Britain ‘dans la merde’
There’s a factual scientific workaround for patients who feel uncomfortable about visiting their GP to discuss problems in the bowel department in the form of the Bristol Scale.
Handy reference categories allow patients to enter more scientific discussions on bowel movements with doctors without embarrassment. The Bristol scale is a very practical model and was widely promoted in the media by many healthcare campaigners, like the late and great Dame Deborah James who campaigned tirelessly to raise awareness of bowel cancer and its symptoms.
Getting rid of any sense of embarrassment to do ourselves and other members of society the power of good by embracing pragmatism is essential. We can all learn much from the experience.
Ignoring problems is a bad strategy
In terms of psychology, ignoring problems often leads to increased stress, anxiety, and emotional turmoil. On the other hand, addressing and resolving issues helps foster emotional and mental well-being. By confronting problems head-on, we rid ourselves of the underlying stressors that degrade our quality of life.
Hiding from problems strains relationships and increases distance. On the contrary, actively working through issues strengthens connections and honest communication increases trust and understanding.
By acknowledging and identifying problems, we put ourselves on the road to positive changes.
Now now Sir Keir, take heed!
Making Brexit work is not exactly honest communication. We know it’s a problem, but if we do not talk openly about it, we can’t fix it. Neither can our parliament. There’s no need for pomp or reinforcing our Britishness with flag frames on TV. There is a need to outline the real symptoms and problems, much like a patient who references the Bristol Scale with a GP.
Medication shortages
These are a serious symptom of the problems caused by Brexit. They are only getting worse, as reported by Sky News this Saturday.
‘A cross-party group of MPs has urged the government to “get a grip” on drugs shortages and commission an independent review of the medicines supply chain. The Health and Social Care Select Committee said the issue means Pharmacy First is at risk of failure’.
The government launched the Pharmacy First policy in January 2024 which allows patients to be treated for seven common conditions at a local pharmacy without the need for a GP appointment or prescription. As we will see, the Pharmacy First policy is not without its own problems…
Conditions which a pharmacist may treat under the Pharmacy First policy include:
– sinusitis
– sore throat
– ear ache
– infected insect bite
– impetigo (bacterial skin infection)
– shingles
– uncomplicated urinary tract infections in women.
Anti-viral treatment options for shingles (acyclovir, valacyclovir, and famciclovir) to reduce the severity and duration of the rash for patients, who are either immunocompromised or have a more severe case of shingles, exist but must be taken within 3 days of onset of symptoms to be effective. While the NHS website points out pharmacy services, it does advise patients to call 111 to get help or book and urgent GP appointment. It is a mixed message, as if the NHS is itself not quite convinced…
Immunocompromised patients are defined as those with a medical condition which impedes the normal functioning of the immune system or those over 65, as age decreases the strength of the immune system in general. This applies to patients who take medications that affect the immune system. Pregnant women are also at higher risk of complications from shingles.
- vision loss or eye damage if the virus gets into the eyes.
- hearing loss or hearing difficulty due to Ramsay Hunt Syndrome
- partial paralysis in facial muscles
- bacterial skin infections because of shingles lesions that take a long time to heal.
- inflammation in the lungs (pneumonia), brain (encephalitis), liver (hepatitis),
- protective membranes around the brain or spinal cord (meningitis)
- stroke
- permanent damage to the nervous system and spine
Some complications of shingles can be fatal if left untreated such as pneumonia, encephalitis, stroke and bacterial infections which can cause shock or sepsis.
Time is of the essence with anti-virals, be that for covid or shingles. Incorporating pharmacy services into urgent needs provision is a good step in many ways, but pharmacists rely on the availability of drugs to help patients, be that for an urgent prescription due to an illness or a standard prescription for an ongoing medical condition.
Drug shortages
A report from the BMJ in 2023 highlighted that drug shortages, which used to be rare, are now commonplace
Drug company alerts about impending shortages had jumped from 648 in 2020 to 1634 in 2023.
The BMJ warned that a “new normal of frequent disruption to crucial products” had placed a major burden on pharmacists and had affected the availability of medicines to patients.
Rishi Sunak’s mother, Usha Sunak, is a pharmacist. He should be very aware of the problems in this sector, but against the ‘B’ word, Brexit, will not appear in any of his speeches or policies.
Hiding the problems and causing the problems with political red tape has further stressed the system. This is not only the result of Sunak’s policies, but those of his predecessors and insufficient actions of members of parliament across the house of commons to push for both open discussion and proactive practical measures to alleviate the problems.
The silence and concealment were worst of all in the conservative party. We recall the heated expose of the consequences of ‘Operation Yellowhammer’ plans in a frank discussion between Jacob Rees Mogg and consultant neurologist, Dr David Nicholl:
what level of a mortality rate would he accept in the event of a no-deal Brexit.
Jacob Rees-Mogg told the doctor who wrote the no-deal Brexit mitigation report that he should be ashamed of saying that patients will die because of Brexit. Doctor David Nicholl wrote the medical section of the Operation Yellowhammer report into what effect a no-deal Brexit could have on the NHS.
Rees Mogg then claimed he had a new team of non-remoaners writing medical reports.
Dr Nicholl went on to discuss both medication shortages and shortages in radio isotopes, which are used in cancer treatment.
People at the Royal College of medicine were very worried and had not approved any of the new Yellowhammer plans the government was preparing.
Rees Mogg dismissed these facts in a supercilious tone as being ‘typical of remoaner campaigners’ who should be ashamed of this scaremongering.
A no deal would be a cliff edge, but the shortages and supply issues do have an adverse impact.
