To think the time has come to abolish the NHS healthcare model

Yeah that’s how it works with my insurance plan. I will pay a higher copay for the office visit ($100 vs $20 for a PCP) but I just make an appointment. Some insurance companies require gatekeeping by a PCP, but when that came into fashion a lot of people found the loophole (myself included) I named my OB/GYN as my PCP. It meant no nonsense seeing them for my annual exam and they gave referrals for everything.

Since then (this was in the 90’s) some insurance companies closed that loophole but carved out appointments to OB/GYNs as not needing a referral. It’s largely irrelevant because 9 times out of 10 if you need a referral for something like a bunion or long term headaches you can call your PCP and describe the issue and they’ll refer without a visit if you’re a patient on their roles.

Some may make you come in but I’ve never not gotten a referral because they have no real incentive to gate keep.

I don't think it's being free at the point of use that is the problem but the whole raft of treatments now available and expected as normal. As well as the overuse of expensive technology to undertake simple tasks such as taking temperatures and blood pressure.

And the societal and cultural pressures exerted to provide treatment at any cost in order to preserve life irrespective of the quality of life afterwards.

And then there's the unwieldy admin of it all.

The model itself is fine.

The NHS didn’t exist for most of the 1940s, it was born in 1948. And it was in pretty good shape in 2010 when the Tories got their hands on it.

https://www.kingsfund.org.uk/insight-and-analysis/reports/high-performing-nhs-review-progress-1997-2010

So if you want to see a neurologist about your headaches you can just make an appointment with one wherever and your insurance company will cover the costs? Yeah no that's not how it works here and I doubt it works like that in Europe. If someone else is paying towards your treatment they will want a say in how the money is spent.

Have you seen healthcare in the USA? People die because they cannot afford healthcare!

The nhs has been a cornerstone of our society since it was brought in by labour. I kniw thats why its hated by the tories - it wasn't their idea so now all they want to do is allow people to feed off tax payers money by privatising lots of the services and noone holds those providers to account for anything. My daughters adhd assessment has taken over 1 year. On the nhs it'd have taken less time. She still doesn't have her appointment to diagnose her wtf. So whose letting patients down? The nhs or private suppliers?

@OptimismvsRealism YA massively Unreasonable even mooting this question. Sure the insurance industry could improve it's offering ref private healthcare, but at a cost of £200pcm for emergency care for a family plus annual excess payments, how many people could afford that?! Remember, every working person is in reality just a few pay checks from destitution and then how do people pay for it?

We all need to get behind the new government and help them sort out the Tories mess and reinstate the NHS as the cornerstone of our society.

I think tory MPs and civil servants should be brought to court for crimes against humanity because of the state of the nation. It's absolutely unforgiveable.

At the end of the day there is no perfect system. I don’t even claim the US system, which works really well for me, is perfect. There ar sadly going to be winners and losers under all systems. I guess you just hope that there are more winners than losers 🤷‍♀️

Free at the point of use is vastly better than the US model

the NHS was world class in 2010- this can be achieved again with the right attitude

pay established necessary professions like doctors, nurses, physios, OTs, SALT etc well- restore their pay

dump new nonsense like ‘physician assistant or associate or whatever they call themselves who are poorly trained and paid far more than many doctors and nurses

Can’t get worked up about lecanemab. Be far more concerned about lack of funding to research and effectively treat childhood brain tumours. I’d like my huge tax payments to fund that, not lecanemab.

My in-laws live in France. If they have appointments at the hospital, they have to go to an office to collect their stickers for the paperwork. They have to visit the chemist to collect, for example, the contrast dye for their scan. If they need dressings done by a nurse, they have to go and collect all the creams, dressings, etc., for the nurse. Similarly, post op injections.

They have to pay upfront for treatments. They have to book their room at the hospital and pay for it. If they have a CT scan, they have to take a disc away with them to take to the specialist who ordered it.

It's a completely different system to the UK.

I don't resent it as I understand the point of it. What I do resent (a bit like you) are people dodging their responsibilities by not paying or not paying enough.

Not sure if anyone has said this as haven't RTFT but lecanemab has very marginal benefits and significant risks.

Nigel Edwards wrote a very helpful comment series for the Nuffield Trust that discusses common myths such as the superiority of some insurance models (Europe included) relative to the NHS: Through the looking glass: myths and magical thinking about the NHS
A series of short articles looking at common critiques of the NHS and why they're mistaken.

https://www.nuffieldtrust.org.uk/comment-series/through-the-looking-glass-myths-and-magical-thinking-about-the-nhs

Statutory pension insurance is 19 % of gross/pre-tax income (again, the employer pays half if you have one. Some self-employed occupations are compulsorily enrolled, others aren't - unlike health insurance, which is mandatory for all). This doesn't eliminate old-age poverty, sadly, although i suspect it's less of a problem than the UK. Workers' rights generally better, especially wrt sickness and sick pay (the UK attitude to sickness as a disciplinary matter shocks me profoundly) - statutory redundancy only a bit better than the UK. Wealthy country but won't disclose.

