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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

    While I do not in principle support a GP consultation fee from Monday to Friday , the devious and unrealistic ego of this government ,wanting to open GP surgeries as well as routine services in hospital ( read BBC health news today:A spat between leading doctors and NHS officials over a seven-day hospital service has led to the breakdown of contract negotiations.), has already divided people and doctors:

    (1) the problem of shortage of doctors and nurses(both primary and secondary care) is phenomenal . If it was not down to the Francis Report on Mid Staffordshire scandal , this government will rather employ less and less medical staff in hospital with the fallacy of better and better efficiency. Same mentality is being applied to GPs
    (2) If you ask me , as a patient , do I want my 'own' GP being available 12 hours everyday and 7 days a week ?My subjective answer is very easy to be a YES. But I think we all know , with common sense , that this is simply not possible and is also not safe.(I would argue giving GPs only 10 minutes to deal with patients' list of problems during weekdays , is not safe). Workload is already beyond what can be coped safely.
    But it is exactly this ambivalence these shameless politicians want to play to their advantage in attracting votes.
    (3) To realistically fund this fantasy , the budget for NHS easily needs to be doubled and this government only wants to cut more and more , the cheaper the better.
    (4) Morale amongst doctors and nurses in both general practice and hospitals are phenomenally low . Many good and experienced ones sadly have chosen to pack it up and leave.Patients are to suffer as a consequence. Hence , one can understand why more ways of recruiting resources are being proposed.
    (5) I think using a fee as a deterrent with a potential to stop patients to see their GPs is contentious and can be dangerous and of course, that does not prevent these politicians from cutting our funding even further as we then would be collecting from patients .
    (6) To me , opening weekends for routine GP appointment( as well as routine services in hospital ) under current setting is impossible and unsafe. There is a major difference between routine and acute services as both out of hour GP services and hospital on call services are always there. They also need to be properly funded as well as better sharing of information about patients with their GPs.
    (7) Yes. if one is so adamant that GP surgery must open on Saturday and Sunday , I can see then a fee to be charged is the only way to fund more GPs to work under this extraordinary time of our history.
    (8) As I always said , identify the origin before trying to manipulate the consequences and outcomes . Who is our common enemy trying to divide and rule?

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  • I foud this a very interesting article with many aspects I agreed, and disagreed, with. Do I think too many people go to the GP rather than try a bit of home remedy first? Yes, certainly. We seem to have lost the common knowledge on how to self treat many minor ailments, as well as the common sense to be able to tell the difference between minor and needs professional advice. Do I think patients value the NHS? Some do, some see it as a right for them to use as they see fit (not always the best way to utilise anything). Do patients have any awareness of the costs involved in providing medication through the NHS? Almost universally no. It may be free but that does not mean without cost and this message needs to be put forward much more strongly. Do I think there should be a nominal charge for all medication - as a principle I am against this because, irrespective of ability to pay, once you introduce a charge, you can increase it (Oh, the heady days when the prescription charge was 30p!) I cannot comprehend the idea of making an appointment then not attending - this shows a rudeness and a willful disregard for the system that is shameful to those who misuse it however if a patient makes an appointment for a particular time, they should be seen at that time, not 30 minutes or an hour later (that one is definitely a two-way street)
    In short, everybody - and I do mean everybody - service providers, users & commissioners need to come to an agreement of what is acceptable "behaviour" - and I know there will be occasions when this "bevahiour" cannot be met but that should be exceptional, not the norm. Basically, ll I am saying is we all need to act like responsible adults

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  • A good start would be education but the Govt gave the Central office of Information the axe - they don't want an informed populace.
    Lots of payment arguments, though valid, have had wider platform more recently - wonder why?! More money spent on transacting costs in recent years and less on actual care I suspect to be bigger picture

    Best yet article on that ever debated question of cost of internal market and charging patients here:

    https://www.opendemocracy.net/ournhs/caroline-molloy/billions-of-wasted-nhs-cash-noone-wants-to-mention
    (Previous select health committee attempted to put a tag on it but the new govt embargoed it indefinitely - wonder why??!!)

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  • Alot of patients take the NHS for granted and dont realise the actual cost and are wasteful.
    why not label the cost of the medicine or drug on the dispensing label
    may make the patient think ""my god -this one medicine alone costs £ 30 per month - and I am on 6 others too"
    "perhaps i am getting a lot for my taxes"

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  • Think again 3.45pm.a script costs over £7...I don't hear 'please NHS give me more' very often.

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  • "Do patients have any awareness of the costs involved in providing medication through the NHS? Almost universally no. It may be free but that does not mean without cost and this message needs to be put forward much more strongly."


    More to the point, do doctors actually have any idea of the real cost of medication paid for by the NHS?

    If they do understand costs, why is it that the NHS is charged £100s for Liothyronine when it can be bought for a couple of pounds on the continent? Why is it that a small packet of hydrocortisone tablets costs the NHS £45+, when the same amount of this drug can be bought for pounds on the continent and many other "Western" countries?

    The British taxpayer is being ripped off regarding drugs costs - and doctors go along with it.

    Before you lecture patients, sort your own houses out.

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  • Anonymous 1.04am: 'Pill' and 'ock' come to mind with your comments. Are you seriously trying to compare the rigorously MHRA controlled systems in place for procurement of medicines and medical devices in the NHS to your on line "all you can eat buffet" pharma originating from Burma, Bulgaria or the Asian subcontinent. Go ahead and order your Liothyronine and hydrocortisone tablets from an on line agent from Bolivia or Kathmandu. But please remember not to bother those pesky NHS docs if the tabs make you impotent, psychotic and break out in hives!!!

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  • @3:09
    Typical straw man - read the original post - which part of "Western countries" are you unable to read?

    We are talking about France, Spain, Greece, Portugal, Belgium etc. where the cited drugs (liothyronine and hydrocortisone) cost a whole lot less than they cost the NHS.

    Are they people of Western Europe dropping dead from their quality tablets? No they are not.

    The British taxpayer is being ripped off and doctors appear to be ignorant of this fact.

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  • Bob Hodges

    "The British taxpayer is being ripped off regarding drugs costs - and doctors go along with it.

    Before you lecture patients, sort your own houses out."

    What a silly thing to write. The UK actually has one of, if not the, highest rates of cost-effective generic prescribing in the developed world. Every so often, blips occur in the pricing and supply side of things under the tarrif, but they tend to be with niche/questionable productucts like liothyronine that are not major costs because they are not widely prescribed.

    A lot of non-medical trolls suddenly posting - has this article been linked somewhere?

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  • Great article Shaba , as usual to the point , but who will listen to our views ?
    I feel a limited number of free appts say 4 per year for those without pathology and 10 for those with would limit wastage , there has to be some sort of cap, thereby a missed appt is a token used .

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