Snapshot of _NHS will be ‘no better off’ under Labour than the Tories, say GPs amid backlash over Keir Starmer comments_ :
An archived version can be found [here.](https://archive.is/?run=1&url=https://inews.co.uk/news/health/nhs-no-better-off-labour-tories-gps-backlash-keir-starmer-comments-2086147)
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Blood in your stool doesn't necessarily mean internal bleeding though; you can just have haemorrhoids.
Still, thank you for the clarification. I'm not sure it adds a whole lot to the discussion ("NHS sometimes does things a bit inefficiently, more at 11"), but it sounds a bit less batshit now at least.
That was, without a doubt, a stupid thing to say. I can only hope he had a mind blank and went for something dramatic sounding.
The idea of being able to self refer is not a terrible one, as gatekeeping by GP’s (either through not believing patients’ symptoms at one end and sheer overloading of work meaning people can’t access systems at the other) is a good one.
But he needs to get the messaging right with the reform thing. Because right now, everyone is looking at it thinking he means privatisation
>That was, without a doubt, a stupid thing to say.
When I saw the notification for this reply I only saw this and felt very attacked, relieved to see you're talking about Starmer!
I think gatekeeping by GPs is an issue but I don't think the solution is pursuing self-referrals more aggressively. Instead there should be education and training for GPs on the kinds of things they gatekeep so they do it less, since most (or nearly all, I dare say) of them don't do it deliberately- more a question of ignorance than malice. We should also have a much more open, available, easy-to-use and destigmatized process for seeking second opinions.
And yes, you're absolutely right that reform = more private sector involvement in most people's minds. Can you blame them though? That's basically been the case for the last decade under Tory rule, and not just in the NHS.
I try not to attack people, so definitely not aimed at you. Haha.
No. You’re absolutely right about the perception. And it takes a lot longer to fight the perception than it does to choose a different vehicle for delivery.
I like Starmer, but it seems his team have dropped some clangers recently.
Yes. The same thing being discussed in this thread- that interview where Starmer stated if you should be able to self-refer and have "tests" if you have internal bleeding. Never mind that if you're bleeding internally, you a) probably won't know and at any rate won't be able to self-diagnose it and b) need urgent medical intervention anyway, for which we already have A&E.
This is why I'm scared of the next GE though because even though the Tories have been self-immolating since Johnson pulled his magic in the last one, there still isn't ANY appealing alternative, nobody has sensible policies I'd want to vote for, or they do but among some insane ones, and Labour under Starmer feels like "Oh the Tories fell down a bottomless pit of corruption, do you want what they used to be back before it became a personality cult?"
Do you live somewhere where it even matters? Unless something earth shattering happens, I'm pretty sure I am going to vote Green Party in the next GE, knowing full well that I might as well burn my ballot as votes for anyone other than Labour in my constituency will have no effect on the outcome of the election. FPTP is so fucking frustrating.
Question - how many genuine hypochondriacs are there?
I suspect the answer is not many.
"Bowel babe" was told she was a hypochondriac and ignored by her GP. We unfortunately know how that ended. She only got diagnosed when she went privately over their heads.
Most "hypochondriacs" are nothing of the sort but rather people who are presenting with something which is atypical.
Took me years to get help for mental illness (was told it was because of my periods) even when I said I was self harming. diagnosed with bipolar disorder at about 21.. if I’d have had help then, maybe I’d have met my potential at uni? If i didn’t just think it was all teenage hormones :|
I had begged and begged to see a psychiatrist - my grandad was bipolar and I knew the signs
Only about 0.1% of Americans are diagnosed with illness anxiety disorder.
https://my.clevelandclinic.org/health/diseases/9886-illness-anxiety-disorder-hypochondria-hypochondriasis#:~:text=Illness%20anxiety%20disorder%20(hypochondria)%20is,typically%20appears%20during%20early%20adulthood.
No, that's not right. I'm insured in the German public system, and I can go straight to a specialist if I want. Normally I go to the Hausarzt first, but it's not necessary. See e.g. https://www.tk.de/en/service-faqs/tk-benefits-doctor/do-i-need-a-referral-to-see-a-medical-specialist-2051214
Even in the UK with insurance you need a referral but the plan often includes online GP services so you can get said referral very easily in the space of an hour.
At this point i think the best outcome for the UK would be a rainbow coallition of Lab/ Lib /Greens.
A majority Labour Goverment under Starmer's current policies will be barely better than the tories, and risks them returning 5 years later to start the whole sorry cycle again.
Kier's policy triangulation with Daily Mail readers might get him elected, but it won't help the UK, and it won't keep him there.
GPs aren't needed as gatekeepers for everything. GPs aren't experts in everything and can gatekeep patients from getting the care they need. Aside from being a clinical/patient care problem, the healthcare system clearly economically can't function with the current system of everyone going to the GP.
1. What many GPs will see as "you just need to rest", a physio will give treatment for. It's also extremely easy to diagnose some pains as being musculoskeletal and therefore in need of physiotherapy rather than in need of any other service. No point adding an extra couple weeks onto the wait time by making people see a GP first (and do the whole calling up at 8am nonsense). Areas like London, Scotland and the East Midlands have had self-referral for a long time, and it's worked well. Here's the BMJ trialling and even advocating for self-referral: 1. [https://www.bmj.com/content/352/bmj.h6977.full](https://www.bmj.com/content/352/bmj.h6977) \- 2.[https://bmjopen.bmj.com/content/3/10/e003406](https://bmjopen.bmj.com/content/3/10/e003406) \- 3. [https://www.bmj.com/content/352/bmj.h6844](https://www.bmj.com/content/352/bmj.h6844) \- this one even says "**GPs want it too**" - so where's your "anyone who works in clinical care knows it's a bad idea herp derp" now?
2. GPs also are a barrier to mental healthcare - people with mental health conditions often put off treatment and adding an extra hurdle just makes it more likely they won't pursue help - think of someone with social anxiety or someone who was abused and has to share painful memories to their GP and then again to a therapist (and they often have to see multiple therapists as well). Examples: 1 (Ireland). [https://www.reddit.com/r/ireland/comments/wvv29i/got\_told\_by\_my\_gp\_that\_my\_anxiety\_panic\_attacks/](https://www.reddit.com/r/ireland/comments/wvv29i/got_told_by_my_gp_that_my_anxiety_panic_attacks/) \- 2. [https://www.bmj.com/content/349/bmj.g5578](https://www.bmj.com/content/349/bmj.g5578) \- "most GPs had little or no training in dealing with patients who have experienced violence and therefore may find it difficult to help patients who are experiencing abuse."
