The current hospital / A&E crisis

The government are definitely in deflection mode.

How does someone in their 70's go to hospital and end up on a trolley for 50+ hours? They shouldn't have been going to a hospital in the first place if they lasted that long with zero care.

Who suggested zero care?

Years ago I brought someone with a stroke to the A&E, they were seen quick enough, they got some medication immediately and they were seen by a consultant in maybe 2h. Then they spent a day on a trolley but they were fully cared for. The investigations were top class, they got xray CT scan and some vascular ultrasound all in one day. Fortunately they fully recovered.

Given that a GP job is probably as cushy as it gets for docs, why aren't more entering the profession ?

Compared to hospital jobs would seem not to be.

Also part-time GP would be a stressful job?

Many don't do out calls. Don't do weekends. Don't do night shifts.

I am in the same boat, if I call the doctor for an appointment today I could be told it could be Thursday or Friday before I get to see them, so I understand the frustration. Even worse I am trying to get my daughter transferred to my and my wifes doctor and they said that is fine but it can't happen until the other GP transfers the records and god knows when that will be so trying to get an appointment for my daughter will be a nightmare. Before 2019 I could rock up to the surgery and I could wait to see the Dr now it is appointments only, which I don't mind. That still doesn't mean that people are told not to go see a GP or go to A&E unless absolutely necessary, who is to decide that? People go to see a Dr or to A&E if they are worried about something and need the reassurance that its not too serious but especially with cancers, which can start off as something small but if not treated early can escalate quickly and then as others have mentioned this causes further problems down the road in terms of accessing treatments. I know in the case of my father, he thought he had a stomach bug and didn't think he needed to go see a dr but it took the rest of my family to convince him to go to the Dr who said it was a stomach bug and gave him some tablets but it persisted, he went back and seen a standin Dr who sent him straight to A&E where he had to sit in a chair to be seen while destroying him and it turned out it was bowel cancer and weeks later he died. I'm not saying he would have survived if he went earlier but his life leading up to that point would have been a lot more comfortable if he had of gone sooner.

As I said I blame the government and by the government I don't mean just the politicians, even though they are a large part of the blame, but I include Public servants in that including those in the department of Health and the Management of the HSE. They have a huge budget but it seems as with a lot of public services in this country that the front line services are drip fed the money and have to fight for every penny while further up the chain there doesn't seem to be a problem. We need to make sure the money goes to front end services and not sucked up along way that when it does get to the services there are only pennies left.

In that regard yes. But they have to manage their usual busy practices and are solely responsible for their patients ie noone to hand over to, except refer to casualty or consultants.

But in the meantime they are the first port of call. And unless they are very irresponsible, which I think you will find they don't usually go into the job if they are, they would be worried about patients and trying to see as many as possible.

Nothing worse - my old GP practice was like that. Told them that was the reason I changed - being medically assessed by a receptionist never sat well with me. Like If I tell you I need to urgently need to see a DR take my word for it. I don't use the word urgent lightly.

Just watching the news there - the measures that they are putting in place to reduce numbers on trolleys do appear to be working - for that particular problem, on this occasion. But they are also give clues to why things are so shambolic. First, we have a report that "the HSE is visiting the hospitals". Eh, the HSE and hospitals are (or should be) the same thing. This sounds like spin from HSE senior management trying to deflect responsibility and claim credit as they swoop down from "headquarters" to show the hospitals the error of their ways..

Secondly, the representative from Nursing Homes Ireland was on saying that there is spare capacity for discharges in nursing homes. Vested interest alert. The nursing homes smell money here and have now provided a solution of sorts to the HSE, are we now going to get people discharged to nursing homes instead of getting to go home with a homecare package because the HSE is in a flap and latching onto any solution that is put forward. Also, given what happened at the start of covid, what's infection control like in these nursing homes, have they enough PPE now or will they again want the state to provide it. They've already been looking for more money under the Fair Deal scheme, crying about energy costs and threatening to close unless they are paid more.

Next one is related - the news that there are more discharges happening at weekends due to consultants coming in and other measures. Great, now where are these patients being discharged to.

Also, if increased weekend discharges do alleviate overcrowding why has the HSE waited until now to implement this. The health service has been in crisis for 20+ years, is it only now that it has gotten crisisey enough to increase weekend discharges?

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Does your GP see all the pts himself? No other GP as well as nurse and secretary to be paid from that 300k? And also I’m not sure what magic genie bottle gives out grants to pay for other GPS and nurses and rent.

maybe hire some nurses then to ask me my personal medical details,

I don’t like my neighbors asking me why I urgently need to see my general practitioner.

