This is why A&E is overwhelmed

[PackedintheUK]

And it's nothing to do with over anxious patients seeking "unnecessary" medical care.

I have a very sore very swollen ankle as a result of an insect bite. I've asked advice at the pharmacy and been told it looks nasty, see your GP, you probably need antibiotics.

So I've tried. I've been calling GP surgery all morning and finally got through to have receptionist incredulously say "you want to see a doctor for a gnat bite?" and then be told the next appointment is 16 Nov.

Me: but pharmacist said I need seeing urgently.
Receptionist: All the emergency appointments are gone for today. You'll have to call back tomorrow.
Me: but I've been calling all morning, won't the same thing happen tomorrow?
Receptionist: Well I can't do anything about that, if you're that worried go to A&E

So,I'm not sure that I am "that" worried, but I have been told by someone better qualified than me that I should be seen. We lost a colleague to sepis this year, a fit young woman and it happened incredibly quickly, plus I have a friend currently in hospital on intravenous antibiotics from a very similar looking bite he got at the same park.

I also don't actually feel that well.My body aches and feels heavy and I'm a bit queasy, which could be coincidence or my imagination.

Probably/hopefully it is nothing that won't heal itself in a few days but it feels irresponsible not to take the advice I've been given. Also to go to A&E

So A&E for something that could (probably) have been dealt with in a matter of seconds in a GP (telephone/video?) appointment?

There's no walk in or minor injuries here.

@Hodgehog

I actually think there will be some more private A and E before long.

There’s already one near Manchester I think.

There private urgent care centres in most large cities and yes, I can see this expanding.

But true emergency /trauma care isn't economically viable as a private service and the quality of service e provision would be - interesting...

The amount of funding currently for the NHS isn’t enough to provide sufficient services. If someone wants to source a private service there is nothing to stop them but they should still contribute to the NHS. If you have cancer, heart problems , a stroke or an accident, you are going to want to NHS as there is nothing as good privately.

The NHS says it costs £50 for a GP appointment, so why don't they pay that as a contribution towards a private GP appointment, so, say, the NHS pays £50 and the patient pays the difference

This is essentially how it works in Australia. The government decides how much a GP or specialist appt is worth (varies depending on the type of appt) and funds that much. Some GPs charge on top of it, some don’t. Those that charge charge less if someone is low income. It’s clear from the onset which “bulk bill” and which don’t.

This is separate from the public hospital system which is free, like the NHS.

^i think we might have to move towards this approach.

I don’t see how we can avoid a partly private system.

"The NHS says it costs £50 for a GP appointment, so why don't they pay that as a contribution towards a private GP appointment, so, say, the NHS pays £50 and the patient pays the difference"

Because the NHS is already strapped for cash paying the GP it employs through General Medical Services Contracts.

Are you saying that money should be withdrawn from that scheme (so even less NHS GPs and less appointments available than now) and set aside to fund those that want to use a private GP instead?

That's just pushing the part of the queue that can afford top up fees to the private sector and making life even worse for those that can't.

Be very careful what you wish for here.

Disclaimer - I use private GP and secondary care services when necessary and have gold standard private health insurance, so I am not knocking private care. I just don't want to dismantle the NHS in the vain hope that the private sector can pick up the slack (it can't).

Tsking money out of NHS to go towards private hospitals is not going to happen in that direct sort of way.

Indirectly, through ingenious government schemes and contracts, maybe.

Meanwhile, things are likely to get worse in GP land, as more GPs retire.

www.theguardian.com/society/2021/oct/29/nhs-facing-mass-exodus-gps-doctors-england-experts-warn

@Parker231

The amount of funding currently for the NHS isn’t enough to provide sufficient services. If someone wants to source a private service there is nothing to stop them but they should still contribute to the NHS. If you have cancer, heart problems , a stroke or an accident, you are going to want to NHS as there is nothing as good privately.

But by going private, they're saving the NHS money, so at least there should be some contribution to reflect that. (That's for necessary treatment I mean, not for lifestyle medical matters).

@ChequerBoard Are you saying that money should be withdrawn from that scheme (so even less NHS GPs and less appointments available than now) and set aside to fund those that want to use a private GP instead?

If the GP practices are short staffed, then they are saving the wages of the GPs who've retired/left etc but are still getting the same funding, so where's the money going? They don't need as much money, especially if patients are relieving them of needing appointments etc by going private instead, so the funding to GP surgeries would be reduced accordingly in accordance with the services they're not providing for those patients going private instead.

