As I was watching one of the episodes of the final season of Spiral, I noted how a French GP called out to check on a detoxing kid was asked by his guardian: ‘How much?’
‘€60’ was the matter-of-fact response. A quick exchange of pleasantries followed, and she was off. I wondered how that felt – to be directly paid for your time and trouble. Did it degrade the relationship, or it did improve it?
I then went down a rabbit hole of wondering how I might feel charging that much when so much of the time we spend in general practice is devoted to dispensing common sense or prescriptions for UTIs.
I stopped myself, because of course there are days when every single second of that ten years in training followed by the years of experience of actually being a GP are used, often over and over again on that day.
I acknowledged that the amount was good value. Lawyers and accountants charge much more for their time for fewer years of training, and they are free to do so. Medicine is different.
There is something about the sanctity of the body and the dignity of the person which makes access to healthcare closer to a fundamental human right. It’s vital that the state should play a role in its delivery and regulation.
Whether the NHS balances this right with what is actually needed on a day-to-day level is increasingly questionable. GPs are in a unique position to understand the breadth of what is not being offered.
An 18-month wait for an allergy appointment even before the pandemic hit, with a small priority given to those who have experienced anaphylaxis, is not helping people live their lives. Neither is waiting two years for some Roaccutane for the acne that is denting your self-confidence, or three months to get some DMARDs for newly-diagnosed rheumatoid arthritis.
A not-for-profit insurance system like they have in nearly every other European country would surely be a better system – my European patients certainly seem to think so. One does exist in the UK, and for £11 a month, the first £1,800 of any specialist consultation and investigations are paid for.
That’s less than a Netflix subscription. True, it doesn’t pay for expensive surgery, but there are many conditions that it would cover, and it would alleviate suffering. This is the middle ground that we don’t have in the UK, and that we desperately need.
We don’t need a binary choice between excellent but inaccessible free healthcare and expensive insurance which often doesn’t cater for people’s needs without costly add-ons. Black or white is our nation’s safe space, it seems, and so healthcare will continue to be eaten away from the inside, leaving just the façade on display for the public.
Dr Charlotte Alexander is a GP in Surrey