Monday, February 08, 2010

Higher pay, shorter hours... but complaints about British GPs soar 12 per cent in ONE year

Complaints against GPs have risen by 12 per cent in just a year. Grievances lodged by patients totalled almost 40,000, official NHS figures show. That means a rise of a quarter in a decade during which GPs have seen their pay increased massively and their workload slashed. Much of the increase in complaints has followed the introduction of a new GP contract in 2004, which sent family doctors’ salaries soaring by 47 per cent to an average of £106,000 a year.

At the same time, more than nine out of ten GPs stopped providing care at evenings and weekends – slashing their workload by an average of seven hours a week in exchange for an annual pay cut of £6,000.

Now figures from the NHS Information Centre indicate that this fall in the amount of work they are carrying out has damaged patient care. Some 7,448 complaints were termed administration errors, including GPs not communicating properly with out-of-hours doctors and, between them, failing to provide proper care. The largest group of complaints – 14,866 – was about clinical care, including failure to diagnose illnesses or refer patients to specialists.

Last week a coroner ruled that failings in NHS out of hours care led to the death of pensioner David Gray at the hands of Dr Daniel Ubani, an exhausted German GP who had just flown in on his first UK shift.

Out of hours care has been the focus of increasing concern since primary care trusts assumed responsibility. A shortage of GPs willing to take up the work means PCTs often employ private companies, many of whom use overseas doctors.

It also emerged recently that medical lawyers have seen the number of complaints about out of hours care shoot up by 50 per cent in two years.

The Daily Mail revealed last week that care is so bad in some parts of the country that you only have a one-in-50 chance of a home visit from an on-call GP.

The latest official figures from the NHS revealed that 48,597 formal concerns were lodged with primary care trusts about GPs and dentists in 2008/09. This was up around 10,000 in a decade – and up more than 5,000 on the 2007/08 total. Dentists accounted for 8,909 of the complaints.

The Patients Association said failings in out-of-hours services and difficulties getting an appointment with a GP were likely to explain the rise in complaints. Claire Rayner, president of the Patients’ Association, called for people unhappy with their GP to complain and do all they can to get onto a rival doctor’s list. She said: ‘Too often people who are ill and frightened are not getting the care they need, especially when they are trying to get care outside normal surgery hours. ‘When people are not happy with their GP, we would urge them to vote with their feet.’

Both major political parties want to see the end of formal boundaries between GP practices, so patients can go to any doctor they choose. But they face a tough battle with the British Medical Association, which would prefer to see them retained.

Tory health spokesman Mark Simmonds called the findings ‘extremely concerning’. He blamed the 2004 change to out of hours arrangements for much of the rise, with family doctors taking the blame when patients could not get adequate help in an emergency in some cases. Other complaints were triggered when out of hours services and GPs failed to share vital information.

Mr Simmonds said the Tories would tear up the 2004 contract and return responsibility for commissioning out of hours care to GPs. He said: ‘I have no doubt that this is in part due to Labour’s failure to put the patients at the heart of the NHS and their changes to the GP out of hours system, which took responsibility for the service away from GPs and gave it to local bureaucrats.’

Dr Laurence Buckman, chairman of the GP committee of the BMA, said that while poor clinical care and bad behaviour could never be excused, it was possible that patients were more likely to complain now than they were ten years ago. He added: ‘Putting this in perspective, there are nearly 300 million consultations every year in general practice and surveys show that, on average, nine out of ten patients are satisfied.’

A league table shows that the London borough of Islington had the highest number of complaints per head of population, followed by Lincolnshire, the London boroughs of Lambeth and Southwark, and Great Yarmouth & Waveney in Norfolk.

The NHS was forced to turn to foreign doctors to plug shortages in hospitals when Labour took office and set targets for cutting waiting times for treatment. Since them, many more Britons have gone through the seven-year training period for doctors and begun work on the wards. But the NHS still has to fly in foreign doctors to cover out of hours shifts since the vast majority of GPs were allowed to opt out of what was a traditional duty of care.

