In my previous posts I described the disastrous state of the English NHS from a financial, administrative and patient perspective. But how are the staff faring? I can offer some insight through the experiences of my wife, who studied medicine in the UK and later specialised in working as a general practitioner (GP).
In short, doctors are not better off than the patients. They are torn apart trying to be good healers in an overwhelmed system. Additionally,with the typical British focus on money, the system forces them to be little more than gear wheels in its big machine.
I got my first glimpse of this when I helped my wife to prepare for her final exams. One is a practical exam where she got confronted with situations from everyday GP life. A group of actors portray different types of patients. For example, the elderly English lady who talks too much about her life but is sparing with details of her condition, a forty-year-old alcoholic, or a young, drug-addicted mother. There are cancer patients, hypochondriacs and suicidal people. Some "patients" are nice, others dismissive, some become aggressive.
The doctors have to remain professional and friendly, make the right diagnosis, prescribe appropriate treatment and follow up on any deeper problems. These can be the described addictions and much more. GPs are the first professionals Britons contact not only for health problems, but also for social problems.
GPs have to learn how to deal with every situation in the demanded time frame of 10 minutes… I don't think teaching efficiency is bad, but a 10-minute limit is hardly realistic in practice. After all, people are not machines. Our problems are not standardised.
But those in charge in the UK see it differently. Even in practice, there is hardly any deviation from the rule. Doctors and patients have to function in the rhythm of the healthcare machine.
GP shifts are also precisely structured. A so-called session includes about three hours for patient contact, plus 70 minutes for administrative tasks. The exact structure may vary slightly from surgery to surgery. A full day consists of two sessions of four hours.
Each session is filled with a set number of patients. For each patient, they are given, you guessed it, 10 minutes. And each patient can have one problem treated per appointment. If one needs to discuss stomach problems in addition to a sore throat, one needs another appointment. Longer slots of 20 minutes can be allocated, depending on management, for the examination of infants or foreign-language patients. For the latter, a translation service is available by telephone.
The three hours of patient contact are not completely scheduled with appointments, so there is some buffer if delays occur. In our GP circle, 15-17 appointments per session are the norm. But even the resulting extra 30 minutes are hardly enough. Many patients don't know the time constraints, nor the limitation to one problem, children certainly don't let themselves be examined according to the rules, GPs are regularly stuck in a queue at the translation service, and receptionists forget to book longer slots when they should.
Then there are seriously ill patients. Someone who has just been told about their cancer diagnosis can hardly be ordered out of the room just because time is up. The same applies to suicidal patients.
Doctors are faced with a dilemma. Either they put the welfare of their patients first and don't care about the 10-minute deadline, in which case they pay for their dedication with several hours of overtime a day. Or doctors function strictly according to plan, no matter what damage they do to their "customers".
Fortunately, most doctors feel committed to their patients. (We know exceptions). Accordingly, they suffer from overwork. As a consequence, hardly any of the GPs in our circle work a full week, i.e. 10 sessions. The standard is rather six to eight. They earn less, but no one is starving. Per session approbated GPs get around £9,000-12,000 a year (the average is more on the lower end). However, patients have even less medical care available than they already do. (As described, there are 30% fewer doctors per patient in the UK compared to Germany [1]).
Quick side note: Fully trained doctors earn quite well, especially by UK standards. But after graduating from university, they need several more years of specialisation. GPs at least five years, others more. And these are not paid well. My wife's starting salary as a junior doctor was just under £27,000 a year, less than today’s median income. And in contrast to the general cost of living, junior doctor wages have barely risen since she graduated from university. Tuition fees, on the other side, have tripled. And I haven’t even mentioned the costs of all the additional exams during training. These can range from several hundred to over a thousand pounds each. In other words, many young doctors live in precarious circumstances. Add the workload described, it is not surprising 40% of junior doctors are actively planning to leave the NHS [2]. And it is not surprising either that we saw several strikes by junior doctors in 2023 to improve their wages. For the sake of the health of the British, it would be better to meet their demands. If by reducing sessions or leaving completely, doctors turn their back on the beloved NHS... But back to the day-to-day work.
British GPs are drilled to work in the 10 minute rhythm. Unfortunately, many surgeries do little to help them meet the time constraints. Join me in the waiting room of a GP surgery for illustration. The furnishing mostly exudes 80s Eastern European charm. The only item standing out is the large screen to which all the chairs are aligned. Patients are called into the treatment room via the screen, by displaying their name and the number of the room.
But only for a few seconds. Then the call is replaced by three or four pages of information, along the lines of "You want to quit smoking? We'll help!" Or: "Chest pain? Call 911 right away!" In other words, hardly anyone pays attention to the screen. Mrs. and Mr. Doctor wait in vain. After a while, the patients are called again via the screen. If there is still no response the GPs call reception or go to the waiting room themselves.
It usually takes 90-120 seconds before the situation is resolved. Doesn't sound like much, but 15-20 per cent of the scheduled treatment time is wasted and the buffer mentioned above is used up.
There is a simple solution to the problem: a sound signal could be played alongside the visual call on the screen. The idea is not unknown. During my journey through various waiting rooms, I was able to see the system in action once. Works great. Why isn't it installed everywhere? In some surgeries it is installed but is broken for ages. Why isn't it being repaired?
One explanation can be found in the organisation and financing of surgeries. The profit of the operators results from the difference between the budget granted and the costs. The budget of a GP practice is generally based on the number of registered patients, not on the number and type of treatments. Whether the employed GPs need eight, nine or ten hours for their daily work does not really matter. While many of the operators are doctors themselves, they have often enough retreated into administration. And since the reforms of the 2000s, practices have been allowed to merge into larger organisations. In these, administration has little to no patient contact.
As the British mentality dictates, they often concentrate on optimising profits instead of improving processes. The fact that the salaried doctors are being burnt out, to the detriment of the patients and the entire system, plays a secondary role.
With that, I end my tour through the NHS. Reviewing my posts, it seems to me the British are either completely committed to capitalism and put money and profit before everything else, as in the 19th century and the last 40 years, or commit to socialism, as in the years after WW2.
Socialism and capitalism both have strengths and weaknesses. One theory more, the other less. This is quite natural, especially since they are man-made. If implemented wisely, those in charge would try to curb the respective disadvantages, or even better, combine the strengths of different ideologies.
Not so in Britain. When neoliberalism and the welfare state existed in parallel in the last few decades, a synergy of the respective weaknesses occurred. The English NHS is the perfect example. Today, it is still bureaucratic and inefficient, while at the same time private operators are happily increasing their profits. The NHS is thus doubly broken, the citizens' money is doubly wasted.
Why can't the British do better? Is it just the general lack of competence due to the miserable education system? Or do the decision-makers have other problems to deal with? It's time to take a closer look at the political system of the UK.
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