DOCTORS REPLACED BY NURSES IN BRITAIN

Doctors are to be instructed to make evening home visits following a surge in the number of patients being forced to use hospital casualty departments at night. Hospital staff say they are struggling to cope with the increasing workload created by patients who find it difficult to see their family doctor. Almost half a million extra patients were treated in accident and emergency departments this summer, compared with the same period in 2003.

Health minister John Hutton will this week give patients a guarantee that they can have a home visit from a GP if their condition requires it - although it may not be their own family doctor. A Department of Health source said: 'Ministers are adamant that, should the clinical need arise, patients should be able to see a GP around the clock. The guidance will show exactly what ministers expect the NHS to deliver for patients in the evenings and weekends.'

Under the new GP contract introduced earlier this year, doctors can take a small pay cut and opt out of providing care between 11pm and 6am, and at weekends. It is now up to primary care trusts to provide cover at night, using nurses, locum doctors and other staff to deal with calls. When the change comes into full force in December, it is expected that nine out of 10 family doctors will choose not to offer night cover.

There are growing concerns about the burden this is placing on A & E departments. They are partly a victim of their own success because the four-hour waiting time target means more people are seen more quickly, but the burden has been exacerbated by difficulties across England in accessing care from GPs. Martin Shalley, president of the British Association of Emergency Medicine and a consultant in Birmingham, said: 'We see an awful lot [of patients] who cannot get in to see their GP with non-emergency problems.'

Casualty nurses take the brunt of the extra work. Some say they have seen a 20 per cent rise in attendance in the last two years, and a 13 per cent rise this year alone. Earlier this year, Northumbria Healthcare Trust was warned by its nurses that they could be forced to quit, so great was the burden of work at night in its overstretched A & E department. Sue Burt, a sister in the casualty department at Norfolk and Norwich Hospital Trust, told the Nursing Times that her department had seen a 13 per cent rise in attendances since January alone, mostly at night. 'People tell me they are here because it is convenient and because they cannot get an appointment with their GP. We are struggling to cope with the onslaught.'

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AUSTRALIA'S MOST LEFTIST STATE CANNOT TREAT THE SICK

"Three thousand people have joined elective surgery waiting lists in the past year and thousands more waited too long in emergency departments, according to a new report on Victoria's public hospitals. The latest quarterly report on the state's public hospitals yesterday painted a grim picture, with most major performance measures pointing to a system unable to cope with growing patient demand. The number of people waiting in emergency for more than 12 hours shot up by 36 per cent, up from 4784 in the first three months of this year to 6547 in April, May and June. Elective surgery waiting lists also rose sharply, increasing by 3486 on the same time last year to 42,120, according to the report. Victoria's hospitals were forced to turn ambulances away 238 times in the three months to the end of June this year, 60 times more than in the same period last year.

Opposition health spokesman David Davis said the State Government had deliberately withheld the figures to avoid embarrassment before the federal election. "These figures should have been out some time ago. Steve Bracks decided to sit on these figures because they are disastrous," he said. Mr Davis said the poor results were due to a decision to close hospital beds and not a nurses' strike earlier this year. "The Bracks Government has to open beds and manage our system better," Mr Davis said....

A decline in performance at The Alfred hospital, where more than one in three patients waited for more than 12 hours on a trolley, would be addressed. "The Alfred hospital, as a major trauma centre, has some challenges," Ms Pike said...... "

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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