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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)

  • and why do people with Cystic Fibrosis have to pay for their prescriptions?

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  • not wanting to sound unsympathetic to people with CF but a prepayment cert for 12mths costs something over £100 - a drop in the ocean compared to their nebulised colistin and other medication.

    everyone believes they are a special case

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  • I would suggest that all patients should pay some amount to see any Primary or Secondary care clinician.

    All OTC medications should be fully paid for
    and threir should be copayment for all prescriptions.

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  • I second the Copperfield for Health Secretary campaign - its ludicrous to have no demand management tools to combat 'choice' and 'free' at point of delivery. In the old days with open access we could at least fill the car park with staff cars so that those who liked to 'pop in' and check something out couldnt park easily...We need to introduce some charging mechanism to get some perspective back on the real 'cost' of health service delivery and appropriate access.

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  • @Monica Stevens if a patient formally opt outs it does not effect targets. Exception reporting is the same too. What is insulting is the fact healthy patients are being hounded for screening purposes etc. There needs to a opt out/do not contact box on the the GMS1. It would save an awful lot of resources if GP Practices did not have to chase patient who are not interested. Its damaging to the GP/Patient relationship.

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  • 'I paid tax and NI all my life, so I should be entitled to get my paracetamol from the GP.'

    I hate it when people say this, because it is usually by someone who has not paid their fair share of tax. i.e. families with 2 children in state education would need to earn an average of over 70k through their career (combined) to pay more into the state than they take out. Those who earn enough to pay more in than they take out tend to be okay with paying 50p for paracetamol.

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  • I have been making exactly the same comments for years- what would it take to bring these issues to the minister for health?!? Instead of cutting down on front-life staff, why does no-one have the courage to draw the line and save at the right end, rather than putting patinets' lives at risk?

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  • The problem is...I find the patients intimidating...come you know "the look" basically means....just do as I tell you and noone is gonna get hurt......argue with me or refuse my request for 30 litres of aqueous cream and you know you gonna regret taking me on.....with a letter to the GMC. Just like many other I diligently do as I am told.........

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  • Come off it know who really holds the power in your practice .and when you ask for your own treatments - do you not expect your medic to comply with your wishes

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  • To clarify, it is a small subset of patients that can intimidate but it defintely happens. If I see a GP, yes, it is appropriate they understand my job role but I do not expect to call the shots-rather that decision making is shared as it should be. I would never visit my own GP and simply say "I want X, Y or Z". If you have never been intimidated then you are lucky. Some people have fixed ideas and have an extreme consumer approach. They don't need to discuss a shop purchase so why discuss a prescription request for say antibiotics or codeine??

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From: Copperfield

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