Radical ideas to revolutionise a broken NHS. Your thoughts?

[PTR 444]

Earlier on today, me and my family were having a discussion on possible ideas to improve the NHS, whether small or large. Unsurprisingly, some ideas put forward by my family were quite radical and probably wouldn’t be policies I advocate personally. At a time when the NHS is at breaking point however, it’s not hard to see why one would have that pattern of thought, even if those ideas would never actually work in practice. Some of the ideas suggested were:

• A&E flat rate charge for weekend revellers who have chosen to go out and get drunk then need treatment as a direct result - While this might discourage binge drinking (making people healthier in the long run too) and raise additional revenue for the NHS, the frequency of such events would make it quite a challenge to administer, not to mention that the administration side might even cost more than any income generated from the drunk revellers.
• Legal Euthanasia pathway for terminal/end of life patients who have capacity and wish to die rather than endure longer term deterioration. While it will ease immediate pressure on the NHS by freeing up bed capacity, this is a very controversial topic and such a proposal will cause a lot of uproar from certain groups.
• Flat rate bill for minor sporting injuries. Might be a good short-term measure when hospitals are at capacity but this comes at the cost of penalising healthy physical activity. As people switch to sedentary lifestyles, this will only put more pressure on the NHS through obesity-related conditions in the long term.
• Reasonable private medical insurance. Might lead more people to choose to go privately and reap the benefits of competition, but at what cost to the NHS?
• Make nursing and medical degrees free (tuition fees fully paid by government) under the condition that students must do a minimum amount of service in the NHS, otherwise they will have to pay back cost. While this might incentivise more people to train as doctors and nurses, it doesn’t really solve the deeper issues within the NHS and of course you cannot force people to stay in the profession.
• Introduce a National Service style scheme whereby all fit-to-work adults must complete a set number of years in an entry-level NHS (or any other critical public service) role to be entitled to benefits, student loans etc. It might solve the UK’s skills gap problem but do we really need to be sacrificing non-critical sectors of the economy just for this?

What are your thoughts, and would you suggest any alternative ideas to fix the NHS?

 

[yorkie]

You made the poll so that you can only choose one option.

I strongly disagree with anything that discourages physical activities such as sports. Indeed people who do not engage in sufficient physical activity are a far greater burden on the NHS! Playing sports has many benefits, not just the obvious physical benefits but they also boost mental health which does in turn affect physical health as the two are more closely linked than many people realise.

I doubt it is workable to charge drunk people for their poor choices but in the unlikely event that a workable method could be found, morally I would support the concept.

 

[PTR 444]

You made the poll so that you can only choose one option.

Apologies, that was an error on my part. I have fixed it now so you should be able to choose multiple options.

 

[gabrielhj07]

Reasonable private medical insurance. Might lead more people to choose to go privately and reap the benefits of competition, but at what cost to the NHS?

Not sure why there would be a cost. People on private medical insurance still pay taxes, while relieving the NHS of a patient.

Introduce a National Service style scheme whereby all fit-to-work adults must complete a set number of years in an entry-level NHS (or any other critical public service) role to be entitled to benefits, student loans etc. It might solve the UK’s skills gap problem but do we really need to be sacrificing non-critical sectors of the economy just for this?

This would just produce a lazy & unmotivated workforce. You can't force people to want to do something, and I'm sure the NHS could do without lots of people idly milling about.

 

[PTR 444]

Not sure why there would be a cost. People on private medical insurance still pay taxes, while relieving the NHS of a patient.

If enough patients are driven away from the NHS that it ceases to be viable, then I would imagine there would be some costs there, not just financially.

This would just produce a lazy & unmotivated workforce. You can't force people to want to do something, and I'm sure the NHS could do without lots of people idly milling about.

True, but you would otherwise just be paying the same in taxes to fund their universal credit. At least with this option it gives them a chance to make a difference, even if they’re not the most hard working of all.

Mind you, it would have come in very handy during the height of the pandemic.

 

[Bletchleyite]

I could not be more strongly against charges for A&E use, even where people have been stupid. The problem is that it's a slippery slope as to where you stop with such charges and what you consider to be stupid. I don't even particularly support the way A&E costs can be claimed from car insurance in an accident; I'd just fund it via motoring taxation.

If a particular thing is causing very high A&E use, then that thing should be taxed to pay for the capacity. For instance, tax on alcohol and pubs should help fund A&E and policing that they cause to be required.

