Is privatisation all it's cracked up to be?

Pennywise

Andy_L wrote: »

Most GPs are self employed/ small businesses who provide services to the NHS though

But it's not true privatisation because their "customer" is the NHS who sets service standards and pay rates. The link between doctor and patient is broken from a commercial point of view as, like the railways, the state is still in control.

If "customers" had real choice and power, things would be very different. If a patient had the choice of surgery and the doctor had the freedom to run their business without state interference, the surgery would open at hours to suit the patient and provide the services that the patient wants. As it is, like railways, the patient has the "choice" of getting exactly the same "service" from Surgery A as Surgery B, neither of whom open lunchtimes, evenings nor weekends, so in reality, because of state control, there is no choice.

Compare with dentists, opticians, etc. I am completely free to choose when and where I have my eyes tested or my teeth fixed. These "private" firms, whilst still funded by the NHS, offer lunchtime, Saturday and evening appointments because of proper competition. Basically because the customer can shop around. You also tend to get far better service from truly private firms (like opticians and dentists) - the receptionists and counter staff actually give the impression they want to help you rather than you being an inconvenience as is the case in most GP surgeries I've endured.

Andy_L

Pennywise wrote: »

As it is, like railways, the patient has the "choice" of getting exactly the same "service" from Surgery A as Surgery B, neither of whom open lunchtimes, evenings nor weekends, so in reality, because of state control, there is no choice.

My GP's surgery opens lunchtime & weekends. Now getting an appointment is difficult because everybody else wants to get then as well and you might not get "your" GP (if that matters to you) since they deserve the odd weekend off now and again.

Andy_L

Pennywise wrote: »

Compare with dentists, opticians, etc. I am completely free to choose when and where I have my eyes tested or my teeth fixed. These "private" firms, whilst still funded by the NHS, offer lunchtime, Saturday and evening appointments because of proper competition. Basically because the customer can shop around. You also tend to get far better service from truly private firms (like opticians and dentists) - the receptionists and counter staff actually give the impression they want to help you rather than you being an inconvenience as is the case in most GP surgeries I've endured.

Assuming you can find an NHS dentist. Most adults don't get NHS optician funding (I think Diabetics do)

Pennywise

Andy_L wrote: »

Assuming you can find an NHS dentist. Most adults don't get NHS optician funding (I think Diabetics do)

No problem with NHS dentists around here. Diabetics and children get free eye tests - it's easy for us to get appointments whether paid for or NHS for both opticians and dentists. More importantly, we have plenty of choice. If we don't like the optician or the service is poor, we move along the High Street to the next one - most operate in different ways, so there's real choice. You just don't get that with the identikit GP surgeries who get paid for numbers on their lists, not paid according to how many visits, reason for visits, etc. That's why the service is generally poorer than proper independent health practitioners.

Pennywise

ukcarper wrote: »

That's why there would be no public libraries as they wouldn't be profitable.

There are alternative libraries open to the public that aren't publicly funded, i.e. you pay an admission fee. Often part of museums. They stay open because people are willing to pay a nominal amount to use their resources, backed up with charitable donations. They wouldn't survive if they only opened very limited hours to suit the staff and shut for a two hour lunch break!

A local authority library will never make a profit because it doesn't charge people. So it doesn't matter to its profit/loss whether it opens 10 hours a day or just 4 hours a day. It's income is the same - zilch! So it's nonsensical to argue that because it's not used too much it should be closed when it would be used a hell of a lot more if it opened when people wanted it to. Isn't that the idea of a "public service" - i.e. to serve the public?

Graham_Devon

Pennywise wrote: »

No problem with NHS dentists around here. Diabetics and children get free eye tests - it's easy for us to get appointments whether paid for or NHS for both opticians and dentists. More importantly, we have plenty of choice. If we don't like the optician or the service is poor, we move along the High Street to the next one - most operate in different ways, so there's real choice. You just don't get that with the identikit GP surgeries who get paid for numbers on their lists, not paid according to how many visits, reason for visits, etc. That's why the service is generally poorer than proper independent health practitioners.

That's not factually correct. Theres a lot of weighting which goes into working out these things, including age, deprivation etc which all links back to likelihood of visits etc.

Graham_Devon

Pennywise wrote: »

A local authority library will never make a profit because it doesn't charge people. So it doesn't matter to its profit/loss whether it opens 10 hours a day or just 4 hours a day. It's income is the same - zilch! So it's nonsensical to argue that because it's not used too much it should be closed when it would be used a hell of a lot more if it opened when people wanted it to. Isn't that the idea of a "public service" - i.e. to serve the public?

Sure, it may not make a profit, but it still has cost control to consider.

You can't just "open longer" without spending more money on the service.

Pennywise

Graham_Devon wrote: »

You can't just "open longer" without spending more money on the service.

But it's not worth opening at all if it's opening so few hours that few people can use it.

Graham_Devon wrote: »

That's not factually correct. Theres a lot of weighting which goes into working out these things, including age, deprivation etc which all links back to likelihood of visits etc.

Yes, I know how the funding works. But my comments are factually correct as funding is based on "likelihood" as you say, not according to reality as I said in my post, i.e. the actual number of visits and reasons for visits. Dr Fred gets £x per year for patient Jim based on Jim's medical conditions, regardless of whether Jim actually uses those services. I.e. proves my point that funding isn't closely linked to the actual real patient's use of the services. There's no incentive for Dr Fred to actually provide the services he's being paid for. Now, if he was paid according to reality, then he'd make damn sure he could offer the services in the manner and format that Patient Jim could avail himself of.

If an optician got paid according to the number of children on his books, there's no incentive for him to open more flexible hours to encourage the parents to bring their kids in. He's getting paid whether or not. That's why in reality, because he's paid according to actually doing the eye tests and supplying the glasses, he makes himself available at times and in locations suitable for the parent/child. It's a complete switch of funding compared with GPs and as result, a better service for the customer.

Andy_L

Pennywise wrote: »

Yes, I know how the funding works. But my comments are factually correct as funding is based on "likelihood" as you say, not according to reality as I said in my post, i.e. the actual number of visits and reasons for visits. Dr Fred gets £x per year for patient Jim based on Jim's medical conditions, regardless of whether Jim actually uses those services. I.e. proves my point that funding isn't closely linked to the actual real patient's use of the services. There's no incentive for Dr Fred to actually provide the services he's being paid for. Now, if he was paid according to reality, then he'd make damn sure he could offer the services in the manner and format that Patient Jim could avail himself of.

What about the extra payments they can get for weekend/evening opening, hitting %age targets of vaccinations etc?

look private GPs. Many of them don't open weekends/evenings either.
I had a plumber in at the start of the year to do my bathroom - guess what: he didn't work weekends either

Conrad

One approach to ownership I quite like the look of is the German pension sector owning large swathes of the rental property market often state subsidised, and in return accept relatively modest yields.


UK Housing Associations trouble me on many counts, they don't seem very efficient and yet again far too many high paid staff found their way into most of them. I deal with one such firm, it pays vast sums to contractors and consultants way over the top, so much so that one of it's building contractors gives most of it's staff an Audi company car. I'm talking raw recruit trainee project managers etc. Just cant imagine this in Germany.