Fast asleep in bed 24 in maternity base ward is the newborn daughter of Nicola Murphy and James Iball, who were on the live blog this morning before their elective caesarean.

“She is the absolute image of her sister,” said Murphy. “I keep wanting to call her Molly, which is her sister’s name.” The baby doesn’t have an official name yet, though the couple seem to have one in mind.

Like her sister, she is a big baby - 9lbs 11 - which Iball guessed exactly right in a bet with midwives. She is blonde like him. “I’m not a cryer but I cried when she came out, a blubbering mess,” he said.

The Hewitt fertility centre is full of silver tanks of liquid nitrogen containing intricate, colour-coded sticks painstakingly labelled for individual patients. Around 6,000 embryos are stored, alongside the frozen sperm of 2,000 men. A 14-year-old boy who might be rendered infertile by cancer treatment can have his sperm stored here until he is 55.

It is one of the most hi-tech units in the country, says consultant embryologist Karen Schnauffer. Both NHS and private patients are offered detailed time-lapse technology that photographs the embryos every 10 minutes, providing a detailed picture of how they are developing and helping embryologists select the one with the highest chance of becoming a viable pregnancy.

When I started more than 20 years ago, we had a success rate of 18 to 22% and that was seen was good. Now, with women under 30, we are more successful than not. It’s a huge advance.

Mothers are definitely getting older, with Schnauffer having an enquiry this week from a 46-year-old hoping to get pregnant.

It is unlikely. I do think people can believe they are fit and healthy - they might have good genes that makes them not have any health problems or the privilege so they can really make themselves look younger- but the reality is those are still 44-year-old eggs, with all the complications that can entail.

Schnauffer believes fertility education should start earlier. “Teenagers are taught a lot about contraception, but I don’t think it is tackled in sex education - the other side of the coin that you might find it hard to get pregnant.”

Rebecca Elms, 35, travelled from near Stafford to have her baby at Liverpool Women’s hospital, more than an hour and a half’s drive away.

Toby Kenneth Elms is a week old, born at 31 weeks because of complications she had with her previous pregnancies. Rebecca is hoping to take Toby home on Friday to meet his brother, 23-month-old Arthur, who was also born early at 34 weeks.

I was worried Toby would be even earlier, but he came out screaming, which is always a good sign. He’s 4lbs 10 now, which is good, but when you compare him to full term babies, he’s so tiny.

He’s been in the incubator with jaundice, but he’s recovering well, feeding a lot. I wanted to come here because of the experiences we had here. You do worry about it, but I travelled so far to come here because of the neonatal team.

Marnie Edwards and Blaine Tierney, both 26, are packing up their hospital bags at Jeffcoate ward, preparing to take their 18-hour-old daughter home.

Edwards was induced on Tuesday, and Teddie was born after a long labour:

It just feels unreal. At the end of labour, it’s just so tiring, and then they put a sheet on your chest and say ‘that’s where baby is going to go’, and it’s just amazing. She came out and she wasn’t crying, the cord was wrapped around her neck and I was so, so worried, but she was fine. Then they said: ‘It’s a girl.’

The couple have spent the day adjusting to being parents.

I said to Blaine: ‘Do you feel like we’re babysitting?’ It’s so unreal that we made her.”

For a woman to walk out of a maternity hospital without a baby in her arms is an incredibly emotional experience.

The bereavement team at Liverpool Women’s hospital – named Honeysuckle – have devised a number of ways for parents suffering a miscarriage or the death of a baby to take away memories that are not just of the trauma.

The method for dealing with miscarriage and stillbirth has been transformed in the past few decades. Professional photographers will come and take pictures as keepsakes, and there is a library of books to explain miscarriage and stillbirth to siblings. Parents are given memory boxes, and tiny knitted cribs for early miscarriages, and are able to spend time with their baby in a small room with a crib hung with fairy lights.

“One dad came in here after his baby died and he told us he had always imagined having a pint with his son,” recalls bereavement support midwife Pauline McBurnie. “So we brought him a beer in here so he could.”

Sarah Martin, a bereavement support officer, had a phone call recently from a man whose baby died in 1962 and who never saw his baby’s body. “I managed to track down where the baby was buried,” she said. “That has changed so much now, we want people to have the best experience of care they can in a really difficult time.”

The team also has to deal with women who have travelled – often from Northern Ireland – for terminations of foetuses with abnormalities. Martin recalls:

There was one family I will always remember who came from Ireland for a termination, where the dad stayed for days after. The family sent us thanks afterwards and brought their daughter here too; they said they’d always have Liverpool in their hearts.

Gillian Walker, manager of the Honeysuckle team, has been a midwife for 30 years but says she can remember the first baby she delivered stillborn. “I can still see that room, that family, I remember it so clearly. I worked with a very progressive midwife then, and that made a big impression on me. As a team, that’s what we are empowered to do, treat each family as individual.”

Zarko Alfirevic is the doctor pregnant women hope not to see. The professor of foetal medicine concentrates on those whose lifestyle, existing health condition or their baby’s condition put them at high risk.

Pregnant women are put through the most phenomenal amount of tests, most of which they just accept unconditionally, possibly without even understanding the majority of them, and all they need is to be constantly reassured that it is going to be OK.

Unfortunately, for some it will not be, and you have that lightning moment where their life changes, and everything goes from being a beautiful, happy time, to being extremely stressful. That is much worse if there is something wrong with the baby. If the problem is with the mother, you interact very much like a normal patient-doctor relationship, but with a third person in the equation it becomes very difficult.

Obesity is a major problem for expectant mums, though Alfirevic says doctors would never apportion blame for an issue in pregnancy.

It is often the deprived population which it affects, with people who might be hard to reach. But you can see both extremes. Significantly older women are also a challenge: they may have other complex health problems like diabetes or hypertension. They come from all social strata, but probably more so from well-off backgrounds where women may have children later in life.”

Alfirevic feels there should be a major public health campaign on pre-pregnancy health, to try to echo the success of the drink-driving and seatbelt campaigns.

We can’t tackle those pre-existing health problems well, if women are presenting to the NHS at 12 weeks pregnant already. When I was in my 20s I would have laughed at wearing a seatbelt, but it is natural for my children. It’s unacceptable not to. It is a hard campaign, to tell young women and men in their 20s to eat healthily and not binge-drink because they are more likely to have healthy children. But there are clever people, I’m sure, who could deliver this message.

If we want to save the NHS, it has to be more about personal responsibility. We can’t continue with this notion that you pay national insurance, and then turn up at hospital and say ‘I abused my body for decades and now sort me out’.

A reader has shared this experience of serious complications during childbirth via GuardianWitness. Thankfully, it has a happy ending.

Nicola Murphy and James Iball are having their baby at lunchtime today, their second planned C-section after their daughter Molly’s birth 22 months ago.

Though the birth is planned, everything else is a surprise. The couple do not know the sex of the baby, and they are curious to know which of them their child will look like.

“I have long straight dark hair. James as a baby was blonde, and when Molly came out, for some reason I was expecting a dark-haired boy and she’s blonde with curly hair.”

One person does know the baby’s sex – their next-door neighbour. The couple paid for non-invasive pre-natal testing (NIPT), which looks for abnormalities and reveals the sex, which the couple asked to be scrubbed out.

When we got the letter it was covered by a felt pen but you could definitely see the writing underneath so I quickly put it down and gave it to my next door neighbour. She knows, but she hasn’t even told her husband.

Molly was delivered by caesarean because she ended up in the breech position and weighed 10.2lbs. Murphy’s consultant recommended she have a C-section this time around too, because the baby was already 8.9lbs after 37 weeks. “I have big babies,” Murphy said.

A second baby is really different, says Iball:

I’ve been so busy at work for the last three weeks and you never get time to stop with a little one. We’d barely packed Nicola’s bag before we came in. I think we had Molly’s ready after about five months, with her nursery all ready.

Murphy is nervous, but says she can’t wait to see her baby. She doesn’t have a name yet. “It depends on my hormones. Sometimes I think of very traditional names, other times very hippy names. We want to see what they look like first.”

Jeff Johnston, the hospital’s associate director of operations, has had a far tougher job in recent years – but for a good reason.

Survival rates for premature babies are higher than ever and more women who might have had pre-existing conditions preventing pregnancies are able to have babies, so the resources to look after those very complex, and costly, needs are more in demand than ever.

The hospital has to cope with more older women who are pregnant and need extra care and more obese women too. Johnston is a member of the vanguard team working across Cheshire and Merseyside to try to replicate the hospital’s higher standards elsewhere.