Under no circumstances whatsoever should A&E use as a result of any kind of sport be charged in any way. Sport is to be encouraged. And who decides what's unacceptably dangerous?

I'd rather pay 20 quid to see a GP than see any kind of restriction whatsoever on patching people up when they've got badly hurt. And indeed lack of GP capacity is where some of the root of this lies - because people can't see their GP they're going to the walk in centre, because the walk in centre is full they're going to A&E.

I am in favour of legal euthanasia, but not to save the NHS money even though it would (motivating it that way is very, very dangerous) - it should be purely to reduce suffering when that person has chosen that approach, with very strong safeguards against others seeking to influence it. I think if I got a terminal diagnosis I would consider it before things got too unpleasant.

== Doublepost prevention - post automatically merged: 5 Jan 2023 ==

If enough patients are driven away from the NHS that it ceases to be viable, then I would imagine there would be some costs there, not just financially.

I don't think there's any danger of that!

I do think there should be a revisiting of what degrees are needed for and what they're supposed to achieve. Clearly a doctor needs one, but does it really need to be mandatory for a paramedic? And could we for instance have ambulances manned by a paramedic plus a very skilled first aider instead of two paramedics, for instance, without losing much effectiveness?

 

[Kite159]

Bring in a charge if you need A&E for being drunk and trying to fight a lamppost. Also, some sort of missed appointment charge (although that will probably cost more to run than it would generate as knowing the NHS they will need to employ a team to deal with it)

 

[Bletchleyite]

Bring in a charge if you need A&E for being drunk and trying to fight a lamppost.

Slippery slope.

Also, some sort of missed appointment charge (although that will probably cost more to run than it would generate as knowing the NHS they will need to employ a team to deal with it)

Generally GPs and consultants are heavily overbooked, so the odd missed appointment helps them catch up or get a break for a cup of tea or to use the loo. It's not the issue some claim it to be.

 

[gabrielhj07]

True, but you would otherwise just be paying the same in taxes to fund their universal credit. At least with this option it gives them a chance to make a difference, even if they’re not the most hard working of all.

Mind you, it would have come in very handy during the height of the pandemic.

Maybe we could get some people to fill those Nightingale hospitals

 

[brad465]

For Nursing degrees I've put down making them free, but would also suggest some sort of tax break for nurses who work in the profession and completed their degree in the UK, as a means to keep them in the country. Or possibly charging tuition fees for them, but then they don't have to pay any of the fees back while working in the UK in the profession, then after say 10 years of working in the UK writing the debt off, so effectively they're free, but if they go abroad they're liable for fee repayment.

I've supported legalising euthanasia despite being Christian as I believe it's possible to be alive but not living a natural life, which would apply to anyone suffering from an illness that requires 24/7 dependence on someone else (like dementia), as well as being a huge financial and logistical burden on the NHS, family members of affected individuals, and the quality of life for those affected is severely compromised. I would not support euthanasia for anybody, they would have to be terminally ill, and/or in care and able to consent (for the latter, early diagnosis of something like dementia would be needed).

 

[dm1]

None of the proposals solve the fundamental problem that around 40% of hospital beds are occupied unnecessarily because elderly patients cannot be safely discharged into longer term care, because the care system has been neglected and underfunded for decades. That is the place to start in fixing many problems in the NHS. The problem is that doing so would involve admitting failure for the tories, who are responsible for many of the issues becoming so much worse in the first place.

There also seems to be a fundamental opposition in the health system to treat things prophylactically or at an early stage, which is understandable when it is so overloaded, but leads to much more complex and expensive treatment being needed in the long run, along with significantly worse health outcomes as a result. Trying to tackle this problem would help a lot as well. Unfortunately that brings a whole trail of public health measures that would be needed, including but not limited to re-thinking the car-centric lifestyle that so many people in the UK are forced to live, which is also extremely complicated.