A Department of Health spokesperson said: 'It is important to note this is not representative of the picture across the NHS. The NHS treats millions of people every day and the vast majority of patients experience good quality, safe and effective care - the Care Quality Commission's recent patient experience survey shows that 93 per cent of patients rate their overall care as good or excellent. 'In April last year, we introduced a new, simpler complaints system, which encourages patient feedback and ensures Trusts act on this to make their services more effective, personal and safe.'


Is Obama finally practicing what he preached: Bipartisanship?

Probably just a publicity stunt designed to "prove" that the GOP are obstructionists

In the first major step to revive his health care agenda after his party's loss of a filibuster-proof Senate majority, President Obama on Sunday invited Republican and Democratic leaders to discuss possible compromises in a televised gathering later this month. Obama's move came amid widespread complaints that efforts so far by him and his Democratic allies in Congress have been too partisan and secretive.

The Feb. 25 meeting's prospects for success are far from clear. GOP leaders demanded Sunday that Democrats start from scratch, and White House aides said Obama had no plans to do so. "If we are to reach a bipartisan consensus, the White House can start by shelving the current health spending bill," said Senate Minority Leader Mitch McConnell, R-Ky.

House Republican leader John Boehner of Ohio also threw some jabs while accepting Obama's invitation. He said he was glad the White House "finally seems interested in a real, bipartisan conversation," adding that Americans have rejected "the job-killing, trillion-dollar government takeover of health care bills passed by the House and Senate."

Obama told CBS's Katie Couric that he and the leaders of both parties will "go through systematically all the best ideas that are out there and move it forward." Asked if he was willing to start from square one, the president said he wants "to look at the Republican ideas that are out there. And I want to be very specific. 'How do you guys want to lower costs? How do you guys intend to reform the insurance markets so people with preexisting conditions, for example, can get health care?"' "If we can go step by step through a series of these issues and arrive at some agreements," Obama said, "then procedurally, there's no reason why we can't do it a lot faster than the process took last year."

Congress' Democratic and Republican leaders have differed sharply on most major questions in the long-running health care debate. Only one Republican voted for the House health care bill approved in December, and no Republicans voted for a similar Senate version.

White House officials said Sunday that Obama does not intend to restart the health care legislative process from scratch. Many liberal groups and lawmakers want congressional Democrats to use all the parliamentary muscle they have to enact the measure that the Senate passed on Christmas Eve, employing rules that could bypass GOP filibusters to make changes demanded by House Democrats. The White House has not ruled out such a strategy. But Obama's recent talk of inviting Republican input and extending the debate for several weeks has caused uncertainty about his plans.


Your tax dollars buy TV talking head

MIT economist Jonathan Gruber has no qualms about speaking his mind on ObamaCare. He’s been one of the most outspoken independent voices defending the healthcare proposals. But there’s a catch. He’s not independent at all. As it turns out, the Department of Health and Human Services paid him nearly $400,000 to provide "technical assistance" in evaluating the healthcare proposals.

Funny how he forgot to mention this blatant conflict of interest on the many TV shows in which he’s touted the plan, or in the newspaper articles where he’s been quoted. He even wrote an Op-Ed piece on health reform in the Washington Post, and again declined to mention that he’s getting paid put a positive spin on the plan.

Yup — just one more elite who takes your money to tell you what’s good for you.

For the record, Gruber says it’s all fine because he told anyone who asked, and anyway he was paid to advise the administration — not for his media appearances. To paraphrase an old saying about ducks: If it speaks like a shill and it’s paid like a shill…it’s a shill.

Counting the days until the midterm elections,


A One Page Alternative to "Obamacare"

Seven Real Reforms That Lower Costs, Raise the Number of Insured and be Deficit-Neutral

In the week between Scott Brown's seismic win and the State of the Union address, the Obama administration tried mightily to explain away the verdict of the Bay State voters. Despite the fact that Brown had plainly made the election a referendum on Obamacare, the voters, according to the administration's narrative, had not rejected it.

