Would a mixed NHS / Private model work?

Waywardmike

I can only speak about my own personal experiences with the NHS.

I'm not a very 'sickly' person, I can probably count the number of times I've visited the GP on one hand in my adult life (I'm 35).

When I was 26 I was sent for an ultrasound for an enlarged testicle, (turned out it was cancer), that was on a wednesday afternoon, the results were faxed to my GP immediately who then called me to say he'd booked an appointment with the urologist the next day. I spent the afternoon at the urologists and with a Macmillan nurse (fantastic people). Had the testicle removed the following Wednesday, then spent the next 3 weeks recovering, having a CT scan, banking sperm and having a kidney function test while the tumour was looked at and I was staged. I then one round of adjuvant Chemotherapy at Addenbrookes.

After that I had regular checkups at Addenbrookes (every three months then decreasing as time went on). I've now been discharged and am officially cured. I've been to the GP once since then to organise a vasectomy. my fertilty was unaffected thankfully and I have two lovely (for the time being anyway) children. How much did I pay during this entire process... £0 (if you disregard the taxes I pay that fund the system, taxes I'd pay anyway even if I was privately insured).

We had private medical care at work but I never signed up for it. I wonder sometimes whether I would have benefited throughout that process by having it. Personally I think not, everyone I dealt with was fantastic and it was remedied faster than I could have ever imagined, the standard of care I received was excellent.

IMO the NHS is fine for my needs, when I really needed it, it was there for me.

Maybe my opinion will change as I age and I rely on it more for a service or procedures where time isn't important.... Maybe it's time I should sign up for private healthcare, I'm not getting any younger...

wotsthat

Generali wrote: »

There would be outrage in Australia if you couldn't get a same/next day appointment with a GP in all but the most rural areas. There just aren't anything like the same sort of waits for an appointment that you have with the NHS.

Here it's just accepted that you discuss your problem in detail with a receptionist whose skillset, as well as 'phone answering, includes determining your medical need for a same day appointment.

I contend that one of the big problems with the NHS is the inefficiency that a 'free' service builds in. If we had free petrol, house heating or water would politicians expect usage to go up or down? Why do they expect something different from health care?

A barrier system at A&E with a £10 charge for patients and £5 for each member of their entourage and tumbleweed would be blowing across the floor.

Of course, it's not very well run either so whilst the public are taking the p**s on the demand side I'm not convinced politicians are the best placed to look after the supply side.

BobQ

michaels wrote: »

But it is worth looking at different international options, it always seems that any criticism of the NHS is met with a 'but look what happens in the UK' but actually there are lots of different international models.

The NHS is probably at the extreme of state funded plus state provision but does not seem to achieve the best health outcomes although it may do per £ spent, but being fully state funded it is at the whim of politicians and competing spending priorities. I am not sure if I am alone in thinking that at times I would be willing to pay a top up to benefit from an enhanced service and looking at the better outcomes in Australia and France where more provision is private even if funding is state provided with an insurance element.

http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror

The UK performs quite well in this analysis. In fact so does everyone compared to the US (did you mean US in the above?)

BobQ

wotsthat wrote: »

Here it's just accepted that you discuss your problem in detail with a receptionist whose skillset, as well as 'phone answering, includes determining your medical need for a same day appointment.

That is not my experience.

Generali

BobQ wrote: »

http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror

The UK performs quite well in this analysis. In fact so does everyone compared to the US (did you mean US in the above?)

It is an interesting piece but I would urge caution on 2 fronts:

1. International comparisons are notoriously tricky to make
2. The Commonwealth Fund is a pressure group that exists to promote health care for poorer Americans so it is perhaps unsurprising that they find a system like the NHS to be best. It is interesting that the UK comes top on almost everything except the bottom line, healthy lives, where it comes 10th of 11. If the NHS was the best system you'd expect better outcomes, no?

I'm not trying to defend the US system, mostly because it's not terribly good for quite a lot of people (although excellent apparently if you are rich). My experience of the NHS and the health care outcomes suggest to me that it isn't as good as many would have you believe.

My experience is that mixed provision as seen in France and Australia leads to better outcomes as there simply isn't the same pressure on services.

CLAPTON

BobQ wrote: »

That is not my experience.

it appears that a similar system was in use in mid staff A&E department

BobQ

Generali wrote: »

There would be outrage in Australia if you couldn't get a same/next day appointment with a GP in all but the most rural areas. There just aren't anything like the same sort of waits for an appointment that you have with the NHS.