 

[PTR 444]

For Nursing degrees I've put down making them free, but would also suggest some sort of tax break for nurses who work in the profession and completed their degree in the UK, as a means to keep them in the country. Or possibly charging tuition fees for them…

The problem with doing that is that the student loans system is really a “Graduate Tax”, therefore many students will never pay back the full amount “owed”. Waiving the fees altogether for medical courses would do more to incentivise prospective students to take up these courses in the first place, on condition that this would need to be paid back if they do not complete a minimum number of years service in the NHS. Maybe as a suggestion to penalise those who just take up medical courses for a jolly, they would have to start repaying the fee straight away rather than having to earn above the minimum threshold for repayment

 

[Bletchleyite]

None of the proposals solve the fundamental problem that around 40% of hospital beds are occupied unnecessarily because elderly patients cannot be safely discharged into longer term care, because the care system has been neglected and underfunded for decades. That is the place to start in fixing many problems in the NHS. The problem is that doing so would involve admitting failure for the tories, who are responsible for many of the issues becoming so much worse in the first place.

There's also a total lack of urgency in business processes involved in discharge. The whole thing needs to be more efficient, which would result in people who could be discharged not being kept in unnecessarily, blocking beds.

I was in for 3 nights a couple of years ago, it could easily have been 2 or perhaps even 1 if they'd pulled their finger out a bit (I was admitted with DVT and Pulmonary Embolism, but only because it had caused my blood pressure to rocket dangerously, and I'm sure it was back down to the normal "a bit high but not ridiculous" after the first night - normally that's just treated by sending you home with some heparin injections and a referral to the warfarin nurse). That isn't to say the staff are lazy, but the business processes are stuck in the 1970s. I'm almost certain I got "I think you'll be out tomorrow but it depends on how busy the pharmacy is" - anyone with any sense would identify that improving pharmacy capacity or changing the system so the first stage of medication is issued from a regular pharmacy would unblock quite a number of beds for far less than the cost of adding them.

To throw one aside in, I'd not have objected to paying for my food during my stay, particularly if that had involved more choice. Obviously that could be means tested in some way.

 

[Magdalia]

Earlier on today, me and my family were having a discussion on possible ideas to improve the NHS, whether small or large. Unsurprisingly, some ideas put forward by my family were quite radical

The NHS doesn't need radical ideas. It needs to pay its staff at competitive rates, compared with the private sector, and it needs to manage queues better.

None of the proposals solve the fundamental problem that around 40% of hospital beds are occupied unnecessarily because elderly patients cannot be safely discharged into longer term care, because the care system has been neglected and underfunded for decades. That is the place to start in fixing many problems in the NHS.

There's also a total lack of urgency in business processes involved in discharge. The whole thing needs to be more efficient, which would result in people who could be discharged not being kept in unnecessarily, blocking beds.

Both of these show that it is the discharge end of the queue that needs to be managed much better. The arrival end of the queue would work fine if it wasn't for the blockage at the other end.

 

[Bletchleyite]

Both of these show that it is the discharge end of the queue that needs to be managed much better. The arrival end of the queue would work fine if it wasn't for the blockage at the other end.

There's also the fact that part of the blockages in A&E are being caused by people going there and to walk in centres because they can't get a GP appointment, that's another big part of the problem.

The privatisation advocates may at this point like to know that the GP service is provided mostly by private businesses under contract, it was never nationalised.

 

[jfollows]

There's also a total lack of urgency in business processes involved in discharge. The whole thing needs to be more efficient, which would result in people who could be discharged not being kept in unnecessarily, blocking beds.

In my limited experience of being in hospital, getting out was harder than getting in, and if that's no longer true it'll only be because getting in has become harder.
To me, it's obvious what needs to be done. I recollect reading earlier today that there are tens of thousands of hospital beds occupied by people who don't need to be in them any more but have nowhere to go.
The most significant aspect of my stroke care was the gulf between hospital care and care back at home - they call it "primary" and "secondary" care I think, although i don't like the terms because I can't ever remember which is which and there's an implied hierarchy I don't like.
It's this that needs sorting out, and I think lots of people know this, but there's no will meaning no money to do this. Health Service means fixing broken people. Local health care is more about stopping them getting broken in the first place if possible, but it's "someone else's responsibility".
Unless and until this is properly fixed, I don't see a solution, radical or otherwise.

 

[duncanp]

In the Irish Republic a visit to A&E costs €100 if you do not have a referral letter from a GP, and to visit a GP you have to pay €50 - €75.

You can take out private insurance to cover the cost of visits to a GP, and claim the cost of a GP visit against tax.

I would support a similar scheme in the UK, because one thing we do need to do is to stop people using A&E for situations which are not a medical emergency.

We also need to make it financially viable for GPs to offer more appointments at times which are convenient for patients, with the time between making an appointment and seeing the GP measured in days rather than weeks.

