This article is from the source 'guardian' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.

You can find the current article at its original source at http://www.theguardian.com/society/live/2016/jan/18/this-is-the-nhs-live-blog

The article has changed 65 times. There is an RSS feed of changes available.

Version 48 Version 49
This is the NHS: live from a 111 call handling centre in Newcastle This is the NHS: live from a 111 call handling centre in Newcastle
(35 minutes later)
4.08pm GMT
16:08
Wednesday's liveblogging ends
That’s it for another day on the NHS’s frontline. Thanks for getting involved with your tweets and comments. And thanks to the staff at the North East ambulance service HQ in Newcastle for giving us such valuable access and sharing their working day with our readers.
Tomorrow Jessica Elgot will be reporting from maternity wards as our #ThisIsTheNHS series moves on to most people’s first experience with the health service, albeit one they are unlikely to remember: childbirth.
3.56pm GMT
15:56
Jessica Elgot
The last call I listen in to with nurse Mary Mallorca is a woman concerned about her young son who had tonsillitis but is having difficulty swallowing his medication.
The first call handler has suggested sending him to an urgent care centre doctor, but Mallorca is concerned by some of the symptoms. “He can’t swallow any of the medication, that could mean he needs to go to hospital because the glands are so swollen.”
She begins to arrange transport to get the boy to A&E, when the woman says her son has changed his mind and no longer wants to go to hospital, and will try again to swallow his medication.
Mallorca switches to a different script, arranging an appointment for an hour’s time at an urgent care clinic. It’s a scenario several members of the team say happens quite often – patients change their minds about the seriousness of symptoms; call handlers and nurses then have the onus to ask the right questions, to get a more accurate picture.
Updated
at 4.01pm GMT
3.16pm GMT3.16pm GMT
15:1615:16
Mary Mallorca, 111 call centre nurseMary Mallorca, 111 call centre nurse
Jessica ElgotJessica Elgot
Not seeing a patient’s face was a tricky thing for nurse Mary Mallorca to adapt to. She has worked in A&E and care homes, but helping patients over the phone is a very different proposition.Not seeing a patient’s face was a tricky thing for nurse Mary Mallorca to adapt to. She has worked in A&E and care homes, but helping patients over the phone is a very different proposition.
It is very, very hard that you can’t see them; you have to find other ways to judge their responses – you can’t take anything for granted over the phone.It is very, very hard that you can’t see them; you have to find other ways to judge their responses – you can’t take anything for granted over the phone.
Mallorca has had to deal with many patients who have said they are suicidal. “Even if you can’t see them, I believe they can feel when you care, when you talk to them, you have to have a positive approach, even though it can be very difficult for you as well.”Mallorca has had to deal with many patients who have said they are suicidal. “Even if you can’t see them, I believe they can feel when you care, when you talk to them, you have to have a positive approach, even though it can be very difficult for you as well.”
Although she has nothing but praise for call handlers, Mallorca said it would be better if everyone answering calls was a qualified nurse. “But we have to be able to cope with demand,” she said. “For a minor case, they can handle it themselves.”Although she has nothing but praise for call handlers, Mallorca said it would be better if everyone answering calls was a qualified nurse. “But we have to be able to cope with demand,” she said. “For a minor case, they can handle it themselves.”
3.14pm GMT3.14pm GMT
15:1415:14
We want to hear your wishlist for NHS mental health servicesWe want to hear your wishlist for NHS mental health services
in a perfect world, what would you like to see from the NHS' mental health services? #ThisIsTheNHS https://t.co/yXdV0PncdLin a perfect world, what would you like to see from the NHS' mental health services? #ThisIsTheNHS https://t.co/yXdV0PncdL
Get involved with the mental health element of our #ThisIsTheNHS series and help shape our future coverage.Get involved with the mental health element of our #ThisIsTheNHS series and help shape our future coverage.
3.05pm GMT3.05pm GMT
15:0515:05
Video: we role-play a 111 callVideo: we role-play a 111 call
Jessica Elgot poses as a sufferer of pharyngitis (that’s a sore throat to you and me) in order to be given an insight into the kind of questions patients are asked when calling 111. Call handler Karl Walker makes sure Jessica isn’t bleeding or sensitive to light before booking her an appointment with a GP within three hours.Jessica Elgot poses as a sufferer of pharyngitis (that’s a sore throat to you and me) in order to be given an insight into the kind of questions patients are asked when calling 111. Call handler Karl Walker makes sure Jessica isn’t bleeding or sensitive to light before booking her an appointment with a GP within three hours.
Walker has taken 999 calls for 5 years, and trained to do 111 when the service first started:Walker has taken 999 calls for 5 years, and trained to do 111 when the service first started:
They can really overlap: you might get an elderly person call 111 because they don’t want to bother an ambulance, but their are signs indicating a heart attack. On 999, you’d be surprised how many times we get people with toothache. It might be painful, but there’s nothing an ambulance can do about toothache.They can really overlap: you might get an elderly person call 111 because they don’t want to bother an ambulance, but their are signs indicating a heart attack. On 999, you’d be surprised how many times we get people with toothache. It might be painful, but there’s nothing an ambulance can do about toothache.
UpdatedUpdated
at 3.31pm GMTat 3.31pm GMT
2.44pm GMT2.44pm GMT
14:4414:44
Lynsey Redpath, team leaderLynsey Redpath, team leader
Jessica ElgotJessica Elgot
“If a 111 call handler was sending more than 5% of their calls to A&E, we want to know why,” team leader Lynsey Redpath said. “It’s not true that we send everyone there.”“If a 111 call handler was sending more than 5% of their calls to A&E, we want to know why,” team leader Lynsey Redpath said. “It’s not true that we send everyone there.”
Around a quarter of calls get transferred to a nurse either straight away, or for a call back. But mostly call handlers are trusted to make the right decision on how to advise a patient.Around a quarter of calls get transferred to a nurse either straight away, or for a call back. But mostly call handlers are trusted to make the right decision on how to advise a patient.
“It’s not just A&E or a GP; we can send people to pharmacists, midwives, opticians, dentists, district nurses, mental health services,” she said. “The pathways system we use is a spider’s web, not a linear process.”“It’s not just A&E or a GP; we can send people to pharmacists, midwives, opticians, dentists, district nurses, mental health services,” she said. “The pathways system we use is a spider’s web, not a linear process.”
1.50pm GMT1.50pm GMT
13:5013:50
Richard Abdy, planning managerRichard Abdy, planning manager
Jessica ElgotJessica Elgot
New Year’s Eve is Richard Abdy’s biggest night of the year – closely followed by whenever Newcastle play Sunderland. His job as planning manager is to try to predict the busiest times for 111 or 999 calls in order to keep staff costs down.New Year’s Eve is Richard Abdy’s biggest night of the year – closely followed by whenever Newcastle play Sunderland. His job as planning manager is to try to predict the busiest times for 111 or 999 calls in order to keep staff costs down.
You hear all the time that frontline services aren’t affected by the cuts. They are. Staffing is, like most places, 60-70% of our budget. When you have got nowhere else to cut, you have to look at how you can use staff effectively.You hear all the time that frontline services aren’t affected by the cuts. They are. Staffing is, like most places, 60-70% of our budget. When you have got nowhere else to cut, you have to look at how you can use staff effectively.
Abdy’s background is in the private sector. “It’s very different to selling insurance or PPI, saving people’s lives, but we also have to be sustainable.”Abdy’s background is in the private sector. “It’s very different to selling insurance or PPI, saving people’s lives, but we also have to be sustainable.”
Patterns that affect staffing are constantly changing. “The weather affects us in all sorts of different ways,” Abdy says. “If there’s snow, we can predict demand won’t be as high as you might think because people stay indoors. If there’s ice, it’s worse because people don’t see the danger, they go out, they fall.”Patterns that affect staffing are constantly changing. “The weather affects us in all sorts of different ways,” Abdy says. “If there’s snow, we can predict demand won’t be as high as you might think because people stay indoors. If there’s ice, it’s worse because people don’t see the danger, they go out, they fall.”