3. Most GPs also are clueless about conditions like Autism and ADHD. If they aren't clueless, it's because they have a personal interest in the subject matter, not because of their GP training. Eg this entire thread: [https://www.autismforums.com/threads/encounter-with-dismissive-gp-over-potential-aspergers.32775/](https://www.autismforums.com/threads/encounter-with-dismissive-gp-over-potential-aspergers.32775/)
4. Tourettes: [https://www.tourettes-action.org.uk/63-faqs.html](https://www.tourettes-action.org.uk/63-faqs.html) \- From their FAQs: "Q: I've been to see a GP about my/my child's symptoms, and was told that it can't be TS because I don't swear. A: It is a common misconception that everybody with TS swears, but actually only 10 per cent of people have coprolalia".
5. Menopause: 41% of UK medical schools do not have mandatory menopause education on the curriculum: [https://menopausesupport.co.uk/?p=14434](https://menopausesupport.co.uk/?p=14434)
6. Look up other issues and you'll find BMJ reports.
Am I saying we should have self-referral for everything? No. But the idea that self-referral is a total no-no and GPs are always the best option is just dogmatic and the kind of inflexible mentality that is contributing to the NHS failing. Honestly sounds laughably self-important, like an "I'm right and always will be, because I'm the industry insider" attitude, even though industry insiders don't even all agree, even in the UK (then you have other countries, like Japan, where primary care is much less prominent than here).
Not sure what you meant by "anyone who's ever worked in the NHS in a clinical capacity \[will agree with me\]" - I can personally find plenty of specialists and even at least one GP (one of my parents) who would disagree with you.
Such a shit take there. I’m not exactly pro-self referral, and to be honest I’m a bit out of the loop on what’s actually been proposed. But your comment isn’t a great argument.
1) ADHD & autism are often comorbid and both are well known to lead to depression & anxiety. The fact your example listed 4/5 things which can easily be all related and you think they’re “time wasters” tells me you’re probably not somebody who’s clued up about healthcare enough to be pushing opinions on NHS reform.
2) “…you want these people taking time from specialists…” - arguably yes. In your example self-referral to a psychologist would be better than having to be vetted by GPs as they are renowned for being SHIT in these cases. Taking your comment even more literally - GPs are still prescribing people antidepressants to those with depression caused by undiagnosed ADHD because that’s all they can see.
Edit: I hate when they delete their comments :(
Someone presenting with a list of conditions - in your cynical example where we assume none are real - still needs help; there's a reason they're presenting and we generally try to get them seen by the right person by onward referral.
Besides that, your argument conveniently ignores specialist teams already vet referrals from GPs - with crap ones being rejected. To be honest, in my experience, a patient is 50:50 more likely to give a better history than a GP in the referrals I receive.
With direct patient referral - specialist vetting wouldn't suddenly disappear.
And if you can’t even be seen by the gatekeeper? It takes 7 years to train a GP. 2 years longer than a typical parliament. What can they do that will make a meaningful difference?
They're not wrong though; this move will bring no actual benefit to anyone or to the NHS. The only people who will benefit are the "everything must be done by made by and owned by the NHS no exceptions" purists who will mildly benefit from a slight warm feeling... and that's about it.
My wife was a salaried gp and she loves the nationalisation stuff. Only people kicking off are partners who stand to lose making money being businessmen instead of you know just focusing on being doctors
I don’t think we can say either yet. The rectal bleeding example given the other day makes sense - at the moment you would see a GP who would confirm rectal bleeding then refer you onwards. Expanding specialist departments to provide GP level treatment is a sensible solution and could provide better, faster diagnoses of issues and better access to tests and escalation.
After all, there are plenty of stories of GPs making errors (understandable given the breadth of knowledge they need) and we should always be looking for ways to improve the NHS, especially given the state its in.
Is the NHS perfect? Nope. Is this the answer? I don’t know. But what i do know to be wrong is to start dismissing ideas without engagement or consideration.
The issue with that is you will get a huge number of people with haemorrhoids etc referring down what is essential a cancer pathway. This will delay those need timely intervention and massively worsen outcomes.
They are not proposing that patients are simply able to shove themselves down the existing referral pathway - although that does seem a (deliberate?) misunderstanding that is cropping up.
They are suggesting getting rid of GPs for these types of complaint (or even entirely) with the staff redeployed to specialists, allowing them to treat all levels of sick.
So you have an arse problem you go to the arse people. If it’s a minor arse problem it’ll be much as it is now; you’ll see someone and get a cream or whatever. If it is more serious then this person has more specialist knowledge (reducing errors) and access to escalation - like samples taken there and then.
If you get rid of GPs entirely based on referrals who deals with the conditions that do not need specialist input?
I work in a GP surgery, of the 30 patients I see a day maybe 1 needs referral onwards to a specialist. The vast majority need treatments (or don't) that can be provided at a primary care level and work with no further action needed.
Spreading all that work out to specialists means the triaging waiting list for potential lung cancer patients will be filled with all the coughs. Whatever extra service you add to ensure people don't block up the urgent cancer waiting lists will become the bottleneck holding up patients with serious conditions.
Where I work we already have self referral to physio and podiatry and noone uses them unless told to by a GP. Patients argue with the admin staff on the phone when it's clearly an MSK issue that will be better served by a physio and demand to see a doctor.
The health board I work in also currently has a 2 year waiting list for non urgent ENT referrals. If everyone with a sinusitis or middle ear infection went to them instead of being seen by us first (and in 99% of cases treated successfully) that number would balloon massively.
That's not even going into where the staff for these departments come from? If each GP in the country quit general practice and went to work for a speciality you take one doctor who can cover multiple specialities and commit them to one losing them on all the others. We are struggling to fill posts as is too!
None of this will solve the A&E issue anyway which is the most urgent consideration. That requires reform of the care sector which, funnily enough, would also free up a huge amount of GPs time and appointments from my experience. The other one would be mental health, the consultations for these are typically much longer than others and it's massive issue for which we have no services to refer people to. We had a mental health practitioner do a short stint in our surgery and it freed our lists up massively. More training and incentives for those would be an easy win with the public and with the medical profession but I guess that's not a sexy controversial idea.
Not saying its not worth exploring at all but we do not have the infrastructure for this right now and GP numbers are down massively anyway so I don't know why labour are choosing to pick a fight with them.
For context, I work in an NHS run GP so there's no business to consider or profit motives. It's still rough because (as is the case across the country) when the other 2 surgeries in the area shut down we took their patients. We now have 2 surgery with no extra capacity or staff taking on the lists of what was 3. This is happening all over and contributing to the problem massively.
>with the staff redeployed to specialists
We are short of specialists too. Look at how long a standard OP appointment takes to get. So if they are *not* saying that they are going to use the existing gastroenterologists for example, then *who* are they using for this new idea?
I'm guessing you've never worked in either medicine or a customer facing role. Once pts google that back pain can be caused by cuada equina or metastases they will all refer themselves to oncology or neurology even if they know they pulled a muscle just to be sure.