Perhaps the way to implement this, in England at least, would be to have an extended version of the Prescription Prepayment Certificate (PPC) whereby you can either pay a certain amount each month and have your costs covered, or pay up front each time. If you choose to pay for an extended PPC, the cost should be tax deductible, as in Ireland.

Those on low incomes and certain benefits should not have to pay anything.

We also need to have a radical reform of the NHS managment structure, and cut out a lot of the red tape which costs a fortune and achieves very little.

 

[philosopher]

I know this would be controversial in the UK, but I do think it is time the UK starts looking at gradually moving towards a system with a compulsory government run health insurance scheme. Perhaps a system where 5% or so of your salary is automatically deducted for the insurance, with additional contributions from employers. This could be supplemented by modest government regulated charges (e.g £20 to see a GP, £50 for an overnight stay in hospital, up to a maximum of 10 days so to prevent excessive charges). Emergency treatment and those on low incomes would not incur any charges. Patients would be able to choose what hospital they get treatment from and hospitals would operate independently as not for profit enterprises.

This is, I think how it operates in most other developed countries.

 

[Bletchleyite]

I know this would be controversial in the UK, but I do think it is time the UK starts looking at gradually moving towards a system with a compulsory government run health insurance scheme. Perhaps a system where 5% or so of your salary is automatically deducted for the insurance, with additional contributions from employers. This could be supplemented by modest government regulated charges (e.g £20 to see a GP, £50 for an overnight stay in hospital, up to a maximum of 10 days so to prevent excessive charges). Emergency treatment and those on low incomes would not incur any charges. Patients would be able to choose what hospital they get treatment from and hospitals would operate independently as not for profit enterprises.

This is, I think how it operates in most other developed countries.

I do think we should move towards a European style social insurance scheme, but I don't support charges at the point of use because they're regressive, and if you're going to start means testing them then you might as well just put it on the "insurance" cost instead.

However I would want to see a visible cut in income tax to take account of the fact that there was now a separate National Health Insurance payment.

 

[Sebastian O]

Earlier on today, me and my family were having a discussion on possible ideas to improve the NHS, whether small or large. Unsurprisingly, some ideas put forward by my family were quite radical and probably wouldn’t be policies I advocate personally. At a time when the NHS is at breaking point however, it’s not hard to see why one would have that pattern of thought, even if those ideas would never actually work in practice. Some of the ideas suggested were:

• A&E flat rate charge for weekend revellers who have chosen to go out and get drunk then need treatment as a direct result - While this might discourage binge drinking (making people healthier in the long run too) and raise additional revenue for the NHS, the frequency of such events would make it quite a challenge to administer, not to mention that the administration side might even cost more than any income generated from the drunk revellers.
• Legal Euthanasia pathway for terminal/end of life patients who have capacity and wish to die rather than endure longer term deterioration. While it will ease immediate pressure on the NHS by freeing up bed capacity, this is a very controversial topic and such a proposal will cause a lot of uproar from certain groups.
• Flat rate bill for minor sporting injuries. Might be a good short-term measure when hospitals are at capacity but this comes at the cost of penalising healthy physical activity. As people switch to sedentary lifestyles, this will only put more pressure on the NHS through obesity-related conditions in the long term.
• Reasonable private medical insurance. Might lead more people to choose to go privately and reap the benefits of competition, but at what cost to the NHS?
• Make nursing and medical degrees free (tuition fees fully paid by government) under the condition that students must do a minimum amount of service in the NHS, otherwise they will have to pay back cost. While this might incentivise more people to train as doctors and nurses, it doesn’t really solve the deeper issues within the NHS and of course you cannot force people to stay in the profession.
• Introduce a National Service style scheme whereby all fit-to-work adults must complete a set number of years in an entry-level NHS (or any other critical public service) role to be entitled to benefits, student loans etc. It might solve the UK’s skills gap problem but do we really need to be sacrificing non-critical sectors of the economy just for this?

What are your thoughts, and would you suggest any alternative ideas to fix the NHS?

Just thought I’d chip in as I work for the ambulance service of our great city of Londinium.

Point 1 - post COVID, except for NYE on a drunk bus, I have picked up a grand total of zero truly drunk patients. It’s a bit of a myth that Friday and Saturday nights are full of drunk people. Doesn’t happen.

Point 2 - we already do this through palliative and end of life care pathways. Not an impact really on urgent and emergency care services. Euthanasia is a red herring - access to withdrawing healthcare for terminal conditions exists and is well engrained into the NHS.

