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At the heart of general practice since 1960

Tottering at the top of the world

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Yay!

We all knew the NHS was the best health service in the world (ahem…), but it’s nice to have it confirmed. A report by The Commonwealth Fund (a US organisation, nothing to do with the proper Commonwealth, it seems), comparing 11 developed nations, has put the UK health delivery system at number one overall, and top in nine out of 12 key health indicators.

Apparently, we lead the world in quality care, safe care, effective care, co-ordinated care, patient-centred care, access, timeliness of care, efficiency and low-cost access to care. The US comes last overall and in a number of indicators, despite spending more than twice the amount of money per capita on healthcare.

Of course, I have no idea what any of those indicators actually mean in real terms, and I notice we are only 10th out of the 11 nations in delivering ‘healthy lives’ – which, I suspect, is the whole bloody point of any healthcare delivery system – but let’s not quibble.

I’m as happy to take a pat on the back as any vet who treats diseases of the back legs of cows, but my naturally suspicious nature makes me want to analyse these findings.

Let’s look at just one where we supposedly lead the way: access. The media are constantly bleating about how hard it is to see a GP in a timely manner, but this comes down to the fact that consultations are free. People don’t always stop to think before using an appointment slot, meaning someone else has to wait.

The Royal College Of Nursing has debated the idea of charging a tenner for an appointment at the doctors – although what it has to do with them is a mystery to me – and maybe it is difficult for some patients, but I just can’t square this circle when I look at some of the reasons people turn up in my consulting room.

It costs the nation about £30 every time someone rocks up to see their GP – great value, I know, compared with almost any other professional/punter interaction. But these visits are not all used effectively. Here are just three, culled from my last two working days:

1 A gentleman used an appointment to thank me for treating his gout. He was fine and didn’t want any more treatment; he just wanted to say ‘thanks’.

2 A lady came to tell me how she’d got on after her operation. Like I wouldn’t get a letter about it, although admittedly not for a month or two.

3 Another lady brought her podgy teenager in, told me he didn’t like having his toenails cut, and asked if it would be possible for them to be done under a general anaesthetic (that one was a very short consultation).

They’ll all get a brief, but polite, letter from me suggesting these issues could have been dealt with differently, but I’ve been doing that for years and the number of absurd wasted consultation slots doesn’t seem to fall much.

I suspect that charging a fiver or a tenner might prevent that type of consultation, but what other, more significant, consultations might be prevented? I don’t know the answer, ladies and gentlemen. But our system, despite its lofty ranking, is very far from perfect.

Dr Phil Peverley is a GP in Sunderland.

Readers' comments (13)

  • On charging a tenner - how about the fee being waived if there is a prescription or a referral? That way treatment is still free at the point of care

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  • The answer is triage and education, not a fee.

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  • David Bush

    Perhaps we should make a 'virtual charge', i.e. no money changes hands but we advertise widely (waiting room, newspaper, TV advert) that every visit to the GP costs the taxpayer £30 and trips to A/E £80. Might that make people think? (I can hear you shouting out the answer!)

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  • No, the time has come to charge for GP and hospital care. It is widely done in other systems without disadvantaging the poor and will undoubtedly figure in the health insurance model that our lords and masters have in mind to replace the NHS.

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  • Vinci Ho

    (1) What I have learnt through 20 years in general practice is NOT to pay any attention to any 'credit' or 'condemnation' from the outside world. The job , however , is still about listening to our own patients, nothing more , nothing less. Hence, do not take 'opinions' too seriously( just like the bureaucrats don't take ours seriously either)
    (2) Charging or not charging targets only part of the whole problem. A system like NHS requires the full commitment of a government . That should be written in the constitution. Yes. People said we , doctors , should do this and do that because there is no chance the government will put more new money in NHS and hence general practice anyway. But why shouldn't that happen ? Why is it , for instance,the difference of corporation tax between US and UK is so substantial considering US does not have a social medicine system? I totally agree charging a small fees can help but will that give a government excuse to withdraw even more commitment from NHS? Think carefully , mate . Bottom line , it is all about the bloody old game, politics.
    (3) Surely, one can argue whether NHS should be scrapped altogether , same old right wing argument. Although I took very little away from this report about NHS being the best, I am sure people in other counties are having a lot of complaints about their health system ( at least I know about Hong Kong and China). Perhaps we really have overlooked the fact that we have a 'relatively' very good health system here. The old saying still applies ,' you only value something when you finally lost it'.
    (4) The government should take absolutely NO credit if NHS is the best in the world . It is all the people , us , who are loyal and believing what we are doing which keep NHS in its shape. Should be proud.
    (5) But like I said before , you have to believe what you say and do everyday before you can carry on. So yes, exit door is always there, no offence , we have to always make a choice about our lives .
    (6) NHS is a flag as I always say, good times and bad times. It has given us 'important' things in our lives( at least to me) but are we now willing to fight for it against those demons who want to burn the flag?
    (7) Life is only short, there are a lot of values and virtues which cannot be bought just by money.......

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  • The NHS is amazing, and it's our job to support it.

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  • Vinci Ho

    And for BMA/GPC
    Remember while we never really want to start a war, the war had already started on the day JH said he did not 'pick a fight' with GPs.
    For those who continue to insult and pay no respect to us , there is no room for 'being polite'....
    Of course, there are always 'prices' to pay in a war:
    There will always be those
    who mean to do us harm
    To stop them , we risk awakening the same evil within ourselves
    Kirk Star Trek into Darkness 2013

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  • The taxman takes almost 50 percent back so it only costs £15 even by your calculation. How come £30.00 pounds? 6 consultations for £60 per year is what we get in NI. It is £80 in England. That works out at £ 10 in NI if we ignore 40 percent paperwork.

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  • I note that the Tory press and the BBC are not covering the report, the lack of positive feedback for the NHS speaks volumes about their actual agenda.

    Only bad press for the NHS is good enough to be put in the public domain.

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  • Why is it a mystery to you what the idea of charging patients to see their GP has to do with the RCN? The NHS doesn't belong to doctors. General practice doesn't belong to doctors. Of course nurses have an interest in access to health care, we are patient advocates, we are patients ourselves. Have a look round your building, there might be even some nurses working there. If you really think that the nursing workforce shouldn't have a voice in these kind of debates, I suggest that you have a think about which is the biggest group of healthcare professionals and who spends the most time with patients.

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