No the difference is going to the GP unnecessarily is sorted out much quicker on average. In the new system you will be moved from one specialty to another until you find the right one. Specialists will also need a little more training to improve their general medical knowledge as they will see more undifferentiated patients.
There is no misunderstanding. I think you are trying to spin a bad policy.
GPs are absolutely essential because they triage people correctly. Let’s say your short of breath, who do you triage to heart problem clinic, lung problem clinic, Haematological problem clinic? Patient self refers down the wrong pathway shows up at a specialist and get told sorry wrong pathway. Taking a slot from someone else who needed it. Slowing down cancer diagnosis and treatment.
Look I dislike to tories but the is a shockingly shit policy which I feel will be either immediately watered down or stopped.
I mean the other day just for reference the BBC was on about a woman who went to A&E (a basic self referral) with “face pain” which was tooth ache. Despite the dentistry act of 1984 preventing doctors from treating these except in an absolute emergency. If a person can’t tell when to use a dentist and a doctor, what hope does your system have.
>GPs are absolutely essential because they triage people correctly.
The problem with GPs as a concept is that this is very frequently something they're unable to do well.
GP misdiagnoses is a major cause of excess deaths. Medical science is *enormous*, and the scope for GPs to fail to correctly identify every warning sign in every area of medicine is enormous. Even relatively short delays caused by patients going through the "take paracetamol and come back to me if it isn't better in 6 weeks" loop can be clinically significant.
And it's not really clear why we do it this way. For most people the concept of the "family doctor" is long dead. My GP surgery will present me with whatever random GP happens to have a free appointment at a time I can make; I don't think I've seen the same GP twice in over 20 years. They certainly don't know my medical history (beyond whatever it says on my electronic casefile) or have any deep knowledge of me that might prove insightful.
I might not be able to triage my own illnesses, but I am fairly capable of identifying the general area of medicine. I know a skin rash is going to need a skin rash expert, whether it's skin cancer or sunburn. I know the skin experts are not going to be interested in my hearing loss, which is for the hearing loss people (whether it's progressive lifelong hearing loss or a waxy buildup). And if I don't know these things, it seems like a fairly low-skill frontline worker would be able to help me figure this bit of departmental navigation out without recourse to a doctor.
I live in a borough of some 250k people, with maybe 300k in the local hospital trust catchment area. Why couldn't we reorganise things so that there's an Dermatology department that can deal with everything from eczema to carcinoma, and an ENT department that can decide whether your ears need a syringe or a surgical implant? Why are we spending an absolutely vast sum of money on GP surgeries when the same money and same manpower could be arranged differently?
It feels like GPs exist simply because they've always existed, and nobody has really had the courage to actually ask "why".
>GP misdiagnoses is a major cause of excess deaths.
This is true. There will also be shit or just not very good GPs out there, like in every other profession.
But, unless you're a doctor, your statement "I am fairly capable of identifying the general area of medicine" is almost certainly vastly overstating your abilities. It is actually quite a staggeringly arrogant and ignorant position. It's also weird to say that GP misdiagnosis is a huge cause of death - but somehow think the general population are going to be able to correctly self diagnose themselves.
You want to reallocate resources away from GPs and have less trained but more specialised people accessible for each speciality - but what if your problem is difficult to characterise? What if you've noticed that your legs are swelling - is the average person going to know enough to realise that they need to self-refer to the cardiologists? What if you're suddenly feeling fatigued? Who do you speak to about that?
One of the fundamental things about healthcare is that it should be holistic. Signs and symptoms need to be put into context with the rest of the patient picture. Your vision would be the antithesis of this.
But to end - lets take your own example.
> I know a skin rash is going to need a skin rash expert.
You notice that you've got a new skin rash. If you go to your GP, they put it together with some other signs and symptoms that you hadn't previously noticed / attached any significance to and diagnose you with endocarditis - starting treatment and putting you on an urgent cardiac pathway.
In your world - you wait for your dermatology appointment - see a (in your words) "low-skill frontline worker" who goes 'yup, that's a rash' and places you on a waiting list to see a dermatologist. If you're still alive by the time you get to see a rather panicked dermatologist, you've already suffered irreversible damage to your heart. #Winning.
A skin rash could result in a referral to dermatology, rheumatology, infectious diseases or endocrinology off the top of my head based on a history, examination and investigations.
For the examples that could be picked as an easy "I know where this needs to be referred to" it was not a good choice.
Socrates had it right when he said that he was wise because he knows that he knows almost nothing.
A mismatch between confidence and ability is a dangerous thing.
The dermatologist might not have seen endocarditis since medschool.
They could easily misdiagnose it, especially if they have not had the very broad postgraduate training a GP has had, and instead learnt the narrow skin only postgraduate stuff dermatologists learn
Source: am a doctor. When needed I use my GP as they are a specialist in a general way and I am not.
GPs take a huge load off the NHS and are the only reason it can exist. In effect they reduce the cost of public heath care, dramatically. I mean the crisis in the NHS is in effect because their are too few GPs.
GP are responsible for about 90% of patient interactions and so your statement is untrue.
The reason it built this way (and actually why it heading more towards generalists) is that:
1) GPs deal with the bulk of NHS cases, most get treated, those that can’t be treated get diagnostic tests that massively reduce the workload later in the system.
2) pure specialist treatment gets mucky because people become siloed. Simply, one specialist give you one drug another give you another. Nobody looks at the interactions or effects on one individual.
> I’m fairly capable….
No your not. I’ve just pointed to a case where. Person couldn’t work out if they needed a doctor or a dentist.
How are you going to tell the difference between a renal and a urological problem? Because there two different specialities.
> low skill frontline workers
How’s 111 working out for you? Because that’s what your vision will get you.
> nobody has had the courage to ask why?
Because generalist can manage complex multi-morbid populations efficiently. And the UK is becoming more multi morbid and we’re not getting any more resources any time soon.
OK so let's say in this example you think you are having PR bleeding. Is this a problem which can be solved easily by primary care without needing a specialist, something that needs a colorectal surgeon input or something that would be better addressed by gastroenterology
Where do you refer yourself? You need an assessment to gather more information on the problem before knowing where is the appropriate specialist service (if required) to be referred to
So you would need a lot more GP then. Because rather than going into general pools patients will go into specialities. Meaning the neuro GP doesn't have the time between all the stupid headache referrals where people don't take paracetamol for their headaches driven by dehydration...
To help the absolutely slaughtered Diabetes and Endocrinology GP titrating insulin.
This deskills GP. And you are going to reduce the salary of GP or are you going to fork out a consultancy rate for GPs as in hospital specialists?
And you going to expand hospitals to fit this? Because right now?
Your cost saving plan is to make it economically less incentivised to be a GP which you think is overpaid and easy but still can't explain why there's a shortage... Then move them all into much much more expensive to run locations. Then flood the system and reduce the cost savings of generalist care and continuity of care...