New Year’s Eve is now a totally different beast to when Abdy first started. “The pattern is later and later. Peak times used to be 1am; now it’s constant until 4am or 5am for 999 – and then it spikes again in the morning for 111. We only have a certain number of staff trained and they aren’t robots, they have to go home and sleep so that is a real challenge.”New Year’s Eve is now a totally different beast to when Abdy first started. “The pattern is later and later. Peak times used to be 1am; now it’s constant until 4am or 5am for 999 – and then it spikes again in the morning for 111. We only have a certain number of staff trained and they aren’t robots, they have to go home and sleep so that is a real challenge.”
One of the ways the service has tried to tackle the pressure is to train staff to take both 111 and 999 calls, so they can immediately switch to a different system if a 111 call seems more serious, or if a 999 caller really only needs a GP appointment. “It makes us more resilient, it means staff can deal with the unknowns, and we have a contingency who can always switch between roles.”One of the ways the service has tried to tackle the pressure is to train staff to take both 111 and 999 calls, so they can immediately switch to a different system if a 111 call seems more serious, or if a 999 caller really only needs a GP appointment. “It makes us more resilient, it means staff can deal with the unknowns, and we have a contingency who can always switch between roles.”
UpdatedUpdated
at 1.55pm GMTat 1.55pm GMT
1.44pm GMT1.44pm GMT
13:4413:44
'The problem is most people don't need to be in hospital''The problem is most people don't need to be in hospital'
We’ve just launched a special report by Steven Morris, who spent some time with Steve Hulks, a new breed of ambulance paramedic charged with keeping people out of hospital, rather than simply ferrying them to and from A&E.We’ve just launched a special report by Steven Morris, who spent some time with Steve Hulks, a new breed of ambulance paramedic charged with keeping people out of hospital, rather than simply ferrying them to and from A&E.
When [Hulks] first signed up a quarter of a century ago the job entailed going to the scene of an emergency and rushing the patient to hospital. “It was about doing some first aid, putting the patient in the back of an ambulance and taking them to A&E. The problem is most people didn’t need to be in hospital – it was no good for them and no good for the hospital.”When [Hulks] first signed up a quarter of a century ago the job entailed going to the scene of an emergency and rushing the patient to hospital. “It was about doing some first aid, putting the patient in the back of an ambulance and taking them to A&E. The problem is most people didn’t need to be in hospital – it was no good for them and no good for the hospital.”
… The idea is to embed teams of highly trained paramedic practitioners into the heart of communities. They have the decision-making skills – plus the local knowledge of regular patients – to know when someone needs to be taken to hospital and when they are better off staying where they are.… The idea is to embed teams of highly trained paramedic practitioners into the heart of communities. They have the decision-making skills – plus the local knowledge of regular patients – to know when someone needs to be taken to hospital and when they are better off staying where they are.
Related: The new breed of paramedics charged with keeping people out of hospitalRelated: The new breed of paramedics charged with keeping people out of hospital
UpdatedUpdated
at 3.01pm GMTat 3.01pm GMT
1.26pm GMT1.26pm GMT
13:2613:26
Cold snap putting more pressure on A&E departmentsCold snap putting more pressure on A&E departments
Guardian reporters Aisha Gani and Nadia Khomami have been calling A&E departments across the country to get a sense of the pressures they are under at this time of year – and during the coldest spell of weather of the winter so far.Guardian reporters Aisha Gani and Nadia Khomami have been calling A&E departments across the country to get a sense of the pressures they are under at this time of year – and during the coldest spell of weather of the winter so far.
The cold snap has particularly affected elderly patients suffering with “comorbidities” – one or more additional disorders – a spokesperson from the Cambridge University hospitals NHS foundation trust said. He added the A&E unit at Addenbrooke’s hospital had been busier – although not unusually so for the time of year.The cold snap has particularly affected elderly patients suffering with “comorbidities” – one or more additional disorders – a spokesperson from the Cambridge University hospitals NHS foundation trust said. He added the A&E unit at Addenbrooke’s hospital had been busier – although not unusually so for the time of year.
A spokeswoman for St George’s University hospitals in south London (the subject of this liveblog on Monday) said the trust was busier than in the same period 12 months ago.A spokeswoman for St George’s University hospitals in south London (the subject of this liveblog on Monday) said the trust was busier than in the same period 12 months ago.
She added that though the hospital had not met its four-hour A&E waiting target on any day in the past fortnight, the performance had been better than a year ago. “St George’s has struggled to meet the target all year and are just above average compared with similar sized London trusts,” she said.She added that though the hospital had not met its four-hour A&E waiting target on any day in the past fortnight, the performance had been better than a year ago. “St George’s has struggled to meet the target all year and are just above average compared with similar sized London trusts,” she said.
There have also been a high number of acutely unwell patients at arriving at Southend hospital in Essex and requiring admission. A spokewoman said: “In common with other hospitals in the region we have been seeing – and continue to see ‐ high numbers of acutely unwell patients arriving at the hospital and requiring admission.”There have also been a high number of acutely unwell patients at arriving at Southend hospital in Essex and requiring admission. A spokewoman said: “In common with other hospitals in the region we have been seeing – and continue to see ‐ high numbers of acutely unwell patients arriving at the hospital and requiring admission.”
Dr Jimmy Stuart, divisional medical director for medicine at the Pennine acute trust, reported similar levels of increased pressure, which has been compounded by inpatient bed pressures on wards andhigh numbers of patients occupying beds both due to clinical care and delayed discharges.Dr Jimmy Stuart, divisional medical director for medicine at the Pennine acute trust, reported similar levels of increased pressure, which has been compounded by inpatient bed pressures on wards andhigh numbers of patients occupying beds both due to clinical care and delayed discharges.
“The majority of patients requiring urgent treatment for what we call major conditions have included head injuries, falls, respiratory problems, abdominal pain and mental health issues,” he said.“The majority of patients requiring urgent treatment for what we call major conditions have included head injuries, falls, respiratory problems, abdominal pain and mental health issues,” he said.
“We have also seen a large proportion of patients coming to us with less serious conditions and minor complaints such as alcohol intoxication, back pain, migraines and headaches, ear problems, and sore throats. Many of these could be treated through local pharmacies, primary care and GP practices.”“We have also seen a large proportion of patients coming to us with less serious conditions and minor complaints such as alcohol intoxication, back pain, migraines and headaches, ear problems, and sore throats. Many of these could be treated through local pharmacies, primary care and GP practices.”
Recent NHS stats reveal that in the week leading up to 8 January 2016, there were 41 instances of A&E diversions across England. In the same period 2,998 beds were closed in hospitals due to outbreaks of norovirus-like symptoms, according to the latest available winter situation report.Recent NHS stats reveal that in the week leading up to 8 January 2016, there were 41 instances of A&E diversions across England. In the same period 2,998 beds were closed in hospitals due to outbreaks of norovirus-like symptoms, according to the latest available winter situation report.
UpdatedUpdated
at 2.01pm GMTat 2.01pm GMT
12.41pm GMT12.41pm GMT
12:4112:41
Gerardine Hope, assistant managerGerardine Hope, assistant manager
Jessica ElgotJessica Elgot
Before working at the North East ambulance service (NEAS) contact centre, Gerardine Hope used to run a call centre for T-Mobile. But customers’ mobile phone problems are a world away from what her call handlers deal with now, which can be matters of life and death.Before working at the North East ambulance service (NEAS) contact centre, Gerardine Hope used to run a call centre for T-Mobile. But customers’ mobile phone problems are a world away from what her call handlers deal with now, which can be matters of life and death.
Her 111 and 999 call handlers arrange up to 4,000 ambulance journeys a day across the north-east of England – though many of those are scheduled transports. She is adamant that her staff are well-trained enough to handle even the most complex scenario, and rejects the criticism that call centre staff are not suitable to deal with the problems callers present.Her 111 and 999 call handlers arrange up to 4,000 ambulance journeys a day across the north-east of England – though many of those are scheduled transports. She is adamant that her staff are well-trained enough to handle even the most complex scenario, and rejects the criticism that call centre staff are not suitable to deal with the problems callers present.
