Should people have to pay to see a GP?

welshdent

ringo_24601 wrote: »

I've actually been involved in installing a system in a hospital which sends out a SMS text message to their mobile phone the night before their appointment - with the aim to reduce DNAs. I think systems like that can be great and pretty cost effective to install.

These do indeed work well particularly for those that genuinely forget. Where they dont work are with those that just dont care unfortunately

welshdent

Eric_Pisch wrote: »

except its based on on actual data from my OHs trust, who is a very senior manager there, the new system increases the cost per patient by 13% and the consortia are allowed to take 10% in profit, thats a real terms reduction in the NHS budget of 23%, and then you can add on the billions that will be waisted in setting up the the whole system and ignoring that at best that GPs are on the whole are completely unqualified to run the system.

What point are you trying to make off my post you quoted?? Who is talking about the proposed/implimented changes that ARE happening?? None of us here thats for certain. We are discussing a proposal of "should people have to pay to see the GP?" - Not, do you approve of the governments changes. Also even if we were .... where is transferring things to GPs privatisation?? Again hysterics and scaremongering .... but kindly stop side tracking and stay on the original line. Why not try suggesting things to improve the system yourself as other have done so?

bargainbetty

If a system was implemented whereby we assumed consent to a fee payable for non-attendance (without a phonecall pre-warning of this). A text message reminder service wouldn't be difficult to set up and thereby remove the possibility of 'forgetting'.

I am aware that doctors cannot always stick to schedules (earlier response from Docjames). I merely note that if I am late, I may get charged, whereas if he is late, he won't. Surely some leeway can be granted, on the assumption that you call to let the surgery know you are running a bit behind schedule.

Anyone turning up for a procedure at hospital who has failed to follow the full instructions should be sent a bill for the wasted time (not the cost of the procedure in full, too expensive) but a flat rate 'waster' rate per appointment. Do it twice/fail to pay and you drop to the back of the queue. If people treated the NHS with respect, it wouldn't be a problem. So lets find a way to show people that they cannot take the mickey with the time and service, or they will have to pay for it.

However, barring access to service with charges is dangerous, and will cause immense distress and increased sickness/welfare bills. Don't believe me? Look at the USA. Over 45,000 unnecessary deaths per year and hundreds on thousands on medical leave because they cannot afford the treatments to get well and be productive.

I have to restate the obvious again - we have mandatory insurance already, based on income. NI contributions are exactly that. Forcing people to buy a secondary insurance is not reasonable - how can you force children, the elderly, the unemployed or the genuinely long-term sick to take out and pay for insurance. JSA is £64 per week. How do you pay for it out of that? A basic state pension is £74 per week - tell me how much you propose to strip out of that from a pensioner who is already struggling to survive?

[Deleted User]

I work full-time and pay tax and NI. I have never claimed any benefits in my life. I have to pay full cost for glasses and dentists. I cannot get an NHS dentist in my area so I have had to go private. Now, I don't mind paying into the system to provide help to others with housing benefit, disability benefit, job seekers' allowance etc), but why should I not be entitled to free health care? Why because I work full-time and provide for my family should I again be penalised? We pay for everything else.

We don't earn loads, but manage on what we have (no overseas holidays, flash cars, expensive house for us). However, having to pay for private health care would be another bill we would have to find the money to foot. It would be very difficult for me to find an affordable package too.

I have a serious, long-term health problem. I have to have regular visits to the doctors and for blood tests. I manage this condition and still work full-time. I don't want to be ill and on medication for the rest of my life, I don't want to have to go to hospital regularly either. I don't drink, don't smoke, I exercise regularly, I am a vegi and eat a very healthy diet so I do everything I can to be healthy, but there is nothing I can do to stop a hereditary disease. I simply could not afford the health care that I need. Without it I would become very ill and have to give up work (but hey at least I would then get free health care!).

If I had to pay then I would not often go to the doctors. I recently had an appointment as I was not feeling very well. I didn't want to go thinking that I was not that ill and I only went as husband and mother-in-law kept nagging me. I got to the doctors and was sent immediately to the hospital. I had a blood clot in my thigh (serious problem). If I had to pay £15 then it unlikely I would have made the appointment.