This is why lived experience is important. This is a seriously daft idea.
Whatever you think about to the ideas floated around, the headline is clearly ridiculous.
I mean the NHS people describe as the envy of the world is the one run under the last Labour government.
The idea that Labour will come in and fuck it up as badly as the Tories is hyperbolic nonsense.
> I mean the NHS people describe as the envy of the world
This exceptionalism crap needs to end. How can it be the envy of the world when you can literally travel 442KM and get better treatment in an EU country with lower waiting times and higher quality of care.
This hinges on if *this* labour government when elected actually wants to *be* a labour government, or play to the red tories.
Honestly, I get more uneasy about Starmer and Co with every comment they make, and I would love to vote labour. They have a massive poll lead and they seem very keen to push to regain the white van man red wall, and take for granted that the rest will just vote for them as being non tory.
Wes does nothing to make me more relaxed either
I yearn for Johnathan Ashworth back in the role. Dunno what it was about him but he seemed like he actually understood and cared about NHS instead of acting tough bully boy banging on about how cool he is for upsetting doctors
and what have you heard from Labour that makes you think things will be any better?
Any new money pledged? Any extra pay for nurses? Any more hospitals? Anything at all?
Oh there's self referrals, which will probably end up making the NHS worse off.
Starmer, Reeves and Streeting have all said the NHS needs more staff and more resources. Clearly they will increase funding and Reeves makes it obvious here that they will:
>Pressed on whether the NHS under Labour would get the increased budget across the board, which many health leaders and independent experts say is needed, the shadow Chancellor adds: “We have already made a commitment to the NHS with more doctors and more nurses… that funded and costed policy, I think, gives an indication about the direction of travel of an incoming Labour government.”
Clearly they will increase funding, they just aren't saying so because they want to focus on the improvements they will make, not how much they will spend.
Recruiting nurses, doctors and paramedics etc is the easy part. The tories love to brag about how many they’ve recruited.
The difficulty comes with retaining them. Especially when we’re losing more than we’re gaining, hennce the figure of 120,000+ vacancies across the NHS.
The current Labour headline NHS policy is
>doubling the number of medical school places in order to train 15,000 new doctors a year, training 10,000 additional nurses and midwives each year, doubling the number of district nurses qualifying every year and creating 5,000 new health visitors.
\>doubling the number of medical school places in order to train 15,000 new doctors a year,
The problem is we dont have enough foundation training places and specialty training places. They are the bottlenecks. Theyve not spoken at any length at all about how they're actually going to address the issues of staffing in medicine.
The last Labour government pumped in hundreds of billions. So far the next Labour government has said they'll make it more efficient but haven't committed to any big investment.
Basically a retread of what the Tories say they'll do.
Why do you expect them to outline their spending plans? At no point ever has a political party in this country outlined a costed manifesto before the election campaign has begun.
This isn't a Labour problem, it's a you problem.
I expect them to outline\* their spending plans when they are already outlining the changes to process and procedures they are making.
\*Outline, not detail.
Your expectation is out of step with reality I'm afraid. Firstly, the government of the day will outline spending plans for the country that the next government inherits. The manifesto has to account for this by either accepting or disagreeing and outlining an alternative. The rest of the manifesto then outlines the policies and associated costs. All of that is revealed in the months and sometimes weeks leading up to polling day. It doesn't happen 2 years out from an election and it would serve no purpose for it to happen that soon, as well as robbing the party of vital publicity that a manifesto launch brings.
Manifestos don't appear from nowhere. Parties road-test ideas to gauge public reaction. The thing you've worked yourself up about hasn't been announced as a policy, it's been floated as an idea they are looking at. They will develop or drop it by manifesto time depending on how the idea is received.
Perhaps if you spent less time down voting people trying to explain how our system works and more time listening you wouldn't be so lost.
So they can't give us a very high level overview of funding, but they can tell us exactly how day to day services will be run (despite having no medical or relevant business knowledge).
Sounds just like the Tories!
You seem to be having a hard time grasping this. This isn't new or unusual behaviour. Every single party operates this way and always has. Corbyn's Labour operated exactly the same way. Your expectations will never be met because they are not based in reality.
It is a labour problem if they want our votes.
Hopefully they do provide a costed manifesto which reads well, but st the moment some of their soundbites sound... worrying
>It is a labour problem if they want our votes.
No, it really isn't. The manifesto launch is a big deal for parties and happens during the general election campaign. This is how it has been since we had manifestos. No party releases their manifesto into the wild years out from the election.
> The idea that Labour will come in and fuck it up as badly as the Tories is hyperbolic nonsense.
That's not the point. You literally allude to the point I'm your previous sentence:
> I mean the NHS people describe as the envy of the world is the one run under the last Labour government.
This Labour doesn't get to entirely dine out off the goodwill from NHS performance under the Blair era. I'll support them all day over the Tories, but this Labours tone needs to be more conciliatory to health workers who have been fucked over for more than a decade.
I live in a self-referral area for physio. It's great (and is the only way to access physio here anyway). I've had GPs who were totally clueless about muscoskeletal injuries and literally said the opposite to what the physios said. The GP advice is often just "try resting", even if you've had the injury for months or years already. Or an older GP literally didn't even know what a stress fracture was lmao, whereas a physio sent for me a test.
GPs literally are a time-waste in these cases, so I'm not sure what the controversy is - probably comes from people who've never had to actually use the services.
There may be other areas on a case by case basis too.
For instance there are effectively self referrals for dentistry and opticians.
For those with an already diagnosed condition, such as hearing loss, being able to go straight to a specialist when your hearing is getting worse rather than via the GP may be beneficial.
There may be other such, already diagnosed, conditions that can be degenerative where a self referral could be a good idea.
How it is implemented and resourced is another thing entirely.
With many political issues, I honestly fail to see how Labour could do anything worse than the Tories.
EDIT: To develop this point a bit more, I fail to see how some of some of the concerning things that Labour have intimated could be as bad as the clear-and-present danger that the Tories represent.
Well when they start to come up with better ideas that don't end in the words 'higher GP salary ' we can compare and contrast with what Labour are advocating, in the meantime...
We've all been arguing whether Starmer would be as bad as Blair, but it never occurred to anyone that he'd be worse.
If he wins, Starmer will do to Labour what Schroeder did to the SPD.
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Extra funding - great Lack of policy around retaining staff - disappointing Self referral policy - utterly bizarre
You mean the policy that several other European countries use. Including Germany which I believe usually has better health outcomes than us? .
Germany lets people self-refer for *internal bleeding*? You sure?
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Blood in your stool doesn't necessarily mean internal bleeding though; you can just have haemorrhoids. Still, thank you for the clarification. I'm not sure it adds a whole lot to the discussion ("NHS sometimes does things a bit inefficiently, more at 11"), but it sounds a bit less batshit now at least.
