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LMCs draw up explosive 'plan B' to take GP practices outside the NHS

Exclusive LMC leaders in England are looking at potentially taking GPs out of the NHS, which could even involve charging patients directly for some GP services, Pulse has learned.

Pulse has learnt that English LMCs are considering breaking off from the GPC due to disillusionment with the national negotiators and setting up a 'National Association of LMCs'.

They are following the lead of the Northern Irish GPC, which is currently developing a ‘Plan B’ in preparation for a mass resignation of GPs.

Pulse understands that the Northern Ireland document is looking at potentially charging patients, basing it on the Republic of Ireland model, where practices set their own fees for patients. 

The GPC in England called off plans in August to ballot members on potentially submitting undated resignations or industrial action after claiming that it has won concessions on workload from NHS England.

But the Northern Irish GPC is to press ahead with plans for a mass resignation, which is being supported by grassroots GPs with a meeting earlier this week in Belfast drawing 200 GP attendees, 97% of whom supported the plans.

Pulse has learned that Northern Irish GPC chair Dr Tom Black has already drawn up a 27-page 'plan B' modelled on general practice in the Republic of Ireland.

Dr Black told Pulse: ‘I think that I would rather have a contract directly with the population than with the Government.

'We already have a situation here in Northern Ireland that one mile as the crow flies from where I am sitting, patients pay to see their GP. We already have a model in the Republic of Ireland that works very well and gets morbidity and mortality statistics which are consistently better than in Northern Ireland.’

LMCs in England are currently considering drawing up 'Plan Bs', following the lead of Northern Ireland, Pulse has learnt.

Oxfordshire LMC chair Dr Prit Buttar is preparing a report for Berkshire, Buckinghamshire and Oxfordshire LMCs (BBOLMCs) on a range of radical alternative options for GP practices in the region after criticising ‘GPC representation and protection of general practice'.

He said that the LMC was considering ‘everything from one extreme to the other’.

Dr Buttar said the LMC was looking at ‘the economics, and the financial reality of what life outside the NHS would look like. How practical is it? How affordable is it? What are the likely consequences for practices and their patients?’

He added: ‘At one extreme, currently the situation is that you bill patients for HGV medicals and stuff like that, while the state pays for everything else.

‘The other extreme is you walk away from your GMS PMS contract and set up privately.’ He added that there were lots of 'shades of grey' between.

Dr Buttar added that they were not the only LMC in England looking at drawing up a plan B for their GPs.

He said: 'There is a general mood of, I suppose, a mixture of resignation and frustration that people need to start looking at alternatives. There is more than one area of the country looking at this, and what can and cannot be done.

The LMCs have also revealed that they are looking at the potential of paying GP levies towards a 'National Association of LMCs' rather than GPC in future.

Dr Paul Roblin, chief executive of BBOLMCs, told Pulse that 'at the moment we’re not particularly impressed with what the GPC is doing to make general practice a more desirable profession to enter'.

But he admitted that the idea of a plan B 'wasn’t universally received in Oxfordshire, because people felt their livelihoods were entwined with the NHS model' and that 'to extract themselves from that would be personal, financial lunacy'.

A BMA spokesperson said: 'The BMA GPs committee is totally committed to supporting and working with LMCs in representing all GPs across the UK. That is why we have completed a major review of the structure and function of GPC to enable closer working with, and optimal partnership with LMCs.

'We have been robust in our negotiations with government, and have been consistently outspoken in challenging flawed political policy such as routine seven day opening. We therefore do not recognise the unsubstantiated description of GPC’s approach as described in the comments of one representative at a recent Oxford meeting, and we do not believe this is reflective of the constructive working relationships GPC has with the overwhelming majority of LMCs.'

 

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Readers' comments (62)

  • This is exactly what the government is looking for. Their plan A is working.

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  • whats wrong with this? This is the reality. Everybody has to face it including patients. They have enjoyed free for all buffet for long time. Its time to contribute.
    Agree with earlier comment. This is what government has wanted from long time, to be precise since 1988 when need for privatisation was realised ,but they just could not openly admit it as this free NHS concept is revered by everybody hence whole drama of increasing demand and choking supply which ultimately leads to collapse of system.

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  • Isnt Dr Bahalkar forgetting that patients already pay via National Insurance and taxes ?

