rich emollient used in the management of eczema, psoriasis and other dry skin conditions.



I have always been a great believer in the NHS. I was what I would term an old fashioned family doctor – the patients advocate.

Recently my elderly father, who lives alone, became seriously ill and we thought we were going to lose him.

He has had three emergency admissions to hospital via 999 calls, paramedics, A&E, medical assessment units and ward admission.

On each occasion all the individuals concerned did a superb job, and were very professional, but somehow he seemed to fall through the cracks in the system. Instead of getting all the investigations needed and seeing the appropriate specialist on the first admission (after a prolonged wait for a bed and being moved in the middle of the night) he was on each occasion discharged home with planned outpatient review.

Eventually a diagnosis of heart failure was made, but still he has not seen a specialist, and his quality of life is deteriorating by the day. He is no longer able to care for himself and has temporarily moved in with my sister. The situation is far from ideal.

Last week  an urgent outpatient assessment came through for September, but still no specialist appointment, so I took it upon myself for him to see a consultant privately. He had an appointment two days later, he has been prescribed additional medication and advised he needs a pacemaker. The estimated cost  privately is £20,000!  The chance of success is around 60%.  I advised his specialist nurse of the situation and he is now on the waiting list for the procedure on the NHS.

I feel guilty at having bypassed the system and have offered to pay for him privately, but my father is a proud man.

There is much to debate here. The role of the GP. Out of hours services. The role of A&E. Diagnostic centres. 24 hour access to investigation. The use of the private sector. Target led systems. Management versus clinicians roles. The ageing population. A free at point of contact NHS. Integrated health and social care.

There are no easy answers.


Dr Roger Goulds

Dr Roger Goulds has over 30 years experience as a General Practitioner in both the NHS and private sector. He has also worked in health screening and is very keen on early diagnosis and disease prevention. He has a special interest in sports and musculoskeletal medicine and works with professional sports men and women.

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