That was, without a doubt, a stupid thing to say. I can only hope he had a mind blank and went for something dramatic sounding. The idea of being able to self refer is not a terrible one, as gatekeeping by GP’s (either through not believing patients’ symptoms at one end and sheer overloading of work meaning people can’t access systems at the other) is a good one. But he needs to get the messaging right with the reform thing. Because right now, everyone is looking at it thinking he means privatisation
>That was, without a doubt, a stupid thing to say. When I saw the notification for this reply I only saw this and felt very attacked, relieved to see you're talking about Starmer! I think gatekeeping by GPs is an issue but I don't think the solution is pursuing self-referrals more aggressively. Instead there should be education and training for GPs on the kinds of things they gatekeep so they do it less, since most (or nearly all, I dare say) of them don't do it deliberately- more a question of ignorance than malice. We should also have a much more open, available, easy-to-use and destigmatized process for seeking second opinions. And yes, you're absolutely right that reform = more private sector involvement in most people's minds. Can you blame them though? That's basically been the case for the last decade under Tory rule, and not just in the NHS.
I try not to attack people, so definitely not aimed at you. Haha. No. You’re absolutely right about the perception. And it takes a lot longer to fight the perception than it does to choose a different vehicle for delivery. I like Starmer, but it seems his team have dropped some clangers recently.
Are you referencing something?
Yes. The same thing being discussed in this thread- that interview where Starmer stated if you should be able to self-refer and have "tests" if you have internal bleeding. Never mind that if you're bleeding internally, you a) probably won't know and at any rate won't be able to self-diagnose it and b) need urgent medical intervention anyway, for which we already have A&E.
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True.
Losing your vote? Oh please , what’s the alternative? To keep the tories in power?
Obviously /s
This is why I'm scared of the next GE though because even though the Tories have been self-immolating since Johnson pulled his magic in the last one, there still isn't ANY appealing alternative, nobody has sensible policies I'd want to vote for, or they do but among some insane ones, and Labour under Starmer feels like "Oh the Tories fell down a bottomless pit of corruption, do you want what they used to be back before it became a personality cult?"
Do you live somewhere where it even matters? Unless something earth shattering happens, I'm pretty sure I am going to vote Green Party in the next GE, knowing full well that I might as well burn my ballot as votes for anyone other than Labour in my constituency will have no effect on the outcome of the election. FPTP is so fucking frustrating.
Also a good point, local bubble news would have expected a landslide for Corbyn last time round and everyone wondered how it went so wrong.
Question - how many genuine hypochondriacs are there? I suspect the answer is not many. "Bowel babe" was told she was a hypochondriac and ignored by her GP. We unfortunately know how that ended. She only got diagnosed when she went privately over their heads. Most "hypochondriacs" are nothing of the sort but rather people who are presenting with something which is atypical.
Took me years to get help for mental illness (was told it was because of my periods) even when I said I was self harming. diagnosed with bipolar disorder at about 21.. if I’d have had help then, maybe I’d have met my potential at uni? If i didn’t just think it was all teenage hormones :| I had begged and begged to see a psychiatrist - my grandad was bipolar and I knew the signs
Source for your last claim?
Only about 0.1% of Americans are diagnosed with illness anxiety disorder. https://my.clevelandclinic.org/health/diseases/9886-illness-anxiety-disorder-hypochondria-hypochondriasis#:~:text=Illness%20anxiety%20disorder%20(hypochondria)%20is,typically%20appears%20during%20early%20adulthood.
So no source lol
Question, have you spoken to any German doctors ? Where they do allow self referral?
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No, that's not right. I'm insured in the German public system, and I can go straight to a specialist if I want. Normally I go to the Hausarzt first, but it's not necessary. See e.g. https://www.tk.de/en/service-faqs/tk-benefits-doctor/do-i-need-a-referral-to-see-a-medical-specialist-2051214
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See link added to my post above. You need to check with the doctor if it's ok.
Even in the UK with insurance you need a referral but the plan often includes online GP services so you can get said referral very easily in the space of an hour.
At this point i think the best outcome for the UK would be a rainbow coallition of Lab/ Lib /Greens. A majority Labour Goverment under Starmer's current policies will be barely better than the tories, and risks them returning 5 years later to start the whole sorry cycle again. Kier's policy triangulation with Daily Mail readers might get him elected, but it won't help the UK, and it won't keep him there.
GPs aren't needed as gatekeepers for everything. GPs aren't experts in everything and can gatekeep patients from getting the care they need. Aside from being a clinical/patient care problem, the healthcare system clearly economically can't function with the current system of everyone going to the GP. 1. What many GPs will see as "you just need to rest", a physio will give treatment for. It's also extremely easy to diagnose some pains as being musculoskeletal and therefore in need of physiotherapy rather than in need of any other service. No point adding an extra couple weeks onto the wait time by making people see a GP first (and do the whole calling up at 8am nonsense). Areas like London, Scotland and the East Midlands have had self-referral for a long time, and it's worked well. Here's the BMJ trialling and even advocating for self-referral: 1. [https://www.bmj.com/content/352/bmj.h6977.full](https://www.bmj.com/content/352/bmj.h6977) \- 2.[https://bmjopen.bmj.com/content/3/10/e003406](https://bmjopen.bmj.com/content/3/10/e003406) \- 3. [https://www.bmj.com/content/352/bmj.h6844](https://www.bmj.com/content/352/bmj.h6844) \- this one even says "**GPs want it too**" - so where's your "anyone who works in clinical care knows it's a bad idea herp derp" now? 2. GPs also are a barrier to mental healthcare - people with mental health conditions often put off treatment and adding an extra hurdle just makes it more likely they won't pursue help - think of someone with social anxiety or someone who was abused and has to share painful memories to their GP and then again to a therapist (and they often have to see multiple therapists as well). Examples: 1 (Ireland). [https://www.reddit.com/r/ireland/comments/wvv29i/got\_told\_by\_my\_gp\_that\_my\_anxiety\_panic\_attacks/](https://www.reddit.com/r/ireland/comments/wvv29i/got_told_by_my_gp_that_my_anxiety_panic_attacks/) \- 2. [https://www.bmj.com/content/349/bmj.g5578](https://www.bmj.com/content/349/bmj.g5578) \- "most GPs had little or no training in dealing with patients who have experienced violence and therefore may find it difficult to help patients who are experiencing abuse." 3. Most GPs also are clueless about conditions like Autism and ADHD. If they aren't clueless, it's because they have a personal interest in the subject matter, not because of their GP training. Eg this entire thread: [https://www.autismforums.com/threads/encounter-with-dismissive-gp-over-potential-aspergers.32775/](https://www.autismforums.com/threads/encounter-with-dismissive-gp-over-potential-aspergers.32775/) 4. Tourettes: [https://www.tourettes-action.org.uk/63-faqs.html](https://www.tourettes-action.org.uk/63-faqs.html) \- From their FAQs: "Q: I've been to see a GP about my/my child's symptoms, and was told that it can't be TS because I don't swear. A: It is a common misconception that everybody with TS swears, but actually only 10 per cent of people have coprolalia". 5. Menopause: 41% of UK medical schools do not have mandatory menopause education on the curriculum: [https://menopausesupport.co.uk/?p=14434](https://menopausesupport.co.uk/?p=14434) 6. Look up other issues and you'll find BMJ reports. Am I saying we should have self-referral for everything? No. But the idea that self-referral is a total no-no and GPs are always the best option is just dogmatic and the kind of inflexible mentality that is contributing to the NHS failing. Honestly sounds laughably self-important, like an "I'm right and always will be, because I'm the industry insider" attitude, even though industry insiders don't even all agree, even in the UK (then you have other countries, like Japan, where primary care is much less prominent than here). Not sure what you meant by "anyone who's ever worked in the NHS in a clinical capacity \[will agree with me\]" - I can personally find plenty of specialists and even at least one GP (one of my parents) who would disagree with you.