Here we’ve done that successfully with neonatal care. We have done not so well with gynaecology, maternity and paediatrics, so that’s what we’ve got to work on.

The idea is to try to avoid a postcode lottery, so there are “standards and pathways across the whole area that mean women get the same experiences wherever they go”. Cost is obviously a key driver.

We’re taught to be competitive to save money, but actually being collaborative can help too. If you get patient flow right, and patient care right, then efficiencies can come from that as well.

The NHS hasn’t got the greatest track record when it comes to innovation, but could the latest developments in tech help plug the gap in its finances?

Joining our special Tech Weekly podcast to discuss the state of the NHS’s digital health are the director of technology for NHS England, Beverley Bryant, Dr Mohammed al’Ubaiydli from Patients Know Best and Stephen Hilton from UCL on his research into 3D printed drugs.

Sarah McGrath, the ward manager in the maternity unit, is checking her schedule for the day. “There’s not much you can plan for in this job. It would be nice if babies were spaced out each hour but that doesn’t happen,” she laughs.

One old wives’ tale seems to ring true more often than not for the midwives on the ward here – that more babies are born at full moon. “There’s research into it which found that isn’t true, but sometimes if we get really busy, we say to each other, is it a full moon? And it usually is.”

The high-risk unit for antenatal and postnatal women, who might have had a caesarean section or more blood loss than expected, is currently caring for 45 women. Ten beds are empty, which McGrath says is an excellent position to be in.

One woman has had an emergency C-section this morning, but McGrath says she is now recovering well. Three women are due to be induced. In the low-risk area, where women have a natural birth assisted only by midwives unless complications occur, there are two women in labour. That could triple by the end of the day, or the ward could have none at all .

Another 13 women are with their newborns in the Jeffcoate ward, a place where new mums can stay overnight for observation if doctors want to keep an eye on them. “It is totally unpredictable this job, but today is looking fine for now. If we get busier, we have to adapt.”

It’s mid-morning and consultant neonatologist Dr Mark Turner is doing the daily ward round to check on Liverpool’s tiniest babies in the intensive care wards.

The first baby he checks on has been on a ventilator, and Turner is debating how long to keep him on the breathing apparatus, and whether to put him on steroids to help him breathe on his own.

It’s a balancing act, we don’t want to put him on steroids for too long or too early because of the risk of brain injury, but we also don’t want to leave him on the ventilator too long either.

He leaves instructions to keep the baby on the ventilator a little while longer but hopes to take him off it very soon.

The second baby Turner looks at was born at 26 weeks, but is growing well and is breathing on his own. The babies are in covered incubators, to make sure they have as little disturbance from noise and light as possible.

Being a premature baby is a bit like having a hangover: if you have a headache, it distracts you. We want babies to have as little distraction as possible so they can concentrate on growing.

One of the biggest babies Turner examines is 5.2kg – 10 times larger than the department’s smallest baby – but still needs extra care to help with his breathing. “In adults, the difference in size is only really people who are twice the size. We have to have equipment, like tubes, to deal with babies who might be ten times smaller than another baby.”

Several others on the ward have improved and moved from intensive care onto high dependency wards. But two had infections – one a common cold and another septicaemia – so are now back in intensive care. Both are improving, but Turner stresses how rigorous the ward had to be about infection. All hair must be tied up, rings removed and no handbags allowed in the ward, with hand disinfected after touching anything.

“There are things about biology we can’t control, but we can control infection – that’s our beginning and end here.”

One thing which can make a huge difference is skin-to-skin contact with parents, and Turner’s staff are trained to make sure parents can cuddle their children and not disturb any of the tubes. “We have to look after babies’ psychosocial needs as well as medical needs. We also want to feed babies on their mother’s milk as much as possible,” he said. “We have donors too who give milk that is pasteurised if mum can’t express her own.”

We’ve just launched the latest in our ‘The day the NHS saved my life’ series, in which Caroline Howe tells the dramatic story of the birth of her second child. Here’s an excerpt:

The paramedics took one look at me and realised I was crowning in the bathroom. Usually they take you to hospital, but they knew there was no way they were going to be able to move me.

And so my youngest daughter was born on our bathroom floor. She was grey. There was nothing, no crying. Because she was late, she had swallowed meconium and wasn’t breathing. The paramedics had set up in the kitchen, where they immediately whisked her away to try to resuscitate her.

Zoe Williams’s article on navigating the myriad options presented when having a baby has inspired our commenters to share their own birth stories below the line.

Ajchm emphasises how you should listen to the professionals:

ajchm

21 January 2016 9:34am

This comment has been chosen by Guardian staff because it contributes to the debate

My twopenneth for what its worth... Medical school and midwifery school plus years of practice means yes they do know more than you! If they are saying that you are high risk, that you need a procedure or test listen - if you are concerned that your assigned person isn't going the direction you want, get a second opinion rather than overrule them - they want a safe birth, that's their priority.

That said my attitude was to stay at home for as long as I dare then take no drugs, nothing. Keeping upright speeds things up. I had a midwife and a trainee, nobody else but knowing there was a nicu down the hall and an ob around the bend meant I had plan b. Birthing balls are the best. I was in, given birth and home within 8 hours, far better than homebirth.

Blibbka told us about the difference between their partner’s two labours:

blibbka

21 January 2016 9:19am

This comment has been chosen by Guardian staff because it contributes to the debate

My partner just recently had our second child.

First labour was frankly hideous - she was in agony for about 5 hours, naked on all fours screaming in agony; scenes reminiscent of a werewolf metamorphosis! Gas and air provided minimal pain relief but caused vomiting. Midwife was apparently reluctant to arrange epidural but when it eventually arrived mad a great deal of difference. Birth plan? Ha! Was never mentioned.

Second time around, much better in part due to us being wiser. As soon as we arrived at the delivery ward we made our birth plan really clear to the midwife: we want an epidural. Midwife was obliged to explain risks and that's fine, but happily complied and this meant that my partner had effective pain relief from an early stage.

The comparison was as night and day; labour was still undoubtedly difficult but far more positive experience.

So my key advice would be to make sure the midwife is very clear about your birth plan at the earliest moment. For first time Mum's - do not underestimate the amount of pain involved (sorry), I'd urge you to remain open minded to all pain relief options.

And RedMove makes the point that sometimes it doesn’t matter how prepared you are – sometimes all your plans go right out the window!

RedMove

21 January 2016 9:40am

This comment has been chosen by Guardian staff because it contributes to the debate

And sometimes the plan just goes out of the window. Baby no 1 was a bit of a disaster, so was determined both 2 would be better. So there I am, well into labour, high as a kite on gas and air, with my relaxation music doing its job, and my water break. Two minutes later there's utter panic as they can't find a heartbeat & 10 minutes later I'm in theatre for an emergency section, with no pain relief until they put me under. Luckily all turned out well, but you can't plan for everything.

There is approximately one baby born every hour (not quite every minute) at Liverpool Women’s hospital. So at least one newborn has arrived since the Guardian live blog launched this morning.

Dianne Brown, director of nursing and midwifery, has seen generations of women pass through the hospital, often spotting grandmas, mums and babies in the waiting rooms together.

It is a very different role than working in a department of a hospital where people are coming in regularly just to get something fixed. Everyone here has an extreme emotional attachment to what is happening: having a baby, having a sick baby taken care of, trying to get pregnant, getting treatment for a problem like endometriosis which might prevent pregnancy, or getting genetic counselling.

Brown has a background as a nurse, rather than a midwife, and is passionate about an all-rounded approach to women’s health, rather than just caring for babies. Women travel to the hospital from across the north of England and Wales for specialist gynaecological treatment, including cancer.

Not only are babies born here, but the hospital has end-of-life suites for women with terminal cancer. “Unfortunately, they are always occupied,” says Brown. “In the 30 years I’ve been here, we’ve see a real increase in early diagnosis and prevention of cervical cancer but we see women presenting at our A&E with late stage cancer of the vulva, with ovarian cancer. We should never want to see that.”

The hospital has the only women’s-only A&E in the country, dealing most frequently with miscarriage. “Women having a miscarriage are obviously going to be extremely distressed, coming here means they don’t have the added stress of waiting in a general A&E.”

The hospital deals with around 1,000 baby deaths every year, from early stage pregnancy to neonatal death. “We do a remembrance service every year and this year 400 women came. But there was one elderly lady I remember who told me she lost her baby when she was in her early twenties. In those days you couldn’t hold the baby – couldn’t even see it – and she has struggled with it all her life.”