“There are a lot of misconceptions about 111,” she said. “It is a competitive job, there is eight weeks’ training with assessments all the way through and staff can fail those and have contracts terminated. We are not just pulling people in off the streets.”“There are a lot of misconceptions about 111,” she said. “It is a competitive job, there is eight weeks’ training with assessments all the way through and staff can fail those and have contracts terminated. We are not just pulling people in off the streets.”
NEAS does not employ agency staff, she said, because there is always a steady stream of applicants.NEAS does not employ agency staff, she said, because there is always a steady stream of applicants.
It is a tough job. I don’t think people always realise that, to be quite honest. We play them a call on the first day of training which is a woman calling when her partner slashed his wrists. We want them to realise what they are responsible for. It takes a special kind of person.It is a tough job. I don’t think people always realise that, to be quite honest. We play them a call on the first day of training which is a woman calling when her partner slashed his wrists. We want them to realise what they are responsible for. It takes a special kind of person.
The main complaint from patients is generally the frustration at how many questions call handlers ask, which may seem completely unrelated, like a person suffering a urine infection who is asked about chest pain. “It’s because we are not diagnosing, we are checking for signs of an emergency, we want to get the right care at the right time,” says Hope.The main complaint from patients is generally the frustration at how many questions call handlers ask, which may seem completely unrelated, like a person suffering a urine infection who is asked about chest pain. “It’s because we are not diagnosing, we are checking for signs of an emergency, we want to get the right care at the right time,” says Hope.
She admits that demand for 111 help is related to the shortage of GPs and the difficulties patients can often have getting an appointment at a surgery, but rejects the widespread criticism that the service sends patients to A&E too readily.She admits that demand for 111 help is related to the shortage of GPs and the difficulties patients can often have getting an appointment at a surgery, but rejects the widespread criticism that the service sends patients to A&E too readily.
We are a natural evolution of the healthcare system. Traditionally a GP was your only option, now there are many alternatives and we can signpost people to a minor injuries unit, or an out-of-hours walk-in centre which they may not know about.We are a natural evolution of the healthcare system. Traditionally a GP was your only option, now there are many alternatives and we can signpost people to a minor injuries unit, or an out-of-hours walk-in centre which they may not know about.
We asked the CCGs [clinical commissioning groups] to assess whether we were sending too many patients to A&E and their research into the patients and our advice on calls showed no one was sent unnecessarily – though some patients said they had been sent by 111, even if they hadn’t.We asked the CCGs [clinical commissioning groups] to assess whether we were sending too many patients to A&E and their research into the patients and our advice on calls showed no one was sent unnecessarily – though some patients said they had been sent by 111, even if they hadn’t.
Hope said she wished the handlers got more plaudits of their own. “Mistakes happen, everyone is human. But GPs can also get things wrong. The praise is often for the ambulance crews, but actually it can be the call handler too who helped save a life.”Hope said she wished the handlers got more plaudits of their own. “Mistakes happen, everyone is human. But GPs can also get things wrong. The praise is often for the ambulance crews, but actually it can be the call handler too who helped save a life.”
UpdatedUpdated
at 2.00pm GMTat 2.00pm GMT
12.15pm GMT12.15pm GMT
12:1512:15
12.05pm GMT12.05pm GMT
12:0512:05
Scotland's chief medical officer launches annual reportScotland's chief medical officer launches annual report
Libby BrooksLibby Brooks
Scotland’s chief medical officer has called for doctors to practise “realistic medicine”, moving away from a culture of over-treatment and involving patients more fully in decisions about their own care.Scotland’s chief medical officer has called for doctors to practise “realistic medicine”, moving away from a culture of over-treatment and involving patients more fully in decisions about their own care.
Starting a conversation with #doctors today on #Realistic Medicine in my first CMO report Views from all welcome https://t.co/YE0P1LlBH7Starting a conversation with #doctors today on #Realistic Medicine in my first CMO report Views from all welcome https://t.co/YE0P1LlBH7
Launching her first annual report in Edinburgh this morning, Dr Catherine Calderwood said:Launching her first annual report in Edinburgh this morning, Dr Catherine Calderwood said:
In striving to provide relief from discomfort, illness and death, modern medicine can sometimes over-reach itself and provide treatment that is of little long-term benefit to the patient.”In striving to provide relief from discomfort, illness and death, modern medicine can sometimes over-reach itself and provide treatment that is of little long-term benefit to the patient.”
It’s an interesting fact that doctors tend to choose fewer treatments for themselves than they offer to their patients. As doctors we should be asking why that is, and whether patients – if better informed – might also choose less intensive and less medicated treatment regimes. A person may achieve a greater quality of their life if less is done - fewer treatments, more targeted medication.It’s an interesting fact that doctors tend to choose fewer treatments for themselves than they offer to their patients. As doctors we should be asking why that is, and whether patients – if better informed – might also choose less intensive and less medicated treatment regimes. A person may achieve a greater quality of their life if less is done - fewer treatments, more targeted medication.
UpdatedUpdated
at 2.02pm GMTat 2.02pm GMT
12.00pm GMT12.00pm GMT
12:0012:00
Your comments so far on today's NHS coverageYour comments so far on today's NHS coverage
Elena CresciElena Cresci
Today’s secret paramedic’s diary has inspired many of you to share your own dramatic stories of ambulance rescue in our comment threads.Today’s secret paramedic’s diary has inspired many of you to share your own dramatic stories of ambulance rescue in our comment threads.
One example is this moving comment from RachaelLondon:One example is this moving comment from RachaelLondon:
To add my voice to the praise: thank you for saving my brother in law when he had a massive head injury. Thank you for scooping up my husband and his broken collarbone when he came off his bike. Thank you for coming out to my elderly neighbour. Thank you for really trying when my dad had a (what turned out to be) fatal heart attack. I wasn't there but from what we were told after it was pretty clear he was dead before he hit the kitchen floor, but you tried for long after it must have looked hopeless.To add my voice to the praise: thank you for saving my brother in law when he had a massive head injury. Thank you for scooping up my husband and his broken collarbone when he came off his bike. Thank you for coming out to my elderly neighbour. Thank you for really trying when my dad had a (what turned out to be) fatal heart attack. I wasn't there but from what we were told after it was pretty clear he was dead before he hit the kitchen floor, but you tried for long after it must have looked hopeless.
Or this from edana23, which describes the time a paramedic made a helpful but non-medical decision they’re still grateful for:Or this from edana23, which describes the time a paramedic made a helpful but non-medical decision they’re still grateful for:
I'm so grateful to the paramedic who, on arriving with his team at my house, had the presence of mind to take up the kitchen rug and throw towels down where I'd been sick - otherwise the rug would have been ruined and I'd have needed to move 2 large appliances to clean the floor a week later, after abdominal surgery! Although it was a non-medical decision, he made such a difference to my recovery - I was very impressed by his thoughtfulness, and by the competence of the team in general - first time I've needed an ambulance in over 50 years, and I'd be dead without them!I'm so grateful to the paramedic who, on arriving with his team at my house, had the presence of mind to take up the kitchen rug and throw towels down where I'd been sick - otherwise the rug would have been ruined and I'd have needed to move 2 large appliances to clean the floor a week later, after abdominal surgery! Although it was a non-medical decision, he made such a difference to my recovery - I was very impressed by his thoughtfulness, and by the competence of the team in general - first time I've needed an ambulance in over 50 years, and I'd be dead without them!
Related: The secret paramedic's diary: 'The worst part is knowing it's likely they will die'Related: The secret paramedic's diary: 'The worst part is knowing it's likely they will die'
UpdatedUpdated
at 12.02pm GMTat 12.02pm GMT
11.51am GMT11.51am GMT
11:5111:51
Welsh government launches 'self-care' campaign to reduce A&E pressureWelsh government launches 'self-care' campaign to reduce A&E pressure
Steven MorrisSteven Morris
A campaign urging people to think very carefully before heading for accident and emergency departments or ringing 999 if they do not have a life-threatening condition has been launched in Wales.A campaign urging people to think very carefully before heading for accident and emergency departments or ringing 999 if they do not have a life-threatening condition has been launched in Wales.