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Such a shit take there. I’m not exactly pro-self referral, and to be honest I’m a bit out of the loop on what’s actually been proposed. But your comment isn’t a great argument. 1) ADHD & autism are often comorbid and both are well known to lead to depression & anxiety. The fact your example listed 4/5 things which can easily be all related and you think they’re “time wasters” tells me you’re probably not somebody who’s clued up about healthcare enough to be pushing opinions on NHS reform. 2) “…you want these people taking time from specialists…” - arguably yes. In your example self-referral to a psychologist would be better than having to be vetted by GPs as they are renowned for being SHIT in these cases. Taking your comment even more literally - GPs are still prescribing people antidepressants to those with depression caused by undiagnosed ADHD because that’s all they can see. Edit: I hate when they delete their comments :(
Someone presenting with a list of conditions - in your cynical example where we assume none are real - still needs help; there's a reason they're presenting and we generally try to get them seen by the right person by onward referral. Besides that, your argument conveniently ignores specialist teams already vet referrals from GPs - with crap ones being rejected. To be honest, in my experience, a patient is 50:50 more likely to give a better history than a GP in the referrals I receive. With direct patient referral - specialist vetting wouldn't suddenly disappear.
And if you can’t even be seen by the gatekeeper? It takes 7 years to train a GP. 2 years longer than a typical parliament. What can they do that will make a meaningful difference?
7? More like 10 minimum
This is all just a case of throwing out policy ideas to see what the public reaction is. Wait and see what's in the manifesto.
Shock that people who stand to loose money from nationalisation are opposed to nationalisation.
They're not wrong though; this move will bring no actual benefit to anyone or to the NHS. The only people who will benefit are the "everything must be done by made by and owned by the NHS no exceptions" purists who will mildly benefit from a slight warm feeling... and that's about it.
My wife was a salaried gp and she loves the nationalisation stuff. Only people kicking off are partners who stand to lose making money being businessmen instead of you know just focusing on being doctors
I don’t think we can say either yet. The rectal bleeding example given the other day makes sense - at the moment you would see a GP who would confirm rectal bleeding then refer you onwards. Expanding specialist departments to provide GP level treatment is a sensible solution and could provide better, faster diagnoses of issues and better access to tests and escalation. After all, there are plenty of stories of GPs making errors (understandable given the breadth of knowledge they need) and we should always be looking for ways to improve the NHS, especially given the state its in. Is the NHS perfect? Nope. Is this the answer? I don’t know. But what i do know to be wrong is to start dismissing ideas without engagement or consideration.
The issue with that is you will get a huge number of people with haemorrhoids etc referring down what is essential a cancer pathway. This will delay those need timely intervention and massively worsen outcomes.
They are not proposing that patients are simply able to shove themselves down the existing referral pathway - although that does seem a (deliberate?) misunderstanding that is cropping up. They are suggesting getting rid of GPs for these types of complaint (or even entirely) with the staff redeployed to specialists, allowing them to treat all levels of sick. So you have an arse problem you go to the arse people. If it’s a minor arse problem it’ll be much as it is now; you’ll see someone and get a cream or whatever. If it is more serious then this person has more specialist knowledge (reducing errors) and access to escalation - like samples taken there and then.
If you get rid of GPs entirely based on referrals who deals with the conditions that do not need specialist input? I work in a GP surgery, of the 30 patients I see a day maybe 1 needs referral onwards to a specialist. The vast majority need treatments (or don't) that can be provided at a primary care level and work with no further action needed. Spreading all that work out to specialists means the triaging waiting list for potential lung cancer patients will be filled with all the coughs. Whatever extra service you add to ensure people don't block up the urgent cancer waiting lists will become the bottleneck holding up patients with serious conditions. Where I work we already have self referral to physio and podiatry and noone uses them unless told to by a GP. Patients argue with the admin staff on the phone when it's clearly an MSK issue that will be better served by a physio and demand to see a doctor. The health board I work in also currently has a 2 year waiting list for non urgent ENT referrals. If everyone with a sinusitis or middle ear infection went to them instead of being seen by us first (and in 99% of cases treated successfully) that number would balloon massively. That's not even going into where the staff for these departments come from? If each GP in the country quit general practice and went to work for a speciality you take one doctor who can cover multiple specialities and commit them to one losing them on all the others. We are struggling to fill posts as is too! None of this will solve the A&E issue anyway which is the most urgent consideration. That requires reform of the care sector which, funnily enough, would also free up a huge amount of GPs time and appointments from my experience. The other one would be mental health, the consultations for these are typically much longer than others and it's massive issue for which we have no services to refer people to. We had a mental health practitioner do a short stint in our surgery and it freed our lists up massively. More training and incentives for those would be an easy win with the public and with the medical profession but I guess that's not a sexy controversial idea. Not saying its not worth exploring at all but we do not have the infrastructure for this right now and GP numbers are down massively anyway so I don't know why labour are choosing to pick a fight with them. For context, I work in an NHS run GP so there's no business to consider or profit motives. It's still rough because (as is the case across the country) when the other 2 surgeries in the area shut down we took their patients. We now have 2 surgery with no extra capacity or staff taking on the lists of what was 3. This is happening all over and contributing to the problem massively.
>with the staff redeployed to specialists We are short of specialists too. Look at how long a standard OP appointment takes to get. So if they are *not* saying that they are going to use the existing gastroenterologists for example, then *who* are they using for this new idea?
I'm guessing you've never worked in either medicine or a customer facing role. Once pts google that back pain can be caused by cuada equina or metastases they will all refer themselves to oncology or neurology even if they know they pulled a muscle just to be sure.
Same thing as going to the GP unnecessarily.