Hello and welcome to Thursday’s #ThisIsTheNHS live blog, the fourth day of the Guardian’s series seeking to get under the skin of the health service.

The big picture

The NHS deals with more than a million patients every 36 hours. Since its founding in 1948, the health service budget of £437m (equivalent to about £15bn today) has snowballed to £136.7bn – or £260,084 a minute – in England alone. The statistical story is staggering: last year NHS England reported almost 10m operations, 22m visits to A&E, 16m hospital admissions, 82m outpatient visits and almost 2 million people getting help from specialist mental health services.

Yesterday, we focused the lens of our journalism on paramedics and ambulance services. Jessica Elgot liveblogged from the North East ambulance service offices in Newcastle, which houses both 999 and 111 call centres. Her reports and interviews – with photographs from Alicia Canter – provided a fascinating insight into the day to day lives of people who can genuinely claim to be on one of the frontlines of the NHS: the staff responsible for taking initial calls from emergency patients.

Jessica even got to play the role of someone with a sore throat (in an acting performance of a lifetime) in order to test the 111 call operator’s question script. She was grateful to be offered an appointment to see a doctor within three hours.

Steven Morris spent a day with Steve Hulks, one of a new breed of paramedics charged with keeping people out of hospital. Hulks says he is still there to save lives, but his job now is much more about helping an ageing population stay out of hospital and remain independent, advising and reassuring troubled young people, and thinking about patients’ mental wellbeing.

Caroline Davies reported on how a trailblazing scheme in the Isle of Wight to bring key staff, from 999 operators to social workers, under one roof has attracted international attention.

And Denis Campbell broke the story that NHS funding is falling behind that of its European neighbours’ average. A King’s Fund study ranks UK 13th out of 15 original EU members and casts doubt on ministers’ claims they are giving the NHS generous cash settlements.

Today’s focus

Today we go back to the start. Childbirth is most people’s first experience of the NHS – albeit one they are unlikely to remember. So far this year there have been more than 43,000 babies born in the UK (you can see live data on this – and other fascinating real-time statistics – in our NHS data dashboard).

In today’s coverage, Zoe Williams seeks to navigate the key issues faced by expectant mothers: home birth or hospital? Birthing pool or bed? Drugs or no drugs? Our readers have shared their own birthing stories, from the vital statistics to the quality of care, and we have a secret diary from a sexual health officer.

Jessica Elgot is at Liverpool Women’s hospital, the largest maternity centre in the UK. Around 8,000 newborns kick and scream their way into the world here every year – an average of 20 a day. It carries out at least 30 gynaecological operations daily, and offers reproductive services as well as a specialised genetics team.

We’ll be spending time with pregnant women and new mums on the neonatal unit, and will be speaking to IVF consultants, midwives and miscarriage experts.

You can comment below the line, tweet us (@marksmith174 or @jessicaelgot) and help shape the conversation on Twitter using the hashtag #ThisIsTheNHS. We hope you’ll stick with us throughout the day.

Guardian Live: This is the NHS

Tonight also sees the first Guardian Membership event devoted to our NHS series. At Kings Place on Thursday there will an evening of debate and discussion on the challenges of working in our most vital public service, featuring: Dr Salyeha Ahsan, A&E doctor and broadcaster; Robert Freeman, consultant paediatric orthopaedic surgeon, the Robert Jones & Agnes Hunt NHS foundation trust; Dr Faye Kirkland, GP; Dame Donna Kinnair, RCN’s director of nursing, policy and practice. The event will be chaired by Guardian writer and columnist Polly Toynbee. Tickets are sold out.

What you’re saying about our NHS series

Wednesday’s most read

1. The secret paramedic’s diary: ‘The worst part is knowing it’s likely they will die’
2. A revolution on the Isle of Wight? How island became health hub pioneer
3. NHS funding is falling behind European neighbours’ average, research finds
4. The day the NHS saved my life: rescuing a kitten nearly killed me
5. The new model GP army: on-site vasectomies and Facebook diagnosis

That’s it for another day on the NHS’s frontline. Thanks for getting involved with your tweets and comments. And thanks to the staff at the North East ambulance service HQ in Newcastle for giving us such valuable access and sharing their working day with our readers.

Tomorrow Jessica Elgot will be reporting from maternity wards as our #ThisIsTheNHS series moves on to most people’s first experience with the health service, albeit one they are unlikely to remember: childbirth.

Not seeing a patient’s face was a tricky thing for nurse Mary Mallorca to adapt to. She has worked in A&E and care homes, but helping patients over the phone is a very different proposition.

It is very, very hard that you can’t see them; you have to find other ways to judge their responses – you can’t take anything for granted over the phone.

Mallorca has had to deal with many patients who have said they are suicidal. “Even if you can’t see them, I believe they can feel when you care, when you talk to them, you have to have a positive approach, even though it can be very difficult for you as well.”

Although she has nothing but praise for call handlers, Mallorca said it would be better if everyone answering calls was a qualified nurse. “But we have to be able to cope with demand,” she said. “For a minor case, they can handle it themselves.”

Jessica Elgot poses as a sufferer of pharyngitis (that’s a sore throat to you and me) in order to be given an insight into the kind of questions patients are asked when calling 111. Call handler Karl Walker makes sure Jessica isn’t bleeding or sensitive to light before booking her an appointment with a GP within three hours.

Walker has taken 999 calls for 5 years, and trained to do 111 when the service first started:

They can really overlap: you might get an elderly person call 111 because they don’t want to bother an ambulance, but their are signs indicating a heart attack. On 999, you’d be surprised how many times we get people with toothache. It might be painful, but there’s nothing an ambulance can do about toothache.

“If a 111 call handler was sending more than 5% of their calls to A&E, we want to know why,” team leader Lynsey Redpath said. “It’s not true that we send everyone there.”

Around a quarter of calls get transferred to a nurse either straight away, or for a call back. But mostly call handlers are trusted to make the right decision on how to advise a patient.

“It’s not just A&E or a GP; we can send people to pharmacists, midwives, opticians, dentists, district nurses, mental health services,” she said. “The pathways system we use is a spider’s web, not a linear process.”

New Year’s Eve is Richard Abdy’s biggest night of the year – closely followed by whenever Newcastle play Sunderland. His job as planning manager is to try to predict the busiest times for 111 or 999 calls in order to keep staff costs down.

You hear all the time that frontline services aren’t affected by the cuts. They are. Staffing is, like most places, 60-70% of our budget. When you have got nowhere else to cut, you have to look at how you can use staff effectively.

Abdy’s background is in the private sector. “It’s very different to selling insurance or PPI, saving people’s lives, but we also have to be sustainable.”

Patterns that affect staffing are constantly changing. “The weather affects us in all sorts of different ways,” Abdy says. “If there’s snow, we can predict demand won’t be as high as you might think because people stay indoors. If there’s ice, it’s worse because people don’t see the danger, they go out, they fall.”

New Year’s Eve is now a totally different beast to when Abdy first started. “The pattern is later and later. Peak times used to be 1am; now it’s constant until 4am or 5am for 999 – and then it spikes again in the morning for 111. We only have a certain number of staff trained and they aren’t robots, they have to go home and sleep so that is a real challenge.”

One of the ways the service has tried to tackle the pressure is to train staff to take both 111 and 999 calls, so they can immediately switch to a different system if a 111 call seems more serious, or if a 999 caller really only needs a GP appointment. “It makes us more resilient, it means staff can deal with the unknowns, and we have a contingency who can always switch between roles.”

We’ve just launched a special report by Steven Morris, who spent some time with Steve Hulks, a new breed of ambulance paramedic charged with keeping people out of hospital, rather than simply ferrying them to and from A&E.

When [Hulks] first signed up a quarter of a century ago the job entailed going to the scene of an emergency and rushing the patient to hospital. “It was about doing some first aid, putting the patient in the back of an ambulance and taking them to A&E. The problem is most people didn’t need to be in hospital – it was no good for them and no good for the hospital.”

… The idea is to embed teams of highly trained paramedic practitioners into the heart of communities. They have the decision-making skills – plus the local knowledge of regular patients – to know when someone needs to be taken to hospital and when they are better off staying where they are.

Guardian reporters Aisha Gani and Nadia Khomami have been calling A&E departments across the country to get a sense of the pressures they are under at this time of year – and during the coldest spell of weather of the winter so far.

The cold snap has particularly affected elderly patients suffering with “comorbidities” – one or more additional disorders – a spokesperson from the Cambridge University hospitals NHS foundation trust said. He added the A&E unit at Addenbrooke’s hospital had been busier – although not unusually so for the time of year.

