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IOM DHSC & MANX CARE


Cassie2
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OK, if we’re onto hip replacement stories try this one, which I often tell patients. 
 

An old boss of mine once had a patient who asked him what he’d do with the extracted femoral head, and he explained they were just disposed of. So the patient asked if he could have it. This was in the days before infection control and health and safety, so my boss said ok, didn’t see why not.  After the operation he gave the chap his femoral head in a sealed plastic pot. 
 

6 weeks later my boss asked what he’d done with the femoral head. Reply: “Gave it to the dog. The bugger’s given me enough pain over the years I wanted to really see it gone”

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2 hours ago, wrighty said:

Well unless we become part of the UK and are getting subsidised by London, we're going to have to finance the health service whether it's here or across, so your last point is moot.

As a small health service we will never be able to carry out everything that is clinically effective here, and certain things will need to be sent to larger centres.  The bulk of services however can be provided.  What I've always said is that we should do the simple, common effective stuff here, the complex, rarer effective stuff across, and the ineffective stuff not at all.  Take my own specialty for example.  About 75% of trauma admissions are accounted for by 4 things - hip fractures, ankle fractures, wrist fractures and hand injuries.  We can manage almost all of those here, and several other things too, such that I'd estimate that 90%+ of trauma admissions can be handled safely and effectively in house.  The same goes with joint replacement surgery.  When operating at full capacity, in our best year we carried out 280 hip and knee replacements.  I personally carry out more hip replacements here than 50% of surgeons who replace hips across the UK, that is to say I'm in the upper half of the distribution for volume (we submit data to the National Joint Registry - all of this is in the public domain).  If we accept that we need surgeons to do trauma, then they may as well also do elective work that is within their experience.  And there you have a clinically effective service that can cope with 90%+ of what is thrown at it, and costs far less to run than sending everyone across.  Apply the same thinking to other areas and you have a functioning hospital.  It has to evolve though, and we need to ensure that when staff are replaced, or if caseload falls, that the procedure mix is still appropriate.  Over the years I've stopped doing procedures that I used to just crack on with either because techniques changed, or evidence evolved, or because I couldn't do enough to maintain competence.  We all do, I hope.

What's your view on actually expanding some services to become a centre of excellence whereby Nobles sells it services to other trusts and the private sector etc??

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1 hour ago, Andy Onchan said:

What's your view on actually expanding some services to become a centre of excellence whereby Nobles sells it services to other trusts and the private sector etc??

It's a non-starter, primarily because of the geography.  Most people want to be treated near home, and I can't see why they might choose to come here instead of a centre of excellence they could drive to and family could visit. The only thing we might be able to do would be something really niche dealing only with people who are otherwise fit and well - if they're medically complex you'd need a full range of services and we can't have that for reasons of size - such as top secret celebrity cosmetic surgery, hair transplants, etc.  But that's never going to happen.  We could become the British Dignitas, but I don't see that happening politically.

Specialist hospitals such as Wrightington tend to grow organically around a pioneering expert such as Charnley and his self-made hip replacements in that case (or for Oswestry, my old teaching unit, around Sir Robert Jones linking up with Dame Agnes Hunt at an old TB sanatorium).  Those days are gone though.

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I’ve resigned myself to the fact I can’t rely on the NHS so if I get like really ill I will probably die. Minor stuff I’ll have to pay for myself. Not blaming anyone but let’s stop treating the NHS like it’s the greatest thing since sliced bread because it’s not.

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Our GP practice won’t accept calls or email because they are ‘too busy’ . I drive past it most days , it’s got big open windows and there is nobody there. Have to book on some online system. Today got a message saying due to sickness we can’t - click here for more info - so clicked to a link that was blank. Also refusing to to flu jabs due to overwork. So got one at the local chemist instead. She was scathing about GP’s. Said she was redressing wounds because GP surgeries refused because of ‘covid risk’.