Though the population of Wales is only 3 million, around 1m visits are made to A&E every year and more than 100,000 non-urgent 999 calls received, wasting the time of call handlers and putting lives of those in real need at risk.Though the population of Wales is only 3 million, around 1m visits are made to A&E every year and more than 100,000 non-urgent 999 calls received, wasting the time of call handlers and putting lives of those in real need at risk.
The Choose Well Campaign includes digital adverts, a Facebook and Twitter campaign, traditional bus adverts and posters and leaflets in GP surgeries, pharmacies, opticians and universities.The Choose Well Campaign includes digital adverts, a Facebook and Twitter campaign, traditional bus adverts and posters and leaflets in GP surgeries, pharmacies, opticians and universities.
The campaign comes after yesterday’s warning that A&E departments in Wales are “on the edge”, with some patients reportedly waiting more than 24 hours in casualty before being seen. Dr Robin Roop, head of the Royal College of Emergency Medicine in Wales, also said no A&E department in Wales had enough consultants to meet minimum RCEM staffing levels.The campaign comes after yesterday’s warning that A&E departments in Wales are “on the edge”, with some patients reportedly waiting more than 24 hours in casualty before being seen. Dr Robin Roop, head of the Royal College of Emergency Medicine in Wales, also said no A&E department in Wales had enough consultants to meet minimum RCEM staffing levels.
Vaughan Gething, the deputy minister for health in the Labour-led government, said compared with England, Wales had an older, sicker, poorer population, meaning it was all the more important that people chose the right service. He said: “It’s about reminding people of the options. A more commonsense approach is needed.”Vaughan Gething, the deputy minister for health in the Labour-led government, said compared with England, Wales had an older, sicker, poorer population, meaning it was all the more important that people chose the right service. He said: “It’s about reminding people of the options. A more commonsense approach is needed.”
Gething described some of the figures around use of services in Wales as “astonishing”. According to the Welsh government:Gething described some of the figures around use of services in Wales as “astonishing”. According to the Welsh government:
Dr Andrew Goodall, chief executive of NHS Wales, said: “Our accident and emergency departments alone see 1 million people a year. However, self care is the best option for treating the minor illnesses and injuries which account for a very large proportion of what health workers deal with. Many illnesses can be treated in your home with over the counter medicine and plenty of rest.Dr Andrew Goodall, chief executive of NHS Wales, said: “Our accident and emergency departments alone see 1 million people a year. However, self care is the best option for treating the minor illnesses and injuries which account for a very large proportion of what health workers deal with. Many illnesses can be treated in your home with over the counter medicine and plenty of rest.
UpdatedUpdated
at 12.02pm GMTat 12.02pm GMT
11.33am GMT11.33am GMT
11:3311:33
'You can't let a stereotype guide you''You can't let a stereotype guide you'
Jessica ElgotJessica Elgot
A key part of a 111 call operator’s training is the “wellness bias”. Foster said he is trained not to assume that a young adult patient is likely to be fine, compared to a child or elderly person:A key part of a 111 call operator’s training is the “wellness bias”. Foster said he is trained not to assume that a young adult patient is likely to be fine, compared to a child or elderly person:
A 14-year-old can have a stroke, a 25-year-old can have a heart attack. You can’t let a stereotype guide you. We have had an incident in a different service where the signs weren’t picked up because of that kind of bias. You have to judge a call on its merits.A 14-year-old can have a stroke, a 25-year-old can have a heart attack. You can’t let a stereotype guide you. We have had an incident in a different service where the signs weren’t picked up because of that kind of bias. You have to judge a call on its merits.
Another thing that can happen often is that callers do not realise how bad their relative actually is. “They might think that the person they look after is always unwell; they can’t quite recognise they are deteriorating until we take them through the symptoms and it starts to dawn on them.”Another thing that can happen often is that callers do not realise how bad their relative actually is. “They might think that the person they look after is always unwell; they can’t quite recognise they are deteriorating until we take them through the symptoms and it starts to dawn on them.”
UpdatedUpdated
at 12.36pm GMTat 12.36pm GMT
11.24am GMT11.24am GMT
11:2411:24
'Sometimes you just get a feeling after a call that it's not quite right''Sometimes you just get a feeling after a call that it's not quite right'
Jessica ElgotJessica Elgot
The second call Craig Foster takes is from a mother concerned about her three-year-old’s chickenpox. She describes particularly bad swelling and a great deal of pain. Something about the description of the child, who is listless and unwilling to play, rings alarm bells for Foster, despite the commonness of chickenpox. He passes the call on to a qualified nurse. “Sometimes you just get a feeling after a call that it’s not quite right, so that’s why we get advice. That’s the training,” he said.The second call Craig Foster takes is from a mother concerned about her three-year-old’s chickenpox. She describes particularly bad swelling and a great deal of pain. Something about the description of the child, who is listless and unwilling to play, rings alarm bells for Foster, despite the commonness of chickenpox. He passes the call on to a qualified nurse. “Sometimes you just get a feeling after a call that it’s not quite right, so that’s why we get advice. That’s the training,” he said.
Next, Foster speaks to a woman worried about her mother, who is in her 90s and has fallen and hit her head in the night. The GP surgery has advised her to go to hospital, but the woman is worried about taking her to A&E herself and calls for advice about whether she should ring an ambulance. It takes a while for Foster to be able to ask his questions, as the woman talks him through her mother’s recent medical history. “Sometimes you have to be quite firm, we have to ask those emergency questions straight away,” Foster says.Next, Foster speaks to a woman worried about her mother, who is in her 90s and has fallen and hit her head in the night. The GP surgery has advised her to go to hospital, but the woman is worried about taking her to A&E herself and calls for advice about whether she should ring an ambulance. It takes a while for Foster to be able to ask his questions, as the woman talks him through her mother’s recent medical history. “Sometimes you have to be quite firm, we have to ask those emergency questions straight away,” Foster says.
You can’t let a person talk and talk. I once had a man who was in a different room to his wife, and he wanted to talk me through everything that has happened in the past few weeks, and I had to keep trying to convince to go in the same room as his wife. When I finally managed to ask the question, I found out his wife was unconscious.You can’t let a person talk and talk. I once had a man who was in a different room to his wife, and he wanted to talk me through everything that has happened in the past few weeks, and I had to keep trying to convince to go in the same room as his wife. When I finally managed to ask the question, I found out his wife was unconscious.
Often people might not actually be listening to you; they have their bit they want to say, and it’s our job to get them to listen, to get them to snap out of it. You can’t be rude, but you have to sometimes be quite blunt, because it could be an emergency.Often people might not actually be listening to you; they have their bit they want to say, and it’s our job to get them to listen, to get them to snap out of it. You can’t be rude, but you have to sometimes be quite blunt, because it could be an emergency.
After the woman describes her mother’s bump, Foster uses a special script for head injuries, asking about medication, recent surgery, bruising and whether there is crackling under the skin. Looking at the symptoms, Foster wants a nurse’s advice, and arranges for one to call her back. “She was advised to go to A&E by the doctor and I think the nurse will probably tell her the same thing.”After the woman describes her mother’s bump, Foster uses a special script for head injuries, asking about medication, recent surgery, bruising and whether there is crackling under the skin. Looking at the symptoms, Foster wants a nurse’s advice, and arranges for one to call her back. “She was advised to go to A&E by the doctor and I think the nurse will probably tell her the same thing.”
There is one call that stands out for Foster in his three years at 111 – an out-of-hours call that came through from Nottingham, when a premature baby had stopped breathing.There is one call that stands out for Foster in his three years at 111 – an out-of-hours call that came through from Nottingham, when a premature baby had stopped breathing.