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  • 10.20am you could argue that we do already pay for the NHS via our National Insurance contributions as was the original intention when it was set up. The fact that subsequent governments have used it to sustain their day to day finances is at the heart of the problem

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  • About time too.

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  • This is playing directly into the government's hands. When the NHS finally falls apart, the government will be able to say 'it's not out fault the NHS has gone down:the selfish GPs wouldn't work with the NHS and have gone private to line their own pockets. Blame them, not us.'

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  • The UK is only spending around 7.5% GDP on NHS and 9.5% with private included. This is much lower than France and Germany at around 11% so in fact, the tax-payer isn't paying the going rate for healthcare which is why we have a crisis.

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  • 10.38 It really doesn't matter if we have to take the blame for this. What matters is that healthcare is provided.

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  • @GP Partner 28 Oct 2016 10:20am. Let's not forget that many of those who are now most in need have spent their working lives paying taxes to fund this healthcare model.

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  • @ Anonymous | Work for health provider 28 Oct 2016 10:32am

    Isnt Dr Bahalkar forgetting that patients already pay via National Insurance and taxes ?
    -----------
    Possibly didn't 'forget' it. perhaps never knew it in the 1st place?

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  • 10.40 No. They paid tax to fund the previous generation and lived unsustainably. The boomers stole their childrens future and are now reaping the rewards.

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  • Great news for the 'bum' bailiffs who will make a fortune 'collecting' debts from patients and/or their surviving relatives.
    Now where did I put those fantasy novels by Cronin?

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  • I did an extended hours surgery this morning. Two patients didnt turn up and one came because he had a wart on his finger that is just at the point where he holds his cigarette and it rubs and hurts. Such bullsh@t is not sustainable. You dont hear of people dying on Eire streets because they have to pay a proper going rate for primary healthcare.

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  • can we scotch this myth about baby boomers stealing this generations future? We worked 100 hour weeks with overtime paid at 30% (NOT 130%),did compulsory 24-hour GP cover, waited 2 yrs even to be granted a mortgage, interest rates reached 15%, inflation reached 27%+, tax rate were higher we couldn't afford a washing machine or go abroad on holiday until we'd been together 3 yrs. We didn't have designer clothes, mobile phones; a night out was a couple of drinks at the local not megabucks. And yes we were evicted from our hole in the road. We have paid our dues, and any generation not wishing to support previous ones should think it through.

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  • Vinci Ho

    I can see where the arguments arise in this dilemma.
    In my opinion , the power of the anti-spinning strategy (as I always advocate in this war) lies on the words 'Plan B' not Plan A. And the right message needs to get out there to let people know how dystopic the government had made general practice and hence NHS , become. Even the loyal Toy Soldiers had to rebel.Yes , the other argument is this would be walking into a trap but politics is always about saying/doing the right thing at the right time at the right place in history , the 'supreme moment ', kairos. I would not even think one could push this Plan B 18 months ago but one day of politics is too long . The gravity of politics somehow reminds me Einstein's general relativity, the more intense the gravity ; the more extreme time-space is curved(warping). That was then, this is now.
    And I agree that this plan B needs a lot of background research to provide substances for colleagues to support and compare . Every region of the country will be different. But the most embarrassing thing to a government is a verdict of a complete failure to deliver health services ,for instance, in the capital and big cities .
    This battle goes on.....
    Good luck, comrades

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  • So instead of "billing" the NHS, the GP will invoice the patient - who will (probably) pass that invoice on to the NHS for payment; either that or GPs will invoice the NHS directly, who, in turn, will negotiate a group rate and any GPs charging more will not be approved - So, in other words, the same system as now but with LOTS more paperwork

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  • To all those who are saying that they pay their taxes and national insurance so why should they pay for their health, Friends I am very much aware of it. but what you don't realise is how expensive is health care? Do you even know the real cost of Gp appointment to NHS (approx 30 £) ,cost of attending A&E (£90) and cost of Hospital appointment 9150-400£ depending on speciality) and cost of hospital stay in ward 300£/day & ICU ( min 1500£/day). How many people pay for prescription charges (less than 10%). Thats the reality. This country spends much less on health care than any of the developed countries.
    GPs get paid aprox 140£ per patient/ year which is same as many of you pay for your dogs insurance.
    This NHS system works on insurance based system and as with any insurance when users use it more, premiums go up. So either government starts paying more to hospital/ GP or someone else pays for it.
    Average punter has taken more out of system than they have contributed to it. You all can work out yourself.

