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Could we learn a thing or two from the French way?



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

READERS' COMMENTS [10]

David Mummery 23 June, 2021 8:25 pm

Thanks Charlotte really great article . I remember being on holiday in Spain and chatting to a fellow tourist with clearly just a simple URTI needing nothing more than a course of amoxicillin. The local GP got him in for daily intramuscular antibiotic injections and 10 minutes daily oxygen ‘treatment’ : total bill 600 euros and a ruined holiday…

Hello My name is 23 June, 2021 8:53 pm

We are failing the public by pretending the status quo is working. It’s not working. People can’t get through to us. Patients cannot see specialists. No-one seems to be getting surgery anymore. The pack of cards are all but flat on the table and sadly our leaders pretend it is still standing, a noble edifice. Time for change, but who will push through the pragmatic, moderate line?

Patrufini Duffy 24 June, 2021 12:45 pm

Like I said – free baguettes end up on the floor, and don’t taste so nice. Buy one for €5 handmade same day, you’ll savour it and care for it. The modern mind is a fickle thing. Whatever levy you choose, take the GP out of it – *the payment goes direct to HMRC or DoH. That will solve ALL arguments. Then they can reinvest in service.

terry sullivan 26 June, 2021 1:30 pm

copayments have to be paid by all–no exemptions

french system is goodish but falling apart because too many are now exempt and hence funding inadequate

Steven Hopkins 27 June, 2021 3:01 pm

I thoroughly agree with Dr Alexander that we need a different funding model but, it seems to me that private insurance and payment via taxation have the same difficulty. They do nothing to reduce demand.

A colleague did a locum at a private surgery in the Channel Islands some years ago. The telephone rang at 2.00 in the morning. The conversation went like this:

Little Johnny has a cough and we can’t sleep.
GP responded by explaining that this was a private practice and the caller would be charged for the visit.
Well, how much if we come to the surgery tomorrow?
The charge was explained.
Well, its only a cough. It can wait till we get back to England.

A small charge worked to reduce the demand for shopping bags. It would certainly stop the flow of coughs and colds to surgeries and A & E depts.

Steve Hopkins

David Church 28 June, 2021 7:55 pm

@ Steven : why did they not phone the GP in England to start with? Don’t they have 24 hour cover?

Matthew Shaw 29 June, 2021 1:37 pm

Even a small consultation charge in countries with similar primary care [New Zealand Ireland] leads to a 65-75% reduction in the consultation rate.
I don’t hear of too many grandmas or babies dying in France for lack of free health care, though this is the usual sanctimonious argument against it.
Reflect on this toward the end of your next 14 hour day full of complaints and crap.
Or shall we just keep sacrificing our young doctors and nurses on the altar of our NHS credo?

James Cuthbertson 29 June, 2021 6:49 pm

The problem is a huge amount of patients would use a “token charge” as an excuse to demand even more each consultation. You then end up getting a tenner for 30 mins extra.

James Weems 30 June, 2021 8:48 pm

Yeah. I agree with James. The result would be an EVEN GREATER sense of entitlement simply because they are paying a nominal fee as an extra. We would need to be absolutely crystal clear on charges and what you get for that. Patients already push it now with 2, 4, 6 problems per consult. It’s energy sapping

Muhammad Rizwan 4 July, 2021 4:06 pm

Thanks Dr Charlotte Alexander, good article,
Totally agree with Patrufini Duffy, Steven Hopkins and Mathew Shaw, even a small amount £5-£10 would do trick, will reduce 60%-70% general practice work load and that time can be spent with patients who really need care.
But who will do it? we just keep moaning here without any use unfortunately.
Riz