A spokeswoman for St George’s University hospitals in south London (the subject of this liveblog on Monday) said the trust was busier than in the same period 12 months ago.

She added that though the hospital had not met its four-hour A&E waiting target on any day in the past fortnight, the performance had been better than a year ago. “St George’s has struggled to meet the target all year and are just above average compared with similar sized London trusts,” she said.

There have also been a high number of acutely unwell patients at arriving at Southend hospital in Essex and requiring admission. A spokewoman said: “In common with other hospitals in the region we have been seeing – and continue to see ‐ high numbers of acutely unwell patients arriving at the hospital and requiring admission.”

Dr Jimmy Stuart, divisional medical director for medicine at the Pennine acute trust, reported similar levels of increased pressure, which has been compounded by inpatient bed pressures on wards andhigh numbers of patients occupying beds both due to clinical care and delayed discharges.

“The majority of patients requiring urgent treatment for what we call major conditions have included head injuries, falls, respiratory problems, abdominal pain and mental health issues,” he said.

“We have also seen a large proportion of patients coming to us with less serious conditions and minor complaints such as alcohol intoxication, back pain, migraines and headaches, ear problems, and sore throats. Many of these could be treated through local pharmacies, primary care and GP practices.”

Recent NHS stats reveal that in the week leading up to 8 January 2016, there were 41 instances of A&E diversions across England. In the same period 2,998 beds were closed in hospitals due to outbreaks of norovirus-like symptoms, according to the latest available winter situation report.

Before working at the North East ambulance service (NEAS) contact centre, Gerardine Hope used to run a call centre for T-Mobile. But customers’ mobile phone problems are a world away from what her call handlers deal with now, which can be matters of life and death.

Her 111 and 999 call handlers arrange up to 4,000 ambulance journeys a day across the north-east of England – though many of those are scheduled transports. She is adamant that her staff are well-trained enough to handle even the most complex scenario, and rejects the criticism that call centre staff are not suitable to deal with the problems callers present.

“There are a lot of misconceptions about 111,” she said. “It is a competitive job, there is eight weeks’ training with assessments all the way through and staff can fail those and have contracts terminated. We are not just pulling people in off the streets.”

NEAS does not employ agency staff, she said, because there is always a steady stream of applicants.

It is a tough job. I don’t think people always realise that, to be quite honest. We play them a call on the first day of training which is a woman calling when her partner slashed his wrists. We want them to realise what they are responsible for. It takes a special kind of person.

The main complaint from patients is generally the frustration at how many questions call handlers ask, which may seem completely unrelated, like a person suffering a urine infection who is asked about chest pain. “It’s because we are not diagnosing, we are checking for signs of an emergency, we want to get the right care at the right time,” says Hope.

She admits that demand for 111 help is related to the shortage of GPs and the difficulties patients can often have getting an appointment at a surgery, but rejects the widespread criticism that the service sends patients to A&E too readily.

We are a natural evolution of the healthcare system. Traditionally a GP was your only option, now there are many alternatives and we can signpost people to a minor injuries unit, or an out-of-hours walk-in centre which they may not know about.

We asked the CCGs [clinical commissioning groups] to assess whether we were sending too many patients to A&E and their research into the patients and our advice on calls showed no one was sent unnecessarily – though some patients said they had been sent by 111, even if they hadn’t.

Hope said she wished the handlers got more plaudits of their own. “Mistakes happen, everyone is human. But GPs can also get things wrong. The praise is often for the ambulance crews, but actually it can be the call handler too who helped save a life.”

Scotland’s chief medical officer has called for doctors to practise “realistic medicine”, moving away from a culture of over-treatment and involving patients more fully in decisions about their own care.

Launching her first annual report in Edinburgh this morning, Dr Catherine Calderwood said:

In striving to provide relief from discomfort, illness and death, modern medicine can sometimes over-reach itself and provide treatment that is of little long-term benefit to the patient.”

It’s an interesting fact that doctors tend to choose fewer treatments for themselves than they offer to their patients. As doctors we should be asking why that is, and whether patients – if better informed – might also choose less intensive and less medicated treatment regimes. A person may achieve a greater quality of their life if less is done - fewer treatments, more targeted medication.

Today’s secret paramedic’s diary has inspired many of you to share your own dramatic stories of ambulance rescue in our comment threads.

One example is this moving comment from RachaelLondon:

RachaelLondon

20 January 2016 10:39am

This comment has been chosen by Guardian staff because it contributes to the debate

To add my voice to the praise: thank you for saving my brother in law when he had a massive head injury. Thank you for scooping up my husband and his broken collarbone when he came off his bike. Thank you for coming out to my elderly neighbour. Thank you for really trying when my dad had a (what turned out to be) fatal heart attack. I wasn't there but from what we were told after it was pretty clear he was dead before he hit the kitchen floor, but you tried for long after it must have looked hopeless.

Or this from edana23, which describes the time a paramedic made a helpful but non-medical decision they’re still grateful for:

edana23

20 January 2016 9:13am

This comment has been chosen by Guardian staff because it contributes to the debate

I'm so grateful to the paramedic who, on arriving with his team at my house, had the presence of mind to take up the kitchen rug and throw towels down where I'd been sick - otherwise the rug would have been ruined and I'd have needed to move 2 large appliances to clean the floor a week later, after abdominal surgery! Although it was a non-medical decision, he made such a difference to my recovery - I was very impressed by his thoughtfulness, and by the competence of the team in general - first time I've needed an ambulance in over 50 years, and I'd be dead without them!

A campaign urging people to think very carefully before heading for accident and emergency departments or ringing 999 if they do not have a life-threatening condition has been launched in Wales.

Though the population of Wales is only 3 million, around 1m visits are made to A&E every year and more than 100,000 non-urgent 999 calls received, wasting the time of call handlers and putting lives of those in real need at risk.

The Choose Well Campaign includes digital adverts, a Facebook and Twitter campaign, traditional bus adverts and posters and leaflets in GP surgeries, pharmacies, opticians and universities.

The campaign comes after yesterday’s warning that A&E departments in Wales are “on the edge”, with some patients reportedly waiting more than 24 hours in casualty before being seen. Dr Robin Roop, head of the Royal College of Emergency Medicine in Wales, also said no A&E department in Wales had enough consultants to meet minimum RCEM staffing levels.

Vaughan Gething, the deputy minister for health in the Labour-led government, said compared with England, Wales had an older, sicker, poorer population, meaning it was all the more important that people chose the right service. He said: “It’s about reminding people of the options. A more commonsense approach is needed.”

Gething described some of the figures around use of services in Wales as “astonishing”. According to the Welsh government:

• Approximately 35% of calls to 999 are for minor illnesses and injuries, such as toothache, sore throats, coughs and colds.
• More than 270 non-urgent 999 calls are made every day.
• Approximately one in three 999 calls to the Welsh ambulance service are non-urgent and would be better dealt with by another NHS provider or a pharmacist.
• Between 70% and 80% of patients who attended A&E departments in Wales in 2014/15 were not admitted for ongoing treatment.
• Almost 1,200 people are admitted to hospital with alcohol-related conditions in Wales every week.

Dr Andrew Goodall, chief executive of NHS Wales, said: “Our accident and emergency departments alone see 1 million people a year. However, self care is the best option for treating the minor illnesses and injuries which account for a very large proportion of what health workers deal with. Many illnesses can be treated in your home with over the counter medicine and plenty of rest.

A key part of a 111 call operator’s training is the “wellness bias”. Foster said he is trained not to assume that a young adult patient is likely to be fine, compared to a child or elderly person:

A 14-year-old can have a stroke, a 25-year-old can have a heart attack. You can’t let a stereotype guide you. We have had an incident in a different service where the signs weren’t picked up because of that kind of bias. You have to judge a call on its merits.

Another thing that can happen often is that callers do not realise how bad their relative actually is. “They might think that the person they look after is always unwell; they can’t quite recognise they are deteriorating until we take them through the symptoms and it starts to dawn on them.”

The second call Craig Foster takes is from a mother concerned about her three-year-old’s chickenpox. She describes particularly bad swelling and a great deal of pain. Something about the description of the child, who is listless and unwilling to play, rings alarm bells for Foster, despite the commonness of chickenpox. He passes the call on to a qualified nurse. “Sometimes you just get a feeling after a call that it’s not quite right, so that’s why we get advice. That’s the training,” he said.

