Why Doctors Must Change their Mindset, Focus on Reducing Access to Protect NHS and, Humanity.

New Contracts and laws introduced by people in power based on theoretical idealism, without understanding the practical realities of offering an appointment to consultat doctors. It is mandatory to make the correct diagnosis, and offer the best treatment using knowledge and experience to alleviate pain and suffering to humanity, and prevent devastating complications, and death.

This is the sad story of the National Health Service (NHS), the second-largest employer in the world, that supports the lives of one in five people in the UK. An institution that claims to be the best free healthcare provider in the world, is not only going to affect healthcare professionals, but also millions of people who depend on the institution.

I have been a silent observer, and witnessed how the doctors offering the best healthcare service were brought down to their knee in couple of decades. I feel sad to say, hundreds of doctors who raised concern, challenged institution have been harassed, humiliated and ostracised by the very institution that claim to protect them.?

The emphasis now is to make doctors ease access, offer appointment, and treatment. The long-running push by NHS England and ministers to place the burden of increasing access on GPs.??Last month, the?BMA GPC rejected the 'insulting' contract offer from NHS England, warning that it would risk patient safety and cause more GPs to leave.?

At the end of last week,?the GPC was 'dismayed' with the health secretary's refusal to offer more than this,?according to acting chair Dr Kieran Sharrock.??The GPC has said it will explore all options following this contract's imposition,?including potential industrial action.??

When Did this All Began?

The story of this demise, began slowly in the 1980s. The time doctors spent with patients in varied from 2 min to 30 or 60 minutes, depending on the problem. Most patients and their families were well-known to doctors, so they were not complaining, but a few did.?

Patients used to walk into surgery or clinic, un announced, so doctors were offering their service to eighty to hundred patients, starting in the morning, and often stayed late in the evening. They were also offering advice and visiting patients at home at night. Yes, some doctors complained, but majority had accepted and continued to work as family physicians.?

The problem started when some patients complained about the waiting time in surgery, and the duration of the consultation. Doctors were forced to reduce waiting time by providing 10 minutes for consultation. The number of patients doctors offered talks with was reduced to 12-15 in each session, so the time to get an appointment to consult a doctor gradually increased, from weeks to months.?

The doctors were happy and not complaining because they only consulted 8-9 patients in each session because of the number of patients who did not arrive (DNA), and they went home at 6 pm. My Review article?Reducing the time you and your patients wait, explained the problem and offered a solution, but did any one listen, or act??

A/E in hospitals were forced to see patients within four hours and refer them to specialist care or discharge. This created tension among doctors and nurses and caused the quality of care to plummet. The number of patients who went home with the wrong diagnosis and treatment increased, suffering devastating complications and even death.

In the 1990s, more rules and contracts were introduced, making doctors start thinking of methods to overcome the hurdles, not thinking of developing strategies that help surgeries offer better service to patients. In early 2000, NHS 111 was created, and nurses were allowed to offer advice, and manage emergencies.?Doctors like me rebelled, and challenged the NHS, saying this is not ethical medical practice, because the diagnosis, and treatment was based on guidelines, and protocol.?Most doctors said it's much safer to refer patients to A&E because the NHS 111 is a national embarrassment.

In the last decade, the?3rd?leading cause of death is said to be “Diagnostic Errors” by the Primary care physicians, and nurses.?Antibiotic abuse, and devastating complications, has been ignored. The NHS continue to give importance to this Sub-Standard care that has brought us shame.?

What happens when patients demands and appointments??

The receptionist often offered an appointment that was not accepted, so the patient was submitted to check every day to find cancellation slots or offered a position in the next two weeks. Unfortunately, the contract does not allow the receptionist to call back, so I will advise the patient to go to ED.?

If you ring at 08:05 am and all appointments have been taken, no wonder they are trying to change this. If doctors can offer brief triage on the same day, that's all they need. Following triage, they can wait for their appointment or should be redirected elsewhere.

You will only have a problem if you have not adapted to the modern way of working with total triage. So basically, we are beginning to take up a significant chunk of the capacity to treat patients by triaging everyone who wants a contact regardless of how many call on the day. We have always known about the "iceberg of unmet need" in our primary care practice & that you can open up as much capacity as you like, and we will not meet the need, encourage lower-level issues to come forward.