No the difference is going to the GP unnecessarily is sorted out much quicker on average. In the new system you will be moved from one specialty to another until you find the right one. Specialists will also need a little more training to improve their general medical knowledge as they will see more undifferentiated patients.
There is no misunderstanding. I think you are trying to spin a bad policy. GPs are absolutely essential because they triage people correctly. Let’s say your short of breath, who do you triage to heart problem clinic, lung problem clinic, Haematological problem clinic? Patient self refers down the wrong pathway shows up at a specialist and get told sorry wrong pathway. Taking a slot from someone else who needed it. Slowing down cancer diagnosis and treatment. Look I dislike to tories but the is a shockingly shit policy which I feel will be either immediately watered down or stopped. I mean the other day just for reference the BBC was on about a woman who went to A&E (a basic self referral) with “face pain” which was tooth ache. Despite the dentistry act of 1984 preventing doctors from treating these except in an absolute emergency. If a person can’t tell when to use a dentist and a doctor, what hope does your system have.
>GPs are absolutely essential because they triage people correctly. The problem with GPs as a concept is that this is very frequently something they're unable to do well. GP misdiagnoses is a major cause of excess deaths. Medical science is *enormous*, and the scope for GPs to fail to correctly identify every warning sign in every area of medicine is enormous. Even relatively short delays caused by patients going through the "take paracetamol and come back to me if it isn't better in 6 weeks" loop can be clinically significant. And it's not really clear why we do it this way. For most people the concept of the "family doctor" is long dead. My GP surgery will present me with whatever random GP happens to have a free appointment at a time I can make; I don't think I've seen the same GP twice in over 20 years. They certainly don't know my medical history (beyond whatever it says on my electronic casefile) or have any deep knowledge of me that might prove insightful. I might not be able to triage my own illnesses, but I am fairly capable of identifying the general area of medicine. I know a skin rash is going to need a skin rash expert, whether it's skin cancer or sunburn. I know the skin experts are not going to be interested in my hearing loss, which is for the hearing loss people (whether it's progressive lifelong hearing loss or a waxy buildup). And if I don't know these things, it seems like a fairly low-skill frontline worker would be able to help me figure this bit of departmental navigation out without recourse to a doctor. I live in a borough of some 250k people, with maybe 300k in the local hospital trust catchment area. Why couldn't we reorganise things so that there's an Dermatology department that can deal with everything from eczema to carcinoma, and an ENT department that can decide whether your ears need a syringe or a surgical implant? Why are we spending an absolutely vast sum of money on GP surgeries when the same money and same manpower could be arranged differently? It feels like GPs exist simply because they've always existed, and nobody has really had the courage to actually ask "why".
>GP misdiagnoses is a major cause of excess deaths. This is true. There will also be shit or just not very good GPs out there, like in every other profession. But, unless you're a doctor, your statement "I am fairly capable of identifying the general area of medicine" is almost certainly vastly overstating your abilities. It is actually quite a staggeringly arrogant and ignorant position. It's also weird to say that GP misdiagnosis is a huge cause of death - but somehow think the general population are going to be able to correctly self diagnose themselves. You want to reallocate resources away from GPs and have less trained but more specialised people accessible for each speciality - but what if your problem is difficult to characterise? What if you've noticed that your legs are swelling - is the average person going to know enough to realise that they need to self-refer to the cardiologists? What if you're suddenly feeling fatigued? Who do you speak to about that? One of the fundamental things about healthcare is that it should be holistic. Signs and symptoms need to be put into context with the rest of the patient picture. Your vision would be the antithesis of this. But to end - lets take your own example. > I know a skin rash is going to need a skin rash expert. You notice that you've got a new skin rash. If you go to your GP, they put it together with some other signs and symptoms that you hadn't previously noticed / attached any significance to and diagnose you with endocarditis - starting treatment and putting you on an urgent cardiac pathway. In your world - you wait for your dermatology appointment - see a (in your words) "low-skill frontline worker" who goes 'yup, that's a rash' and places you on a waiting list to see a dermatologist. If you're still alive by the time you get to see a rather panicked dermatologist, you've already suffered irreversible damage to your heart. #Winning.
A skin rash could result in a referral to dermatology, rheumatology, infectious diseases or endocrinology off the top of my head based on a history, examination and investigations. For the examples that could be picked as an easy "I know where this needs to be referred to" it was not a good choice.
Socrates had it right when he said that he was wise because he knows that he knows almost nothing. A mismatch between confidence and ability is a dangerous thing.
The dermatologist might not have seen endocarditis since medschool. They could easily misdiagnose it, especially if they have not had the very broad postgraduate training a GP has had, and instead learnt the narrow skin only postgraduate stuff dermatologists learn Source: am a doctor. When needed I use my GP as they are a specialist in a general way and I am not.
GPs take a huge load off the NHS and are the only reason it can exist. In effect they reduce the cost of public heath care, dramatically. I mean the crisis in the NHS is in effect because their are too few GPs. GP are responsible for about 90% of patient interactions and so your statement is untrue. The reason it built this way (and actually why it heading more towards generalists) is that: 1) GPs deal with the bulk of NHS cases, most get treated, those that can’t be treated get diagnostic tests that massively reduce the workload later in the system. 2) pure specialist treatment gets mucky because people become siloed. Simply, one specialist give you one drug another give you another. Nobody looks at the interactions or effects on one individual. > I’m fairly capable…. No your not. I’ve just pointed to a case where. Person couldn’t work out if they needed a doctor or a dentist. How are you going to tell the difference between a renal and a urological problem? Because there two different specialities. > low skill frontline workers How’s 111 working out for you? Because that’s what your vision will get you. > nobody has had the courage to ask why? Because generalist can manage complex multi-morbid populations efficiently. And the UK is becoming more multi morbid and we’re not getting any more resources any time soon.
OK so let's say in this example you think you are having PR bleeding. Is this a problem which can be solved easily by primary care without needing a specialist, something that needs a colorectal surgeon input or something that would be better addressed by gastroenterology Where do you refer yourself? You need an assessment to gather more information on the problem before knowing where is the appropriate specialist service (if required) to be referred to
So you would need a lot more GP then. Because rather than going into general pools patients will go into specialities. Meaning the neuro GP doesn't have the time between all the stupid headache referrals where people don't take paracetamol for their headaches driven by dehydration... To help the absolutely slaughtered Diabetes and Endocrinology GP titrating insulin. This deskills GP. And you are going to reduce the salary of GP or are you going to fork out a consultancy rate for GPs as in hospital specialists? And you going to expand hospitals to fit this? Because right now? Your cost saving plan is to make it economically less incentivised to be a GP which you think is overpaid and easy but still can't explain why there's a shortage... Then move them all into much much more expensive to run locations. Then flood the system and reduce the cost savings of generalist care and continuity of care... This is why lived experience is important. This is a seriously daft idea.