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5 minutes ago, Anyone said:

Our GP practice won’t accept calls or email because they are ‘too busy’ . I drive past it most days , it’s got big open windows and there is nobody there. Have to book on some online system. Today got a message saying due to sickness we can’t - click here for more info - so clicked to a link that was blank. Also refusing to to flu jabs due to overwork. So got one at the local chemist instead. She was scathing about GP’s. Said she was redressing wounds because GP surgeries refused because of ‘covid risk’.

Indeed, it would seem that all the islands GP's  have retired on full pay by hiding behind "COVID"!

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6 hours ago, finlo said:

Indeed, it would seem that all the islands GP's  have retired on full pay by hiding behind "COVID"!

It might seem so, but we haven’t.

Several surgeries are struggling to recruit doctors and demand is far higher than I have ever known it (in 23 years as a GP).

The surgery is open from 8 to 6 and we often have 50 and sometimes 60 patient contacts per day, each. A mixture of face to face, phone/video calls and emails, but all need detailed evaluation. Thats one person every 10 minutes for 10 hours, to take a history, examine, decide a management plan, prescribe, sometimes refer and complete all the paperwork. 
 

Plus we have up to 150 lab reports and imaging results to deal with every day. And up to 90-100 medicine management queries. And around 100 incoming clinical letters.

And we’re doing flu jabs, and covid boosters. 

Not complaining BTW, I enjoy my job, just trying to explain why it can sometimes be difficult to provide the level of service we’d like to.
 

 

 

 

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39 minutes ago, FSM said:

It might seem so, but we haven’t.

Several surgeries are struggling to recruit doctors and demand is far higher than I have ever known it (in 23 years as a GP).

The surgery is open from 8 to 6 and we often have 50 and sometimes 60 patient contacts per day, each. A mixture of face to face, phone/video calls and emails, but all need detailed evaluation. Thats one person every 10 minutes for 10 hours, to take a history, examine, decide a management plan, prescribe, sometimes refer and complete all the paperwork. 
 

Plus we have up to 150 lab reports and imaging results to deal with every day. And up to 90-100 medicine management queries. And around 100 incoming clinical letters.

And we’re doing flu jabs, and covid boosters. 

Not complaining BTW, I enjoy my job, just trying to explain why it can sometimes be difficult to provide the level of service we’d like to.
 

 

 

 

That's interesting to know. To put that in context are you able to share how many GPs there are in your clinic and the total number of patients on your register?

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6 minutes ago, Andy Onchan said:

That's interesting to know. To put that in context are you able to share how many GPs there are in your clinic and the total number of patients on your register?

I could. But that would identify the surgery and probably me 😀

Suffice to say we have about 1800 patients per whole time GP. (I think this is about average for the island).

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Thank you for your posts @FSM

I really do empathise with our GPs and other medical professionals, but the situation for many resident patients is still dire. On social media, some posters are going ballistic about delays in getting fancy dining furniture delivered for Christmas, and yet a lot more people are suffering pain and discomfort (physical and mental) for months on end, waiting for proper health care services to be delivered. Regrettably, at times, basic human compassion for patients can be in short supply, even by medical professionals who are under stress.  

Another aspect of this is that while the UK NHS have serious staff shortages, long waiting lists etc., their needs will be major obstacles to attracting people with the appropriate skills to come here. If the private sector on this Island is to flourish economically, then we must have well-functioning public health services too.

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Asking out of ignorance, can other branches of medicine be tapped to spread the load?

How about nurse practitioners, osteopaths, chiropractors, naturapaths. acupuncturists, TCM, local chemist/pharmacist.

Of any of those are competent (how do you judge that?) how about someone with say a weight/diet issue to a naturapath, someone with pain maybe try an acupuncturist.

Would this be covered by the NHS. (I think not)

In essence use doctors for what they are good at and divert people to other areas. Who would decide? How would it work and be monitored. Customer decides?

Say you need medical attention, think you know what you need, do not want to bother a doctor, simple issue, who can decide or direct you (with the doctors appointment necessary if needed as backup).

