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At the heart of general practice since 1960

NHS services have become an all-you-can-eat buffet

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Talk to a child about the founding principles of the NHS, and they will invariably say they sound just right. Like many people of all ages, they believe health is a basic human right and, unlike housing or food, should not correlate with the size of your pay packet.

But as these kids get older they realise human nature is such that we are liable to abuse what is provided for free. We tend to gorge on free-for-all buffets; I remember the lengths we went to as students to lay the ‘foundations’ of our salad bowl at pizza establishments. They were always left uneaten.

As a teenager, I remember suffering with viruses, period pain, abdominal pain (which I now know to be IBS) and headaches (which I now know to be migraines). I didn’t dream of attending the GP with any of these ailments as I felt they were a normal part of life. 

In today’s society, nothing is normal as you can’t be too careful, can you? A cough lasting two days is a chest infection until inspected by my magical tubes. A headache for three days is a brain tumour until proven otherwise by my ophthalmoscope. A relationship breakdown four days ago is depression, until my mental state examination.

And don’t misunderstand my point. I am an avid NHS supporter. It is a safety net for the poor, children and elderly and is hugely underfunded: only 9.4% of GDP compared with 17.7% in the US and more than 11% in France and Germany. 

But how can we offer fair services for everyone without discrimination, while also ensuring people use the system responsibly?

First, we must address DNA issues, which cost the NHS £700m a year. When I book an appointment at the dentist or hairdresser, my credit card details are logged and I understand I will be charged if I fail to show up. Yet there are no consequences for depriving another patient of an appointment in the NHS.

Drug wastage costs the NHS approximately £300m annually, but we continue to dish out multiple medications to patients who don’t pay a penny for them. A nominal charge for all patients, regardless of income, would deter patients from stockpiling drugs and asking for cheap, over-the-counter medications. Patients who want esomeprazole or Gaviscon rather than the alternatives, should have to pay for the privilege.

Those who wish to pay extra for these choices should be allowed to. I will happily see the commuter in my Saturday morning clinic for a fee of £75, provided an NHS prescription can be generated if required. Even commercial organisations in the US do not offer routine care on Sundays, as few people would be willing to pay the hike in insurance rates to cover this. Yet the Tories believe the NHS should offer just such a service.

Evidence suggests I am in the majority when I say I want the philosophy of this amazing institution to be preserved. But we have to think like adults, because if we continue to abuse the NHS, we will lose it.

Dr Shaba Nabi is a GP trainer in Bristol. 

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Readers' comments (37)

  • Vinci Ho

    A fee for consultation in the weekend is certainly up for a debate but manpower is still the first obstacle. One can argue these two issues can become interrelated as GPs may be attracted to work in weekends (whether they are already working during the week or not).

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  • Where I work there is a small fee for each script item - people don't stock-pile, there's also a 'gap' payment on-top of the government rebate for a consultation - and GPs can set this at their chosen level - there's definitely less abuse of the system than in the UK - and yes I work in Australia now. I don't think there's any political will to start charging in the NHS, and reduce the free-at-the-point-of abuse culture.

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  • An excellent comment and 100% accurate.What I find of concern however is that I remember reading an almost identical article by a then Pulse commentator in 1981 when I first entered General Pracice.No one either medical or political will dare change the system as it is too embedded in society.The only way will be if the system implodes naturally with no blame apportioned to politicians as I am sure this is their hope.

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  • Buffet - more like a free bar at the end of a wedding. Queue for the bar, half drunk drinks all over the place, and various people behaving disgracefully.

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  • "A nominal charge for all patients, regardless of income, would deter patients from stockpiling drugs and asking for cheap, over-the-counter medications."

    How do you propose that people born with severe disabilities will be able to afford a "nominal charge"?

    Easy to make these statements from the vantage point of a wealthy GP, less easy if you're living on the breadline.

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  • Your 'nominal charge' is still prohibitive if - like the sickest patients - you have multiple morbidities and require several prescriptions every month.

    In terms of drugs charges, we should look at what the NHS is paying suppliers. For example, 10mg hydrocortisone tablets for which the NHS pays £60 per pack of 30, when the same tablets cost just a few euros on the continent.

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  • Thank you for an excellent entry.

    If it's free - it's a cheap commodity that can be thrown away.

    When there's a £30 billion pound funding gap - can the tax payer really afford to subsidise the non-attenders, the frequent fliers and inappropriate users?

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  • A nominal charge would be affordable to the majority of the population because the poorest would be subsidised as with housing and other benefits. Most of the Europeans have some form of charging that is affordable to all and ensures their medical service is valued and used appropriately.

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  • Farah Jameel

    Well done Shaba, as always saying it how it is.

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  • What you propose is appropriate for people who can pay the costs & fees but due to social inequalities, mental health & poverty this would not work for the majority & incur higher health costs. Furthermore lower end hairdressers only take cash and dentists in high poverty areas do not take credit card details as lots of their patients do not have a bank account. That is the reality of our not so great Britain today.

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