Point 3 - fairly rare, but I suspect those actually use healthcare less overall, due to improved fitness comparatively.

Point 4 - if you can afford private medical insurance, you don’t generally interact with hospitals, and if you do, you’re critically unwell; ITU coverage is almost non existent in private hospitals. If it goes bent, you get taken to an NHS hospital.

Point 5 - yes I agree, although apprenticeships sort of cover this for nursing or paramedicine, and medical apprenticeships about to start.

Point 6 - I wouldn’t have an issue but all allied health professions (physios, paramedics, ODPs, physios) have quite a technical job that takes a good number of years to get to a point of independent, safe practice.


Happy to respond to replies.

 

[GS250]

The model used in some European countries appears to work well. There are no point of service charges and insurance is very reasonable. The automatic assumption that private healthcare will only every be like the horrific USA version is just untue. However....how do those European countries deal with those who don't have insurance? Can you imagine the outcry when the first person in the UK dies because they couldn't afford even moderate insurance? I can't either because I don't think any hospital could afford the bad PR. So those with insurance would then wonder what they are paying for if treatment is being given out anyway. That would have to be addressed.

 

[Bletchleyite]

JPoint 6 - I wouldn’t have an issue but all allied health professions (physios, paramedics, ODPs, physios) have quite a technical job that takes a good number of years to get to a point of independent, safe practice.

Thanks for those insights, most interesting.

I wonder on this one (I mentioned it above re paramedics) is there scope for less skilled people to work with more skilled people in teams, for instance an ambulance crewed with a driver who is trained in advanced first aid (that's basically a week's course) and a paramedic who does the heavy medical stuff, rather than two paramedics? Or less technical nurses who are more like the ones of old who are only tasked with patient welfare and care in addition to those who might also be prescribers etc?

It seems fairly well established to pair a "proper" Police Officer with a PCSO, to give an example from another emergency service.

== Doublepost prevention - post automatically merged: 5 Jan 2023 ==

The model used in some European countries appears to work well. There are no point of service charges and insurance is very reasonable. The automatic assumption that private healthcare will only every be like the horrific USA version is just untue. However....how do those European countries deal with those who don't have insurance? Can you imagine the outcry when the first person in the UK dies because they couldn't afford even moderate insurance? I can't either because I don't think any hospital could afford the bad PR. So those with insurance would then wonder what they are paying for if treatment is being given out anyway. That would have to be addressed.

Fairly easy to have automatic enrolment unless you proved you had another private scheme with certain minimum coverage in place.

 

[Sebastian O]

Thanks for those insights, most interesting.

I wonder on this one (I mentioned it above re paramedics) is there scope for less skilled people to work with more skilled people in teams, for instance an ambulance crewed with a driver who is trained in advanced first aid (that's basically a week's course) and a paramedic who does the heavy medical stuff, rather than two paramedics? Or less technical nurses who are more like the ones of old who are only tasked with patient welfare and care in addition to those who might also be prescribers etc?

It seems fairly well established to pair a "proper" Police Officer with a PCSO, to give an example from another emergency service.

== Doublepost prevention - post automatically merged: 5 Jan 2023 ==



Fairly easy to have automatic enrolment unless you proved you had another private scheme with certain minimum coverage in place.

Yeah I do understand the concept of having less skilled with more skilled, although this is a model we already work on and have done for 15 years.

This leads to situations where you run out of the staff who perform heavy medical stuff, as they get drawn into better paid, and arguably more useful jobs such as in GP practises, walk in centres etc. Then you have lots of advanced first aiders - do you crew them together to provide an ambulance or leave them not working together, yet no providing an ambulance? And it’s exhausting doing 12 hours with an advanced first aiders; we aren’t infallible and often need to bounce an idea off of people - I’ve been lucky having done an internal training course, where I joined as an advanced first aider, now I can make independent clinical decisions, yet at what point is that met?

Same goes for foundation doctors in A&E - I know I can comfortably manage more risk in the community than they would purely because I have seen more patients and bluntly, I am more experienced in assessing patients. In London we are leaving more than half of the people who call 999 (and 111 transfers) at home - is this a sustainable model?

 

[Bletchleyite]

This leads to situations where you run out of the staff who perform heavy medical stuff, as they get drawn into better paid, and arguably more useful jobs such as in GP practises, walk in centres etc.

