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Gold, incentives and meh

Half of all managers expect NHS charging to be reality within a decade

Half of all senior NHS managers believe the NHS will be unable to sustain comprehensive care free at the point of access, and will have to charge for some services within ten years.

A Nuffield Trust survey of 78 senior managers found that 47% of managers thought it was quite or very unlikely that the NHS would still be universally free at the point of access in 2024.

The ‘Into the red’ report also found that despite Government plans to shift care into the community, spending on general practice had only experienced a 0.1% (£10 million) increase in 2012/13, compared with a 2.4% real terms increase for hospitals, and predicts similar increases for 2013/14.

And the report goes on to state that ‘there is no evidence’ to support ministerial claims that the Better Care Fund £3.8bn pooled budget for health and social care will reverse trends in rising emergency admissions.

The Nuffield Trust examined official financial data for 2012/13 from PCTs and hospitals, as well as provisional finances from regulatory bodies for 2013/14, and interviews with senior managers.

Health minister Earl Howe said the findings were ‘unrealistic’ and ‘pessimistic’.

Earl Howe said: ‘These predictions are pessimistic and paint an unrealistic picture of how our NHS is working.’

‘We know some parts of the NHS are under pressure due to an unprecedented rise in demand — which is why in very tight economic circumstances, we have taken tough decisions to increase the NHS budget by £12.7bn over this Parliament, and are ensuring the NHS is sustainable in the long term’

BMA chair Dr Mark Porter said: ‘This report provides audited figures that show the NHS is buckling under the pressure of rising patient demand and stagnating resources.’

‘Every part of our health service is suffering, from understaffed, overworked hospitals to GP practices that are being overwhelmed by the sheer number of patients coming through the surgery door.’

‘Instead we need to focus on working with health professionals and the public to find long-term solutions to the challenges facing our health service.’

At the annual LMCs Conference in York this year, GPs voted to oppose charging patients for general practice visits.

Readers' comments (21)

  • Charging the patient is long overdue.
    The usual platitudes about educating the patient to self-care etc are utter pie in the sky.
    There is only one way to make patients take more responsibility for using the service and that is to make every patient decide whether or not their ailment is worth the £30/40/50 fee for making an appt with their GP or turning up at A&E.
    And to those who whine that it would stop the poor and elderly etc from seeing a doctor, please explain why every other civilised country charges patients and they don't have that problem?
    If we charged, at a stroke the demand for appts would go down markedly, GPs could spend 20 mins with patients and have time in between surgeries to properly deal with results, manage patient conditions and so on. Gps would get some life back instead of the full timers working 11 hour days and stressing out.
    Please give up this uniquely British cult religion of a free NHS

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  • It's a bit of a no-brainer really. Since the government are unable to raise taxes to meed the funding needs of the NHS and match our competitors new revenue streams are required. The only choice is whether we do this through direct pay as you go or insurance. We have to accept the reality that you cannot have everything with an ageing demographic and rising inequality between the generations. The needs of the poor will still be met, probably better as most of the worlds co-payment systems massively outperform ours in terms of outcome if not efficiency.

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  • Vinci Ho

    Confucius said,' Things have their roots and ramifications, matters have their end and beginning. Only when you know what comes first and what comes last, then you are near the 'Way of Life' .' He talked about origins and consequences.

    Charging our patients is a consequence and it will be inevitable the way this is going. But what is the origin? The attitude and behaviour of the government must be changed because what is the guarantee that politicians will not withdraw even more resources from NHS once patients are to be charged? The consequence then will be we will have to charge more and more.
    Of course, one can take down the NHS flag and go for all medical insurances. Is that really what people want to have? Every health system has its advantages and disadvantages and I do not believe other countries do not have problems with whichever the system goes .
    However ,I agree that there can be a happy medium somewhere in between but you still need a government with conviction and commitment to really look after people .

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  • Having just seen a 50 year old lady with a 1mm pimple on her neck in my emergency clinic because she was concerned it needed antibiotics I am convinced re charging - unless someone can inject a shed load of common sense into the population.

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  • Vinci Ho

    Education of the public is part of this commitment and responsibility of the government . Misguided education is a form of ignorance , one of Beveridge's giant evils.....

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  • But the public will NEVER be educated wrt demanding appointments. I have been a PM 19 years and have heard every new Govt minister and GPC et al bleating about their latest public education campaigns. None have ever worked and none ever will.
    Charging isn't perfect, no system is, but charging will work and no other system will.

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  • Interestingly appointment charging does not necessarily reduce demand but it does empower the patient to chose who they see. The system we would adopt would be similar to the one we have for prescriptions in the UK. A lot of our demanding patients get these for free and adopting a similar system for appointments would negate any arguments about preventing the poor from receiving healthcare. What charging does effectively do is to make people realise that there is a monetary value to their appointment and that does subtly change the dynamic. Appointment charges are a double edged sword for a multitude of reasons but allowing patients to make co-payments to get the service they want is the only thing that makes sense in the current direction of travel. Politicians talk about choice but if one of my "healthy" patients wants a flu jab they have to go elsewhere - no choice there.....

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  • Charging patients is looong overdue - it is the only way they will take some responsibility. Forget about trying to educate patients - the horse has already bolted on that one.

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  • Having worked as a GP in Canada, where co-payment is normal, it does not necessarily reduce demand for consultations. However more consultations will bring more financial resources.

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  • According to the OECD, countries that charge for appointments don't necessarily have fewer appointments per person - they may well have a higher average number of appointments per person than the UK.

    Patients will still demand appointments - they'll just expect their money's worth and more if they have to pay for the appointment.

    If you think patient expectations are high now, you'll be in for a surprise if charging for appointments comes about.

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