the prime minister says the important thing was to build on the special relationship. i will be talking to donald trump about the issues we share and how we can build on this special relationship. it's a special relationship. it's a special relationship were we can talk about things that we do find unacceptable. the white house has accused the media of falsely reporting the size of friday's inauguration by insisting the crowd for the event was the largest ever. the ministry of defence says it has absolute confidence in the uk's nuclear defence system after reports that a trident missile test went wrong, weeks before a crucial commons vote on its future. one in five women do not receive the life—saving smear test because they are either too embarrassed or don't think testing reduces the risk of cervical cancer, according to a charity. the former president of the gambia yahya jammeh has left the country after agreeing to hand over power to adama barrow, who defeated him in a presidential election last month. andy murray's hopes of winning a first australian open title ended with a shock defeat by world number 50 mischa zverev of germany in the fourth round. now on bbc news, inside out.

hello, welcome to a brand new series. in the next half an hour, a close—up look at health care. we're on the rounds with a local gp, fighting financial pressure as well as infection. it drives me up the wall. i want to do what i'm trained for, not to be some sort of clinical accountant. we ask — do we still have a national health service? or does where you live increasingly affect your care? the fact that i've had to pay for my treatment, it's criminal. it is absolutely criminal. sorry. and learning to help ourselves, should a lesson in life saving be compulsory? she was lying there on the sofa, totally unconscious, with eyes wide—open. if i hadn't done the cpr my mother wouldn't have survived today.

i'm chris jackson. this is inside out. tonight, in a special programme, we look at the increasing pressures on the nhs. as budgets tighten and the number of patients arriving in a doctors' surgery rockets, gps are under increasing pressure to cut the cost of care. we followed one tyneside doctor to get a first—hand account of how he and his patients are coping. mike scott has been a gp in newcastle for more than 35 years. good morning. thanks, julie. life saver. cheers. the nhs is under huge financial pressure. gps like mike are at the sharp end, making decisions about where the money is spent. good morning, surgery,

julie speaking. the surgery has more than 5,500 patients. donna has back problems and suffers from depression. it got to the stage where i didn't want to be here and i wanted to be rid of myself. when they said that was useless, i thought, "what is the point?" the first tough call of the day. the drug that works for donna being rationed because its price has rocketed. we're being strongly encouraged by the people who run the health service not to prescribe this. the plan then for the next four weeks is i keep supplying you with it, if i get struck off, it will take them a few years and i'll retire any way. after losing eight—and—a—half stone, donna needs surgery to remove the loose skin. that counts as cosmetic. i will put in an application, because you just told

me you felt suicidal. i will have to full in an ifr, an independent funding request and look, just don't get your hopes up. it drives me up the wall. i want to do what i'm trained for, not to be some sort of clinical accountant. we need to configure the health service to fit the needs of patients, not the patients to fit the design of the services. if you bear with me, i'm afraid there will be a bit of a wait for dr scott. i will double check for you. come in. there's a patient who has had three seizures in the last 15 minutes. would you mind looking at that as soon as possible, please. deprivation, unemployment and poverty here are all significantly worse than the national average. it's12.30pm, mike's now on home visits.

hello. dorothy has a severe muscle wasting disease and has developed suspected chest infection. if the nurse hadn't been in, would you have been thinking about calling us? would you have been worried? no, not at all. let's have a listen. dorothy has had the disease for 15 years. i've had it specially refrigerated to give a thrill. 0k. that's looking good. all right, ok? that's fine. often patients have already diagnosed their illness before the doctor arrives. do you want my clothes... don't worry, we'll preserve your modesty. i'm not bothered. when you get to blooming nearly 83. never say die, don't say that. give us a few deep breaths. yeah, you're sounding like a bag of weasels here.

i thought i was. i think your vest is tucked into your socks here or something. my thermal vest. i agree with your diagnosis. it's more than a cold certainly. you have a flair up of the bronchitis there. lunch at the surgery. there are five part time gps here, earning less than 59,000 a year on average. their time is rationed. ten minutes a patient. if i had 15 minutes to see all my complex patients with half a dozen different medical problems, i'm sure i could improve their quality of life. but you basically have to do what's feasible. the average waiting time in england for a routine appointment is now almost two weeks. it can be stressful at times. i can understand when people are poorly, they want to be seen. it's hard if you try to say there's no appointments left. you notice everything. a couple of deep breaths.