Next, Foster speaks to a woman worried about her mother, who is in her 90s and has fallen and hit her head in the night. The GP surgery has advised her to go to hospital, but the woman is worried about taking her to A&E herself and calls for advice about whether she should ring an ambulance. It takes a while for Foster to be able to ask his questions, as the woman talks him through her mother’s recent medical history. “Sometimes you have to be quite firm, we have to ask those emergency questions straight away,” Foster says.

You can’t let a person talk and talk. I once had a man who was in a different room to his wife, and he wanted to talk me through everything that has happened in the past few weeks, and I had to keep trying to convince to go in the same room as his wife. When I finally managed to ask the question, I found out his wife was unconscious.

Often people might not actually be listening to you; they have their bit they want to say, and it’s our job to get them to listen, to get them to snap out of it. You can’t be rude, but you have to sometimes be quite blunt, because it could be an emergency.

After the woman describes her mother’s bump, Foster uses a special script for head injuries, asking about medication, recent surgery, bruising and whether there is crackling under the skin. Looking at the symptoms, Foster wants a nurse’s advice, and arranges for one to call her back. “She was advised to go to A&E by the doctor and I think the nurse will probably tell her the same thing.”

There is one call that stands out for Foster in his three years at 111 – an out-of-hours call that came through from Nottingham, when a premature baby had stopped breathing.

The mother described the child as limp and floppy. I was shaking but you just have to go into autopilot. I put the phone on mute and screamed across to colleagues in 999 to get in touch with Nottingham ambulance service; we sometime get calls from outside the area but we don’t then have a direct line to contact them.

I talked the woman through how to perform CPR on the phone, as we waited for the ambulance to arrive. I got a message back at about 2 or 3 in the morning that the baby was in hospital and had survived. It was really scary stuff though – you train for it but it could have been disastrous. But when something like that happens, everyone piles in: the whole team came to help.

Craig Foster has been taking 111 calls since the service began three years ago; he was one of the call handlers who worked on the pilot in Durham and Darlington. “At the beginning it was very quiet,” he says. “No one knew about us; there were just a few posters in GP surgeries, but now it’s completely different.”

Flashing boards above the call handlers show the room is currently in the “green”, meaning that the service is meeting national targets of answering 98% of calls in 60 seconds, though Wednesday mornings are not exactly the busiest time for handlers here.

Foster’s next call is a carer worried for her client who has slipped and fallen. She’s not injured, but her size means she needs assistance to get up from the floor. “Is she awake and alert?” Foster asks, reading from his script to check for other warning symptoms, such as whether her face has frozen, or whether she feels a crushing on her chest.

The questions may seem obvious, but he also asks if the woman is on a carpeted or cold wooden floor, to make sure she is comfortable. He decides to book an ambulance to assist her, though he decides she is unlikely to need to go to hospital.

Welcome to day three of the Guardian’s ambitious series attempting to get under the skin of the NHS and tell the story of one of the most complex organisations in the world, through the voices of those on its frontline.

To get this morning briefing sent to your inbox each day please sign up here.

The big picture

Our aspiration is to examine a broad range of issues, from the strains on A&E to standards of care for elderly people, the multi-layered issues surrounding mental health, chronic disease, the high cost of drugs and the impact of alcohol. And exciting treatments using new sciences and cutting-edge technology.

We want to understand the dilemmas over prioritisation, over-prescribing and the cost of drugs – and the fiendishly complicated way the service is managed and run. We want to address the question: do we have the NHS we need? The aim is to do this through diaries, fly-on-the-wall reporting, interviews, films and explanation.

Yesterday we focused on the issues surrounding GPs and family practices, with our intrepid reporter Jessica Elgot liveblogging from the Haxby group of surgeries in York and Hull.

Among the professionals she spoke to was pharmacist Dan Hurley, who is based at the surgery rather than at a separate dispensing chemist. “We don’t have to be separate, which I think has been the tradition,” he said. “It makes sense for us to work together.”

Guardian writer Zoe Williams also visited the Haxby group of surgeries for this study of the “new model army” of family doctors changing the way the NHS operates in communities across the UK. She writes:

... If reorganisation in the first place was a quest for modernity, Haxby is its beacon: its GPs were among the first to perform vasectomies on site, for example; one GP diagnosed a rash from a photo a patient sent him on Facebook; their onsite pharmacies employ full-time pharmacists, an economy of GP time that only a scaled-up practice could do. The surgeries train ex-paramedics as primary care practitioners, who treat some minor illnesses and injuries in the surgery

One of the highlights of the coverage was Severin Carrell’s special report from the most northerly GP practice in the UK: Hillswick health centre in Shetland, which has been run by Dr Susan Bowie for the past 21 years. The surgery, which serves 764 patients dispersed over 77 sq miles of open country, still exists thanks to Bowie’s efforts to subsidise it with profits from her dispensary and two holiday cottages. But Bowie is nervous about the future of her practice. She will retire soon and there is a chronic shortage of new family doctors across the UK.

We also broke the news that the UK’s family doctors are the most stressed in the western world, according to new research by the world’s most influential health thinktank, the Health Foundation. Denis Campbell’s story reported that the situation is now so bad that almost 30% of British GPs plan to quit in the next five years due to their overwhelming workloads.

We also received fantastic news of the first ever Guardian liveblog baby, as Kerri Calthorpe gave birth to her son Rex hours after being featured in Monday’s live blog from St George’s hospital.

Today’s focus

On this third day of our NHS series, we’re concentrating on the sharp end of emergency medicine – paramedics and ambulance personnel. Jessica Elgot is in the north-east of England and will be liveblogging from an ambulance service 111 call centre in Newcastle.

The 111 service was set up to triage urgent but non-life-threatening cases, and help reduce the strain on 999 call handlers. But it has come in for heavy criticism over the last 18 months, both for supposedly creating congestion in hospitals by sending too many patients to A&E departments, and for not sending others who perhaps should have gone. There have been claims that the service is staffed by unskilled workers with too little supervision from clinicians, and complaints that the algorithm that prompts handlers’ questions is too formulaic.

Jessica will be talking to the call handlers and clinicians on the frontline to hear their perspective, and get a sense of the types of call they have to deal with day to day.

And of course we’ve got the latest from our regular series The NHS saved my life - and today’s secret diary is from an emergency paramedic.

You can tweet me or Jessica (@marksmith174 or @jessicaelgot) and follow the conversation on Twitter using the hashtag #ThisIsTheNHS. We hope you stick with us throughout the day.

Yesterday’s most read

1. On call in Shetland: a cliff-hanging GP at the NHS’s northern limits
   
2. I was pregnant, alone, and bleeding, but didn’t realise the danger
3. Junior doctors’ strike suspended as talks to end contract row continue
4. NHS has the west’s most stressed doctors, survey reveals
5. Saturday working is major sticking point in junior doctors’ dispute

The shortage of GPs and the constant financial pressure on practices has led to some very creative thinking, Dr Mike Holmes says. He is the clinical lead for the Supporting Federations programme at the Royal College of GPs and only sees patients a few times a week so he can spend time developing digital systems to ease the workload at the practice, and its financial burdens.

Holmes brings up a list of hundreds of blood test results the practice sees in a single day:

Traditionally, a doctor might have looked at every single one, but if they are normal, there’s no reason a healthcare assistant can’t file them, and even be trained to file the more complex, multiple blood tests, if a doctor doesn’t need to take any action. We have people we think are capable of doing that in place, we just need to take down the barriers.

Modern general practice has fewer doctors and less funding, but is far greater in complexity than it was before, he says. In 10 years, the number of consultations shot up 60%, with the number of blood tests up 300% and administrative work up 200%.

“People are living longer, they have multiple, complex and chronic problems which are difficult to solve, and if we don’t start to address the issues now, we could see people start to lose confidence in GPs,” Holmes says. He will travel to London tomorrow for his work with the RCGP programme on federations – helping other GP practices to merge and work together, like Haxby has done.

It is a model very much favoured by NHS England and likely to become more common. “It’s working for us,” Holmes says.

We can work at scale, we can better meet patient demand, and we are gathering evidence to show as much as we can that it does improve patient care. New technology can help enormously, but of course it can’t ever replace the one on one with a doctor. We have tried consultations by Skype – it works for some people but for others it doesn’t. Sometimes there’s just no replacement for face to face.

His last patient of the day is Geoffrey Brown, in for a combination anaesthetic and cortisone injection for his arthritic knee. “They’ve put me through a lot of pain over the years here,” Brown says as he climbs on to the bed in the consulting room. “But I have no complaints at all, every doctor I see is brilliant.”

“There’s a reputation that we are dragons,” says Lesley Rientoul, senior receptionist at the practice. “We’re really not, but we have to ask the questions.”