What was the story this morning with the announcement several hundred patients had been discharged, but had no where to go.?

you missed his core point 'caps should have been removed on GPs'

It should be an open market, private operators should be able to open franchises across the country ,current system is dogshit and failing badly.

They cant keep up, won't keep up, time to completely revamp the system so people can actually see a doctor.

And its not like GPs are cheap either.

I don't know whether I should say this.

But I will.

But i had a kidney infection that I only managed to get rid of coming up to christmas ....it took three months to get rid of it.

I asked my GP to maybe ring into the pharmacist ahead of christmas incase it came back to have a standby course of anti biotics (it was something the other gp in the practise suggested). He said oh no ..dont worry if it comes back we will just send you to A& E over the Christmas they have everything there etc.

My GP was going to send me to A& E for a complex UTI. 😐️

That is nuts.

I didn't go ..cuz im sane.

Also i got the TINIEST bit of bleach in my eye during covid lockdown ..GP and a pharmacist BOTH insisting i go to A&E ...I did. I wasted people's time in there they just gave me eye drops I felt so embarrassed.

Now I go to a laya dr during weekends ..its ok. Faster than A& E obv you have to be with laya and pay though.

I have always wondered if there is a bias. Oh you seem super fragile get yourself to A&E ....

I'm sorry about your relative. I hope she was ok. It must have been so stressful.

That reminds me I had a seizure a few years ago ...they made me stay in until I had the MRI scan ..which was NOT necessary because I was able to go back with my parents and the Doctors were told they would watch me like a hawk and i could go in later for the scan when it was available.

They kept me in hospital for EIGHT DAYS ..talking up a bed until the MRA machine was available. I have private insurance so my dad thought maybe it was just to get the insurance. But no it's hospital policy. But if you can go back home and someone is going to be watching you 24/7 why not? I can understand if you lived alone.

My was like look we are just taking her home this is ridiculous. But the doctors started to get really aggressive. The MRI by the way came back totally clear.

When they released me even though they then knew I was ok they told me it was hospital policy for me to go out in a wheel chair and made me do it. It was nuts. I bet someone else could have used that wheel chair. I was perfectly able to walk! My dad was laughing!

What is happening in UHL is inhumane. It is depriving patients of the fundamentals of privacy and dignity in healthcare

You need to work on your manners mate.

Actually there are 3 major issues called out in the competition report.

One of the major ones seems to be accessing the medical card scheme for GPs who want to start a new practice.

Anyway, there certainly are significant barriers there.

https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.ccpc.ie/business/wp-content/uploads/sites/3/2017/03/General-Medical-Practitioners-Report.pdf&ved=2ahUKEwiBtpmhu7z8AhWbBIgKHfFtA0gQFnoECAwQAQ&usg=AOvVaw3mSgzc0FatCx1V6WY6SvYE

Key findings

The Competition Authority has identified three factors that are having an impact on competition in GP services in Ireland:

1. Restrictions on the number of qualifying GPs; 

2. Restrictions on advertising by GPs; and,

3. Restrictions on GPs wishing to treat public patients.

These restrictions are contributing to difficulties being experienced by patients - in terms of accessing regular GP services in 

certain “blackspot” areas of the country and rising prices for private patients. 

The cost of visiting a GP has risen rapidly in recent years, significantly outpacing the general rate of inflation in the economy. 

There are indications that a substantial number of private patients are delaying GP visits due to cost factors and are “shopping 

around” for cheaper consultation fees. The State paid an average of €65 for every GP visit made by a public patient in 2008. 

In examining these issues, and engaging with those with the power to make reforms, the Competition Authority has identified 

solutions to improve the supply of qualified GPs and facilitate informative advertising by GPs, and their implementation 

has already been progressed. Training more GPs and allowing them to advertise will have a limited impact on competition 

however, unless those GPs are able to get a General Medical Services (“GMS”) contract. 

A GMS contract is very valuable to a GP practice; very few GP practices operate without one. The current GMS system 

favours existing GP practices and protects them from competition from newly qualified GPs. 

The restrictions on competition arising out of the GMS system affect both private patients and public patients. 

• Both public and private patients have fewer GP practices to choose from, and

• There is less pressure on GP practices to compete on price for private patients and to be innovative in the service 

 they provide.

The impact of the GMS on private patients is often overlooked. It is assumed that “the market” will take care of them. This 

ignores the fact that the market for private patients is itself significantly affected by the operation of the GMS. The GMS 

system impacts directly on the commercial behaviour of almost every GP practice in the State, affecting decisions on where 

GPs locate, the number of GP practices established, the nature of such practices and the profitability of individual practices. 

This in turn affects the provision of services for private patients and indirectly in