there's all sorts of squeaks and rattles. you know i don't like steroids, i don't mind a short period of them. 0k, doctor... i'll go on your recommendation. the commissioning group that funds hospital services recently began paying gps to reduce their referrals to specialists. mike thinks it's wrong. inevitably, some people who should have been referred will not be referred. i think more pernicious is the message — if your practice is signed up for that, don't trust your doctor any more. when he tells you, i don't think you need to go to hospital, he could be saying, i honestly don't think you need to go to hospital or he could be thinking, i need to save up for my foreign holiday and if i don't refer this person to hospital, it will cover some of the cash flow that we missed last year. if i'm honest, i don't think anybody‘s going to be saying that, but it puts you in an invidious. the commissioning group said it was to make

best use of resources. said it was to make there are schemes in other areas, after you made the referral, another doctor looks after the referral letter and says no, you can't make that referral. i think that absolutely stinks. somebody who doesn't know me and doesn't know them says no. you know, i just don't accept that. i would do everything to circumvent that. they made 2,500 referrals to specialist last year. for operations like removing tonsils many hurdles have been overcome. seven or more well documented clinically significant sore throats in the previous year. that to me isjust a rationing criteria. the bar is too high. a seriously ill patient is deemed ready for work by the department

more telephone consultations. a seriously ill patient is deemed ready for work by the department of work and pensions. i find it mindboggling that someone who has never met you in your life before overrules my opinion. he has very severe arthritis and a very severe depression. i think my opinion as to whether he's capable of working is worth a whole lot more than this other guy, who's dog a tick—box exercise for a private company, contracted to the government. it's now approaching 7pm. mike has seen 26 patients, but there are still three home visits to do. do you still feel sickly now? a bit. 0k. what you need from me tonight is pain relief and not vomiting? uh-huh. 0k. home visits are costly in time terms.

but they can also save the nhs money. that lady there, i think, as a result of visiting her this evening, we can keep her out of hospital. if we hadn't seen her tonight, she could have been in hospital by midnight. i give myself a day off each week, as well as the weekend, otherwise i couldn't cope with this. i'd crack up, quite frankly. i'm going to go home and i may pour myself a nice, cold beer and watch something that involves no mental effort at all on the telly. while dr mike is facing the squeeze on the frontline, others are looking at the bigger picture and asking — is the nhs still a national service? or does where you live now matter more than ever when it comes to the care on offer? the nhs is facing the most significant financial challenge in its history. there are fears the service we've grown up with is

beginning to fragment. it's not a national service. absolutely there is a postcode lottery. it's criminal. it is absolutely criminal. this is the start. this is going to get worse. so, is the nhs in danger of ceasing to be a national service, where everyone is entitled to the same care? it is treating more patients but is it becoming a postcode lottery where access can depend on where you live? we're going to put that to the test. on a bad day it ruins your life. muscle pains, it feels like my bones are actually screaming at me, at times. 33—year—old ben franklin has hepatitis c, the virus can cause life threatening liver damage. i'm about to lose myjob.

i haven't been at work since april. i've been off sick. i could possibly lose the flat over my head. there are new drugs that could potentially cure ben's hepatitis. they're expensive and rationed. ben has been denied them. all i got was wait, basically, because my liver wasn't bad enough. and that made me want to go out and just get absolutely wasted and ruin my liver. just so that they would treat me. i wouldn't do, that but i wouldn't be surprised if anyone else wouldn't. the money is there forjust over 10,000 treatments. each area has a target to meet. it's claimed that means there are no queues in parts of the north and long waits in places like london. two people with exactly the same state of liver damage could present themselves in different parts of the country and in one, they'll be able to walk in, get hepatitis c treatment immediately, get cured. in another part of the country, they may go there and be told, i'm sorry, you're going to have to wait.

this is just inherently unfair. nhs england told us it was regularly re—allocating unused hepatitis c treatments to places with waiting lists. the number of patients treated will increase by 25% next year. it's the fact that it's down to money that upsets me the most. just money. so ben is taking the risk of treating himself with cheaper copies of the new drugs. how much have you spent on that box? £1300. £1300, yeah, i don't really have that. the fact that i've had to pay for my treatment is criminal. it is absolutely criminal. sorry. i'm tired of being tired basically. ben is hoping the generic drugs will cure him in a matter

of weeks and he's not alone. the hepatitis c trust estimates around a thousand people in britain may have bought the drugs abroad. if you go outside, it's halos around the lights, like some shadows. it's often hard to see things, they're a bit distorted. gloria has cataracts in both eyes. i can't take stairs, go up or down stairs with any kind of confidence. cataracts are supposed to be treated within four—and—a—half months of referral. gloria, who lives in the north—east, says she's been waiting seven. it's too long because there is such potential for accidents. there's such a change in the person's mood. if gloria had lived in luton, her wait could have been as little as 15 days.