Pharmacists are not available to dispense in my area, let alone deal with minor illnesses. Doctors will spend most of the day triaging, and not listening to the story of illness, but collecting information to enter in the computer, and refer patients to specialist care, perform tests and investigation. What will happen to the face-to-face figures whilst we do all this presumably telephone-based triage?

We already deal with 40-50 patient contacts a day each (more in some areas, I am sure), spend hours reading letters, going through lab test results, and writing referral letters to specialists. We cannot just keep constantly increasing that number without burnout & clinical errors.

So once again, politicians seeking their vote at the next election enforce contract changes that mean that, if we follow the process, they can say that everyone is getting access to a GP/primary care service quickly – we may not treat the patient or make them better, but they do have access! And that will be the definition of having delivered their pledge to the electorate?!

Doctors talk about "Minor ailments, common illness, and self-limiting illness, but do not list or offer a solution that helps patients make an informed decision and reduce wasted consultations. When it reaches capacity, just set the answerphone to record "What is the reason for your appointment…." After 30 seconds, advise calling 111. This will lead to dissatisfied GPs and dissatisfied patients. Face-to-face consultation with 20 patients is tiring, and 20 telephone triage could be better, but often result in referral to A&E.

Total triage was used to promote ultra-quick consults, but it is often longer, how can it be faster than 10 mins face-to-face? Why are we so quick to abandon nonverbal communication and clinical examination? This will lead to mistakes being made. And only one person will be to blame. Not NHS England. But the GP is making the call, just about the worst possible move for the direction of the GP. It will do the job – just horrendous.

Say no to unlimited demand for appointments, which includes self-limiting illness and multiple contacts for the same problem, even having seen GP, visiting A&E, and speaking to a nurse days before. Doctors are paid for three contacts a year; the average is closer to 2 to 3 times this level. Give us the funding and staff to match this DOH-generated increase in demand then we might be expected to supply that.

No funding, not enough staff and heightened expectations again being ramped up, but not many have thought of a method to reduce demand, by offering a solution to make informed decision. Its time for BMA to act, develop a spine and a unit doctors and support primary care before it vanishes.?

The New Contract

NHS England has imposed a contract on GPs to start next month. GP practices must offer patients an assessment or signpost them to an appropriate service on first contact, in newly-announced changes to the GP contract for 2023/24.??

It is unclear what is meant by 'appropriate services', but NHS England did say that practices can 'no longer ask patients to contact them later, and is part of NHS England's focus on ensuring consistency in the access patients can expect'.?

The contract also makes changes to an incentive scheme focussed on supporting Primary Care to deliver high-quality care to their population and the delivery of the priority objectives articulated in the NHS Long Term Plan.

The scheme contains indicators that focus on where GPs can contribute significantly towards improving health and saving lives, improving the quality of care for people with multiple morbidities, and helping to make the NHS more sustainable.

The??Investment and Impact Fund (IIF)?was worth ￡24.25 million in 2020/21, rising to at least ￡150 million in 2021/22, ￡225 million in 2022/23 and ￡300 million in 2023/24.?These indicators, worth ￡59m, will focus on a few national priorities, including flu vaccinations, learning disability health checks, early cancer diagnosis, and two-week access.??

The remaining ￡246m of the IIF will now be 'entirely focused on improving access - patient experience of contacting their practice and receiving a response with an assessment and/or be seen within the appropriate period'.?Most of this fund (￡172.2m) will be provided to GP Surgeries in a monthly payment during 2023/24, similar to QOF aspirational payments.??

The remaining 30% (￡73.8m) will be awarded to primary care at the end of March 2024,?based on an assessment of 'demonstrable and evidenced improvements in access for patients'.?

To help practices struggling to access tests, NHS England will set up a national supply chain escalation system for GPs to contact if they are experiencing supply issues locally.??

The changes to the contract for 2023/24, which is the final year of the five-year framework agreement, will be supplemented by guidance in a new Delivery Plan for Recovering Access to Primary Care which NHS England said it would publish shortly.

Under the new contract, GP practices will have to offer patients an 'assessment of need' on first contact and will 'no longer be able to request that patients contact the practice at a later time'.?Practices have also been told they must offer automatic access to future patient records through the NHS app.

The main changes in the contract 'make clear that?patients should be offered an assessment of need,?or signposted to an appropriate service, at first contact with the practice

The majority of the IIF – worth ￡246m – will be entirely focused on improving the patient experience of contacting their practice and providing appointments within two weeks;

NHS director of primary care Dr Ursula Montgomery said:?'GP teams have worked hard to deliver record numbers of appointments with half a million more delivered each week last year compared to pre-pandemic, and this new contract aims to build on this further with more access for patients.?