There have been issues where the gateway is no good and mistakes are made, do not know when to defer.

Or does this already happen?

 

 

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14 minutes ago, philwebs said:

Asking out of ignorance, can other branches of medicine be tapped to spread the load?

How about nurse practitioners, osteopaths, chiropractors, naturapaths. acupuncturists, TCM, local chemist/pharmacist.

Of any of those are competent (how do you judge that?) how about someone with say a weight/diet issue to a naturapath, someone with pain maybe try an acupuncturist.

Would this be covered by the NHS. (I think not)

In essence use doctors for what they are good at and divert people to other areas. Who would decide? How would it work and be monitored. Customer decides?

Say you need medical attention, think you know what you need, do not want to bother a doctor, simple issue, who can decide or direct you (with the doctors appointment necessary if needed as backup).

There have been issues where the gateway is no good and mistakes are made, do not know when to defer.

Or does this already happen?

 

 

Didn't the chemists recently get saddled with people being told to inundate them? Except no one thought to tell them.

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1 hour ago, philwebs said:

Asking out of ignorance, can other branches of medicine be tapped to spread the load?

How about nurse practitioners, osteopaths, chiropractors, naturapaths. acupuncturists, TCM, local chemist/pharmacist.

Of any of those are competent (how do you judge that?) how about someone with say a weight/diet issue to a naturapath, someone with pain maybe try an acupuncturist.

Would this be covered by the NHS. (I think not)

In essence use doctors for what they are good at and divert people to other areas. Who would decide? How would it work and be monitored. Customer decides?

Say you need medical attention, think you know what you need, do not want to bother a doctor, simple issue, who can decide or direct you (with the doctors appointment necessary if needed as backup).

There have been issues where the gateway is no good and mistakes are made, do not know when to defer.

Or does this already happen?

 

 

Yes… and no.  The minor ailment pharmacy scheme has been running for a few years now. Some surgeries have nurse practitioners, we have a prescribing nurse, who deals with a lot of chronic disease management- diabetes, asthma etc. 
we’re moving towards mental health and physiotherapy in primary care. Some doctors and physios use accupuncture.

The problem is, practitioners seeing unselected/self selected patients have to have a really broad based training, they need to know what they don’t know. These people are in short supply.

I don’t think the NHS will be funding the “alternative” stuff (osteopathy, chiropractic TCM, homeopathy, naturopathy etc.)

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3 hours ago, code99 said:

Thank you for your posts @FSM

I really do empathise with our GPs and other medical professionals, but the situation for many resident patients is still dire. On social media, some posters are going ballistic about delays in getting fancy dining furniture delivered for Christmas, and yet a lot more people are suffering pain and discomfort (physical and mental) for months on end, waiting for proper health care services to be delvered.

Agreed. Waiting lists for (some) secondary care services are unacceptable. Manx Care has said so publically and are taking steps to try to improve things. The situation is a big driver for GP workload. I can refer somebody who needs to see a specialist and then see them another 5-6, or more, times to try to help their symptoms, before they get seen by a consultant. (This isn’t unique to the island, I worked in the Uk for 13 years before moving here and the issues were similar, especially after 2010)

Edited by FSM
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Waiting lists on the island are CRIMINAL

We should send most patients off island for the best care.

Some of our docs/ surgeons are competent but from personal experience of several disciplines in Nobles, most seem to be here to take the money. FFS.

If you have the misfortune to be ill enough to be sent to a UK hospital you would see for yourself. Nobles is SH1T. 

Simple things like the cleaning of the curtains around beds, look at nobles curtain's nice 3 legs designs, when were they last cleaned? Who the FCUK knows because it is not written on the curtains as it is in every proper hospital I have been to in the UK

I could go on and on about it but unless you have properly experienced first world NHS care in the UK you wont appreciate how bad it is here.

As I said, its CRIMINAL how bad it is here.

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