The mother described the child as limp and floppy. I was shaking but you just have to go into autopilot. I put the phone on mute and screamed across to colleagues in 999 to get in touch with Nottingham ambulance service; we sometime get calls from outside the area but we don’t then have a direct line to contact them.The mother described the child as limp and floppy. I was shaking but you just have to go into autopilot. I put the phone on mute and screamed across to colleagues in 999 to get in touch with Nottingham ambulance service; we sometime get calls from outside the area but we don’t then have a direct line to contact them.
I talked the woman through how to perform CPR on the phone, as we waited for the ambulance to arrive. I got a message back at about 2 or 3 in the morning that the baby was in hospital and had survived. It was really scary stuff though – you train for it but it could have been disastrous. But when something like that happens, everyone piles in: the whole team came to help.I talked the woman through how to perform CPR on the phone, as we waited for the ambulance to arrive. I got a message back at about 2 or 3 in the morning that the baby was in hospital and had survived. It was really scary stuff though – you train for it but it could have been disastrous. But when something like that happens, everyone piles in: the whole team came to help.
UpdatedUpdated
at 12.02pm GMTat 12.02pm GMT
10.52am GMT10.52am GMT
10:5210:52
10.37am GMT10.37am GMT
10:3710:37
Craig Foster, 111 call handlerCraig Foster, 111 call handler
Jessica ElgotJessica Elgot
Craig Foster has been taking 111 calls since the service began three years ago; he was one of the call handlers who worked on the pilot in Durham and Darlington. “At the beginning it was very quiet,” he says. “No one knew about us; there were just a few posters in GP surgeries, but now it’s completely different.”Craig Foster has been taking 111 calls since the service began three years ago; he was one of the call handlers who worked on the pilot in Durham and Darlington. “At the beginning it was very quiet,” he says. “No one knew about us; there were just a few posters in GP surgeries, but now it’s completely different.”
Flashing boards above the call handlers show the room is currently in the “green”, meaning that the service is meeting national targets of answering 98% of calls in 60 seconds, though Wednesday mornings are not exactly the busiest time for handlers here.Flashing boards above the call handlers show the room is currently in the “green”, meaning that the service is meeting national targets of answering 98% of calls in 60 seconds, though Wednesday mornings are not exactly the busiest time for handlers here.
Foster’s next call is a carer worried for her client who has slipped and fallen. She’s not injured, but her size means she needs assistance to get up from the floor. “Is she awake and alert?” Foster asks, reading from his script to check for other warning symptoms, such as whether her face has frozen, or whether she feels a crushing on her chest.Foster’s next call is a carer worried for her client who has slipped and fallen. She’s not injured, but her size means she needs assistance to get up from the floor. “Is she awake and alert?” Foster asks, reading from his script to check for other warning symptoms, such as whether her face has frozen, or whether she feels a crushing on her chest.
The questions may seem obvious, but he also asks if the woman is on a carpeted or cold wooden floor, to make sure she is comfortable. He decides to book an ambulance to assist her, though he decides she is unlikely to need to go to hospital.The questions may seem obvious, but he also asks if the woman is on a carpeted or cold wooden floor, to make sure she is comfortable. He decides to book an ambulance to assist her, though he decides she is unlikely to need to go to hospital.
UpdatedUpdated
at 10.43am GMTat 10.43am GMT
9.35am GMT9.35am GMT
09:3509:35
Jessica ElgotJessica Elgot
Today, Alicia and I are at North East ambulance service’s 111 centre in Newcastle, where we’ll be speaking to call handlers about how they deal with a huge range of different problems, and to medical advisers and management about the reputation of the service and the times of day, week or year it is under most strain.Today, Alicia and I are at North East ambulance service’s 111 centre in Newcastle, where we’ll be speaking to call handlers about how they deal with a huge range of different problems, and to medical advisers and management about the reputation of the service and the times of day, week or year it is under most strain.
I'm here at @NEAmbulance in Newcastle to live blog from their 111 centre #ThisIsTheNHS pic.twitter.com/fqMn5MhXm2I'm here at @NEAmbulance in Newcastle to live blog from their 111 centre #ThisIsTheNHS pic.twitter.com/fqMn5MhXm2
UpdatedUpdated
at 10.27am GMTat 10.27am GMT
7.50am GMT7.50am GMT
07:5007:50
Today’s liveblogging will be starting a little later than usual, as Jessica is not due to arrive at the 111 centre until around 9.30am. Please check back then for full coverage.Today’s liveblogging will be starting a little later than usual, as Jessica is not due to arrive at the 111 centre until around 9.30am. Please check back then for full coverage.
7.47am GMT7.47am GMT
07:4707:47
Wednesday's morning briefingWednesday's morning briefing
Mark SmithMark Smith
Welcome to day three of the Guardian’s ambitious series attempting to get under the skin of the NHS and tell the story of one of the most complex organisations in the world, through the voices of those on its frontline.Welcome to day three of the Guardian’s ambitious series attempting to get under the skin of the NHS and tell the story of one of the most complex organisations in the world, through the voices of those on its frontline.
To get this morning briefing sent to your inbox each day please sign up here.To get this morning briefing sent to your inbox each day please sign up here.
The big pictureThe big picture
Our aspiration is to examine a broad range of issues, from the strains on A&E to standards of care for elderly people, the multi-layered issues surrounding mental health, chronic disease, the high cost of drugs and the impact of alcohol. And exciting treatments using new sciences and cutting-edge technology.Our aspiration is to examine a broad range of issues, from the strains on A&E to standards of care for elderly people, the multi-layered issues surrounding mental health, chronic disease, the high cost of drugs and the impact of alcohol. And exciting treatments using new sciences and cutting-edge technology.
We want to understand the dilemmas over prioritisation, over-prescribing and the cost of drugs – and the fiendishly complicated way the service is managed and run. We want to address the question: do we have the NHS we need? The aim is to do this through diaries, fly-on-the-wall reporting, interviews, films and explanation.We want to understand the dilemmas over prioritisation, over-prescribing and the cost of drugs – and the fiendishly complicated way the service is managed and run. We want to address the question: do we have the NHS we need? The aim is to do this through diaries, fly-on-the-wall reporting, interviews, films and explanation.
Yesterday we focused on the issues surrounding GPs and family practices, with our intrepid reporter Jessica Elgot liveblogging from the Haxby group of surgeries in York and Hull.Yesterday we focused on the issues surrounding GPs and family practices, with our intrepid reporter Jessica Elgot liveblogging from the Haxby group of surgeries in York and Hull.
Among the professionals she spoke to was pharmacist Dan Hurley, who is based at the surgery rather than at a separate dispensing chemist. “We don’t have to be separate, which I think has been the tradition,” he said. “It makes sense for us to work together.”Among the professionals she spoke to was pharmacist Dan Hurley, who is based at the surgery rather than at a separate dispensing chemist. “We don’t have to be separate, which I think has been the tradition,” he said. “It makes sense for us to work together.”
Guardian writer Zoe Williams also visited the Haxby group of surgeries for this study of the “new model army” of family doctors changing the way the NHS operates in communities across the UK. She writes:Guardian writer Zoe Williams also visited the Haxby group of surgeries for this study of the “new model army” of family doctors changing the way the NHS operates in communities across the UK. She writes:
... If reorganisation in the first place was a quest for modernity, Haxby is its beacon: its GPs were among the first to perform vasectomies on site, for example; one GP diagnosed a rash from a photo a patient sent him on Facebook; their onsite pharmacies employ full-time pharmacists, an economy of GP time that only a scaled-up practice could do. The surgeries train ex-paramedics as primary care practitioners, who treat some minor illnesses and injuries in the surgery... If reorganisation in the first place was a quest for modernity, Haxby is its beacon: its GPs were among the first to perform vasectomies on site, for example; one GP diagnosed a rash from a photo a patient sent him on Facebook; their onsite pharmacies employ full-time pharmacists, an economy of GP time that only a scaled-up practice could do. The surgeries train ex-paramedics as primary care practitioners, who treat some minor illnesses and injuries in the surgery
One of the highlights of the coverage was Severin Carrell’s special report from the most northerly GP practice in the UK: Hillswick health centre in Shetland, which has been run by Dr Susan Bowie for the past 21 years. The surgery, which serves 764 patients dispersed over 77 sq miles of open country, still exists thanks to Bowie’s efforts to subsidise it with profits from her dispensary and two holiday cottages. But Bowie is nervous about the future of her practice. She will retire soon and there is a chronic shortage of new family doctors across the UK.One of the highlights of the coverage was Severin Carrell’s special report from the most northerly GP practice in the UK: Hillswick health centre in Shetland, which has been run by Dr Susan Bowie for the past 21 years. The surgery, which serves 764 patients dispersed over 77 sq miles of open country, still exists thanks to Bowie’s efforts to subsidise it with profits from her dispensary and two holiday cottages. But Bowie is nervous about the future of her practice. She will retire soon and there is a chronic shortage of new family doctors across the UK.