Around her, other receptionists are taking appointments and reassuring patients who are ringing up for blood test results.

How many calls does she answer in a day? “Hundreds. Absolutely hundreds. Anything from 30 seconds to five minutes. It’s a lot of responsibility. We have to decide where to send them – to a doctor, a nurse, even to say they should go to hospital. And we have to get it right.”

No matter how difficult a patient can be, Rientoul says she tries to remain very, very calm. “It’s hard sometimes, though.”

Dr Mike Holmes, a partner in the Haxby group, is seeing one of his regulars, Keith Pearson, 73, who is keen to get back to his regular tennis game after being told to rest up after a bad chest infection. “I caught a cold in the pub, fella gave it to four of us,” he says.

Holmes tells him his chest sounds fine but he should try not to tear around the court too much.

“I feel much better now,” Pearson says. “But there were times I couldn’t breathe and that was quite frightening. I sing, do entertainment and do magic shows for the kids but I cancelled all my gigs. I want to get back to it.”

Holmes suspects Pearson has had chronic bronchitis, but that it is now improving well. Pearson travels across the city to see Holmes since the doctor moved from the partner practice. He has been treated by him for at least five years, including for prostate cancer, which Pearson spotted the early symptoms of after reading a poster about the warning signs in the waiting room of the GP.

“It is touching, when someone is so determined to come back and see you,” Holmes says. “I had one family where the husband had Huntington’s disease who I saw for 10 years, looking after him and his wife through the entire progression of the disease. That was one family which really taught me, more than anything, the value of general practice.”

We’ve just launched another important news story from Denis Campbell, the Guardian’s health policy editor.

Stress levels are so acute among British GPs that almost 30% plan to quit in the next five years, new research by the world’s most influential health thinktank reveals.

Campbell reports:

Just under six in 10 GPs (59%) find their work stressful, with 39% of these saying it is very stressful| and 20% extremely stressful, which is higher than any other leading western nation in the triannual study. Researchers surveyed 11,547 GPsin 11 countries, including France, Germany and the United States.

“These worrying findings reveal the scale of the challenge facing general practice,” said Dr Jennifer Dixon, chief executive of the UK-based Health Foundation thinktank, which helped with the study.

Researchers found that family doctors in Britain spend less time with their patients than anywhere else. In all, 92% of the 1,001 GPs surveyed said they spent less than 15 minutes talking to patients, while internationally in the survey just 27% of GPs spent less than this time. Similarly, only 8% of NHS GPs are spending more than 15 minutes with patients; on average, almost three-quarters (73%) of patients get at least that long.

You can read the full story here.

The doctors are out on the road at lunchtime, making home visits. Gale Farm’s staff average more than 40 trips to patients’ houses each day.

“People think we don’t do this any more, but we do, every day,” says Dr Chris Stanley. “The majority are older patients who can’t get to the surgery. We can travel quite a distance, sometimes to the villages outside York.”

The first stop is Audrey Shillitoe, who is struggling with lung disease and sounded breathless on the phone. Stanley, seeing this patient for the first time, said he was concerned he would have to convince her to go to hospital, but when he arrives at her home, his checks found she was doing a little better than expected.

“I hate going to hospital,” Shillitoe said. “Once they put me in a ward with alcoholics and drug addicts, and I thought to myself, I don’t ever want to go back.” Stanley prescribes her medication but told her to get in touch quickly if things get worse.

Shillitoe was full of praise for the doctors, but said she was feeling the loss of a regular case management nurse visit, which cannot continue because of funding cuts.

Stanley asked her to call him to ask for extra help at home if she needed it. “Everyone criticises the NHS, but it isn’t their fault, the doctors and nurses; it’s others that are trying to cut things,” she said. “If these doctors weren’t here, I wouldn’t be here.”

The second stop on Stanley’s list of home visits is 87-year-old Valerie Winter, who needs a check-up after a spell in hospital with pneumonia. She is keen to get better quickly so she can get back to her hobbies, drawing classes, tai chi, singing in a choir and a sequence dancing class, though she no longer does the dance steps and just attends for the company.

Stanley checks her blood pressure, listens to her chest, and checks her oxygen levels, as we as discussing her medication and organising prescriptions to be delivered tomorrow.

Winter rejects the need for any extra help around the house. “I’m going to get a cleaner in because I was doing it all myself.” But she doesn’t need help with dressing or cooking. “I do all the cooking, vegetables, everything. I can manage.”

Though she seems lively, she said her time is hospital was bad. “It was the worst I’ve ever felt. But I always want to get better. It’s silly giving up, really.”

Those of you who were following the live blog yesterday may be anxious to hear news about Kerri Calthorpe, 31, who was described by nurses at St George’s hospital, Tooting, as being “halfway”, through her labour after 12 hours.

We are now pleased to announce that baby Rex has been safely delivered. Congratulations to Kerri, husband Harry, and all the staff at St George’s maternity unit!

For those who may have missed yesterday’s post – here’s how we last saw Kerri:

The shortage of up-and-coming GPs is a major challenge for the profession, with many newly qualified doctors preferring to work in hospitals.

Some might be daunted by the heavy workload of a GP, including out-of-hours paperwork, says Dr Claire Anderton. She is mentor to registrar Dr Bhavesh Desai, who is in his last year of GP training at Gale Farm. “I think some consultants can try to tempt good junior doctors away from general practice – they think it’s just prescribing antibiotics all day,” Desai said.

Anderton agrees there is a misconception that “it’s just coughs and colds”:

It is an incredibly complex and varied job, but it is a huge workload, and I think that is starting to be addressed. There is an awful lot of burnout. Other than that it is the best job on Earth: I have patients who feel like friends, and when two of them died recently, I felt like I had lost two friends.

Desai made up his mind to pursue general practice after his third year, and has taken a particular interest in palliative care – particularly after looking after one patient for the last six weeks of his life. He said that, rather than dying in hospital, “it’s better for anyone to die at home”.

Anderton, who has been a GP for more than 20 years, said she was constantly learning. “I have learned particularly to always trust mothers when they say something is wrong with their children,” she said. “But Bhav has taught me so much, too, because he’s newly trained, particularly about new technology, he’s downloaded apps for me on my phone that help enormously with different aspects of patient care.”

Aside from the workload, the only complaint Anderton has about her work is the effect of national politics:

The NHS is a huge organisation, and it is adaptable. But we have had to deal with a horrendous amount of change, and we have to have some stability as well. We employ people here; and we ask them to do a job and if policies change it might change people’s jobs and we might have to make people redundant. The cuts have been happening for the last eight years, and we have to constantly try to innovate in order to keep ahead.

In her practice room, healthcare assistant Lorraine Rankin is carefully dressing her patient’s foot. Rachel has had surgery after falling down the stairs and developing a bunion-like lump on the side, near her toe.

She has been having the wound dressed at the surgery every few days, but is keen to be rid of her crutches. “It’s only a couple more weeks now, I’m seeing the surgeon next week so I want it to look good for that.”

Rachel had an allergic reaction to one of the dressings so Rankin calls in practice nurse Laura Atherton for her advice on dressings to use.

It is a new role for Rankin, with healthcare assistants now trained to take on a huge expansion in tasks, including not only dressing wounds but procedures such as ear syringes, flu jabs, NHS health checks and aiding surgical teams in vasectomies – jobs traditionally done by a practice nurse.

Both Rankin and Atherton sort through the dressings, showing Rachel different kinds. “I know the orange and the blue packets, and the orange ones were what I thought worked,” Rachel said. She prefers to remove the old dressing herself, to ease it over the most painful spots. With the dressing on, she hobbled out of the surgery. “It’s not too painful,” she winced.

“If I was 10 years younger, I’d definitely train to be a practice nurse,” says Rankin. “But it’s the practical side that I like: if you do an ear syringe then it seems like not such a major procedure. But it can make a huge difference to someone – you see their face change and they are so grateful they can hear again.”

Rankin is planning to do a foundation course at York University to help her advance as a healthcare assistant. And this week she will be trained to administer shingles vaccinations – her first live vaccine. It is a major shift in her role from what she was doing initially, but Rankin said the practice is keen to give healthcare assistant more responsibility for simple procedures. “I’d like to train now so I can be at the top level of everything I’m allowed to do.”

Dan Hurley has an unusual role – but it is one that could become far more common.

He is a pharmacist based in the Haxby Group’s GP practice, not in a separate chemist. The clinic has trialled the position for about 18 months, getting Hurley to deal with repeat prescriptions, manage patients with chronic conditions such as asthma, and monitor the drugs that patients take to make sure different medications are not conflicting with each other.