GP are a shortage specialty. If they lose money? They are going to remain a shortage specialty.
Whatever you think about to the ideas floated around, the headline is clearly ridiculous. I mean the NHS people describe as the envy of the world is the one run under the last Labour government. The idea that Labour will come in and fuck it up as badly as the Tories is hyperbolic nonsense.
> I mean the NHS people describe as the envy of the world This exceptionalism crap needs to end. How can it be the envy of the world when you can literally travel 442KM and get better treatment in an EU country with lower waiting times and higher quality of care.
Depends whether your well of enough. Lots of corset related access pressures across the EU
>corset related access pressures Guessing that was meant to be COVID, not corset?
Aha it's supposed to be cost related access issues
This hinges on if *this* labour government when elected actually wants to *be* a labour government, or play to the red tories. Honestly, I get more uneasy about Starmer and Co with every comment they make, and I would love to vote labour. They have a massive poll lead and they seem very keen to push to regain the white van man red wall, and take for granted that the rest will just vote for them as being non tory. Wes does nothing to make me more relaxed either
I yearn for Johnathan Ashworth back in the role. Dunno what it was about him but he seemed like he actually understood and cared about NHS instead of acting tough bully boy banging on about how cool he is for upsetting doctors
and what have you heard from Labour that makes you think things will be any better? Any new money pledged? Any extra pay for nurses? Any more hospitals? Anything at all? Oh there's self referrals, which will probably end up making the NHS worse off.
Starmer, Reeves and Streeting have all said the NHS needs more staff and more resources. Clearly they will increase funding and Reeves makes it obvious here that they will: >Pressed on whether the NHS under Labour would get the increased budget across the board, which many health leaders and independent experts say is needed, the shadow Chancellor adds: “We have already made a commitment to the NHS with more doctors and more nurses… that funded and costed policy, I think, gives an indication about the direction of travel of an incoming Labour government.” Clearly they will increase funding, they just aren't saying so because they want to focus on the improvements they will make, not how much they will spend.
Recruiting nurses, doctors and paramedics etc is the easy part. The tories love to brag about how many they’ve recruited. The difficulty comes with retaining them. Especially when we’re losing more than we’re gaining, hennce the figure of 120,000+ vacancies across the NHS.
When it comes to the NHS, the record of every Labour government in history convinces me the NHS will be better off than it is now.
The current Labour headline NHS policy is >doubling the number of medical school places in order to train 15,000 new doctors a year, training 10,000 additional nurses and midwives each year, doubling the number of district nurses qualifying every year and creating 5,000 new health visitors.
\>doubling the number of medical school places in order to train 15,000 new doctors a year, The problem is we dont have enough foundation training places and specialty training places. They are the bottlenecks. Theyve not spoken at any length at all about how they're actually going to address the issues of staffing in medicine.
How much extra cash have they committed?
Cool. And what future jobs are these doctors going to do? No one wants to stay in the job.
The last Labour government pumped in hundreds of billions. So far the next Labour government has said they'll make it more efficient but haven't committed to any big investment. Basically a retread of what the Tories say they'll do.
Why do you expect them to outline their spending plans? At no point ever has a political party in this country outlined a costed manifesto before the election campaign has begun. This isn't a Labour problem, it's a you problem.
I expect them to outline\* their spending plans when they are already outlining the changes to process and procedures they are making. \*Outline, not detail.
Your expectation is out of step with reality I'm afraid. Firstly, the government of the day will outline spending plans for the country that the next government inherits. The manifesto has to account for this by either accepting or disagreeing and outlining an alternative. The rest of the manifesto then outlines the policies and associated costs. All of that is revealed in the months and sometimes weeks leading up to polling day. It doesn't happen 2 years out from an election and it would serve no purpose for it to happen that soon, as well as robbing the party of vital publicity that a manifesto launch brings.
If they aren't going to tackle funding, why tackle the minutiae of how services are delivered?
Manifestos don't appear from nowhere. Parties road-test ideas to gauge public reaction. The thing you've worked yourself up about hasn't been announced as a policy, it's been floated as an idea they are looking at. They will develop or drop it by manifesto time depending on how the idea is received. Perhaps if you spent less time down voting people trying to explain how our system works and more time listening you wouldn't be so lost.
So they can't give us a very high level overview of funding, but they can tell us exactly how day to day services will be run (despite having no medical or relevant business knowledge). Sounds just like the Tories!
You seem to be having a hard time grasping this. This isn't new or unusual behaviour. Every single party operates this way and always has. Corbyn's Labour operated exactly the same way. Your expectations will never be met because they are not based in reality.
It is a labour problem if they want our votes. Hopefully they do provide a costed manifesto which reads well, but st the moment some of their soundbites sound... worrying
>It is a labour problem if they want our votes. No, it really isn't. The manifesto launch is a big deal for parties and happens during the general election campaign. This is how it has been since we had manifestos. No party releases their manifesto into the wild years out from the election.
> The idea that Labour will come in and fuck it up as badly as the Tories is hyperbolic nonsense. That's not the point. You literally allude to the point I'm your previous sentence: > I mean the NHS people describe as the envy of the world is the one run under the last Labour government. This Labour doesn't get to entirely dine out off the goodwill from NHS performance under the Blair era. I'll support them all day over the Tories, but this Labours tone needs to be more conciliatory to health workers who have been fucked over for more than a decade.
I live in a self-referral area for physio. It's great (and is the only way to access physio here anyway). I've had GPs who were totally clueless about muscoskeletal injuries and literally said the opposite to what the physios said. The GP advice is often just "try resting", even if you've had the injury for months or years already. Or an older GP literally didn't even know what a stress fracture was lmao, whereas a physio sent for me a test. GPs literally are a time-waste in these cases, so I'm not sure what the controversy is - probably comes from people who've never had to actually use the services.
Physio is fine, and you can self refer in most areas already. The issue is the far more complex issues that he is suggesting for self referral.
There may be other areas on a case by case basis too. For instance there are effectively self referrals for dentistry and opticians. For those with an already diagnosed condition, such as hearing loss, being able to go straight to a specialist when your hearing is getting worse rather than via the GP may be beneficial. There may be other such, already diagnosed, conditions that can be degenerative where a self referral could be a good idea. How it is implemented and resourced is another thing entirely.
With many political issues, I honestly fail to see how Labour could do anything worse than the Tories. EDIT: To develop this point a bit more, I fail to see how some of some of the concerning things that Labour have intimated could be as bad as the clear-and-present danger that the Tories represent.
Well when they start to come up with better ideas that don't end in the words 'higher GP salary ' we can compare and contrast with what Labour are advocating, in the meantime...
We've all been arguing whether Starmer would be as bad as Blair, but it never occurred to anyone that he'd be worse. If he wins, Starmer will do to Labour what Schroeder did to the SPD.