We also broke the news that the UK’s family doctors are the most stressed in the western world, according to new research by the world’s most influential health thinktank, the Health Foundation. Denis Campbell’s story reported that the situation is now so bad that almost 30% of British GPs plan to quit in the next five years due to their overwhelming workloads.We also broke the news that the UK’s family doctors are the most stressed in the western world, according to new research by the world’s most influential health thinktank, the Health Foundation. Denis Campbell’s story reported that the situation is now so bad that almost 30% of British GPs plan to quit in the next five years due to their overwhelming workloads.
We also received fantastic news of the first ever Guardian liveblog baby, as Kerri Calthorpe gave birth to her son Rex hours after being featured in Monday’s live blog from St George’s hospital.We also received fantastic news of the first ever Guardian liveblog baby, as Kerri Calthorpe gave birth to her son Rex hours after being featured in Monday’s live blog from St George’s hospital.
We are delighted to say that Kerri had a baby boy, Rex. Kerry was featured on the live blog @guardian @jessicaelgot pic.twitter.com/8q33EXxKQPWe are delighted to say that Kerri had a baby boy, Rex. Kerry was featured on the live blog @guardian @jessicaelgot pic.twitter.com/8q33EXxKQP
Today’s focusToday’s focus
On this third day of our NHS series, we’re concentrating on the sharp end of emergency medicine – paramedics and ambulance personnel. Jessica Elgot is in the north-east of England and will be liveblogging from an ambulance service 111 call centre in Newcastle.On this third day of our NHS series, we’re concentrating on the sharp end of emergency medicine – paramedics and ambulance personnel. Jessica Elgot is in the north-east of England and will be liveblogging from an ambulance service 111 call centre in Newcastle.
The 111 service was set up to triage urgent but non-life-threatening cases, and help reduce the strain on 999 call handlers. But it has come in for heavy criticism over the last 18 months, both for supposedly creating congestion in hospitals by sending too many patients to A&E departments, and for not sending others who perhaps should have gone. There have been claims that the service is staffed by unskilled workers with too little supervision from clinicians, and complaints that the algorithm that prompts handlers’ questions is too formulaic.The 111 service was set up to triage urgent but non-life-threatening cases, and help reduce the strain on 999 call handlers. But it has come in for heavy criticism over the last 18 months, both for supposedly creating congestion in hospitals by sending too many patients to A&E departments, and for not sending others who perhaps should have gone. There have been claims that the service is staffed by unskilled workers with too little supervision from clinicians, and complaints that the algorithm that prompts handlers’ questions is too formulaic.
Jessica will be talking to the call handlers and clinicians on the frontline to hear their perspective, and get a sense of the types of call they have to deal with day to day.Jessica will be talking to the call handlers and clinicians on the frontline to hear their perspective, and get a sense of the types of call they have to deal with day to day.
And of course we’ve got the latest from our regular series The NHS saved my life - and today’s secret diary is from an emergency paramedic.And of course we’ve got the latest from our regular series The NHS saved my life - and today’s secret diary is from an emergency paramedic.
You can tweet me or Jessica (@marksmith174 or @jessicaelgot) and follow the conversation on Twitter using the hashtag #ThisIsTheNHS. We hope you stick with us throughout the day.You can tweet me or Jessica (@marksmith174 or @jessicaelgot) and follow the conversation on Twitter using the hashtag #ThisIsTheNHS. We hope you stick with us throughout the day.
Yesterday’s most readYesterday’s most read
UpdatedUpdated
at 9.46am GMTat 9.46am GMT
6.50pm GMT6.50pm GMT
18:5018:50
Thanks so much for joining us, and for all your comments and tweets. We’ll be back again tomorrow morning from 8am, when our focus will be on emergency medical care, paramedics and 999 call handlers.Thanks so much for joining us, and for all your comments and tweets. We’ll be back again tomorrow morning from 8am, when our focus will be on emergency medical care, paramedics and 999 call handlers.
UpdatedUpdated
at 6.52am GMTat 6.52am GMT
6.00pm GMT6.00pm GMT
18:0018:00
'We need to take down the barriers''We need to take down the barriers'
Jessica ElgotJessica Elgot
The shortage of GPs and the constant financial pressure on practices has led to some very creative thinking, Dr Mike Holmes says. He is the clinical lead for the Supporting Federations programme at the Royal College of GPs and only sees patients a few times a week so he can spend time developing digital systems to ease the workload at the practice, and its financial burdens.The shortage of GPs and the constant financial pressure on practices has led to some very creative thinking, Dr Mike Holmes says. He is the clinical lead for the Supporting Federations programme at the Royal College of GPs and only sees patients a few times a week so he can spend time developing digital systems to ease the workload at the practice, and its financial burdens.
Holmes brings up a list of hundreds of blood test results the practice sees in a single day:Holmes brings up a list of hundreds of blood test results the practice sees in a single day:
Traditionally, a doctor might have looked at every single one, but if they are normal, there’s no reason a healthcare assistant can’t file them, and even be trained to file the more complex, multiple blood tests, if a doctor doesn’t need to take any action. We have people we think are capable of doing that in place, we just need to take down the barriers.Traditionally, a doctor might have looked at every single one, but if they are normal, there’s no reason a healthcare assistant can’t file them, and even be trained to file the more complex, multiple blood tests, if a doctor doesn’t need to take any action. We have people we think are capable of doing that in place, we just need to take down the barriers.
Modern general practice has fewer doctors and less funding, but is far greater in complexity than it was before, he says. In 10 years, the number of consultations shot up 60%, with the number of blood tests up 300% and administrative work up 200%.Modern general practice has fewer doctors and less funding, but is far greater in complexity than it was before, he says. In 10 years, the number of consultations shot up 60%, with the number of blood tests up 300% and administrative work up 200%.
“People are living longer, they have multiple, complex and chronic problems which are difficult to solve, and if we don’t start to address the issues now, we could see people start to lose confidence in GPs,” Holmes says. He will travel to London tomorrow for his work with the RCGP programme on federations – helping other GP practices to merge and work together, like Haxby has done.“People are living longer, they have multiple, complex and chronic problems which are difficult to solve, and if we don’t start to address the issues now, we could see people start to lose confidence in GPs,” Holmes says. He will travel to London tomorrow for his work with the RCGP programme on federations – helping other GP practices to merge and work together, like Haxby has done.
It is a model very much favoured by NHS England and likely to become more common. “It’s working for us,” Holmes says.It is a model very much favoured by NHS England and likely to become more common. “It’s working for us,” Holmes says.
We can work at scale, we can better meet patient demand, and we are gathering evidence to show as much as we can that it does improve patient care. New technology can help enormously, but of course it can’t ever replace the one on one with a doctor. We have tried consultations by Skype – it works for some people but for others it doesn’t. Sometimes there’s just no replacement for face to face.We can work at scale, we can better meet patient demand, and we are gathering evidence to show as much as we can that it does improve patient care. New technology can help enormously, but of course it can’t ever replace the one on one with a doctor. We have tried consultations by Skype – it works for some people but for others it doesn’t. Sometimes there’s just no replacement for face to face.