On another note all the treatment I have had at my doctors and local hospital has always been fantastic.

mr_rush

Hello docjames, can you tell me how you got to a figure of £60 per appointment?

Cheers

welshdent

moggylover wrote: »

#69

I had a long message typed out and my computer threw a wobbly and I lost it all LOL!

anyway!

genuinely I feel much of your frustration towards your dental and medical services are aimed at the wrong people. They are simply following the contracts they were obliged to sign up to.

Let me explain.

Firstly I need to stress that dentistry and medicine, particularly the hospital system are funded COMPLETELY differently.

Dentists are NOT paid a salary and their earnings are directly related to the amount of patients they treat and therfore how much work they do. In addition the practice owner is wholly responsible for ALL risk and costs. That means they have to pay for the building, staff, materials, bills, rates etc. The NHS does not have any input to this. Average overheads are approximatel6 60% and as an associate, whatever my gross income is, I give 60% to the principal dentist that owns the place to pay for my materials and nurse plus contributions for reception staff etc. On top of that I pay lab fees to make things such as denures and crowns. I pay around 15 - 20K per year for these depending on how much I do.

Lets be absolutely clear on this .... If I do zero work I earn £0. That is NOT a salary where I COULD potentially do nothing and still be paid. If I were a practice owner I would actually be in minus figures as my costs would still be there but income would be £0.

A few years ago labour changed the dental contracts and GP contracts. They removed out of hours and certainly for us, set clinical hours. This means its not the GPs fault or the dentists for not having out of hours.

We are not funded for out of hours at all and are only contracted to provide a service from 8.30 - 6 monday to friday IIRC. That doesnt mean we have to actually physically be there it just means that there needs to be some way to access advice such as an answer phone message directing a caller to emergency out of hours. My practice for example has opening hours 8.30 to 5.30 monday to friday with last standard appointments 4.30 which means I am normally finished by about 5.15 depending on what I have in.

All out of hours is the responsibility of the LHB in wales and PCT in england. .. NOT the fault of the practitioners who had no input to contract negoiations.

A practice is awarded a financial amount corresponding to an allocated number of UDAs which correspond to COURSES of treatment and not items of treatment. If we go over they take money off us and if we fail to hit 95% of total .. they take money off us. We have no control realistically over how much that contract is worth and from that we need to account for employing staff and all the other items that need paying for. The contract is cash limited. Therefore your dentist understandably could not take on another dentist. Incidentally I consider 2000 patients a very small NHS list size NOT big as you think. That clearly to me could not sustain 2 dentists. Firstly no additional funding was being made available. That means that no matter how many dentists worked there... no additional patients could be seen. It would be the same level of work but carried out by 2 not 1. As there would have been no additional funding, there would have been no additional money to pay for the additonal costs of hiring more staff and paying for the additional cross infection costs etc etc. It would have been financial suicide NOT lining their own pockets to take on another dentist. You do not have any idea of what was going through that dentists mind when he upped and left so I do feel you are being a bit harsh on them. I for one know how hard this job is with increasing interference from above and constant negative press.

Basically the harder we work, the more efficiently we work .. the more we earn to a point. The less we work the less we earn. Basically if you think dentists should earn less, the only way to do this is to make them see less patients .... but this would INCREASE pressure on the service because more staff would be needed to meet the same demand. It was different on the old contract when you were able to get late night appointments. Dentists were then paid fee per item and there was no limitations on clinic times. You COULD have additional dentists working there because they would have worked and been paid for it and then earned their keep and then income without affecting the practice as a whole.
You can thank labour for that one! (my one and only political point scoring comment!!)

IIRC the overal NHS spend on dentistry is approx under 5% of total NHS spend. there has been a great under investment in dentistry for decades despite the bad press about how much we allegedly earn. ... again EARN ... not salaried.

There have actually been funding cuts. What this means is that despite there being great advancements in technology and materials, we can not provide them on the health service as their costs would be too prohibitive and patients miss out.

