Wait weeks to see a GP: Some patients face delays of more than a fortnight for appointment with family doctor
Many patients are having to wait up to three weeks or more to see their GP, a survey has revealed. A poll of more than 2,000 patients has found that well over two-thirds are not able to see their family doctor within two days. More than a quarter cannot get an appointment within a week, including some who are made to wait longer than a fortnight or even three weeks.
There are concerns that waiting times have steadily increased ever since the Government scrapped a bonus last year which encouraged family doctors to see patients within 48 hours. In addition, GPs say they are being forced to spend increasing amounts of their time filling in forms, attending meetings and ‘appraising’ themselves.
Patient groups say the situation is ‘abysmal’. They warn that in some parts of the country people count themselves as ‘very lucky’ if they manage to secure an appointment within three weeks.
The poll, commissioned by the Daily Mail, found that fewer than a third – 30 per cent – were able to get an appointment within 48 hours the last time they had needed to see a GP. Forty-three per cent were made to wait between two days and a week. More than a quarter – 27 per cent – waited longer than a week, according to the poll carried out by insurers Aviva Health UK. This included 5 per cent who waited longer than a fortnight, of whom 2 per cent were made to wait longer than three weeks.
If the results of this survey are representative of Britain, it means that more than one million patients routinely wait longer than three weeks to see their family doctor.
Joyce Robbins, of Patient Concern, said: ‘It is a completely unsatisfactory situation. It is abysmal. I myself would normally allow three weeks to see my own doctor. My practice in London serves 12,000 patients and people are very lucky if they manage to get an appointment within three weeks.’
David Stout, director of the NHS Confederation’s Primary Care Trust Network, which represents primary care trusts, said: ‘Many GPs successfully manage to see and treat their patients within reasonable time.
‘But with the removal of government targets for GP access and growing financial pressures throughout the NHS, it is not surprising there will be an increase in some places in the numbers of patients waiting longer.’
A spokesman for the British Medical Association, the doctors’ union, said GPs ‘always strive to meet demand, but the reasons why some people may wait longer than a week for an appointment will vary’.
It’s heating or eating in winter for us, retirees warn London Mayor
British electricity bills are heavily laden with government charges used to support Warmist projects
Pensioners today urged Boris Johnson to tackle fuel poverty as it emerged that more vulnerable people than ever are struggling to pay their energy bills.
More than one in four people in the capital are currently unable to meet their energy bills as rising prices and welfare reforms threaten to send even more into fuel poverty.
A report by London Councils today warns that rising fuel prices means that fuel poverty could be a key issue this winter.
A group of pensioners submitted a petition to City Hall last week calling on the Mayor to do more to assist vulnerable people across the capital who are unable to pay their bills.
Fuel poverty in London is defined as when a household has to spend more than a tenth of its income to “maintain an adequate level of warmth” after housing costs. George Durack, 87, a retired post office worker who chairs the Islington Pensioners’ Forum, today warned that elderly people could die if something is not done to combat the problem.
He said: “Something needs to be done about this. They are reducing the fuel poverty allowance and a lot of people are going to struggle. “There are pensioners dying because of fuel poverty. It’s horrible. A lot of pensioners are really going to feel it this winter. The cost of living has already gone up so much and this just makes things much worse.”
Mr Durack added: “It has got to the point where, for a lot of pensioners, you either heat or you eat. People are going without meals – it is that bad. Something needs to be done and that is why we are taking our petition to City Hall.”
Between 2004 and 2009 domestic electricity prices increased by over 75 per cent and gas prices increased by over 122 per cent. A number of suppliers including British Gas and NPower, this year announced further price rises.
Catherine West, chairwoman of London Councils’ Transport and Environment Committee, said: “Fuel poverty is a real and growing danger to low-income families in the capital. With rising living costs and fuel bills, more households face a miserable winter fighting off the cold.
“While boroughs will do what they can to support families with advice and through energy efficiency schemes like Re:New, we also need Ofgem to bear down more aggressively on energy companies who are benefiting from lower wholesale prices.”