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  • Still on the plus side, there will be lots of money saved by DoH because they won't have to pay GP pensions or building/rental/staff costs directly. Also, national vaccination contracts will then open up to AQP - bring it on!

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  • Vinci Ho

    The other anti-spinning slogan is clearly the broken 'promise' of the money going into NHS after Brexit.

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  • Anonymous | Pharmacist28 Oct 2016 11:00am


    I'm sure you'll enjoy the competition from dispensing surgeries everywhere too!

    I think the biggest risk is to pharmacies - unfortunately some of the biggest pharma co. would be happy to cut out the pharmacy role totally

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  • The problems is that the Great British Public has been part of the problem. Not enough is paid for Primary Care. It's Government's job to fix this, not ours.

    There is nothing to say that individual GPs should be forced to work in an unsatisfactory, dangerous (at times) system. This is not our problem to fix.

    Personally I would welcome privatisation of this market. As a patient, it wouldn't be good for me. As a provider, I know that I would work less and earn more.

    Unfortunately it's time to stop this lie - you cannot have excellent primary care for approx £130 per year - it just doesn't add up.

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  • Dear Pharmacist at 11.00 am .You are very much ill informed about GPs pension and staff costs. Please go and check facts. GP partners pay for their pensions themselves (both employees and employers contributions). Staf cost are paid from GPS gross income.
    With regards to payment of rent, yes that is paid by NHSE ,they can stop paying rent and increase our gross payments .Its one and same.

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  • Took Early Retirement

    I think there was a misprint: the BMA statement should read, "The BMA GPs committee is totally committed to supporting and working with Jeremy Hunt in mis-representing all GPs across the UK. That is why we have completed a major review of the structure and function of GPC to enable closer working with, and optimal partnership with Jeremy Hunt".

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  • Took Early Retirement

    Also, the idea that patients have somehow "already paid" is a myth. If they did (and the same for education and social care) we would npt be running up billions in debt every month. The problem is that the British Public want a Rolls-Royce Sevice, but want to only pay for a Hyundai.

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  • But I am sure that the pharmacist knows that the 140/pt includes staff wages and running costs. etc. Profit in NI used to be 80 pounds per patient year, for about 4 consults and 20 other contacts [ prescriptions, lab, letters, phone calls, treatment room etc].
    I think it is good value but obviously the Govt does not think so because they have cut the share of GP land from 11 to 5.5%, so that profit is about 56 for 6 consults and 32 other contacts per year.
    Ultimately, market forces will either find enough GPs at that rate or they will be gone and may find a better rate. Only time will tell.
    In any case, I think different causes will change doctor land. The GMC, litigation costs and trauma, CQC and the dangers associated therein will decrease the folks wanting to do Medicine.
    I know that I would not embark on this perilous journey today.
    I would have become a computer nut or looked out at the stars. Medicine is just frightening and I do not recommend it to anyone.

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  • £140 yr for pet insurance, wow that is cheap who are you insured with.

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  • Dear GP Partner, its bulk discount 1 dog and 2 cats (approx £140/ animal)
    Moral of the story is people whinge at GP getting that much amount to look after them, so basically government equates people life same as animals life. Thats great for animal lovers but not for us human beings.
    Public has to realise that If you want Rolls Royce service be prepared to pay for that. ,Don't expect that service when only pay for Fiat.

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  • 10:55am The boomers have done a lot of damage, not you personally. We know most doctors did 100h weeks in the past but things have changed and you weren't hunted to extinction by venal lawyers and a corrupt government. As for mortgages - where have you been living? - The housing crisis is at least as bad as the NHS one! A short period of hyperinflation ate away at your debts unlike the present medical graduates who owe £100,000 and are threatened with being imprisoned in the NHS to pay back their "training". Mobile phones are not really a luxury item any more and at least you still had a local rather than a rip-off wine bar! Good good, how out of touch can you be with the struggle of the millennials? No wonder they are unhappy. The boomers have a huge debt to pay to society and the creditors are knocking on your door...

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  • I wonder where have all those anonymous contributors who have been saying that because people pay national insurance contributions they should get free health care for rest of the life have gone?

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  • Having had a couple of days off I woke at 3:30 this morning (2hrs before my alarm) worrying about what I would come into this morning, and how I would squeeze the quart of demand into my pint pot of a day. Working in NHS general practice is like being waterboarded for 40hrs a week. And I'm not even clinical.