And this is different from your current system how? I didn’t think you could just go to any GP with an opening?

I just searched my insurance company by my plan. I have 227 PCP/GP’s to choose from and I picked 2 at random from the first page. First one, first appointment Oct 17th second one- August 27th.

If I need a specialist I just schedule an appointment with them. I do not need a referral. Honestly as an outsider that’s half the problem nobody can get a GP appointment because people are funneled through them for referrals. If people could see GPs sooner a lot of conditions might be treated early enough that specialist care isn’t needed. Yes specialists may end up seeing people who don’t need them but that’s still less resources overall for one visit to be told ‘no you don’t need my treatment’ vs 5 GP appointments to try random things that ultimately lead to specialist care anyway with a bigger issue.

@MereDintofPandiculation

Social care is far more than dementia care and dementia care is far more than social care.

Those suffering from dementia do not always need outside social care - many are cared for by families and partners who provide support for their activities of daily living.

Others require residential care that involves provision of many services - housing services, hotel services (food/laundry) and social care services (washing/dressing toileting assistance). They may also have some health care services provided linked to the disease process of dementia.

Why would people with assets not pay for their housing, food and help with what they can no longer do?

The healthcare parts will still be paid for, just not the rest.

That still requires insurance companies who will set their own terms and conditions.

Sadly, the wait in our GP surgery is longer than 2 hours and that is with an appointment. You can only get an appointment if you call bang on 8am and by about 8:15 all appointments are gone and you have to try again the next day.

Being able to go into a GP surgery and just wait and know you will be seen is a luxury. This is partly why A&E in the UK now routinely over 8 hour waits - people who should see GPs go there because they know they will be seen. Even though inappropriate for A&E

The NHS funding does need a rethink but to claim it's one of the worst in the world is total nonsense, and low productivity is nothing to do with health. The NHS's main problem is that social care has been terrible for a long time and has now pretty much crashed. People get admitted for social reasons (need care at home and fall/ can't eat & drink or take their meds without it) then get stuck in hospital because they need care at home or a residential placement. None of this is under NHS control.
Plus the public have totally unreasonable expectations. A large chunk of GP consultations are either total nonsense or for social reasons. A European co-pay model with compulsory insurance is needed. EU countries with better outcomes spend more as a percentage of GDP than the UK does. You want better healthcare - pay for it!

When I compare the NHS (however challenged) to dentistry, I really fear for the future if the NHS follows the same track.

I can pay for my dental care, so I do. I do it for convenience, to see my preferred dentists and dental technicians, to find people I trust. But I can do that because my dental requirements are relatively simple and not beyond what I can afford.

By comparison I know of many who can't access an NHS dentist easily. And when they do their choices of treatment option are severely limited - either in what can be offered or the timescale.

But healthcare is a whole other ball game. I can't afford private treatment, and at an older age with a couple of minor age-related problems I cannot find any affordable health insurance.

I agree if we all paid more it should work better. But this is the UK, with any further privatisation the additional costs will just be profit for private companies.

I work in the ambulance service and they've privatised a lot of the transport services/PTS. So private companies undercut the NHS ambulance services to get the contract - then they provide little to no cover so when they don't arrive the ambulance service picks up the slack, or the patient is ever so slightly unwell (shock horror they've been booked to be taken to hospital by a Dr) so they also refuse to take them and the ambulance service again steps in. It's effectively a few old minibuses with a glorified taxi driver and a first aid certificate. Or the care alarms they put in old people's homes, privatised - all those households paying £25 a week for a pendant that goes through to the office where they'll have 1 staff member working - who just passes the info onto the ambulance service. These companies make millions for nothing and the NHS does the actual work. All privatising does is take more and more money away from healthcare.

But that's just as silly as saying you've been to Brazil, seen the same, and that's what socialised medicine gets you.

There are plenty of other models besides the UK and US ones.

If the UK voting public isn't prepared to fund the NHS at the rate that demographics demand (they aren't), then there's no virtue in them proclaiming loyalty to the NHS. It's just delusion. Pick a system that can scale to the needs of the country and that won't be permanently underfunded. Many advanced European and Asian countries have good mixed systems that work.

Quite, let's stop idealising other systems.
All systems have their flaws.

Yes my treatment is world leading and was very swift from the point of diagnosis onwards. And I have a specialist nurse who responds within 24 hours if I message or call.

Meanwhile in the US people are desperate because their insurers make them fight battles for months and months to get the same treatment

No thank you. My experience of the nhs had always been amazing. Stop comparing and realise how lucky you are to have the nhs. Can't stand people that complain about it.

NHS England agrees GP access is currently a crisis in the UK. And there have multiple initiatives to try and address it. GPs are currently working to rule to force the government to provide more funding so they can provide better care.

This does not mean some individuals are not able to access a GP but most aren't.

https://www.england.nhs.uk/gp/case-studies/600-gp-hours-released-a-year-after-reducing-inappropriate-appointments-chiswick-health-practice-london/