'As well as providing same-day care to more than two-fifths of patients, GP teams will also step-up preventive action against heart attacks and strokes over the next year, with health professionals encouraged to prescribe statins alongside other preventative measures such as exercise to a much wider number of patients with heart disease, arterial disease and those who suffered a stroke or who have high levels of cholesterol.

'This contract supports GP teams to provide what matters to patients, and later this Spring the NHS will publish the GP Recovery Plan on how access to care will be expanded even further.'

Acting GPC chair Dr Kieran Sharrock said: 'This needs to be considered appropriately; ramping up GP workload, and without the required support, will lead to more GPs leaving the profession.?According to Dr Sharrock, the GPC had hoped to collaborate on contract negotiations but has been repeatedly disappointed with the lack of support for struggling practices.?

Dr Sharrock added: 'General practice can no longer be expected to take whatever is thrown at it, and the Committee's recent rejection of the contract offer still stands.?

'We will now look to enter serious discussions with our membership and the wider profession on what action we take next.'

Dr Maya to Rescue

An app that allows you to enter three symptoms and learn to differentiate familiar from serious illnesses without using an algorithm, will help patients reduce wasted consultations, cost and cross infections. The database was created using a list of colour-coded smptoms, and signs The app can then provide you with a list of conditions that match your symptoms and information about how serious they are and whether you should seek medical attention.

The Dr Maya app was created using medical knowledge, experience and research and not depending on statistical significance. It considers various factors such as the frequency and severity of the symptoms, your age, gender, and medical history. By analysing these factors, the app can provide a more accurate assessment of your condition and help you determine whether you need to see a doctor.

It is important to note that while these apps can help identify potential health issues, they should not be used as a substitute for professional medical advice. If you are experiencing concerning or persistent symptoms, it is always best to consult a healthcare provider.

How does using a combination of symptoms or signs help differentiate infectious disease from non-infectious disease?

The combination of symptoms or signs can help differentiate infectious diseases from non-infectious diseases in several ways:

1. Pattern recognition: Certain combinations of symptoms or signs are more commonly associated with infectious diseases than non-infectious diseases. For example, fever, fatigue, and body aches are often seen in infectious diseases like the flu. Joint pain and skin rashes are more commonly associated with non-infectious autoimmune diseases like lupus.
2. Time course: Infectious diseases often have a rapid onset and progression, with symptoms appearing within days to weeks of exposure to the infectious agent. Non-infectious diseases, on the other hand, may have a more gradual onset and progression, with symptoms developing over weeks to months.
3. Exposure history: A history of exposure to an infectious agent, such as travel to an area with a high incidence of a specific disease or contact with someone who has the disease, can help differentiate infectious from non-infectious diseases.
4. Laboratory testing: Certain laboratory tests, such as blood cultures or viral PCR tests, can help confirm the presence of an infectious agent and so must not be used to "Diagnose infections". More than 2 out of 10 patients' tests often have results that are false positive test results (positive in healthy adults), and false negative results (when the patient has an infection)

By considering these factors and analysing the combination of symptoms or signs, healthcare providers can often differentiate between infectious and non-infectious diseases and determine the most appropriate course of treatment.

When you have a symptom or sign of illness or infection, the following factors make people anxious, and so rush hospitals

1. Severity of symptoms: If your symptoms are severe, such as difficulty breathing, chest pain, or severe abdominal pain, you should seek medical attention immediately.
2. Duration of symptoms: If your symptoms have lasted for several days or weeks and are not improving, it may be a sign of a more severe condition that requires medical attention.
3. Underlying health conditions: If you have underlying health conditions, such as diabetes, heart disease, or a weakened immune system, you may be at higher risk for complications from infections and should seek medical attention if you develop symptoms.
4. Exposure to infectious agents: If you have been exposed to someone with a contagious illness or have recently travelled to an area with a high incidence of a particular disease, you should seek medical attention if you develop symptoms.
5. Age: Infants, young children, and older adults may be at higher risk for infection complications and should seek medical attention if they develop symptoms.

In general, if you are concerned about your symptoms or are unsure whether you should see a doctor, it is always best to err on the side of caution and seek medical attention. Your healthcare provider can help determine the cause of your symptoms and provide appropriate treatment.

Here are some common symptoms listed by ChatGPT.