We might have someone on 20 or 30 medicines a day, with heart disease; then they might be overweight and that leads to diabetes and hypertension; they could have asthma on top of that, and chronic ulcers as a side-effect; then mental health problems caused by ill health. All this can add up when it comes to medication – and they might be seeing three different specialists. I can be there to keep track of what they are taking and spot conflicts.

Hurley deals daily with patients who have seen miracle drugs and cures in newspapers or on the internet, or have concerns about their medication because of what they have seen in the press, or what their neighbours have told them.

“It’s really hard. Take statins for example: professors of cardiology are divided over the minutiae of it so it’s very hard to explain in the lay press. And they read about some cures too, say for dementia, and that is really hard sometimes for family to cope with, especially if they read there’s a cure.”

The NHS is keen to have more pharmacists like Hurley in GP practices around the country. “We don’t have to be separate, which I think has been the tradition, it makes sense for us to work together.”

Readers have been getting involved with the project in a number of ways, whether below the line, on Facebook or via GuardianWitness. Yesterday’s 10 truths about the NHS piece led to this personal story from MysteryMachines:

MysteryMachines

18 January 2016 10:02pm

This comment has been chosen by Guardian staff because it contributes to the debate

As someone who nearly died age 28, I am thankful for our amazing NHS every bloody day. They have saved my life and all I can really offer is its ridiculously comforting to know that throughout my treatment and rehab from a traumatic brain injury i would not receive a bill in the post for it.

But that's the least of your problems as a patient, there are the countless nurses, doctors and staff keeping you going through what is undoubtedly the worst time of your life also for free. How dare they.

I had a 10-15% chance of instant death from my injury, I lived and received excellent care throughout my 3 month stay. I had brain surgery on 1st May to correct my problem, I was back at work 3 weeks later happy to pay my tax bit back in to help fund the NHS and help others help themselves.

Underneath our piece about funding elderly and social care, janeinalberta shared her experiences as a relative providing unpaid care for the elderly:

janeinalberta

18 January 2016 12:33pm

This comment has been chosen by Guardian staff because it contributes to the debate

I'm one of the small army of relatives providing unpaid care for the very elderly and frail. I don't mind doing it, but it is challenging and I no longer have confidence that there will be back-up from social services and the NHS if I can't cope. I also worry about what will happen to myself and my husband in our extreme old age, since we do not have children of our own, and our own financial resources will be less because of the money being spent on my mother's care.

I'd be quite happy to forgo the fuel allowance and the 'triple lock' if it guaranteed that whatever my savings and income I'll get adequate care in my old age. But, I do not trust the government on this issue. The Care Act was supposed to solve the problem, but implementation turned into a farce.

The index linking of my local government pension, and my husband's civil service and teacher's pensions has been reduced from RPI to CPI and recently we've discovered that part of my husband's pensions will lose their index linking altogether when the flat rate pension comes in -- and that is despite my husband not benefitting from the flat rate pension increase. So suggesting that we should lose further benefits, supposedly to pay for care, just adds further insecurity and uncertainty.

You’ve also been submitting your stories to our GuardianWitness callout. Hannah Harris wrote to us about how St George’s, the hospital we were liveblogging from yesterday, saved her six-week-old daughter:

And we haven’t just been receiving stories from patients: we’ve also heard from NHS staff too. Greengables1, a ward sister, wrote about her concerns with staffing levels on hospital wards for GuardianWitness.

As always, you can get involved with our journalism below the line on this liveblog and on other selected pieces. You can also join the conversation using the hashtag #ThisIsTheNHS – that is, once Twitter is properly back on its feet.

Next week’s strike by junior doctors has been suspended as talks continue with the government over new contracts, the British Medical Association has said.

For the full story on this breaking news, click here.

By mid-morning, nurse Laura Atherton is doing a diabetes patient’s yearly review. The patient has been taking notes of their blood sugar levels, and has adjusted their medication dosage recently, which they say has been having a positive affect.

One thing they are concerned about is their weight. Atherton checks the patient’s BMI, but cautions that it is not an exact science.

I get a lot of patients who have seen things in the media about new diets or nutrition, so I really do have to keep on top of it. People ask me things like ‘should I do the 5:2 diet?’ so I do have to know what it actually is.

Her main guidance is on portion size and exercise. “I do tell them about BMI, but I’m far more concerned if they are getting active and eating healthy food than whether they have exactly the right numbers.”

Atherton says she tries to be sensitive when discussing weight with patients. “I’m not a bullying kind of nurse. Often, I do find people are self-aware if you bring it up sensitively.”

Though much of the discussion Atherton often has with diabetes patients is about diet, she checks their feet for signs of change to the nervous system, reminds them how to cope with a dip in blood sugar and talks to them about the new alcohol guidelines – particularly the recommendations that people should have at least a couple of days a week that are alcohol-free.

Cyril Reynolds, 78, used to swim three or four times a week. Early one Tuesday morning, he pulled himself out of the pool and into the showers to wash off. The next thing he remembers is waking up in hospital – on the Sunday.

“Apparently I woke up from the coma on Friday but I don’t remember it. I’d had a massive heart attack, and the doctors told me I’d actually had an earlier one, which I didn’t realise.”

That heart attack was 16 years ago, but Reynolds is still coming for regular heart check-ups, as well as other matters that he says are a result of his age. He likes to see a regular GP, who knows his health history:

I saw a doctor here for many years who retired, but he knew me. He once said to me ‘come back in four days’ so I did, and he saw me in the waiting room, took one look at me and said ‘you look better than you did’. A computer can’t tell you that. I believe you have to know a person, and I don’t have that here now, but it’s something I’d like to have again with a new doctor.

One key debate in the GP realm surrounds how to bring the NHS’s patient records into the digital era, such as using health data from personal smartphones and fitness trackers, and how to keep this data secure.

One group, Patients Know Best, believes the solution is to put the patient in control of their data, collating it into one central place that plugs directly into NHS systems and pulls in data from other sources, including personal devices.

Dr Mohammad Al-Ubaydli, the founder and chief executive of Patients Know Best, said:

Patient control improves safety, raises quality, cuts costs and makes patients happier. It saves time for both patients and medical staff allowing modern communications, while making sure privacy is at its heart through strict controls over who has access to what based on patient consent.

Giving patients access to their records, treatment plans and adding data from audited systems including the quantified self can more effectively guide their care. It’s a workflow for the medical team, but also for the patient to help them understand what’s happening and keep them informed about their treatment plan.

But Beverley Bryant, director of digital technology for NHS England, rejected this proposal:

Frankly I think it’s a sad indictment of the NHS that the patient has to take control of their data in this way. I think citizens in England that use the NHS should reasonably expect that doctors and nurses that have treated them, hospitals, institutions and local authorities that have cared for them and their family, know stuff about them, like who they are, what treatments their on, what they’re allergic to.

NHS England has pledged to move the health service to be paperless at the point of care by 2020, to join up disparate systems and bring the health service into the 21st century. But with 90 regional groupings all tendering for new record management systems, compatibility and interoperability are far from guaranteed – particularly given the NHS’s record of IT projects.

The NHS is still saddled with ancient computer systems, many of which still run the 14-year-old, unsupported and vulnerable Windows XP. But the NHS currently doesn’t know how many machines it has or what software they are running, which is what the Digital Maturity Assessment, due this month, will uncover and hopefully be able to phase out.

For the immediate term patients should expect repeat questioning, testing and forgetting who they are each time they visit, but there is light at the end of the 2020 tunnel, should the joined-up system work.

Chris Stanley, one of the Gale Farm practice’s newly qualified GPs, is seeing patients from 8.30am in the large office he was chuffed to acquire from a retired senior partner.

“The variety is massive. On one day last week I did a home visit to a member of the House of Lords, and a few hours later I saw a man living on the streets, an intravenous drug user. That’s not unusual, to see that difference in just a few hours.”

The practice holds 12-minute appointments, longer than the standard 10. A few years ago, the normal time was five minutes. “It still feels not long enough sometimes, especially when a patient has such long and complex list of problems.”

Even in his short time as a GP, Stanley said he has learnt so much from patients:

I once got a baby in, a few days old, with a chest infection, which is horrible in a tiny baby. I listened to the heart too and it didn’t sound quite right either. We called an ambulance and sent the family to hospital, just in case.

I almost forgot all about it, but got a letter back saying the baby had gone into cardiac arrest in the ambulance and the hospital had saved the baby’s life; it has a really rare heart condition. I essentially saved the baby’s life by accident, just by checking a chest infection. Now I always check the heartbeat whenever a baby comes in with chest infection.