Pharmacy Staff and Budget Shortages
It’s not only the availability of drugs which could compromise a government policy to use a pharmacy first approach. Guardian journalist, Steven Morris, highlighted concerns in the industry voiced by a pharmacist, Jithender Ballepu, at the former Sunak family chemist on the Pharmacy First approach in May 2023.
Steven Morris,’ Pharmacist at former Sunak family chemist wary of PM’s health plans’
Ballepu voiced reservations about Rishi Sunak’s plans for chemist shops to provide prescriptions for millions of patients in England.
“Already there is not enough funding for pharmacies […] Pharmacies are facing a lot of pressure in terms of providing services. We are not able to cover the cost of providing enough colleagues. There have been so many pharmacies that have closed because of lack of funds.
“We would need much more funding and definitely more staff to provide any new services. I would need another one full-time dispenser and whether you can get the staff depends if you are able to pay the right salary. We would need more trained colleagues.”
There are concerns pharmacists may be put under pressure to prescribe antibiotics where patients did not really need them, which is risky. Such prescriptions would be better authorised by a GP.
Pressure on the GP front: GP shortages and Policy Failures
The Doctors’ Association sent a new book written by its past co-chair, Dr Ellen Welch, to every MP to put general practice at the top of every manifesto, Why Can’t I See My GP – The past, present and future of general practice (8 February 2024).
The Liberal democrats plan to hire 8,000 GPS to alleviate primary care pressure.
Those GP posts are extremely necessary, especially due to a glitch in government policy which
has proved counterproductive, which is a shortcoming of funding policies, meaning many newly qualified GPs are not able to secure a permanent job.
Sarah Graham wrote about the paradoxical background of this in her piece, ‘‘I’m a trained GP, but I can’t get a job’: the absurd new crisis in the NHS’.
While the conservative government promised 6,000 more GPs by 2024/25,
NHS statistics show that in January 2024, there were 1,830 fewer fully qualified full-time equivalent GPs than in September 2015.
There may be enough qualified candidates to fill GP positions but practises themselves do not have the budget to take on staff. They are moving to recruiting non-GP roles owing to a government funded incentive to hire non-GPs due to reimbursements, whereas patient needs merit more GPs.
Here’s why: government subsidises recruitment of other health professionals, who are.
cheaper to employ than GPs via the Additional Roles Reimbursement Scheme (ARRS), introduced in 2019 by NHS England. This allows primary care networks to claim reimbursement for the salaries of pharmacists, paramedics, physiotherapists, mental health practitioners, physician associates (PAs) and others working within general practice, i.e. anyone but GPs and practice nurses.
The GP shortage is therefore one of the government’s own makings via policies and cuts.
The Royal College of General Practitioners (RCGP) asked the Government to allow ARRS funding to be used to recruit both GP and nursing roles. The BMA has also seen instances of practices not replacing GPs when they leave, or even making salaried GPs redundant. Newly trained GPs are sitting around without a job, which is absurd.
Physician associate (PA) roles are being used to get healthcare done cheaper, while PA staff are very capable of handling lots of tasks, it’s not the same role.
A GP has 10 years of training, whereas a PA has two. More expensive experienced GPs would not make as many mistakes according to the Doctors’ Association
“A GP has 10 years of training, whereas a PA has two. They can’t know what they don’t know, and I don’t think they’re necessarily getting the supervision a GP trainee would get,” Dr Steve Taylor (Spokesman, Doctors’ Association).
Even though the government pushed for more medical trainees and there are now more trainees coming through the system, the funding to employ them at the other end is not there. Funding per patient GP practices receive has fallen 20 per cent since 2016.
“We’re seeing a real erosion in the standards of care that patients can expect. If things don’t change, if the Government doesn’t back general practice, I worry it will go the way of dentistry.” Dr Steve Taylor (Spokesman, Doctors’ Association).
Getting to the root of the problems
With the best will in the world and dedication, our pharmacists cannot take on extra work without sufficient support. Clearly, the conservative government has tried to kick the can down the road by delegating tasks to other professionals in the healthcare chain.
Neither GPs nor pharmacists can fulfil their duties to the public without funding and the tools of their trade, which include a seamless supply of vital medications. Brexit red tape blocks medication supplies, a key element of this service provision.
Brexit has exacerbated problems with sewage dumping, with faecal matter seeping into water supplies. The problems have extended from the SW to both Thames Water and many more; our own Northumbrian Water is guilty of slipping standards of their duty of care to the public. The London Economic reports:
Traces of faecal bacteria have been found in EIGHT other areas across the country. Data from the Drinking Water Inspectorate (DWI) logged 34 separate incidents, ranging from Northumberland to Bristol.
Britain is well and truly ‘dans la merde’ and the government itself is to blame for this:
‘ Complete collapse in water safety standards in the UK, after the government allowed private firms to dump raw sewage into rivers, lakes, and seas nationwide’.
Problems with our waterways already reduced business for travel and tourism/leisure sectors in many regions. Devon and Cornwall reported 20% reduction in tourism due to sewage dumping in September 2023, long before the recent bacterial outbreaks in the SW this year.
The word is out: Britain stinks, literally.
Healthcare should be a serious business in terms of disease prevention and treatment. There is a will to improve the NHS from opposition parties, but without honest admissions, it won’t necessarily work. A patient should discuss all adverse symptoms with a doctor to get to the bottom of the problem. We can’t hide anything anymore, not from ourselves and not from the country. Keir Starmer must bite the bullet at some point to address the dreaded ‘B’ word using a factual approach as much as a patient who learns to describe embarrassing bowel movements using the Bristol Scale for the good of the nation’s health.