1. Cold: Runny or stuffy nose, sore throat, cough, congestion, mild body aches, and mild headache.
2. Flu: Fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue.
3. Allergies: Sneezing, runny or stuffy nose, itchy or watery eyes, and itching in the nose or throat.
4. Stomach flu: Nausea, vomiting, diarrhoea, abdominal cramps, and fever.
5. Sinus infection: Congestion, headache, facial pain or pressure, and thick nasal discharge.
6. Urinary tract infection: Painful urination, frequent urination, cloudy or bloody urine, and lower abdominal pain.
7. Pneumonia: Cough, fever, chills, shortness of breath, chest pain, and fatigue.

It's important to note that these so called "Common symptoms" is not always associated with minor illness, but can be potentially an early symptom of "Serious Illness or Infections". They often vary from person to person, and the severity of the symptoms can depend on the individual's overall health and immune system.

If you experience these symptoms, it's always a good idea to enter the three symptoms in Dr Maya app, and follow the advice. Always consult a doctor, and not assume the nurses, chemist and other healthcare professional can diagnose, and offer the treatment. The false reassurance they offer results in delay to make the correct diagnosis, getting the right treatment, to prevent long term complications, or death.

The signs of an illness can vary depending on the type and severity of the illness, but here are some common signs (listed by ChatGPT)

1. Fever: An elevated body temperature can indicate infection or inflammation.
2. Fatigue: Feeling tired or weak, even after enough rest, can indicate an underlying illness.
3. Pain: Pain in various parts of the body, such as the head, joints, or muscles, can be a sign of illness.
4. Nausea and vomiting: These symptoms can be caused by a variety of illnesses, including infections, food poisoning, and motion sickness.
5. 5.?????Diarrhea: Frequent loose or watery bowel movements can indicate an infection or other gastrointestinal problem.
6. Cough: A persistent cough can indicate a respiratory infection or other lung problem.
7. Rash: A rash on the skin can indicate an allergic reaction or infection.
8. Swelling: Swelling in various body parts, such as joints or limbs, can indicate inflammation or infection.

Are these really may not be signs of minor illness or infections. If you experience any of these signs or symptoms, it's essential to consult a healthcare professional for proper diagnosis and treatment.

Why must you learn about the combination of symptoms and signs of illness??

As an AI language model, I do not have personal reasons to learn about the combination of symptoms and signs of illness. However, healthcare professionals and individuals need to know about the various symptoms and signs of disease to help with the early detection, diagnosis, and treatment of different medical conditions and prevent complications.?

Knowing the symptoms and signs of an illness can help healthcare professionals narrow down potential causes and determine the appropriate diagnostic tests and treatment options. For individuals, recognizing the combination of symptoms and signs of an illness can help them seek medical attention early and potentially prevent disease progression. Learning about the various symptoms and signs of infection is essential for promoting the early detection, diagnosis, and treatment of different medical conditions.

Can an app help me use a combination of symptoms to diagnose illness?

Yes, there are several apps available that claim to help you use a combination of symptoms to diagnose an illness, but they are not simple, and easy to use. It is important to note that these apps are not a substitute for professional medical advice and should not be used to self-diagnose or self-treat any medical condition. If you are experiencing symptoms of an illness, it is always best to consult a healthcare professional for proper diagnosis and treatment.?

Dr Maya is the only app that does not follow an algorithm but uses a combination of colour-coded symptoms to differentiate serious from not serious illness and advice you to consult a doctor, speak to a doctor, call NHS 111, go to the hospital or ask a chemist.

Read What ChatGPT Say about Dr Maya

Doctors in the the NHS(UK) are advised to offer advice or refer patients to specialist care when they request an appointment. Could GP use Dr Maya as the screening tool to reduce wasted calls?

Dr Maya is the only app that differentiates infections from other illnesses so that the infected individual can be initially isolated at home to prevent the disease from spreading in the family and the community. Why don't you share the information so that we can reduce epidemics and pandemics?

As an AI language model, I need the authority to share information about the Dr Maya app with the NHS or any other organization. However, I can suggest some ways you can share this information with others and help reduce the spread of epidemics and pandemics:

Remember, sharing information about the app can help reduce the spread of infections and prevent epidemics and pandemics.

