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Independents' Day

What the NHS needs is a 'Fair Use' policy

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Tory MP and occasional locum GP Dr Phillip Lee put his head right above the parapet this week when he said that patients should pay for their medication if their condition was a result of their own bad lifestyle choices.

He citied type 2 diabetes as an example. If somebody chooses to eat lardy bacon sarnies for breakfast and pile down a couple of doughnuts to keep them going at elevenses then he reckons that they ought to pay for their medicines 'at cost', implying that if they end up injecting liraglutide then their bank balance will take as big a hit as the bathroom scales they almost certainly don’t possess.

Cue uproar on Twitter and on the comments pages of national newspaper websites. How dare he! Tory plans to dismantle NHS no longer secret! 

Well people, it’s like this. THERE IS NO MORE MONEY.

Dr Lee also took a swipe at patients with low consulting thresholds - those who phone us or show up at the surgery to tell us about their norovirus, common cold or verruca. It wasn’t like this in the old days, he reckons. Back then old soldiers would shine their boots till they shone, put on their best three piece suit and apologise for turning up unannounced to have a chat about the persistent crushing central chest pain they’d woken up with.

Older people don’t go on and on about their arthritic pains, they just get on with their lives and work around them. When the Baby Boomers hit their seventies and start to stiffen up and slow down, the NHS will have to invest billions in pain clinics, set up to tell the wimpy children of the Sixties that they’ll have to stop going on and on about the pain and learn to work around it, just like their Grandma and Grandpa did. But unlike Granny and Granddad they’ll get help from a team of specialist nurses, counsellors and physiotherapists.

Well people, it’s like this. It’s not going to happen because… THERE WON’T BE ANY MONEY THEN EITHER.

The NHS simply isn’t going to survive in its current form, the much-praised but never copied 'free at the point of abuse' model. I work in a health centre populated by prescription-happy health visitors, and my practice spends more on moisturisers and emollients than it does on simvastatin. So yes, I’m sorry that Sainsburys charges over six quid for a medium sized tub of E45 but that’s no reason for your kid to have a repeat prescription for the first ten years of his life just because he had a patch of dry skin around his navel in the puerperium.

It seems that for years we’ve been debating the same problems and coming up with the same potential solutions time after time - but when push comes to shove, nothing really gets done.

Why do patients with underactive thyroids get all their medicines free instead of just their levothyroxine? Why don’t we charge patients a small fee to consult and levy a fee if they don’t attend? Why don’t patients know the actual cost of a GP consultation or their monthly medicines? Why do we write prescriptions for pills and potions that are available over the counter for less than a pound? Why don’t patients have their own personal 'NHS Account' with an annual budget? Why can’t patients who really want an  expensive branded product instead of the NHS own brand generic be given the option of topping-up and co-paying?

I confess, I do hand over the occasional bottle of paracetamol or ibuprofen to parents who bring their snuffly kid in to the surgery as an 'urgent extra'.

But stapled to the prescription they’ll find an information leaflet about coughs and colds in children explaining to them, in the nicest possible way, that I don’t need to see the child or expect to be asked for a prescription next time around.

What the NHS needs is a 'Fair Use' policy. Our patients all know that there’s really no such thing as 'unlimited broadband' - if they do nothing but download music and movies all day and all night they’ll find their connections getting slower and slower as it’s throttled by their internet provider. The AA, who have saved my bacon on more than one occasion in the last twenty-odd years, now have a cap on the number of free call outs allowed per annum and if they get you home, tell you what needs fixing and you call them out again because of the same problem, you’ll pay for the privilege.

So let’s set some limits. Number of patient-initiated consultations, number of prescribed items, number of investigations, referrals, second opinions. Exclude screening procedures and call backs from the count.

But FFS, let’s do something. The time for jaw-jaw is over.

Dr Tony Copperfield is a GP in Essex. You can email him at and follow him on Twitter @DocCopperfield.

Readers' comments (23)

  • Copperfield for health secretary......

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  • Oh gosh - remember that patients are tax payers and they have paid for their health care in their taxes, direct or indirect taxation. Remember that GP's are paid out of taxation in effect. Remember that patients have already paid and continue to pay for their GP's and their medicines.

    Oh, and while I'm writing - there are some patients with type 2 diabetes who haven't got it through lifestyle - I'm one, I'm slim, BMI 19, never eaten junk or processed food yet I'm inexplicably type 2 - hey even my endo is puzzled...but it's definitley nothing to do with how I have lived my life !

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  • I'm a trainee working on a ward where patients, unhappy to be discharged, threaten to repeat the habits that brought them in if we let them go home.
    We waste days and days on people until they're 'in a good place'.
    I have a family member who was recently diagnosed type 1 diabetes. The support they got initally was very poor because they were self motivated 'and already doing so well why would you provide them with any further help?' In certain areas of the country the best treatments such as insulin pumps aren't available to those whose control is good- even if it could make it better.
    If people can't be bothered to look after themselves then leave them to it- and support those who want and will benefit from advice.
    Why is the current NHS so geared to helping those who blatantly refuse to help themselves?

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  • Anne Bedish,

    You do realize GPs are not employed by the tax payers don't you? We are in effect (though not directly) employed by the NHS which is commissioned using the tax pater's money. The difference is, we should not be tasked to do what individual patient demands, but rather to achieve the goals set out by the DoH. This cannot be done without having reasonable sense of social conscience and budget to match. Hence Dr Copperfield's comment above.

    I some times get people (often woman in their 20s for some reason) telling me I should do what they want as they are my paymasters and they paid their due, much like your argument. I always suggest they reconsider their understanding of the NHS and welfare system.

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  • What I want to know is why money is wasted on constantly hounding me for screening. My GP is lucky if sees me as a patient very 2 years. I do see him more than that, but as a colleague. Only the other weekend I handed him my screening and told hom to file it in the shredder. Then he and I had to sign a triple form to opt me out. He had to countersign the form as us women are too dim to make our decisions.

    Its quite frankly insulting to women and pure waste of NHS resources.

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  • Have you ever thought it might be insulting to the GP ?

    It is so because the Department of Health has tied funding to achieving targets in this area. We do it because the money is needed to pay the bills of the surgery. If we lose funding we lose the resources we need for patient care. It is as simple as that.

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  • Australia: emollients, anti-fungal creams, NSAID gels, anti-histamines and a host of other non-life saving medications are OTC or private scripts. The government script scheme has essential meds only. There's a small charge for each item, even if you're a pensioner or unemployed - so no popping in to see the GP for paracetamol for your toothache or sore throat. Many practices will also charge a 'gap' to those that can afford it. It all encourages sensible use of healthcare, and makes people value the service more than they seemed to in the UK. It also makes the funding of healthcare more sustainable into the future - rather than the unlimited demand on the NHS.

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  • Coming originally from Ireland the fundamental issue is that NHS patients have no appreciation of the costs involved in delivering an essentially free heath care system. The sense of entitlement is staggering. As most things are free then patients do not value them - all in favour of charging for DNAs, top up charges for the "must have Losec" patients - only when patients feel the financial effect of such behaviour might we be able to change behaviour......unless we do something and very soon to quote a famous TV character "we're doomed!!!" and then we will all be in the proverbial....

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  • Barry - the NHS is not an "essentially free health care system" - we all pay for it in our taxes - as do you.

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  • Anne - you are correct - essentially free to the user - taking the Irish example much higher tax rates and unless you qualify for free medical care you pay 50-60 euro to see your GP, pay for your meds and add in at least 2k for private medical insurance....removing the waste / unnecessary Rxs would reduce the cost to us all (and then hopefully we would get a tax rebate :) )

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder