NHS: pay for GP visits?

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  • So the bma is soon to ballot it's members on whether or not to lobby parliament to charge for some NHS services.

    Primarily the ballot will be about somekind of charge for an NHS GP consultation.

    Background is that the agreed NHS budget increase cannot support the increasing demand on services and GPs have previously (separately) voted in favour of a consultation charge of upto £25.

    Realistically the bma would likely lobby (should the vote go in favour) for a maximum charge of £5 for gp visits and 'walk in' A and E consultations.

    Clearly the NHS isn't really working out and is unsustainable at current and projected funding levels and there is no easy solution.

  • Now let me think about this! Firstly, I have paid more than enough into the system via tax and NI contributions and secondly, since it is nay on impossible to get a gp appointment, I won't be in favour of a charge no matter how small!

    The NHS is on its knees because of a lack of funding over the last few years not just because of increased demand.

    The government continually finds money for things I don't want to discuss here so if they genuinely wanted to increase funding to an acceptable level they would find a way!

  • Doesnt seem reasonable to be charged for something that we essentially have already paid for. And not to be speaking out of turn, the ones that overstretch the system eg hypochondriac types & old people are probably all on benifits anyway, so will get these charges quashed, leaving the already much milked taxpayer to be fucked over again!

  • since it is nay on impossible to get a gp appointment, I won't be in favour of a charge no matter how small!

    You go in our doctors and its the same elderly residents week after week who will openly admit they go for a chat with the doctor.

    Charge a fiver a time you weed out all the timewasters. You pay for an eye test, you pay for a dental check so why not a token fee for a gp appointment.

  • Already happens in Sweden - the cost to see your GP is about £10, but once you reach a cap of around £100 in a year for your visits, treatment and prescriptions, it's free. Considering it's a high tax country, it may seem strange, but the service is a league above the UK, noticeably so in dentistry as I've witnessed.

    Weeds out the timewasters, but doesn't penalise the chronically sick. Personally they should make it a £20+ charge for those who don't bother turning up to appointments. Might actually mean I can get to see a doctor without waiting a month.

  • All any charge to see a doctor will do is to send yet more people down to A&E, and the walk-in surgery at A&E, if you have one. Nationally, A&E's are grossly overcrowded already.

    There's no walk-in 'free' dentists, nor walk-in 'free' opticians, so we can't really compare these other two services with that of a doctor.

    But it is true that many people waste their doctor's time, going in for just a 'reassurance chat'. These sort of people should have their visits rationed.

    It would probably be the thin end of the wedge if the NHS started charging to see a doctor. They'd soon bump the charge up to £25, £50, £70 a session.

    So we would soon be back to the 1920's and the 1930's, where poorer folk couldn't afford the doctor until someone was at death's door, when relatives would have a whip-round to bring in a doctor - often too late.

  • Historically the bma and it's members have resisted and opposed any direct charges to patients using the NHS.

    If bma members vote in favour it is likely that the lobbying would include charging for 'walk in' consultations (emergency departments etc)

    Personally I'd favour something along the lines of a limited number of free visits followed by a limited number of charged visits followed by free visits again.

  • It is a difficult one.

    Some of my neighbours never visit the local surgery, about 300 metres away, even with no charge. Because they will have to wait a week or two or three to get seen.

    So they get on the bus or motor down to the local hospital, about three kilometres away, where they will be seen the same day if they wait.

    People will tend to use the system to suit their own needs, so the system needs to be adjusted for maximum efficiency; something the NHS has lacked since the 1990's.

  • To me, society works best when certain essentials are free, and NHS is one of them.

    Hopefully, Theresa May Knot will soon be history and things can resume as normal.

    Yes, something should be done about the timewasters . . . the GPs should be encouraged to target them and instructed to give them enemas for their 'conditions', something to put them off easy social visits.

  • In Ireland its about 20Euros to see a GP and more to go to A&E. I can see merit in the idea to stop the time wasters although I think a lot of the time wasters are rich enough not to mind paying it TBH.

    Its not so much about lack of resources as misuse of resources. However, this move comes from the GPs themselves and they are seeking to reduce their case load which is exploding. The biggest single factor is an aging population.

    I pay to go to the dentist and that's NHS, why not charge to see the GP?, but they should first charge for A&E

  • I’m in two minds with this.

    Today I phoned the dr to get a appointment for my 12yr old daughter. Cutting things short she’s been suffering from migraine etc. After trying natural healing it was a last resort.

    The “care co-ordinator” told me the first appointment available is 2nd August! When I questioned this she told me that last month they had 234 no show appointments! If they charged people would be more likely to attend but what if you were unable to afford the fee?

    It’s a lot to consider really.

  • I also didn't pay tax in the UK for many years but have done so in other EU countries which was used to calculate my pension here in the UK. Also gave me access to public health where I lived. If one pays in one expects the service free of charge at point of service!

  • I have noticed the logic of some folk seems to be that because they hate time wasters so much, they will penalise and punish everyone with a charge to see a doctor.