If it’s good enough for Eton: State comprehensive sees grades rocket after headmaster cuts class sizes to 15 pupils
These relatively small gains are entirely consistent with a placebo (“Hawthorne”) effect rather than any effect due to class size itself
A comprehensive has seen its pupils’ grades rocket after cutting class sizes in English and maths to levels normally found in private schools. Headmaster Adam Dare slashed the number of 11-year-olds in these lessons from 26 to 15. Pupils studying English GCSEs have equally small classes.
As a result, the number of pupils achieving five or more GCSEs at grades A* to C – including English and maths – has risen from 35 per cent to 43 per cent this year. The A* to C pass rate for English has increased from 41 per cent to 59 per cent.
Mr Dare has employed extra teachers at King Richard School in Paulsgrove, Portsmouth, to enable him to honour the class size pledge.
The secondary school used money it received from government funds for specialist status, deprivation and free school meals.
The head said: ‘If you were at Eton like our Prime Minister you wouldn’t expect to be in a class of 30. If small class sizes are good enough for Mr Cameron, they’re good enough for our kids.’
He added: ‘I am in no doubt that our class size guarantee has contributed to an improvement in grades. ‘The core of good progress is good teaching but it’s hard to provide good teaching in a big class. ‘Children need individual support and to have their voices heard in the classroom. If all you are expecting from students is a C grade, you can afford to have class sizes of 30-odd. ‘But if you want them to achieve their full potential and aim for the As and A*s, less is more.’
This year King Richard School, which has 760 pupils, recorded 120 A* and A grades at GCSE, with 14 students achieving five or more A* and As. Just seven students achieved five or more A*s and As last year.
Mr Dare said that in a perfect world he would apply the small class guarantee to all subjects. He has applied it to Year Seven to give pupils ‘the best possible start’ in the basics and to Year Eleven because of the importance of their exams.
Year Eleven pupil Lily-May McQuilken, 15, said: ‘Last year there were 26 of us in an English lesson and our teacher didn’t have time to come round to everybody. Now that has changed and it feels much more personal. It has also given me extra confidence to speak out in class.’
Figures from the Department for Education show the average class size in state secondary schools is 20.4.
Schools are often criticised for focusing on lifting the D students to a C to improve league table ratings. But Mr Dare said he is aiming for the top grades so his school-leavers can aspire to the best universities. ‘We want more of our kids thinking “when I leave here I’m going to go to University College London or Cambridge”.’
Walking through traffic fumes ‘can raise risk of heart attack for six hours’ (?)
This is a very ambitious study, correlating the TIME of heart attacks with the known level of pollution in the air at the time. Journal article here.
It seems unlikely that epidemiological data can answer the question asked. A firm conclusion would depend on the time of each person’s heart attack being known and accurately given in official records — a very dubious assumption. On the other side of the correlation, the air quality data is taken from the UK National Air Quality Archive. Is that archive specific enough to record what exposure EACH PERSON had to pollution? Surely not. Just being indoors versus outdoors could have a large effect.
The only cautious conclusion we could draw from the results reported is that they are a random walk
Higher levels of air pollution can increase the risk of having a heart attack for up to six hours after exposure, warn UK researchers. Even moderate levels of pollution from traffic carry an extra risk, according to a new study in the British Medical Journal.
The findings come from a detailed analysis of almost 80,000 heart attack cases and the level of pollution to which they were exposed.
Air pollution is currently estimated to reduce the life expectancy of everyone in the UK by an average of seven to eight months, probably by affecting the heart and lungs.
In the latest study Krishnan Bhaskaran, an epidemiologist from the London School of Hygiene and Tropical Medicine, and colleagues found rising air pollution was linked to a rise in heart attacks up to six hours after exposure. However, there was no increased risk after the six-hour period, with the number of heart attacks then falling to a lower level than expected.
The researchers reviewed 79,288 heart attack cases from 2003 to 2006 and exposure, by the hour, to pollution levels. They used the UK National Air Quality Archive to investigate the levels of specific pollutants in the atmosphere. These included pollutant particles (PM10), carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2) and ozone. Higher levels of PM10 – tiny toxic particles – and NO2 are well-known markers of traffic related pollution from vehicle exhaust fumes, said Dr Bhaskaran.