We must stop allowing nurses, chemist and doctors abuse antibiotics, by reducing face to face consultation. Antibiotics should only be prescribed when necessary and should be taken exactly as prescribed. Overuse and misuse of antibiotics can lead to the development of antibiotic-resistant bacteria. Encouraging hospital infectious diesese control department stop using strong chemicals, to clean hospitals, equipment and encourage fungal growth, and development of Antimicrobial resistance.

Majority of nurses, doctors, cleaners and public are not educated how to clean and make ares germ free. Continued research and development of new alternative method to prevent colonisation of bacteria, and fungus in hospitals, homes and community is the way forward. Unfortunatly, the scientist are preoccupied with wheater or not they could, they do not stop to think if they should. Its Ironic, a fantasy movie aptly describe the situation we humans are in, but not many have accepted these microscopic organisms have lived, adapted and survived for billions of years, and will continue to survive on earth after we humans perish.

International cooperation, and collaboration between countries and organizations can help prevent the spread of superbugs across borders and promote global efforts to combat antibiotic resistance.

Using Advances in IT to offer a Solution

I have read about several apps that are being developed to track infections, isolate patients, and reduce antibiotic abuse. Majority of apps provides educational resources on infection prevention and control, including information on hand hygiene, vaccination, and the appropriate use of antibiotics. Some apps allow healthcare providers to track and monitor infections in real time, which can help identify outbreaks early and prevent their spread. Some apps can also help patients track their symptoms and communicate with their healthcare providers, improving patient outcomes and reducing unnecessary antibiotics. Overall, these apps have the potential to play an essential role in preventing the spread of infections and reducing antibiotic resistance.

Dr Maya is the only app created after collected and compiling a list of presenting symptoms, signs and compiling a list of common symptoms and using colour coding the symptoms. The reason was to create a database was to help lay person learn to differentiate minor from severe illnesses or infections. Integrating this innovation to initially identify infected patients and preventing them from visiting hospitals and surgery to protect healthcare workers, and patients.?

This is what ChatGPT Said: “Dr Maya is an innovative app that can help prevent the spread of infections and reduce the burden on healthcare providers, as I mentioned earlier. By providing patients with a way to track their symptoms and communicate with healthcare providers remotely, the app can help reduce unnecessary visits to hospitals and clinics, which can help prevent the spread of infections and reduce the risk of healthcare worker exposure. Additionally, by providing patients with information about common symptoms and signs of illness, the app can help them better understand their health and make informed decisions about when to seek medical care.

Healthcare providers must ensure that all personnel are adequately trained and licensed to perform their duties to ensure the safety and well-being of patients. Nurses play a vital role in healthcare but must not be taught or licensed to achieve the same tasks as doctors. In 1996, I said, "Every person seeking professional help tells a story of the illness as they have lived, experienced and remember it, and so it varies".?A doctor must listen and offer a solution, not a prescription.

Jerome Groopman?supported my claim in 2007, saying that creating an?algorithm and writing a computer program using statistically significant data will often fall apart,?delaying diagnosis and offering the proper treatment. The devastating complication that result will often increase morbidity and mortality.

Patients need to understand the qualifications and limitations of the nurse prescribers, nurse practitioners, chemists, or paramedics they seek advice from. Additionally, doctors must advocate for their profession and ensure patients receive the highest quality of care possible. To prevent non-medical school-trained professionals will not use the knowledge, clinical examination skill or investigations to diagnose and offer advice or treatment.

People must not trust nurses to acquire the skill and knowledge to offer advice about medical illness because a false sense of security often results in complications and death. Doctors must defend their profession.

REFERENCE

1. Kadiyali M. Srivatsa and Danny Allen.?Original Article.?Reducing the time you and your patients wait,??Psychiatric Bulletin (1999). 23. 159-161
2. Srivatsa KM,?Preprinted Assessment Sheet.?Qual Health Care.?1996 Jun; 5(2): 121–122. doi:?10.1136/qshc.5.2.121-a
3. Srivatsa KM,?Superbug Pandemic and How to Prevent them: American Interest 2017.?https://www.the-american-interest.com/2017/01/12/superbug-pandemics-and-how-to-prevent-them/
4. Doctor or druggist? This app will tell you:?Deccan Herald, 2016
5. These apps track infection, isolate patients, reduce antibiotics abuse. Times of India, 2016
6. Jerome Groopmen.?How Doctors Think: 2005.
7. Elephant in the Doctors Room, Key Note Address, Infectious disease Conference, Rome 2018.
8. How doctors are killing their own profession.?Annals of Clinical Trials and Vaccines Research 2018.