His last patient of the day is Geoffrey Brown, in for a combination anaesthetic and cortisone injection for his arthritic knee. “They’ve put me through a lot of pain over the years here,” Brown says as he climbs on to the bed in the consulting room. “But I have no complaints at all, every doctor I see is brilliant.”His last patient of the day is Geoffrey Brown, in for a combination anaesthetic and cortisone injection for his arthritic knee. “They’ve put me through a lot of pain over the years here,” Brown says as he climbs on to the bed in the consulting room. “But I have no complaints at all, every doctor I see is brilliant.”
UpdatedUpdated
at 6.06pm GMTat 6.06pm GMT
5.36pm GMT5.36pm GMT
17:3617:36
Lesley Rientoul, senior receptionistLesley Rientoul, senior receptionist
Jessica ElgotJessica Elgot
“There’s a reputation that we are dragons,” says Lesley Rientoul, senior receptionist at the practice. “We’re really not, but we have to ask the questions.”“There’s a reputation that we are dragons,” says Lesley Rientoul, senior receptionist at the practice. “We’re really not, but we have to ask the questions.”
Around her, other receptionists are taking appointments and reassuring patients who are ringing up for blood test results.Around her, other receptionists are taking appointments and reassuring patients who are ringing up for blood test results.
How many calls does she answer in a day? “Hundreds. Absolutely hundreds. Anything from 30 seconds to five minutes. It’s a lot of responsibility. We have to decide where to send them – to a doctor, a nurse, even to say they should go to hospital. And we have to get it right.”How many calls does she answer in a day? “Hundreds. Absolutely hundreds. Anything from 30 seconds to five minutes. It’s a lot of responsibility. We have to decide where to send them – to a doctor, a nurse, even to say they should go to hospital. And we have to get it right.”
No matter how difficult a patient can be, Rientoul says she tries to remain very, very calm. “It’s hard sometimes, though.”No matter how difficult a patient can be, Rientoul says she tries to remain very, very calm. “It’s hard sometimes, though.”
5.00pm GMT5.00pm GMT
17:0017:00
Dr Mike Holmes, Haxby Group partnerDr Mike Holmes, Haxby Group partner
Jessica ElgotJessica Elgot
Dr Mike Holmes, a partner in the Haxby group, is seeing one of his regulars, Keith Pearson, 73, who is keen to get back to his regular tennis game after being told to rest up after a bad chest infection. “I caught a cold in the pub, fella gave it to four of us,” he says.Dr Mike Holmes, a partner in the Haxby group, is seeing one of his regulars, Keith Pearson, 73, who is keen to get back to his regular tennis game after being told to rest up after a bad chest infection. “I caught a cold in the pub, fella gave it to four of us,” he says.
Holmes tells him his chest sounds fine but he should try not to tear around the court too much.Holmes tells him his chest sounds fine but he should try not to tear around the court too much.
“I feel much better now,” Pearson says. “But there were times I couldn’t breathe and that was quite frightening. I sing, do entertainment and do magic shows for the kids but I cancelled all my gigs. I want to get back to it.”“I feel much better now,” Pearson says. “But there were times I couldn’t breathe and that was quite frightening. I sing, do entertainment and do magic shows for the kids but I cancelled all my gigs. I want to get back to it.”
Holmes suspects Pearson has had chronic bronchitis, but that it is now improving well. Pearson travels across the city to see Holmes since the doctor moved from the partner practice. He has been treated by him for at least five years, including for prostate cancer, which Pearson spotted the early symptoms of after reading a poster about the warning signs in the waiting room of the GP.Holmes suspects Pearson has had chronic bronchitis, but that it is now improving well. Pearson travels across the city to see Holmes since the doctor moved from the partner practice. He has been treated by him for at least five years, including for prostate cancer, which Pearson spotted the early symptoms of after reading a poster about the warning signs in the waiting room of the GP.
“It is touching, when someone is so determined to come back and see you,” Holmes says. “I had one family where the husband had Huntington’s disease who I saw for 10 years, looking after him and his wife through the entire progression of the disease. That was one family which really taught me, more than anything, the value of general practice.”“It is touching, when someone is so determined to come back and see you,” Holmes says. “I had one family where the husband had Huntington’s disease who I saw for 10 years, looking after him and his wife through the entire progression of the disease. That was one family which really taught me, more than anything, the value of general practice.”
UpdatedUpdated
at 5.08pm GMTat 5.08pm GMT
3.39pm GMT3.39pm GMT
15:3915:39
UK's family doctors are most stressed in western worldUK's family doctors are most stressed in western world
We’ve just launched another important news story from Denis Campbell, the Guardian’s health policy editor.We’ve just launched another important news story from Denis Campbell, the Guardian’s health policy editor.
Stress levels are so acute among British GPs that almost 30% plan to quit in the next five years, new research by the world’s most influential health thinktank reveals.Stress levels are so acute among British GPs that almost 30% plan to quit in the next five years, new research by the world’s most influential health thinktank reveals.
Campbell reports:Campbell reports:
Just under six in 10 GPs (59%) find their work stressful, with 39% of these saying it is very stressful| and 20% extremely stressful, which is higher than any other leading western nation in the triannual study. Researchers surveyed 11,547 GPsin 11 countries, including France, Germany and the United States.Just under six in 10 GPs (59%) find their work stressful, with 39% of these saying it is very stressful| and 20% extremely stressful, which is higher than any other leading western nation in the triannual study. Researchers surveyed 11,547 GPsin 11 countries, including France, Germany and the United States.
“These worrying findings reveal the scale of the challenge facing general practice,” said Dr Jennifer Dixon, chief executive of the UK-based Health Foundation thinktank, which helped with the study.“These worrying findings reveal the scale of the challenge facing general practice,” said Dr Jennifer Dixon, chief executive of the UK-based Health Foundation thinktank, which helped with the study.
Researchers found that family doctors in Britain spend less time with their patients than anywhere else. In all, 92% of the 1,001 GPs surveyed said they spent less than 15 minutes talking to patients, while internationally in the survey just 27% of GPs spent less than this time. Similarly, only 8% of NHS GPs are spending more than 15 minutes with patients; on average, almost three-quarters (73%) of patients get at least that long.Researchers found that family doctors in Britain spend less time with their patients than anywhere else. In all, 92% of the 1,001 GPs surveyed said they spent less than 15 minutes talking to patients, while internationally in the survey just 27% of GPs spent less than this time. Similarly, only 8% of NHS GPs are spending more than 15 minutes with patients; on average, almost three-quarters (73%) of patients get at least that long.
You can read the full story here.You can read the full story here.
Related: NHS has the west's most stressed GPs, survey revealsRelated: NHS has the west's most stressed GPs, survey reveals
UpdatedUpdated
at 4.14pm GMTat 4.14pm GMT
3.20pm GMT3.20pm GMT
15:2015:20
'We do home visits every day''We do home visits every day'
Jessica ElgotJessica Elgot
The doctors are out on the road at lunchtime, making home visits. Gale Farm’s staff average more than 40 trips to patients’ houses each day.The doctors are out on the road at lunchtime, making home visits. Gale Farm’s staff average more than 40 trips to patients’ houses each day.
“People think we don’t do this any more, but we do, every day,” says Dr Chris Stanley. “The majority are older patients who can’t get to the surgery. We can travel quite a distance, sometimes to the villages outside York.”“People think we don’t do this any more, but we do, every day,” says Dr Chris Stanley. “The majority are older patients who can’t get to the surgery. We can travel quite a distance, sometimes to the villages outside York.”
The first stop is Audrey Shillitoe, who is struggling with lung disease and sounded breathless on the phone. Stanley, seeing this patient for the first time, said he was concerned he would have to convince her to go to hospital, but when he arrives at her home, his checks found she was doing a little better than expected.The first stop is Audrey Shillitoe, who is struggling with lung disease and sounded breathless on the phone. Stanley, seeing this patient for the first time, said he was concerned he would have to convince her to go to hospital, but when he arrives at her home, his checks found she was doing a little better than expected.