National air pollution warnings on weather reports alert people to changes using bands ranging from low, to moderate, to high, to very high. People who are sensitive to air pollution are advised to spend less time outdoors during high and very high episodes of air pollution, and not to exercise, along with those suffering asthma and heart disease.
Dr Bhaskaran estimated there would be an extra five per cent risk of a heart attack caused by a change in air pollution from ‘low’ to ‘moderate’ in the following six hours. The risk would increase further during ‘high’ and ‘very high’ episodes but they are uncommon in Britain, he added.
Dr Bhaskaran said the data suggested that after the first six hour period following pollution peaks, the number of heart attacks was lower than expected. Some people who were going to have a heart attack in that later period may have simply had their heart attack brought forward by a few hours as result of the pollution exposure, he said.
‘We know from many studies that there are more deaths when pollution levels are higher, but whether heart attacks make a major contribution to this is not clear.
‘Although we found a short period of increased risk of heart attacks in the few hours after air pollution peaks, the risk was small and had little net impact on the overall number of heart attacks’ he added.
Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, which co-funded the study, said: ‘This large-scale study shows conclusively that your risk of having a heart attack goes up temporarily, for around six hours, after breathing in higher levels of vehicle exhaust.
‘We know that pollution can have a major effect on your heart health, possibly because it can “thicken” the blood to make it more likely to clot, putting you at higher risk of a heart attack.
‘Our advice to patients remains the same – if you’ve been diagnosed with heart disease, try to avoid spending long periods outside in areas where there are likely to be high traffic pollution levels, such as on or near busy roads.’
The study looked at heart attacks in England and Wales.
Electric-shock therapy lifted me from the hell of depression
There is a strong body of thought that the good attention that medical staff give to the patient while conducting the electroshock procedure is the curative influence — a type of placebo effect. The fact that a series of treatments is needed before any progress is seen supports that view
Life for Tania Gergel could not have been more thrilling. Captivated by academic study, she quickly became one of the highest-achieving students on her Classics degree course at Bristol University, finding time to play percussion with several bands and orchestras, too. Tania, then 19, also met and fell in love with Matthew, a maths student, now her husband.
Then tragedy struck: the couple just returned from their first holiday together when Tania was told that her best friend, Ali, had been killed in a car accident. ‘It was a terrible shock — as though a screen suddenly came down between me and the rest of the world,’ recalls Tania, now 38, from North London. ‘After the funeral, when I went back to university, I felt detached from everyone. My mind had started racing and I couldn’t sleep.’
Within a month, Tania had stopped studying altogether. ‘I remember sitting in a common room waiting for a lecture. It felt like everything was swimming around me and I had to get out of the building.’
Tania was experiencing depression, specifically an episode of bipolar disorder, previously known as manic depression. According to the NHS, around 500,000 Britons have been diagnosed as bipolar, although recent studies suggest the true incidence may be more than five million. Sufferers typically swing between two phases — manic and depressive.
During the manic phase they may experience feelings of euphoria, talk at extreme speed and go for days without food or sleep. The depressive phase is characterised by severe low mood, a loss of sense of purpose and, at its most extreme, thoughts of suicide.
Several weeks after her friend’s death, Tania sought help from her GP who prescribed tricyclic anti-depressants — the standard treatment at that time. ‘It was a shock to be diagnosed with depression,’ she recalls. ‘When the doctor prescribed medication, I realised something was very wrong with me.
‘I’ve since learned that my grandmother had been hospitalised twice for psychiatric depression: she had heard voices.’ (There is strong evidence for a genetic vulnerability to developing the illness.)
However, after five months of taking anti-depressants, Tania was forced to acknowledge they were having no effect. ‘The depression got worse. I was getting two hours’ sleep at night, if that, invariably with sleeping pills involved. ‘I gave my pills to Matthew to look after as I felt I couldn’t trust myself any more not to take them all as an overdose.’