a postcode lottery? absolutely, there is a postcode lottery. it's not about clinical need. it's about some places in england having poor systems, having budgetary pressures and deprioritising cataract surgery. that doesn't feel national to me. gloria expects her operation later this month. it really makes me angry because i think that it's almost like the survival of the fittest. clinical commissioning groups or ckgs control health budgets. it's claimed some are delaying treatments like cataract surgery by slowing down referrals. others are requiring patients to lose wait before getting operations, like hip replacements. postponing an operation in these circumstances can save money in the short—term. whilst the ccg says it can be clinically justified the royal college of surgeons say it can't. there's very good evidence that

people are now got getting elective operations, which they desperately require simply because of financial restriction. it is up to the clinicians to decide who should have what treatments. a bureaucratic system which produces a blanket ban, we think it's morally wrong. it's claimed new systems for vetting appointments with specialists are another form of rationing. why are they treating their patients with such contempt? last month mps complained about a private company being paid £10 for every gp referral they stopped. this is rationing by the back door and has the potential to compromise patient safety. the same private company oversees referrals in north tyneside. we've spoken to doctors who say the system is putting patients at risk. gps, who fear speaking out, have told us that cancer diagnoses are being held up.

i tried to get a patient referred to a dermatologist. the referral management service said it was a skin lesion. that was a disaster. it was a nasty, invasive skin cancer. the system is dangerous. they're putting up barriers. they're using delaying tactics. it's getting between the doctor and the specialist. in a statement, north tyneside ccg said there was no evidence the system caused additional risk or delay. cancer referrals do not go through the system and are made directly to hospital. the number of referrals knocked back to gps in england has risen by about 30% in the last two years. you can see the details of our research online. shortage and regional difference have always been part of the nhs. today the differences could get much worse. the nhs is under an unprecedented level of pressure. if it doesn't get more funding,

waiting times will get longer and the quality of patient care is going to suffer. so we will see different decisions taken in different parts of the country and different services being available to patients. so, is the nhs still a national service? one of our most prominent medics is clear. no, it's not a national service. it's now a local health service. it matters because it means it leads to inequality in health care. that's the problem. some people will get health care for free and others won't. in the statement the department of health told us: far we asked the health secretary and nhs england for

an interview, both declined. the people actually paying for nhs services, the clinical commissioners, did agree to speak. it's a national service with local variation based on the need of the population. demographically populations vary quite significantly from town to rural, from county to county. it's really important that we commission and respond to the needs of that population on a local basis. it's about making sure the pathway is correct. we don't want to squander any money. we have limited resources. it's really important that we spend most effectively and get the best value for our population. for those forced to take their own action, rationing appears all too real. would you know how to save a life? well, this year, around 30,000 people will have a cardiac arrest and need urgent help until a medic arrives. campaigners say that means that resuscitation should be taught even at a very young age. we've met a newcastle teenager, who understands that only too well. i'm 15. i raise money for a charity that defibery lators in primary schools and public places and raises money

for cpr training. i started fundraising when i lost my best friend michael. michael was just 1a when he had a cardiac arrest. it was triggered by an asthma attack. she was absolutely devastated, totally broken hearted. as a mother, it was hard watching her go through it. i couldn't do anything to make it better for her. bobby has now raised over £10,000 and funded her own cpr and defibrillator training. after what happened to her friend, she wants everyone to knowjust how important it is to know life—saving skills. cpr is what keeps the organs going, what keeps you alive.

if you don't act fast and do cpr, you have so much less chance of surviving. i think it's something that when you get to a certain age, you should be trained, in because anything could happen. but if bobbi lived in denmark, she and her peers would already have learned it. resuscitation skills, cpr, has been a compulsory part of the school curriculum here for the last ten years. in a copenhagen classroom, 11 and 12—year—olds are being challenged to make their own films about resuscitation. this class will produce five films. each film will be a campaign film telling me or you how to act if you see a person dropping down on the streets. the aim is that the children have fun and creative day and by making films about it, they will obtain the knowledge and they will obtain the idea that it's a good thing to help. it's always interesting to see the children's perspective on these

quite difficult issues about life and death. 20—year—old rasmus knows more than mostjust how important it is to help. two years ago, he was at home ah, loan with his mum, when she had a cardiac arrest. she was lying there on the sofa, totally unconscious. indeed it was very scary. the only thing that kept me going was really that i could hear her breathe slightly sometimes. if i hadn't done the cpr my mother wouldn't have survived today. it is a very, very, very good thing to know. you never know when it's going to happen. it could come all of a sudden. like for me, my mum, of course, she is very grateful. the first thing she told me when she could speak again, was, "you saved my life." i really didn't know how to respond to that, but well, i guess i did.