“I hate going to hospital,” Shillitoe said. “Once they put me in a ward with alcoholics and drug addicts, and I thought to myself, I don’t ever want to go back.” Stanley prescribes her medication but told her to get in touch quickly if things get worse.“I hate going to hospital,” Shillitoe said. “Once they put me in a ward with alcoholics and drug addicts, and I thought to myself, I don’t ever want to go back.” Stanley prescribes her medication but told her to get in touch quickly if things get worse.
Shillitoe was full of praise for the doctors, but said she was feeling the loss of a regular case management nurse visit, which cannot continue because of funding cuts.Shillitoe was full of praise for the doctors, but said she was feeling the loss of a regular case management nurse visit, which cannot continue because of funding cuts.
Stanley asked her to call him to ask for extra help at home if she needed it. “Everyone criticises the NHS, but it isn’t their fault, the doctors and nurses; it’s others that are trying to cut things,” she said. “If these doctors weren’t here, I wouldn’t be here.”Stanley asked her to call him to ask for extra help at home if she needed it. “Everyone criticises the NHS, but it isn’t their fault, the doctors and nurses; it’s others that are trying to cut things,” she said. “If these doctors weren’t here, I wouldn’t be here.”
The second stop on Stanley’s list of home visits is 87-year-old Valerie Winter, who needs a check-up after a spell in hospital with pneumonia. She is keen to get better quickly so she can get back to her hobbies, drawing classes, tai chi, singing in a choir and a sequence dancing class, though she no longer does the dance steps and just attends for the company.The second stop on Stanley’s list of home visits is 87-year-old Valerie Winter, who needs a check-up after a spell in hospital with pneumonia. She is keen to get better quickly so she can get back to her hobbies, drawing classes, tai chi, singing in a choir and a sequence dancing class, though she no longer does the dance steps and just attends for the company.
Stanley checks her blood pressure, listens to her chest, and checks her oxygen levels, as we as discussing her medication and organising prescriptions to be delivered tomorrow.Stanley checks her blood pressure, listens to her chest, and checks her oxygen levels, as we as discussing her medication and organising prescriptions to be delivered tomorrow.
Winter rejects the need for any extra help around the house. “I’m going to get a cleaner in because I was doing it all myself.” But she doesn’t need help with dressing or cooking. “I do all the cooking, vegetables, everything. I can manage.”Winter rejects the need for any extra help around the house. “I’m going to get a cleaner in because I was doing it all myself.” But she doesn’t need help with dressing or cooking. “I do all the cooking, vegetables, everything. I can manage.”
Though she seems lively, she said her time is hospital was bad. “It was the worst I’ve ever felt. But I always want to get better. It’s silly giving up, really.”Though she seems lively, she said her time is hospital was bad. “It was the worst I’ve ever felt. But I always want to get better. It’s silly giving up, really.”
UpdatedUpdated
at 3.36pm GMTat 3.36pm GMT
3.12pm GMT3.12pm GMT
15:1215:12
We have our first Guardian live blog baby!We have our first Guardian live blog baby!
Those of you who were following the live blog yesterday may be anxious to hear news about Kerri Calthorpe, 31, who was described by nurses at St George’s hospital, Tooting, as being “halfway”, through her labour after 12 hours.Those of you who were following the live blog yesterday may be anxious to hear news about Kerri Calthorpe, 31, who was described by nurses at St George’s hospital, Tooting, as being “halfway”, through her labour after 12 hours.
We are now pleased to announce that baby Rex has been safely delivered. Congratulations to Kerri, husband Harry, and all the staff at St George’s maternity unit!We are now pleased to announce that baby Rex has been safely delivered. Congratulations to Kerri, husband Harry, and all the staff at St George’s maternity unit!
We are delighted to say that Kerri had a baby boy, Rex. Kerry was featured on the live blog @guardian @jessicaelgot pic.twitter.com/8q33EXxKQPWe are delighted to say that Kerri had a baby boy, Rex. Kerry was featured on the live blog @guardian @jessicaelgot pic.twitter.com/8q33EXxKQP
For those who may have missed yesterday’s post – here’s how we last saw Kerri:For those who may have missed yesterday’s post – here’s how we last saw Kerri:
UpdatedUpdated
at 3.25pm GMTat 3.25pm GMT
2.28pm GMT2.28pm GMT
14:2814:28
Dr Claire Anderton and Dr Bhavesh Desai, GPsDr Claire Anderton and Dr Bhavesh Desai, GPs
Jessica ElgotJessica Elgot
The shortage of up-and-coming GPs is a major challenge for the profession, with many newly qualified doctors preferring to work in hospitals.The shortage of up-and-coming GPs is a major challenge for the profession, with many newly qualified doctors preferring to work in hospitals.
Some might be daunted by the heavy workload of a GP, including out-of-hours paperwork, says Dr Claire Anderton. She is mentor to registrar Dr Bhavesh Desai, who is in his last year of GP training at Gale Farm. “I think some consultants can try to tempt good junior doctors away from general practice – they think it’s just prescribing antibiotics all day,” Desai said.Some might be daunted by the heavy workload of a GP, including out-of-hours paperwork, says Dr Claire Anderton. She is mentor to registrar Dr Bhavesh Desai, who is in his last year of GP training at Gale Farm. “I think some consultants can try to tempt good junior doctors away from general practice – they think it’s just prescribing antibiotics all day,” Desai said.
Anderton agrees there is a misconception that “it’s just coughs and colds”:Anderton agrees there is a misconception that “it’s just coughs and colds”:
It is an incredibly complex and varied job, but it is a huge workload, and I think that is starting to be addressed. There is an awful lot of burnout. Other than that it is the best job on Earth: I have patients who feel like friends, and when two of them died recently, I felt like I had lost two friends.It is an incredibly complex and varied job, but it is a huge workload, and I think that is starting to be addressed. There is an awful lot of burnout. Other than that it is the best job on Earth: I have patients who feel like friends, and when two of them died recently, I felt like I had lost two friends.
Desai made up his mind to pursue general practice after his third year, and has taken a particular interest in palliative care – particularly after looking after one patient for the last six weeks of his life. He said that, rather than dying in hospital, “it’s better for anyone to die at home”.Desai made up his mind to pursue general practice after his third year, and has taken a particular interest in palliative care – particularly after looking after one patient for the last six weeks of his life. He said that, rather than dying in hospital, “it’s better for anyone to die at home”.
Anderton, who has been a GP for more than 20 years, said she was constantly learning. “I have learned particularly to always trust mothers when they say something is wrong with their children,” she said. “But Bhav has taught me so much, too, because he’s newly trained, particularly about new technology, he’s downloaded apps for me on my phone that help enormously with different aspects of patient care.”Anderton, who has been a GP for more than 20 years, said she was constantly learning. “I have learned particularly to always trust mothers when they say something is wrong with their children,” she said. “But Bhav has taught me so much, too, because he’s newly trained, particularly about new technology, he’s downloaded apps for me on my phone that help enormously with different aspects of patient care.”
Aside from the workload, the only complaint Anderton has about her work is the effect of national politics:Aside from the workload, the only complaint Anderton has about her work is the effect of national politics:
The NHS is a huge organisation, and it is adaptable. But we have had to deal with a horrendous amount of change, and we have to have some stability as well. We employ people here; and we ask them to do a job and if policies change it might change people’s jobs and we might have to make people redundant. The cuts have been happening for the last eight years, and we have to constantly try to innovate in order to keep ahead.The NHS is a huge organisation, and it is adaptable. But we have had to deal with a horrendous amount of change, and we have to have some stability as well. We employ people here; and we ask them to do a job and if policies change it might change people’s jobs and we might have to make people redundant. The cuts have been happening for the last eight years, and we have to constantly try to innovate in order to keep ahead.
UpdatedUpdated
at 5.34pm GMTat 5.34pm GMT