    If you think you have a better alternative I'm all ears.

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  • The Government is pushing us to strike/ go private . They want the NHS to fail in order to privatise it. Bronze funding = bronze service . Supply what is paid for. Let the politicians take responsibility . Don't let them off the hook by allowing them to force us out of the NHS .

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  • Wholly regrettable. Equally inevitable. It’s a 1948 funding model failing to cope with 21st century life expectancy.
    You can’t argue with an exponential demand curve.

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  • This comment has been moderated.

  • 'Mass resignation'...cardigans still Talking that Talk...armchair , red wine talk ...too drunk to Walk that Walk .

    Inevitable Privatisation staring you in the face and you still can't see it! Been on the cards for 5 years...Merry Xmas GPC/NHSE and thank you for playing your part in Plan B !

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  • P Bahalkar seems unable to recognise the hand that feeds him or that people registered at his practice have more knowledge about the the way the NHS was created and funded by citizens on behalf of all in need of care than a young twirp of little intelligence will ever have.'Buffet'!! there never has been one and nobody expected one or thought that some GPs like P B would feel so much hostility towards people who do not in general misuse the service.quite the opposite is true - try to get to know people rather than slagging them off to satisfy a denigrating stereotype P G - or are you using Pulse to have a bit of misplaced 'fun'?

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  • "P Bahalkar seems unable to recognise the hand that feeds him or that people registered at his practice have more knowledge"

    There is nothing to suggest that Bahalkar doesn't understand the detail about the creation or funding of the NHS. Equally, there are no grounds to question his intelligence.

    However, there are grounds to question yours: the reasons for the creation of the NHS are irrelevant. The fact is that the funding does not meet the demand and this is unsustainable.

    Bahalkar seems to be closer to the truth than you are.

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  • Nye Bevan said it best (about the National Insurance “Fund” actually. He said (and you can Google it)
    “Comrades, there ain’t no fund!”
    It’s a state sponsored Ponzi scheme - fine when there are more people putting in than taking out; collapses when the reverse happens - like now and henceforth.

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  • Dr Buttar was "looking at lots of "Shades of Grey".
    How many precisely??

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  • Has anyone asked the patients how they would feel about paying a little extra weekly for what is now a much improved national health service?

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  • Patients will not care as they take it all completely for granted. They will only start to care when they realise by doing nothing, it has been lost

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  • Interesting development. It would be sad to lose the NHS but not all the interference beurocrasy and excessive workload. Being able to decide how many appointments you can see in a day rather than it being open ended and hence dangerous.

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  • I find the content of this article very very discomforting. The likes of people like Prit and Paul, both very knowledgable to come out with this, right in the middle of contract negotiations, maybe they know something and are trying to help GPC, the timing is rather curious considering the LMC meeting took place in September.

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  • This comment has been removed by the moderator.

  • i had a 10 year olds mother at the end of a consultation about another issue tell me 'oh by the way it occured to me that my son could have some loratidine for free on prescription. He doesnt use it often' I reply 'Why do you want me to prescribe something thats so cheap to buy?" She replies "because its free for him" I reply "this conversation we are having now costs money, the ink in my printer ther prescription paper, the charge from the pharmacy to the NHS and our presciption budget is not free. Loratidine can be purchased for a pound from a pound shop i know i have some in my pocket for my allergies. If you want your boy to still have free health care when he's your age dont ask for OTC meds from us. Obviously if its something very expensive or we directly recommend it we make an exception but this isnt one of those occasions' fortunately she took it without complaint. Ive tried tjat elsewhere and got abuse and entitlement in return... i want more funding to provide superior service shorter waiting lists and improved outcomes as well as reducing work load and stress. I dont want government funding just to feed a sense of entitlement. We have lost our way somewhere we need to reign it back in

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  • Anonymous | Other healthcare professional28 Oct 2016 5:41pm

    I think you don't understand the misuse of NHS by patients. I have had so many requests for OTC meds from patients for themselves and their kids. If there is a small misuse, then yeah, it can be sustainable. Now its not misuse anymore - its entitlement. one guy told me,"I f...g pay your wages" for refusing to prescribe paracetamol - 15p for a box in shops. I kept quite. I didn't want to lose my job/risk another complaint. I was so close to saying, '' No, U don't f....g pay my wages. But my taxes pay your benefits. I know because I did your sick notes and I know from the DWP letter you are on long term disability.