Rather, they had rejected Martha Coakley. They had been voting on other issues. They hadn't understood the bills in question. They were frustrated that change wasn't coming quickly enough. Indeed, they were simply expressing the same frustration that had swept Barack Obama into office. (In other words, they had apparently decided to stick it to George W. Bush by filling Ted Kennedy's Senate seat with a Republican.)

In the State of the Union, Obama offered another response. The Massachusetts voters had rejected Obama-care, but that didn't mean that he had to abide by their wishes. "I never suggested that change would be easy." "Democracy," he said, "can be noisy and messy." "We can do what's necessary to keep our poll numbers high and get through the next election." Or we can do "what's best for the next generation."

House Democrats seemed a bit stunned by this language, responding with silence rather than applause. They will face the voters in just nine months, and many of them represent Republican-leaning districts. Now, in the wake of Scott Brown's triumph, President Obama wants them to "take another look" at his proposals.

The American people have already taken a long look at Obamacare, and they don't want it. They don't want a government takeover that limits choice and competition, funnels $1 trillion from American taxpayers to insurance companies in its first dozen years (2014 to 2025), cuts Medicare Advantage benefits by an average of $21,000 per enrollee (except in South Florida) in its real first decade, and contains enough shady backroom deals to make Jimmy Hoffa blush.

Most of all, the American people don't want a $2.5 trillion bill that does all of that and still fails to do the one essential thing: lower health care costs.

During his State of the Union address, Obama also said that "if anyone from either party has a better approach ..... let me know." Well, without seeming too presumptuous, Mr. President, here you go!

The small bill offers seven real reforms (the last a combination of smaller reforms) that together would lower costs, significantly increase the number of insured, and be deficit-neutral.

Its proposals are not revolutionary or even particularly novel. They reflect ideas that are widely shared by Republicans in the House and Senate, as well as by many of their Democratic colleagues. The bill incorporates proposals that Tevi Troy and I have previously advanced. And it reflects scoring by the Congressional Budget Office (CBO) of the House Republican bill-the one bill proposed so far that the CBO has said would actually lower health costs. But the small bill would meet the American people's goals for health care reform-while Obamacare wouldn't-and it would do so at only a fraction of the price.

The small bill would cut health costs by roughly as much as the House Republican health bill, which contains very similar cost-cutting provisions. The CBO estimates that by 2016, the House GOP bill would cut insurance premiums by 7 to 10 percent in the small-group market, 5 to 8 percent in the individual market, and up to 3 percent in the large-group market, in relation to current law. Under Obama-care, the CBO says that the average family's premiums in the individual market would rise by $2,100 a year in relation to current law. The small bill would achieve these favorable results despite costing only about $180 billion in its real first decade-just 7 percent as much as Obamacare. And, unlike Obamacare, which would not go into effect in any meaningful way until 2014, the small bill would start next year.

Under the small bill, approximately 10 million additional people would acquire insurance, at a cost of about $18,000 per newly insured person versus about $76,000 under Obamacare. In other words, for every $20 billion spent, Obamacare would result in approximately 260,000 additional people becoming insured, compared with 1.1 million people under the small bill.

When the federal government isn't limiting their ability to do so, Americans know how to shop for value, and they will have no problem identifying the small bill as a far better value than Obamacare. In truth, even the status quo is clearly a better value than Obamacare. But the choice needn't be between those two unpleasant alternatives. Real reform is within our reach.

A recent McLaughlin and Associates poll asked Americans whether they would prefer Obamacare or a bill that took "more modest steps like allowing the purchase of insurance across state lines to improve competition, creating a risk pool to help people with preexisting conditions afford coverage, and curbing lawsuits against doctors." By almost three to one-61 percent to 21 percent-respondents favored the more modest alternative to Obamacare. Among those who felt "strongly," the tally was 31 percent to 9 percent.

Let's start over and give the American people what they want.


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