u/IndependentIll6531

The one you actually witnessed. The one where you were standing in that crowd and understood in real time that something special was happening. What was it and what made it feel different to everything around it.

Interested because there’s definitely equipment I paid almost no attention to initially that now seems far more important in practice.

I have spent the last 6 months as the Senior Lead Resident Doctor for my trust. For those that don't know, this allows me to sit in executive and board meetings, and essentially gives a link for resident doctors at the most senior level in a trust. The role itself is an absolute gimmick, but it has been an eye opening experience. What I can now say that most resident doctors have absolutely no idea what is happening behind the scene.

While we are sitting here posting about training posts and this and that, the extent of the financial pressure of the NHS is absolutely insane. It's made me come to the conclusion that most of these people have absolutely no idea, and the NHS is essentially unviable in the long-term. If the tory party was doing what is happening now people would be rioting in the streets. The extent of the budget cuts being expected from certainly my trust and pretty much all others is orders of magnitude higher than the worst of the worst during the austerity years, and probably any time in the entire history of the NHS.

We are talking about real terms cuts to the tune of something like 5-15% over the next couple of years. During the worst of austerity, most trusts budgets were frozen or just didn't rise as much in real terms compared to historical averages - these are actually genuine real terms cuts and by a humongous amount. The scale of staffing cuts on the horizon is shocking. Just this year my trust is being expected to reduce staffing costs by over 5% (i.e. literally hundreds of staff less) and similar numbers for the next and the next year. And this is not like in previous years where they could overspend and say oopsie and the government would bail them. They have been told in no uncertain terms that if they miss their agreed targets they will lose their jobs.

It's hard to believe a few months ago we were talking about a workforce crisis, when actually looking down the barrel we are looking at trusts massively reducing staffing, again quite possibly to the highest extent in NHS history. Every senior manager that I have spoken to, and I have interacted with all of them up to the CEO and many of them have been around the block has said that this is by far the worst financial pressure that they can ever remember.

Remember that we have been talking about how the Conservative Party has destroyed the NHS by underfunding it over a decade and all they did was merely increase by a few % above real terms. Absolutely insanity now that the party which is supposed to "save" ARRR NHS is actually actively reducing trust's already threadbare budgets. Honestly how is any of this actually viable in the long-term. Instead of fixing the chronic understaffing secondary to the workforce crisis, they are now actively and aggressively cutting back on staffing.

I personally think political leaders need to have a proper discussion with general public what they actually want from the NHS, because these people are literally living in cloud cuckoo land.

I find it difficult to balance both without feeling like I am compromising somewhere.

Despite the BMA raising the ACP issue, I’m not optimistic about anything being done about it in the NHS.

Currently it seems that every nurse and paramedic and their grandmothers want to skip medical school and become GPs via primary care ‘advanced practice.’

And why wouldn’t they? It’s a gravy train where they get to take all the simple cases leaving the salaried GPs to deal with all the complex and risky cases in 10 minute slots (without a compensating increase in consultation time for these cases).

In other words ACPs not only take jobs away from GPs but make working conditions for GPs worse too by increasing said complexity-risk load on GPs.

Even though we were told they were supposed to help relieve the increasing pressure on GPs by helping with work load (lol).

If GP were to go the way of dentistry then the market will naturally introduce compensatory mechanisms to correct this absurd situation we’re in.

Sure patients might prefer to pay £40 instead of £80 to see an ACP instead of a doctor for their foot corn but most will go to a GP for any real medical issue. Similar to how people will pay to see a dental hygienist for routine cleaning but will go to the dentist for any actual dental problem.

Like in dentistry, there will be a time price linkage mechanism where complex patients would have to be seen in longer consultations and be charged higher prices for that consultation.

Second, there will be demand filtering because most rational patients won’t pay to go see anyone about their toe corn to begin with which will reduce the overall volume of consultations demanded from GP.

This would generally lead to better working conditions for salaried GPs. Private GPs in London already enjoy much better working conditions compared to NHS salaried GPs.

Now I anticipate I’ll get moralistic outrage mongering from the usual suspects about how this will lead to poor people being unable to afford to see a doctor or how big, bad private equity corporations will eat up general practice, but the dentists made it work and from what I can see they enjoy better working conditions than the government serfdom called NHS model GP.

And sorry but I’m CCTing and fleeing to Australia if working conditions do not improve.

Been rewatching a few episodes across different eras and something clicked that I never really paid attention to before. There are quite a few moments where someone asks the Doctor a very direct question (usually something serious or emotional), and instead of answering, he either deflects, changes tone, or just moves the situation forward without addressing it. It’s not even played as a joke most of the time, it’s just, skipped over. At first I thought it was just writing pacing things, but it happens enough that it feels intentional, like part of the character. Almost like he avoids sitting in certain conversations for too long. Now I can’t unsee it and I’m noticing it across different Doctors, not just one era.