now nearly 70% of people in denmark know cpr. that's compared to just 10% in the uk. and the survival rate from cardiac arrest has trebled. this is the emergency dispatch centre in copenhagen. it is about changing the attitude that you can do something and you cannot do anything wrong and to take a social responsibility. it has an impact on survival. it has an impact on the new future generation of life savers. give me just one reason not to teach children cpr in school. i cannot find that reason. it'sjust one hour, it's cost effective and it doesn't cost very much. everybody should be able to do cpr. back in the classroom, the sixth grade students are finishing off their films about resuscitation. anybody wants to help? you're ok.

thank you, thank you. you can save lives. everybody can save lives. but the more you hesitate, the chances of surviving gets smaller and smaller. that's what one paramedic wants to teach children here in the north—east. this class is for five and six—year—olds in south shields. come up here and sit in the middle. little ones are like sponges. i've been shocked at how much they cannot only take on board and retain. then deliver. they're really interested. i think the characters really help. always wanting to get involved in the characters and activities that we run. no, it's not compulsory, i think it should be because personally i think it's probably one of the most important life skills that you can ever have. are we any closer to making this the norm in uk classrooms?

and following the lead of denmark? the department of education told us: it's not good enough at all. we're way behind the curve here. we're failing our population because people are dying prematurely unnecessarily. push really hard. it makes me really sad. it's such a simple thing to introduce. it doesn't cost much. the benefits would be so huge. good job! in newcastle, it's a special day for 15—year—old bobby. she's up for an award. this awards are to recognise unsung heroes and champions

in the local community. overall i've raised about £10,000, i've bought ten defibrillators in the areas where me and michael were. the award goes to bobby... cheering. it's about getting the word out. everyone will know that michael had a cardiac arrest. he would be over the moon. he really would be. congratulations to bobbi on that fantastic award. that's it for now. there'll be more from the bbc‘s inside out teams on the bbc news channel next weekend. good morning. it is a very wintry

sunday morning across many parts of the uk. even with the frost with temperatures as low as minus eight celsius. freezing fog patches in kent and some of us has seen snow. a dusting of that in parts of wales, the west midlands and a few spots in north—west england. in scotland as well some flurries giving a light dusting in places. high pressure in control of our weather, but there is this weather disturbance moving through western and northern parts of the uk. a few potential showers in the south—west and in west wales, mostly falling as rain. the odd flurry is still possible into parts of northern england. northern ireland will see some sunshine, but

across scotland there will be further flurries of sleet and snow. a cold field. in the south—west compared with recent days, plenty of sunshine. hard frost setting in for some of us tonight, but also some mist and four patches developing. they are possible just about anywhere, but there is a risk in england and wales of seeing dense freezing fog patches that could cause problems during the monday morning rush hour. it will be slow to clear, so if you are heading out tomorrow morning, check the traffic and travel situation. not everyone will see it, but problematic possibly. not just will see it, but problematic possibly. notjust monday morning it's tuesday morning as well. the fog will clear, but for some it will linger perhaps all through the day. the risk of that is highest towards the south east. temperatures will stay around freezing. out of the

fog, a day of variable cloud with some sunny fog, a day of variable cloud with some sunny spells. a dry day, but another cold feeling day. into monday evening and again, the fog will develop. once more it is england and wales most at risk. the air isn't moving very far of fast because of the centre of high pressure. tuesday morning, problematic fog, but scotland and northern ireland will get closer to low pressure. the isobars are closer together and the winds are picking up, so your weather will change, gradually turning more unsettled. more as ever available online. this is bbc news.

i'm gavin esler. the headlines at 11. theresa may will be the first world leader to meet president trump when she travels to washington on friday. the prime minister says she won't be afraid to tell the president what she thinks. whenever there is something ifind unacceptable and will not be afraid to say it. after millions took to the streets in protest against the new president, the white house accuses the media of dishonestly reporting the size of the crowd at his inauguration. the ministry of defence says it has absolute confidence in the uk's nuclear defence system after reports that a trident missile test went wrong. the gambia's defeated leader — yahya jammeh — flies into exile, 22 years after taking control of the west african state in a coup. world number one andy murray crashes out of the australian open after a shock defeat in the fourth round.