This is an overstated problem in my view. If you declare your need as urgent you can get an appointment in my experience. It may not be with your GP but one of the practice GPs will see you. There are also minor accident units and walk in centres in many towns and an out of hours phone service that in my experience will see you after a telephone discussion of the problem with a nurse if it is needed.

I called my out of hours service at 2am on a Saturday with a condition that I realised was not dangerous but was likely to be a lot worse by Monday. I did not demand an appointment just explained the situation. After about 10 minutes on the phone I had a call back from a doctor 20 minutes later who gave me an appointment at 5am in a local heath centre with a doctor who gave me a prescription.

Of course I do accept that this may not be everyone's experience and if you regularly abuse the service because you have a sore throat or stomach bug they may not treat you so readily.

Generali

BobQ wrote: »

This is an overstated problem in my view. If you declare your need as urgent you can get an appointment in my experience. It may not be with your GP but one of the practice GPs will see you. There are also minor accident units and walk in centres in many towns and an out of hours phone service that in my experience will see you after a telephone discussion of the problem with a nurse if it is needed.

I called my out of hours service at 2am on a Saturday with a condition that I realised was not dangerous but was likely to be a lot worse by Monday. I did not demand an appointment just explained the situation. After about 10 minutes on the phone I had a call back from a doctor 20 minutes later who gave me an appointment at 5am in a local heath centre with a doctor who gave me a prescription.

Of course I do accept that this may not be everyone's experience and if you regularly abuse the service because you have a sore throat or stomach bug they may not treat you so readily.

It's a fair point and it's definitely good for me to remember that the plural of annecdote is annecdotes not data!

BobQ

Generali wrote: »

It is an interesting piece but I would urge caution on 2 fronts:

1. International comparisons are notoriously tricky to make
2. The Commonwealth Fund is a pressure group that exists to promote health care for poorer Americans so it is perhaps unsurprising that they find a system like the NHS to be best. It is interesting that the UK comes top on almost everything except the bottom line, healthy lives, where it comes 10th of 11. If the NHS was the best system you'd expect better outcomes, no?

I'm not trying to defend the US system, mostly because it's not terribly good for quite a lot of people (although excellent apparently if you are rich). My experience of the NHS and the health care outcomes suggest to me that it isn't as good as many would have you believe.

My experience is that mixed provision as seen in France and Australia leads to better outcomes as there simply isn't the same pressure on services.

I agree that comparisons are difficult. I too thought the rankings for UK seemed a little generous, although on previous reports (as I recall) UK performed well overall all (but not that well). I was just trying to point out that there is an air of pessimism in some people's mind who see the NHS as unaffordable and poor. In reality it is fairly good (I accept it may not be the best) and is reasonably priced. If we spent as much as France we could have better outcomes I dare say, but equally Aus has good outcomes without spending more.

lostinrates

BobQ wrote: »

This is an overstated problem in my view. If you declare your need as urgent you can get an appointment in my experience. It may not be with your GP but one of the practice GPs will see you. There are also minor accident units and walk in centres in many towns and an out of hours phone service that in my experience will see you after a telephone discussion of the problem with a nurse if it is needed.

I called my out of hours service at 2am on a Saturday with a condition that I realised was not dangerous but was likely to be a lot worse by Monday. I did not demand an appointment just explained the situation. After about 10 minutes on the phone I had a call back from a doctor 20 minutes later who gave me an appointment at 5am in a local heath centre with a doctor who gave me a prescription.

Of course I do accept that this may not be everyone's experience and if you regularly abuse the service because you have a sore throat or stomach bug they may not treat you so readily.

There are fewer walk in centres than there used to be. The NHs are still advertising one in the city that is closed ( not sure if DH said its an offy now?) A weekend walking in the larger GP centres that don't open at weekends so there were more might be useful for the rural but populated areas like mine. We rely on ood and treatment centres.


Our out of hours service in this rural area is actually rather good. Not provided by practice but still good. You go to one of the community hospitals to see an ood. Very good, on all occasions I've had to use it.

Minor treatment centres too, can be excellent.( sadly have had to go to those too)

I personally avoid a and e at all costs. For a start as a casual tactic, they are too far to make it worth while! The a and e's in both directions are a considerable drive, and neither is near the train station. When I was last at a and e I was kept in over night and discharged in the early hours and was grateful some one could collect me. While I FULLY ACCEPT transport, like health, should be a personal responsibility and cost, for out of city residents its not an inconsiderable additional cost or, depending on the nature of health problem, hassle, getting home. I most certainly would have managed, but it did give me pause for thought as to how I might in the future or on a day when the impact of my condition were different.