Saving NHS Scotland

One of the biggest political campaign points in recent years is saving NHS Scotland.

Everyone talks about the NHS, the institution of it, the benefits it offers our citizens. When we talk about it for the most part it’s like we are reminiscing about a hot summer fling we had somewhere sunny on ’96. But that’s not the reality. Everyone talk about how much they want to save the NHS but other than throwing an enormous amount of funding to it, I have yet to see a solid plan laid out by anyone.

I have a plan!

Well, I say that. I have a small number of ideas that I feel could improve NHS Scotlands performance, without a high cost factor. In fact, the way I envision these changes playing out could potentially save the NHS a large amount of money in the future. But for that to happen the NHS has to survive our current struggles. Search for HS Scotland in any news outlet search engine and you will find articles about wait times, GP/Nurse shortages. Lack of funding for education, lack of beds, hospitals poorly functioning or closing. For an outsider this would support the idea being pushed by some that the time of the NHS is over, and that a private healthcare system will soon take over.

The ideas that have inspired me to write this article have played on my mind for several years now. I take a lot of it from my experience not only within NHS Scotland but also from over 9 years of receiving healthcare in the US. A model that many Westminster politicians feel is the only way forward for us. As much as I feel that the healthcare system in the US is all about money, and it’s the people that suffer through medically related bankruptcies and often times death (due to lack of coverage) there are a few things that the Americans get right.

So I draw from my experience there and share those ideas here along with the experience from my own professional view. Which I guess I should get out of the way first. For the last 7 years I have worked as a Massage therapist. I was trained in the US which offers a longer, more in-depth schedule of training than you would get here from your initial diploma, but it has allowed me to work with injuries, rehabilitation, palliative care, and a vast range of clients looking for not only relaxation but also a way to manage an injury or health condition and in some instances find alternate methods of pain management. I have several clients who have been referred from local pain clinics and have reported a great benefit from the massage industry.

Don’t dismiss me just yet, i’m sure you are thinking “Oh Great, she’s going to suggest providing Massage on the NHS and problem solved. She has a secure job who cares about the rest.” Although this is an avenue I wouldn’t mind the NHS investigating, it’s not the primary suggestion or desire from my thoughts on saving Scotlands NHS.

Change is Scary, but it needs to happen

Part of the problem, as I see it, is that we are operating in a way that hasn’t adapted to the increased population, the less isolated “village surgeries” and the personal service that is still expected despite strain on the system.

What happens when someone wants to see a GP at the moment?
I am basing this on my own Dr’s office and those in surrounding areas as shared by my clients.
Scheduling an appointment with your GP is almost impossible. You have to call the practice either at a specific time of the day, or on a particular day of the week. Attempting to schedule an appointment for non-emergency issues are often impossible as the “schedules aren’t open” for advanced booking, or they simply don’t book appointments 2-6 weeks ahead.

So if non-emergency issues can’t schedule an appointment in advance, they take advantage of the same day appointment system. Calling or showing up (although some Dr’s surgeries will not schedule same day appointments in-person) as soon as the practice opens. Hoping they are one of the first in the queue and are awarded an appointment that day.

If this doesn’t work, guess what happens next? Yup, the patients just take themselves off to Accident and Emergency.

They need to see a Dr and feel that this is their only recourse, which in turn puts strain on the A&E department, increasing waiting times, frustrating patients and medical staff equally and causing further tension within the NHS.

Implementing a Triage system

This is a combination of experiences I had whilst living in the US that I feel could greatly improve the efficiency of our local GP Practices, without necessarily having to find a large number of GP’s to fill the many holes in the system.

How would this work?

A triage system would make use of our wonderful Nurse Practitioners in the community, allowing them to use their deep knowledge and their specific skill sets to address the appointment issues with patients at the local level.
A nurse practitioner has the ability to identify less-serious ailments and if necessary arrange for prescriptions, as well as escalate patients to
a GP if they feel the patients needs warrant it.

There is one local GP practice who makes use of this system to address those patients seeking same day appointments. This weeds out the health issues of those who were unable to make a future appointment so try to be seen during one of the limited same day appointments.
A nurse practitioner used in this manner would also be able to take some of the slack of the ongoing health issues patients experience that require recurring appointments. Be this a renewal of sick lines, clearance to return to work, weight loss & diabetes follow ups.

The average salary of a nurse practitioner is £34,000
The salary of a GP is between £55,000 and £84,000

At this rate each practice could employ 2 nurse practitioners for the cost of one GP and vastly reduce the number of patients waiting for a GP appointment.

This practice of utilising nurse practitioners has been implemented in a few surgeries local to me, and reports from other healthcare workers in those practices is that it is generally seen as a successful endeavour, reducing waiting times for GPs from weeks to days, and sometimes even same-day appointments for some non-urgent issues.

Taking back ownership of our health.

The next idea I would love to see implemented is the idea of our healthcare system switching to a more “preventative care” focused practice.

This would involve introducing the idea of annual health screenings for people, including blood screens and other testing options should their family history indicate a risk of serious sickness or disease.

Another controversial opinion on this is that these annual screenings should not be free, but could certainly be offered at a subsidised rate.
I feel that a reasonable cost for this check up each year at around £50-75.

Although cost effectiveness in early detection compared to reactionary care is still in it’s infancy, there have been studies such as those carried out by the NHS Breast Cancer program that show that survival rates increase with early detection and intervention.

I believe that the same could be said for a lot of conditions that may require surgery or medical intervention.

Not only would these annual screenings allow us to catch any possible health issues earlier/quicker but it also allows the patient to be more informed about their health.

Being informed and educated is extremely important if we want patients to take their health seriously, and if we want them to take ownership of their health.

At some point in time society has slowly handed over control of their health to the medical profession, and at times we just carry on with whatever ails us until it becomes an urgent medical issue.

Adding Massage and other modalities to the NHS

Finally, I would like to see consideration for alternative treatments for patients, particularly in pain management.

According to the British Pain Society pain management in adolescents alone costs the NHS upwards of £4 Billion per year.

NHS Scotland provided a Cost Analysis report for Prescription medication costs to the NHS for 2015/2016.

To focus on our pain management topic, during this analysis it cost the NHS £19.18 Million to prescribe Co-codamol.
One of the most common pain killer offered by the NHS.

I would like to see the NHS consider including offerings such as Massage Therapy, Acupuncture, Osteopathy and many other modalities as alternative treatment options. Not only (with correct training and certification) do these practitioners offer the ability to provide patients with pain relief, many of the treatments have additional positive affects for the patient.
This can include a better mind-body connection for the patient (see my point about patients needing to take ownership of their health) but also reduction in stress and improved cognitive abilities.

Another bonus with these methods of pain management?

Reduction in “sick time” taken from employment.

Self certificate absences add up to about 7 days per year per employee, and lead to costs for UK businesses of around £29 Billion. (CIPD Absence Management Survey)

These costs are slowly being reduced by businesses implementing wellness programs, including counselling, therapies and activities that promote healthier happier lifestyles.

If these programs were supported by the NHS practices, our population would have the opportunity to live healthier, happier and more productive lives by choice.

When push comes to shove, I hope that the NHS survives so that it’s an institution that my grandchildren can also be proud of. I am just someone who hears from people day-in and day-out how they feel let down by current NHS practices, and I wish so desperately that I could change these experiences for everyone.

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