Cookie Notice

However, this blog is a US service and this site uses cookies from Google to deliver its services and analyze traffic. Your IP address and user-agent are shared with Google along with performance and security metrics to ensure quality of service, generate usage statistics, and to detect and address abuse.

Wednesday, 26 June 2019

GP shortages signal NHS failures

Young people want to live in cities, and young doctors are no different. This is true not only for the UK but for much of Europe - and in Europe the effects of rural depopulation are far more pronounced. It is this metro-centricity that is being blamed for what the Telegraph terms an alarming crisis in rural NHS GP provision. Yet not everywhere that experiences rural depopulation also experiences GP shortages - here in Austria, for example.

A shortage of GPs in rural areas can only be because of two reasons. Either the nation does not have enough GPs, or we have enough overall but imperfections in the GP employment market create surpluses of GPs in the cities and shortages in rural areas. In the UK, both problems can be laid at the feet of NHS mismanagement. It has failed, just like any centrally planned economy. It has failed because the NHS distorts the employment market.

Here in Austria everyone pays into social insurance firms - there are several - that also run hospitals and clinics. GPs are self-employed, and hang their shingle wherever they judge they can earn a living. Some GPs have more than one surgery. Commonly, they work alone - which is not a problem when they're away on holiday (which is frequently) as insured citizens can use any GP; there's no such thing as being registered with just one. Consequently, their skills are offered to the market on very much a commercial basis; If I like Dr Musterman, I can take my business to his ordination, if not I can see young Dr W├Ąchter down the road. An E-card confirms one is insured. For each visit, the GP is paid €18.86 by the social insurance firm and the insured pays a premium of €3.77 on their insurance cost. Of course there are central government subsidies in various forms to the social insurance providers so it is not wholly like the US insured model (for a start, my health insurance is only about €45 a month), but this mix of health by both tax and free market mechanisms works - at least to the extent of ensuring there are plenty of GP surgeries in rural areas.

You see, the reason that UK doctors give to the Telegraph for not wanting to work in rural and coastal practices - the pressure of high numbers of elderly people - is the very reason that Austrian GPs hang their shingle in such places. Old people are good business, if you're paid per consultation.   


Stephen J said...

The NHS is like Chris Grayling, and yet we all love him for the national treasure that he is.

As an aside, what would be interesting is first hand knowledge of the system employed by the Austrians for the specialised care that some older folk require.

Presumably they don't murder them as in the Netherlands?

Raedwald said...

RW - huge subject - both society, values and land and housing costs are very different here. The elderly can normally expect to live out their lives with family members to care for them, in extended, clustered or semi-independent housing. The idea of putting granny in a home so the kids can sell her £1m house in Virgina Water is utterly unrecognised here. If I say ties of home, land and blood are stronger here it sounds a bit fascistic - but there's an element of truth in it.

Stephen J said...

Raedwald - It sounds like there are enough Austrians around in Austria, to ensure that government reflect and place a value on traditions.

Perhaps that is because the Austrian government does not believe that it owns the people, rather the people own their government.

No democratic government worth its salt would institute and maintain a communist model for health insurance, not even communists.

Why do I feel like I am being flim-flammed when something is "free", whilst I pay for other services and get the service that I require.

The apparent Austrian tradition of placing granny in the corner of the kitchen by the fire, is also traditional almost everywhere else, but the NHS has destroyed that. As with so much else, nanny knows best.

So no, not Austrians being fascistic, but Brits.

CheerfuI Edward said...

Doctors are urbane, intelligent people, normally.

Why would they want to live among what the population in small provincial towns and villages has so often become?

Money is not the answer.

Raedwald said...

"Why would they want to live among what the population in small provincial towns and villages has so often become?"

What, congruent, peaceful, law-abiding, altruistic, socially concerned, civically responsible, democratically engaged, self-sufficient, mutually supportive with a sense of place, identity and belonging you mean?

As opposed to your semi-feral urban citizens of nowhere kowtowing to their Globalist masters and on the take for every selfish, self-rewarding advantage going?

Yeah sure.

Dave_G said...

Ones guesstimation of Cheerfuls age drops with each pronounement from that orifice/keyboard he/she/zhe/etc uses.

I'm down into the 'teens now - for 'its' age AND its IQ.

RAC said...

@ Tearful Ted

"Why would they want to live among what the population in small provincial towns and villages has so often become?"

