GP refuse to refer and have a policy not to see under 16's

GPs are private businesses, and more or less do whatever they feel like. It is about time we had a National Health Service that is truly national and accountable.  My own view is we need a tax-funded insurance system and a mixture of publicly-owned and private providers that the >patient< can choose, not be at the mercy of bureaucratic commissioners.

Many years ago I had a job opposite Guy's. I needed a routine blood test, and was told to go to my local hospital - which meant taking a morning off work. I asked the GP if I could go to Guy's in my lunch break ... no, the GP Commissioning Group (or whatever it was called back then) had a "contract" with the local NHS Trust.

Personally, I would like to see health centres that provide access to the full range of primary care, including minor treatment, pathology, OT, physiotherapy, counselling ...  and patients can go wherever is convenient. In 1948 it made sense to be "registered" with a local GP ... now we have computer systems, it should be possible to go to any provider and for them to access your basic NHS record.

My local GP practice has four doctors, three nurses, and >twelve< admin and clerical staff. It still takes two weeks to get a routine appointment, if you can get through on the phone to book one.

in my view the solution is just to remove GPs all together. For routeen things like vacination and routeen tests pharmacys could do it fine. We can move the diagnostic / referal function directly into hospitals with dedicated diagnostic wards. Then we only really need peripetetic GPs to do house calls.

The hospital service might work in towns ... our local hospital has a GP-led service that diverts patients with minor ailments from A&E. However, many areas do not have a local hospital, or poor transport services etc. Hence my suggestion of a local open access NHS Health Centre with salaried GPs, specialist nurses, therapists, phloebotomy, and mental health services all in a "one stop shop".

In our area, most home visits, particularly out of hours, are provided by a locum service ... often the same GPs working shifts, seeing each others' patients (and getting paid more.) 

My elderly mother recently had a local pharmacy call to do her COVID-19 and 'flu vaccinations. She said they had a van with all the equipment, and did vaccinations, blood pressure checks, etc. for housebound patients requested by local GP practices. This sounds like a good idea.

It would help if GPs' time wasn't wasted on "sick notes" for people with chronic conditions such as back pain, mental health conditions etc. that do not need active treatment. One GP I know said he " works two days a week for the NHS and three days a week for the DHSS"

The other time and money waster is patients who go to their GP to write "free" NHS prescriptions for over-the-counter medicines  I know one person who goes to the GP to get a "free" prescription for paracetamol tablets that cost £2 in Sainsbury's. Their "free" prescription costs the NHS at least £30 for GP time, pharmacy fees and administration, and means that genuinely ill people have to wait longer for appointments.

Ian said:

Hence my suggestion of a local open access NHS Health Centre with salaried GPs, specialist nurses, therapists, phloebotomy, and mental health services all in a "one stop shop".

So again in effect a mini hospital? Like you get a tessco extra you can get a hospital local. That might work well for small towns and cluster of near by vilages. The important thing is if they are run by an NHS trust specialists can be rotated in and out from larger hospitals on the odd shift to take part in diagnostic clinics.

Ian said:

One GP I know said he " works two days a week for the NHS and three days a week for the DHSS"

I think that's technically DWP. There is no DHSS. That kind of the point. As goverment departments DHSC and DWP are often acting in oposition these days, in practice if not in theory.

Ian said:

Hence my suggestion of a local open access NHS Health Centre with salaried GPs, specialist nurses, therapists, phloebotomy, and mental health services all in a "one stop shop".

So again in effect a mini hospital? Like you get a tessco extra you can get a hospital local. That might work well for small towns and cluster of near by vilages. The important thing is if they are run by an NHS trust specialists can be rotated in and out from larger hospitals on the odd shift to take part in diagnostic clinics.

Ian said:

One GP I know said he " works two days a week for the NHS and three days a week for the DHSS"

I think that's technically DWP. There is no DHSS. That kind of the point. As goverment departments DHSC and DWP are often acting in oposition these days, in practice if not in theory.