garlic toast on the side. And Man and Woman unfastened their belts following the repast.

God then said, “I have sent you heart healthy vegetables and olive oil in which to cook them.”

And Satan brought forth deep fried coconut shrimp, butter dipped lobster chunks and chicken-fried steak so big it needed its own platter.

And Man’s cholesterol went through the roof.

God then brought forth running shoes so that his Children might lose those extra pounds.

And Satan came forth with a cable TV with remote control so Man would not have to toil changing the channels. And man and woman laughed and cried before the flickering light and started wearing stretch jogging suits.

Then God brought forth the potato, naturally low in fat and brimming with potassium and good nutrition.

Then Satan peeled off the healthful skin and sliced the starchy center into chips and deep-fried them in animal fats and added copious quantities of salt. And Man put on more pounds.

God then gave lean beef so that Man might consume fewer calories and still satisfy his appetite.

And Satan created McDonald’s and the 99-cent double cheeseburger. Then Satan said, “You want fries with that?” and Man replied, “Yes! And super size’ em!” And Satan said, “It is good.”

And Man went into cardiac arrest.

God sighed… and created quadruple bypass surgery.

And Satan cackled in his own evil way, and created the National Health Service.

(I found this on practicalairsoft.co.uk and thought it was hilarious!)

Killer ‘pillars!

File under sci-fi, bizarre or cool–your choice! Apparently the UK has been invaded by killer caterpillars. Seriously. The Oak Processionary has hitched a ride into the country via imported lumber and has been found in the west London area.

The caterpillar is armed with up to 63,000 toxin-filled bristles that will cause a nasty rash. Worse still, the bristles can become airborne and cause epidemic caterpillar dermatitis. I am not kidding! Read all about it here.

The moral of the story is that if you see one of these, you should leave it alone! And please notify your local authority of any sightings so they can do something about them before we end up like the Netherlands where 20,000 people needed treatment during an outbreak ten years ago.

Watched pots

Don’t you love waiting in for delivery companies? I feel like a child on Christmas eve, struggling to sleep and running to the window at the slightest little sound.

No delivery today, so I get to experience the excitement again tomorrow!

Vote time again!

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You move so psychedelically

Hm, I wonder what’s in that cake they’re eating!