Stanley’s first patient of the day takes 15 regular medications, for conditions including asthma, blood pressure and arthritis. He’s here for the result of a blood test which he asked for because he’s concerned about memory problems, but the blood test rules out any obvious problems.

The GP arranges to do a memory test, and checks various other concerns the man has about headaches. “You can see a patient who has had many different problems in the same 12 minutes, with several unrelated concerns you have to address,” he said. “And you also have to bear in mind each of the medications someone is on which might affect different symptoms.”

His second patient is worried about a lump they have found, which Stanley refers for more checks, and a third is recovering from a knee injury but wants get back to work so Stanley writes a note for him.

Another patient has what initially appears to be a water infection. She tells Stanley that she has been treated for that already without any improvement, and is keen for an x-ray to rule out cancer. Stanley examines her, and says he is unsure of the cause of the pain, agreeing to send her to hospital for the scan to put her fears at rest, though he does not think cancer is the cause.

“I do always try to be reassuring – especially when I’m sure it’s isn’t actually what the patient thinks it is. But in other cases, you don’t want to be overly reassuring, because then the patient might not come back if it gets worse,” he said.

Problems with a troubled new telecoms and patient information system for NHS Scotland have deepened, with costs due to spiral by a further £7.6m, the service has admitted.

The system for NHS 24 – the call-in service for patients and the public looking for medical advice – was due to be up and running by the middle of 2013, but will not now be operational until the summer of 2016.

Its launch in November last year, already much delayed, had to be quickly abandoned after it failed to work properly, in some cases preventing 999 calls from being transferred. NHS 24 staff were forced to revert to pen and paper.

In a new submission to MSPs on the public audit committee at Holyrood before an evidence hearing tomorrow, NHS 24 said the IT project was now expected to cost around £125m, against an original cost of £75.8m.

It told the committee: “The original business case was inadequate, the program governance ineffective, commercial management was weak, too much reliance was put on suppliers’ promises and the organisation had insufficient understanding of call centre system implementation to successfully launch.”

My colleagues on the data team Delphine Robineau and Pamela Duncan have produced this revealing guide to the key statistics behind the UK’s army of family doctors, who account for 90% of all patient contact within the NHS – GPs really are at the frontline of Britain’s healthcare.

According to figures compiled by Deloitte for the Royal College of GPs, NHS England estimates that the average patient makes six GP visits each year. Exact figures on the number of patients a GP sees in a week are not routinely collected. However, it was estimated that in 2009, the average GP working in England saw 132 patients a week. In Wales that measure stood at 137 patients, while in Northern Ireland it was 126 and in Scotland it was 112.

The number of GP appointments in England is rising, up by an estimated 22% between 2009 and 2015.

However, between 2010 and 2014 the number of GPs (excluding retainers and registrars) grew by just 4% in England and 2% across the UK.

With the NHS careers website advising that GPs can see between 30 and 40 patients a day, it is no surprise they report feeling the strain. The latest Commonwealth Fund survey of primary care doctors reported that six in 10 UK GPs found their work “very stressful” or “extremely stressful”, higher than in any of the other 10 countries surveyed.

It also found that satisfaction levels among UK GPs had fallen: while 81% of GPs said they were “satisfied” or “very satisfied” with practising medicine in 2009, that fell to 67% in the latest survey.

The demographics of patients visiting their GP is also changing, with 43% of all GP visits in England now by people aged 60 or over. As recently as 2008 it was 38%.

Salaries explained

GP salaries differ depending on whether they are a partner in a practice or a salaried GP, and on the kind of practice they work in. The average taxable income for all UK GPs across the categories stood at £90,200 in the 2013-14 financial year.

A GP partner operating under a General Medical Services contract with the NHS had an average taxable income of £96,000, while those on a Primary Medical Services contract had an average taxable income of £106,800. The average taxable income for salaried GPs was lower, at £54,600.

Patient satisfaction

The satisfaction levels of those on the other end of the stethoscope is measured by the GP patient survey. Most of the 854,000 patients who participated in the latest survey reported that they were satisfied with the attention they had received in their local surgery, with 85% reporting that their GP gave them enough time.

Half of people surveyed said they had sought to make their doctor’s appointment on the same day or the next working day. Overall, 85% of patients seeking an appointment managed to get one.

However, 11% of patients surveyed in 2015 said they were not able to get an appointment at all the last time they wanted to see their doctor, a higher proportion than the 9% in mid-2012.

The majority of patients (55%) said they had waited between five and 15 minutes and one in four (27%) was left waiting for more than 15 minutes. A third of patients in the survey said they felt they had to wait too long to be seen by their GP.

Overall three-quarters of patients said they were satisfied with their GP’s opening hours.

Welcome to day two of our unique NHS series – an ambitious attempt to get inside Britain’s most complex, cherished and criticised institution.

The big picture

Already we have discovered that the health service plans to introduce a sugar tax on treats sold on its premises – but that our readers would rather it cut out the sticky stuff altogether.

In a wide-ranging interview with the Guardian’s deputy editor, Paul Johnson, NHS England’s chief executive, Simon Stevens, also called for a new political consensus on how to pay for elderly and social care.

Our ambitious project also seeks to tell the story of the NHS in terms of the raw data – and some of the numbers are mind-boggling. The NHS is the world’s fifth largest employer, an operation so vast that it occupies one in 20 British workers. That is just one of an almost endless list of superlatives that are often forgotten in the daily shriek of claim and counterclaim about its performance.

Our piece 10 truths about Britain’s health service seeks to cut through some of the tabloid myths and present the raw facts – including the pay disparity between NHS staff and agency contractors.

We’ve launched a series of diaries from secret NHS professionals, and a startling collection of dramatic life-saving stories called The day the NHS saved my life.

And we’ve found some of you out with our fiendish quiz, which we are tentatively calling a Q&A&E. For those of you who scored poorly, our animated short video should provide some answers.

Today’s focus

Today we head to the north of England and Scotland and switch the focus to an indispensable group of medics described variously as generalists, gatekeepers and the essential glue in the NHS puzzle: GPs. There are about 43,000 in the UK and between them they get through 381m consultations a year – roughly 10,000 per GP. But would you recommend yours?

Like everywhere else in the health service, GPs are trying to work out how to operate more smartly. For other practitioners the average day quickly descends into “a whirlwind of a suspected forearm fracture, gallstones, viral illnesses, an alcoholic wanting help to stop drinking, and a young woman with a new diagnosis of diabetes” –as you will read in our secret diary post launching later.

The Guardian’s Scotland editor, Severin Carrell, has sent this special report from the Hillswick health centre in Shetland, one of the most remote surgeries in the UK. The piece paints an evocative picture of the challenges that face practices such as Hillswick in attracting the right staff (and the pictures, by the brilliant Murdo McLeod, really are something else. We hope to have a gallery of these coming separately).

Severin writes:

There is a chronic shortage of new family doctors across the UK. Scotland, where a third of all GPs plan to retire in the next five years, is no exception. The Royal College of General Practitioners estimates between 563 and 915 new family doctors may be needed by 2020. Shetland alone has five GP vacancies.

Also online now, Will Self has written this almost elegiac piece about one Christmas night spent in A&E:

We don’t simply revere the NHS − we worship it. Why wouldn’t we, given it’s a nationwide public institution with branch offices in every town and hamlet; and a mechanism for the redistribution of the most precious resource known to us: the preservation of life itself? It goes further, though, because the NHS is for many of us what takes religion’s place when it comes to contemplating our end – for, if there’s one thing we devoutly wish, it’s to cease upon the midnight hour cosseted and with no pain whatsoever. The terminal is of the essence when it comes to healthcare anyway, given the vast majority of spending on any individual takes place in the last six weeks of their life.

Today, reporter Jessica Elgot will be liveblogging from the Haxby Group of surgeries around York and Hull, finding out from GPs the biggest rewards and challenges of the job.

You can tweet Jessica and me – @jessicaelgot and @marksmith174 – and please join in the conversation with the hashtag #thisistheNHS and below the line. We’ll be monitoring your comments and will feature the best in the blog. And please sign up to our daily email here.

What people are saying about our NHS project

Monday’s most read

1. 10 truths about Britain’s health service
2. NHS chief demands political consensus on funding elderly and social care
3. The secret 999 call operator’s diary: I want to end my life, says a man
4. Quiz: how well do you know the NHS?
5. This is the NHS: on the frontline at St George’s hospital in south London