Eventually, Tania went as a voluntary inpatient to a private psychiatric hospital in London, where she stayed for two months. But despite being given every type of major antidepressant, nothing seemed to help and Tania and her family became desperate.
Then, by chance, Tania met a friend of a friend who was a psychiatrist at London’s Charter Nightingale Hospital (now Capio Nightingale). ‘He said it was clear the drugs weren’t working and suggested I come off all the pills and have electroconvulsive treatment.’
Many will recoil at the thought of electroconvulsive treatment (ECT), which was famously depicted in the 1975 Jack Nicholson film One Flew Over The Cuckoo’s Nest. But it is considered an effective treatment for severe depression which is resistant to medication and talking therapies such as Cognitive Behavioural Therapy.
About 20 per cent of all depression sufferers fall into this category, of which more than half would benefit from ECT, says Dr Cosmo Hallstrom, consultant psychiatrist at the Royal College Of Psychiatrists in London.
The treatment involves sending an electric current through the brain, under general anaesthetic, to cause a fit. Although it is not exactly known how it works, one theory is that the fit triggers certain brain chemicals, including the ‘feel-good’ chemical, serotonin, which is thought to be depleted in patients with severe depression.
The treatment was first introduced around 70 years ago but it fell out of favour following the introduction of antidepressant medication in the Fifties and Sixties.
In the past, ECT has been used indiscriminately, at times under duress and without general anaesthetic. As a result, it remains the most controversial treatment in modern psychiatry.
Indeed earlier this year the British Psychological Society called for it to be banned, describing the treatment as ‘inhumane and degrading’, and having only a short-term effect on people with manic depression.
However, many clinical studies show ECT is significantly more effective than antidepressants in inducing a speedy remission for severe treatment-resistant depression, says Dr Hallstrom. ‘It can cure a particular bout of depression — although it does not prevent relapses,’ he says.
Indeed, it is even recommended by the National Institute For Health And Clinical Excellence (Nice).
In 2008 Nice published guidelines on the management of bipolar disorder, which recommended ECT ‘to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening’.
Tania’s brother, then a practising psychiatrist, had himself carried out ECT many times and told her he had seen it have remarkable results. ‘He was very much in favour,’ she says. ‘You know your own brother has your best interests at heart.’
‘It wasn’t what people may think — being restrained in some sort of straitjacket. It was all very civilised. You go under a general anaesthetic for a few minutes and that’s really all you know.’
Dr Hallstrom says patients see an improvement after six twice-weekly treatments. Tania started to feel things changing after five. ‘It was a very sudden thing. I just woke up one day and thought: “I feel like something’s lifted.” Suddenly you’re released from internal torment.’
Six months after completing her course of ECT, Tania returned to her studies and got a First.
The treatment is not risk-free — half of those who undergo it experience side-effects, such as confusion and disorientation, after each treatment. ‘But this tends to fade after a few days,’ says Dr Hallstrom.
A trial is under way in Australia on a new form of ECT, which involves running an electric current through the brain for less time, and has been shown to have less of an effect on memory.
Tania had some memory loss in the period during which she received ECT, ‘but nothing really substantial’ she says. Indeed, after university she went on to gain a Masters and eventually a PhD in Classics, and fulfilled her dream of teaching.
For 11 years, she remained off medication and had no contact with any psychiatrist. Tania and Matthew married and had a daughter who is now seven.
ECT does not cure the problem for good, though, as Tania discovered. When her daughter was two, she became pregnant again. But then she miscarried, plunging her into a severe depression.
‘Within three weeks I was in hospital. My consultant psychiatrist suggested I try ECT again. It worked and after six treatments, all of a sudden I didn’t feel suicidal any more.’
Dr Hallstrom believes more people suffering with severe, medication-resistant depression should be given the option of ECT.‘It can be a lifesaver,’ he says.
Tania can only agree. ‘ECT won’t cure you, but it will get you out of the crisis state,’ she says. ‘Hands down I owe my life to ECT.’