    What lovely people. :rolleyes:

    Sorry but you're being naive here. If a system is being abused, doing nothing is not the best option. Even a small charge (£5 per booking) is not the end of the world and would stop timewasters and freeloaders. Just about anywhere in Europe you'd have to pay either for a GP visit or for medicines, and I can't see much complaining.

  • Sorry but you're being naive here. If a system is being abused, doing nothing is not the best option. Even a small charge (£5 per booking) is not the end of the world and would stop timewasters and freeloaders. Just about anywhere in Europe you'd have to pay either for a GP visit or for medicines, and I can't see much complaining.

    The NHS is free at the point of access, if you hate the time wasters then penalise them, not people who actually attend appointments. The whole charging argument is a slippery slope as it can lead into other arguments about who is deserving of healthcare and whether or not they should pay for their treatment.

  • As stated in the thread it does appear that whilst Dr's as a whole tend to vote against charges GPs appear to be in favour of charges.

    This is about booked appointments not about attempting to charge a fine for non attenders. (Unenforceable).

    GPS appear to be expressing the opinion that many people are not chatting to pharmacists or really attempting to take responsibility for their own health or even heeding the basic advice issued online by the NHS with regard to self treatment for minor ailments.

    A little prod that suggests people should think just a little more before saturating scarce resources that nobody wants to pay for......hence the scarcity.

    It is indeed a slippery slope and it is one that nobody wants to take responsibility for.... nor pay for.

  • I think the biggest problem with paying at the point of use is that presumably you would then be entitled to a refund if the doctor is running late and disrupts the rest of your day, or if they don't know much about your particular set of health problems and so aren't really helpful, or if their suggestion or prescription doesn't work and you have to go back? The system works both ways; I can fully understand how frustrating it must be when people turn up with something that can easily be dealt with at a pharmacy or by staying in bed for a few days, but equally doctors can and do miss symptoms and/or misdiagnose, leading to multiple appointments that aren't the patient's fault. They also prescribe drugs that don't work or have such debilitating side effects that they aren't useful which again, requires further appointments which arguably have been caused by the doctor 'getting it wrong'.

    Most of the GP appointments with my son aren't really health related; they're medication reviews or requests for letters or referrals or just standard checks he needs because of his existing healthcare problems. Those appointments are generally only required to comply with 'the system' - meds have to be reviewed at regular interviews, medical evidence has to come from a medical professional, referrals have to be made via a GP and so on. So I think you'd have a lot of situations where people with ongoing or complex healthcare problems that require frequent appointments would feel they are being penalised financially. Equally it begs the question of what happens if someone needs to see a doctor but doesn't have the money? If we haven't got the £20 or whatever it is for the appointment for the medication review do we then not get the prescription? Which in turn could lead to a much more serious medical situation that would cost a lot more and possibly be life threatening. I think it sounds like one of those situations that just wouldn't be practical to implement and would quickly cost more money than it saved.

    I wonder if they'd be better off with a triage system similar to A&E, so that people can be redirected to the pharmacist or just given general advice on treating a cold rather than seeing the doctor? And if people are just popping in for a chat, as mentioned earlier on in the thread, perhaps it would be more cost effective to organise coffee mornings or something like that where they have a medical person of some kind present - perhaps from the local pharmacy? So that people get their social time but could also learn more about looking after themselves without taking up doctors' appointments?

  • It does work both ways and redress for non optimal treatment already exists.

    Why would a stipulated medication review attract a charge?

    Nobody wants to fund the system....who will pay for the coffee? Who will host and attempt to educate those so obtuse that they cannot look online.....nobody wants to fund that anymore.....it did not work.

  • I agree charging would be a very slipper slope. Not forgetting many folk are reluctant to even bother a doctor with health issues at the best of times. I know myself if there was a charge involved every time I/a Patient went through the surgery doors. Most folk like me would just put visits off. Often this could be to the potential detriment of our health. I’m lucky in that I heal really quickly, I recover quickly and Im unlikely to bother my GP with colds, sprains and strains. Cuts/wounds, Infections that are not responding to over the counter products unless they are potentially hazardous, embarrassing or very distressing.

    I’m of the opinion it would make a lot of the “frequent” visitors to the doctors think about if it really is nessessary. So in one way it would reduce patient attendances at a practice, save the practice money, free up doctors time.

  • Time-wasters usually call in to see a particular doctor. Usually one with a pleasant, chatty manner, who reassures them that they are no worse than they were last week. The doctor can try to get rid of the beggars by making them a next appointment three months in the future.

    But this doesn't work because they can call up with some invented problem to get an appointment for another reassuring visit a few days later, like anyone else, and get to see him/her again next week, or the week after.

    Perhaps these sort of people should be charged for every visit where they are found to be no worse than they were a week or two before.

    ("You're fine, Mr Jones, you had no need to come in at all. Give this red card to the receptionist on the way out, and put ten quid in the box").