I dont really think it matters how much an individual earns if they have earned it legally and ethically. There has ALWAYS been disparity between incomes. Medical and dental practitioners have spent years training and then more years keeping up to date. If you wanted to be a maxillofacial surgery consultant you are looking at the best part of 19 years of training to get to that level. What matters to me is the inaccuracy in which it is presented to the public by the press and politicians. Those of us on here that give our time to pass on advice do so because we care. The likes of Doc James are simply seeking opinions on ways the whole system can be improved for the betterment primarily of patients ... but there HAS to be an appreciation of the costs involved. The service can not function with no money.

Regards costings to the patients .... well any business person would be a fool to not bear in mind their client bases wealth or lack thereof! BUT they DO need to bear in mind how much it costs them to PROVIDE the service. An all ceramic crown for example costs me £120 in lab fee alone. A metal denture costs me approx £180. The cost to the patient has to reflect these costs otherwise I go out of buisness. Regards NHS charges ... well we dont set them. We have no input in to them and we do not keep them. They are set centrally by the DOH in england and WAG in wales. If you feel they are too high then I would suggest speaking to them. The charge is actually a tax and does not correspond to the cost to the dentist.

Also we do not denigrate the NHS for fun or because we do not like social healthcare. We do so because it is chronically mismanaged, abused and lets down the 2 important groups ... patients and workers. We discuss it because we want a better health care system for all but are realistic about how things work. It has nothing to do with how much we can screw out of it despite what naysayers would have you believe.

docjames_2

mr_rush wrote: »

Hello docjames, can you tell me how you got to a figure of £60 per appointment?

Cheers

Locally it was assessed what the cost of appointments was.
For the majority of traditional GP practices it was approx £40-60 for each patient seen. For the local walk-in centre (which is nurse run and has no GP) it was £100 per patient seen. For the Darzi 8am-8pm centre it was £140 per patient seen.

Now the cost takes into account all associated costs such as building/heating/lighting/cleaning/equipment/admin and office costs/telephone etc etc. (the list is endless). So its the total cost of running a service divided by the number of patients seen over a period of time.

The average was just under £60 due to much more traditional GP practices compared to the othe centres.

lostinrates

docjames wrote: »

What about compulsory medical insurance which would cover a certain number of attendances and then everyone would have cover. Those with incomes under a set amount could have insurance premiums paid for by the government. This would then allow a top up charge for people with risky behaviour and lower premiums for healthy fit people? I think Germany has a similar set up and has an excellent health care system with fast access and far better outcome measures in virtually all areas!

It seems to me that the people who neeed most appt...those with chronic long term illness, would be most endangered.

The thing that troubles me about insurance preiums is there are a lot of things that are not lifestyle choices that could impact on premium....genetics, previous illness making you more vulnerable to future illness etc etc.

something has to change n the NHS, but preferably something that doesn't make it less fair to all.

Incidentally, we use a mixture of NHS doctors and private health. DH has just found out that the very poor decisions made by THREE consultants in a row his treatment choices are now limited and will impact on his future health. He found this out when the tertiary referral (via GP) as going nowhere (the GP sat on consultant request for over two months with no action) and he went private, and was seen by GP, then consultant within 24 hours. As the sole earner in our family, and being in a position of responsibility he simply cannot sit for the hours delays in gps waiting rooms. He'd pay for a guaranteed to time appt!

welshdent

If hypothetically there was a greater encouragement and development of a private service or if there were a mandatory additional insurance scheme ... would it be better if the providing companies were not for profit organisations?? I did mention this but its been a bit lost I suspect.

The major companies have reputations for excluding certain cover, not paying out etc etc. Also there is a genuine dislike (understandably) of profit beyond all else. If there were organisations that could be allowed to fund healthcare but proftis would have to go to funding research or put in to research or emergency fund pots would these be more acceptable to people?

Miss_Piggy_2

Sorry, haven't read whole thread.

In reply to OP, I usually ask to see Triage nurse unless I feel its something only a doctor can deal with. I feel doctors appointments should only be for more serious ailments (only my opinion!)

I feel doctors are underated and overused. The triage system is very effective and should be used more widely.

Miss P
xx