    Anonymous Health care professional - U have no clue whats going on and how serious this is. Just don't comment on this website please.

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  • Correction.

    I know from the DWP letter you are on long term disability without any illnesses.

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  • In the UK the NHS has attained godlike status, there is an almost religious belief in it being the only model of healthcare that is even conceivable, whilst it has massive benefits we should not forget it's weaknesses because of blind faith in it!
    GP does not work! It is underfunded, overused and collapsing nationwide, can our work be done in a different fashion? Perhaps, we need to collectively re-examine how we provide primary care services with the budget and resources allocated to us and then decide as a profession if we can consider alternative models of care, private GP? Perhaps! The way things are going in my patch presently means that there won't be any gps left anyway in a few years!

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  • Those who criticise this initiative need to realise that GPs now have only two choices - to broil gently in the pot of increasing workload and decreasing resource, burning themselves out until exhaustion or breakdown forces early retirement - or to look at other inititives such as the one reported here. There are no other ptions currently on the horizon.

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  • This is heresy.

    everyone knows that the NHS model is sacrosanct and we must never ever consider any other models. If we ever do then the universe will collapse in on it's self and we will cease to exist.

    no we must soldier on and find a way to deliver care within this system for as cheaply as we can but must not scrimp on staffing or quality if care. as pointed out the public (well most) pay taxes. Even if they paid 1p / year for GP care that's no excuse. We must be innovative and use new technology (which gets paid for by pixie dust), and have enough staff (who will obviously work for free) and provide every service that the public wants - even expensive cancer drugs, top of the range scanners etc etc. All of these items can be paid for by magic beans and pixie dust.

    the bottom line is - we are out of cash and our collective leaders have no solution. what the LMC have cheekily suggested is that all options are considered to see what possible solutions there are.

    look even if all GPs in the UK worked for Free we still won't have enough money to pay for care i.e. the other staff, equipment, drugs etc. you can hate GPs as much as you like but no money is no money.

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  • Note to Editor Nigel. Perhaps Pulse can help this debate by doing a big feature on national-scale private GP models like Ireland. How do they work? What's the day to day GP experience like? What's the patients view? What do secondary care think of it? What's the outcome data look like? What are the financials.

    The way things are going, we will need the info.

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  • Honestly don't think patients will mind that much if we start slowly introducing the notion our service is not free. Remove the restriction on charging your own patients for additional services - such as weekend or late night appointments. Many of us would happily see our own punters for, let's say £25 per 10 min appointment paid on booking. Some people happy to pay for convenience. That's how it should begin.

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  • I remember as a child well before I went to medical school or even contemplated medicine as a career when the prescription charge of 6d (decimal 2.5p) was introduced in I believe in 1966 (I maybe wrong as I was very young at the time) and I recall experts saying people wouldn't be able to afford scripts and the outrage at having to pay for medicines by some of the population.
    In fact the number of prescriptions filled went up I believe by 10% as they now had value.
    I work in Oz and have done so for decades. It seems to me, if the National religion of America is the right to bear arms then the right to free health care is the National religion of Great Britain.
    I charge a fee for most patients and the government issues a rebate that is paid back into their account usually that day or the next day. The internet is quite effective these days.
    I can choose to accept the governments very low rebate should I so choose to make the consult free. It is up to me to assess the patient's ability to pay and by and large the profession gets it right. Waiting times are non existent and specialist referrals I can mostly get seen within weeks if I twist my mates' arms.
    I understand that there are many patients who say they cannot pay in Britain. My reply is why do you drag the whole population down to the lowest common denominator and by the way how does that result in quality care.
    Last time I was in the UK I ran out of Pregabalin and was told by a GP it was"Black banned".I then asked for a private script and paid for it and sent the bill to my health fund to be rebated. No worries.
    My friends and colleagues,there are many examples of how to fund health care in the world. America is one extreme example as is the NHS. Both appall me. There are many other middle road examples and as is often the case with many problems the middle road is often the best course. The Republic of Ireland is another example with non free health care and better morbidity and mortality statistics. Look at the longevity statistics of Australia versus those of the UK.

    Is"free health care" killing your patients?

    I suspect GPs might have to charge some patients in the UK. Now I have committed sacrilege. Sorry.

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