Obviously you need to replace them if they leave (proactively).

 

[MikeWM]

None of the proposals solve the fundamental problem that around 40% of hospital beds are occupied unnecessarily because elderly patients cannot be safely discharged into longer term care, because the care system has been neglected and underfunded for decades. That is the place to start in fixing many problems in the NHS. The problem is that doing so would involve admitting failure for the tories, who are responsible for many of the issues becoming so much worse in the first place.

And not remotely helped by the government causing 40,000 staff in the care sector to be fired in 2021. Most found easier, better-paying jobs as a result, and so most won't be returning to the care sector, which has caused many more vacancies in an industry already struggling to find people.

--

There's also a total lack of urgency in business processes involved in discharge. The whole thing needs to be more efficient, which would result in people who could be discharged not being kept in unnecessarily, blocking beds.

Absolutely this. Everyone I've ever known that has been an inpatient in any hospital, including myself, have been delayed on discharge for hours (or more) due to 'waiting for the pharmacy'. I can't believe this is a tough problem to fix, but it never gets addressed.

--

...one thing we do need to do is to stop people using A&E for situations which are not a medical emergency.

Which would be helpful, but I remain baffled why this is apparently such a major problem. If they *can* get to see the GP - admittedly very difficult nowadays - they will be dealt with in a 10-minute appointment. Why can't A&E do the same?

--

On the original questions : definite no to charges for 'lifestyle', definite yes to free degrees (though also reverse the silly policy that nurses are now *required* to have a degree), no to a requirement for National Service - *but* it would be very good to have something voluntrary, rather like the Territorial Army, whereby you have people sufficiently trained to step up if extra capacity is suddenly needed due to a pandemic (or due to it being January).

As for euthanasia I'm very split. I do think people should be allowed to end their life if they are very ill, have no chance of recovery, and don't want to endure days/months/years of pointless pain and misery. But you have to have extremely strong safeguards against it, and I'm particularly nervous about the slippery slope you can start down when you embark on this route - Canada is quite concerning.

 

[Bletchleyite]

Which would be helpful, but I remain baffled why this is apparently such a major problem. If they *can* get to see the GP - admittedly very difficult nowadays - they will be dealt with in a 10-minute appointment. Why can't A&E do the same?

As in have a sit-and-wait GP service at hospitals? That's actually a pretty good idea.

 

[The Ham]

I disagree with charges, simple reason, there'll be a lot of admin costs in doing so. As such they won't bring in nearly as much as you may think. To the extent that a tiny amount extra in tax would likely raise as much.

If drinks are a problem, then raise the "sin" taxes more.

Also how do you draw the line as to who is drunk enough to have the fee applied? Someone who is obviously drunk? Someone who's over a given limit?

Reduced cost (free or nearly free) nursing training makes sense. You could link it to time in service, so they pay as any other student, however tution fees are removed at 3, 5, 8 and 11 years of NHS full time equivalent employment (wouldn't have to be concurrent).

Social care is the thing which needs sorting as a priority, as without somewhere for people to go to it blocks beds.

 

[MikeWM]

As in have a sit-and-wait GP service at hospitals? That's actually a pretty good idea.

I hadn't thought it through that far but yes, you could triage them on arrival and then offer them an in-house GP service, if that appeared a more suitable clinical option than leaving them sitting around for hours of end to see an emergency consultant that they don't need to see anyway.

 

[Bletchleyite]

I hadn't thought it through that far but yes, you could triage them on arrival and then offer them an in-house GP service, if that appeared a more suitable clinical option than leaving them sitting around for hours of end to see an emergency consultant that they don't need to see anyway.

Probably also worth merging the walk in centre (mainly a nurse-led service) into the mix too with one set of triage staff for the lot. And include a pharmacy too, so if it's just a case of needing straightforward pills you can get those too.

If most people turn out to want to see GPs that way, fine, increase that GP service and reduce the service "in the field" to compensate. Cheaper to have one building than lots.

A one stop health shop.

 

[cactustwirly]

There's no point increasing funding with these radical schemes if you don't reform the health service.

The management scheme needs to be completely overhauled because it is grossly inefficient and expensive. The amount of trusts should be reduced, with GPs and Ambulances being managed from the same management as the hospitals.

Another point is NHS dentist, it's impossible to be taken on as a new patient, it's a postcode lottery whether you need to pay for unaffordable private treatment or not.