    This might sort some of them out.:D

  • I know there are many who routinely pester/visit the doctors over the slightest, sometime imagined illness/problem. Sometimes it’s mothers with their children. This is particularly worrying as I can’t see a payment system stopping them from worrying and visiting the service.

    I just don’t like bothering our doctors at the local surgery.

    However What I do like is to have contact with the same GP over many years.

  • One thing I have been told by the local practice manager is that time-wasters never want to see a doctor they don't know, particularly if it's just a visiting locum. The regular doctor only calls in two days a week, the rest of the time it is locums.

    The receptionists, if they know the time-wasters, try to book them a locum first. This is rarely successful. So the regular doctor who knows more about local patients than anyone else, and is therefore most help to patients who may genuinely need him, also gets the maximum number of time-wasters.

    Like you, Steve, I rarely go up there for the usual small stuff, I don't like bothering them either. I go in now and then for a scheduled check-up, and that's about it, if there's nowt more serious to worry about.

  • Some months ago I tried getting to see my doctor and every morning for three weeks, same thing, no appointments left sorry. She (my GP) covers two practices, 6 miles apart. I’m polite to receptionists every time. Not the receptionist fault. But by week 3 they feel sorry for me and suggest they get my doctor to give me a phone call back. Brilliant I say. Why couldnt they do that more often. It would save me worrying every morning about not getting a phone signal or getting pipped at the post by landline owners 5 minutes after free appointments go live at 8.30am. Saves me the 4 mile drive and having to make sure I’m dressed and fit enough to drive if they do have a appointment.

    It doesn’t matter what health service appointments we can’t make/get to, it’s just curtesy to cancel appointments if we can’t make them. Let someone else desperate have it.

    I pay for dentist, I’ve been going private since I started work and pay for treatment. Paying private, does get quicker treatment. No waiting weeks to get a dentist appointment and often they could fit it around my work hours. My last dental bill about 4 years ago was over £4grand for one implant and some surgery to the gum following a fall.

    I struggle with back pain and trying to sit back in a chair for half hour without freaking out in pain and having to shift my body doesn’t sit well with every-day dentists. So I was referred two years ago to the NHS hospital dentist. I still have to pay, but they are really considerate.

    However. They have a DNA charge of £15 for missed appointments. So if I have to cancel I do give more than 24 hours notice and then there’s no charge.

    When I went to Dovedale (jays wedding) I had a dentist appointment booked for the following Tuesday morning. Bank holiday Monday at Dovedale is not to be missed. I had known this was a close appointment and considered phoning to cancel the dentist a week before Dovedale. I even googled “good excuses to cancel dentis appointment.” (No kidding, I really did) it’s hard enough getting dentist appointments so didn’t go through with it. But Monday morning, I tatted down, forced myself to drive 100 miles. Got back late Monday night.

    Got a phone call from dentist reception Tuesday 8.15am. 2 hours before my dental appointment. Sorry, Tom the dentist can’t come in to work today. I first thought, fk, good job you rang. 15 mile drive for nothing, not fun. 2nd thought. I should charge him £15 DNA and if he/they weren’t such a good NHS dental practice. I would have pushed it. 3rdly, I thought “No need to have tatted down and leave a Dovedale” bugger.

  • That's a bummer trying to get an appointment on the phone when you only have so much time.

    Our surgery used to do that, you could only ring between 8 and 8.15 am. It was chaos, the phone wasn't always answered, and people got desperate; it was almost impossible to get an appointment.

    So a fair number of people got fed up trying, and went down to A&E walk-in instead, a couple of miles away. A&E started charging the surgery for these people, so far as I can remember it was about £65 a time.

    Now we can walk in and get an appointment, or phone anytime they are open. It still takes two or three weeks to get to see a doctor, but making appointments easier to get has been the single biggest improvement.

  • I know a woman who went to the doctor with athlete's foot simply to get a free prescription for the cream. The cream is readily available over the counter but not free.

    Were she paying for her prescriptions she would not have done this, stopping prescriptions for over the counter item would be one small way of stopping a number of time wasters

  • Generally, I think the postal code idea of giving certain treatments to patients works. It's an economically cold decision that allows the NHS to focus expediently on certain conditions which are more of a problem in a certain area. I would hope there is some flexibility in it so that GPs can ensure their patients don't suffer. However, there seem to be a postal code mentality behind different methods of GP service: particularly at reception / getting an appointment. IE, GPs have different ways of seeing their patients. I don't get this. For me, I just walk in and make an appointment, or I phone them (and not at a particular time). alices wonderland - talks about how hard it is to get an appointment and the distance needed to get there + other things which go wrong. You always have to have a system where it is easy to get an appointment with a GP, otherwise serious patients (which I take it you are alice?) miss out. As citizens, we have to remember the balance of power. GPs are there to serve us, not the other way around. It's an example where in a civilised society, you can not legislate around the bad examples. Yes, target the bad examples somehow, but don't make the innocent suffer from it.