Stop tippy toe-ing around, tell us what you really think, what have they so often become.
Spell it out, give us a better insight into your rabid mindset.

Anonymous said...

Is Edward trying to tell us that rural Britain isn't like The Archers?

Cheerful Edward said...

Peaceful? Law abiding? Take a place like Chippenham, or Whaley Bridge for that matter. Rough as f***.

Raedwald said...

Yes, the over-70s bingo evenings in some Wilts towns can be a bit rough, especially when they've been on the plum wine, but at heart they're diamonds

Mark said...

What you mean Monty Python's "hells grannies" wasn't a joke?

Dioclese said...

The NHS is pretty much fucked - and who's the cunt that fucked it?

Why none other than our prospective PM, Jeremy Cunt

He's fucked up the NHS and wants to move on to fucking up the entire country...

Sackerson said...

Sounds as though you need to be involved in official discussions on the future of the NHS.

Mr Ecks said...

If their are naff parts of this country Cheesy look to the toxic combo of welfare-handout fatherless bastardy and imported 3rd world evil. Both the direct result of sanctimonious middle class leftist scum like you.

mikebravo said...

Poor little cheerful Ed's fake, happy and jovial mask is slipping.
He is starting to look a lot like a spiteful and bitter SJW type.


Cheerful Edward said...

Wrong, Ecky.

It was one Enoch Powell, no less, who began mass imports of people from the Commonwealth, nominally as cheap labour for the NHS when he was health minister.

And who let in all those people who rioted in Bradford, under Thatcher in 1989?

Hardly Blair, was it?

Mark said...

"Hardly B-Liar was it"

No, it's what he did after 1997 though isn't it.

Cheerful Edward said...

Yes, the numbers increased again Mark, but the Tories did nothing significant since, to reverse that long-established consensus policy towards the Commonwealth.

For those of us worried about the islamification of the UK however, the increase in the number of that religion is now mainly down to the fact that they have larger families than it is to immigration.

An Islamic State would be illegal in the EU, incidentally.

Mark said...

"An Islamic State would be illegal in the EU, incidentally"

So that's why Germany doesn't seem to care how many it imports. Thanks for clearing that up.

We know the Tories did fuck all. One of the reasons they're circling the plughole of history. Ditto labour.

Cheerful Edward said...

Germany did a great favour to those bearing the brunt of the unlawful entrants to the European Union.

Or would you rather that all those people were still hanging round your holiday resorts in Italy and in Greece, Mark?

For the record, Germany only grants residence to about one in forty-five applicants.

Sebastian Weetabix said...

In which case they must have had 90 million applicants.

I don’t want them hanging around my holiday resort either. I want them all to go home. It can be done.

Anonymous said...

"Germany did a great favour to those bearing the brunt of the unlawful entrants to the European Union."

You mean after Merkel invited them in, and then in her usual sense of magnanimity, decided that quotas for the other EU countries was the way to go.

Ed, you dont half talk some utter bollocks.

Mark said...

@Cheerful Edward

I'd rather they remained in the shiteholes they came from since you ask.

So what happens to the other 44 then?

What would YOU do with them.

sok said...

ha ha, would never trade living by the coast in England for some god awful city. love it when you lot get your claws out.)

Cheerful Edward said...

Angela Merkel invited no one in to the European Union, and has been foremost in trying to stop illegal entry.

Almost all of those people now in Germany and in Sweden had already entered when she answered the question put to her, as to with how many Germany could cope if pushed.

But twist her words to suit your useless purpose.

Mark said...

@Cheerful Edward

So who did?

Please twist your words to provide a cogent answer.

Cheerful Edward said...

No one invited them in.

They were fleeing the murderous chaos, created in their homelands by the US and UK's interventions there. A load of others, from Pakistan, Morocco etc. tried to hide amongst them at that point.

Mark said...

@Cheerful Edward


So who brought them here? Who transported them across the Sahara? Who gave them boats and life rafts? Who picked them up and brought them to Italy? Why were the first arrivals not immediately sent back to deter subsequent chancers? Who granted them rights to anything and everything (The ECHR? - you know, trivial impact on decent and civilised people).

All just one of things was it?

Oh and the EU is hardly innocent when it comes to "creating chaos". And presumably it must be "second hand chaos" for those countries not touched by anyone.