If the U.K. were to go down that route, would the same apply to those who pay for private schools?

[quote user1497207191]**@ChequerBoard* Are you saying that money should be withdrawn from that scheme (so even less NHS GPs and less appointments available than now) and set aside to fund those that want to use a private GP instead?*

If the GP practices are short staffed, then they are saving the wages of the GPs who've retired/left etc but are still getting the same funding, so where's the money going? They don't need as much money, especially if patients are relieving them of needing appointments etc by going private instead, so the funding to GP surgeries would be reduced accordingly in accordance with the services they're not providing for those patients going private instead.[/quote]

This is ludicrously naive that I can't even be bothered.

If you want to believe that there is cash swilling around primary care that isn't accounted for, crack on.

@Parker231

If the U.K. were to go down that route, would the same apply to those who pay for private schools?

I think it should, yes. There should be some contribution to reflect the savings made by the state provision.

(Again, only for basic/essential things that state schools would otherwise pay for, such as full time curriculum education and not for the peripheral things like piano lessons, horse riding lessons, etc - we really don't want the taxpayer to be subsiding "lifestyle" choices).

@ChequerBoard This is ludicrously naive that I can't even be bothered. If you want to believe that there is cash swilling around primary care that isn't accounted for, crack on.

It makes no sense.

If GP surgeries were fully staffed, then their wages bills would be higher, yet, surgeries are paid "per patient" not "per consultation/treatment", so how would they be paid?

Either GP surgeries don't have enough money to pay for the full quota of staff, or they're getting the money but not spending it on staff in which case it's going elsewhere.

But the people going private would still be using NHS services for the most serious illnesses.

In my experience, private healthcare is very keen to transfer patients back to the NHS if they have something very serious or complicated wrong with them.

Private healthcare is really good if you want to get treatment expedited for your hernia. You could say jump the queue, but if you need a knee replacement etc., I can see that people would be happy to pay to get relief for something which, though not life-threatening, impinges hugely on their quality of life.

If a patient deteriorates/there is a complication, they might well be treansferred to an NHS ICU for recovery.

So it makes sense that private patients have also contributed towards NHS resourcing.

Also, it is not all that unusual for NHS and private patients to effectively be waiting for the same assessment , but paying gets you seen more quickly for exactly the same input. So in that scenario, you aren't "relieving" NHS resources, you are inserting yourself at an earlier point in the queue. There are of course reasons why you might want to do that. However, I don't think people in that situation should get out of paying towards NHS provision.

@user1497207191

Again, only for basic/essential things that state schools would otherwise pay for, such as full time curriculum education

You think the state fund a full time curriculum education? For everyone?

Bless.

[quote user1497207191]**@ChequerBoard* This is ludicrously naive that I can't even be bothered. If you want to believe that there is cash swilling around primary care that isn't accounted for, crack on.*

It makes no sense.

If GP surgeries were fully staffed, then their wages bills would be higher, yet, surgeries are paid "per patient" not "per consultation/treatment", so how would they be paid?

Either GP surgeries don't have enough money to pay for the full quota of staff, or they're getting the money but not spending it on staff in which case it's going elsewhere.[/quote]
GP surgeries forced to pay for locums will be paying a very high cost for the locums.

There must be a load of costs associated with covid, distancing, can't see as many patients, GPs going off with stress, covering for colleagues who are isolating or ill etc.

We are in a pandemic, it makes a lot of sense that this will have been extremely difficult and stressful for the staff on the front line who have had to keep services going.

It's not rocket science to understand that.

Likewise,"the gap between private school fees and state school spending per pupil has more than doubled in England over the past decade, with private fees now more than 90% higher than spending on state schools, a report from the Institute for Fiscal Studies has revealed".

So it would be extremely stupid to take yet more money out of the state system. This is literally the last thing that this country needs, Give your head a wobble, that poster.

www.theguardian.com/education/2021/oct/08/english-private-school-fees-90-higher-than-state-school-spending-per-pupil

How are you OP?

Never used i t but can see a doctor via Lloyds and I assume they can prescribe antibiotics. But it's video.
onlinedoctor.lloydspharmacy.com/uk/video-gp

I agree with OP . Unfortunately people are forced into going the AE route because there is not an alternative. An infected insect bite is potentially a catastrophic problem if AB treatment is delayed.
Am not blaming GPS but I wonder how many lives have been lost because there wasn’t a GP appointment available or too worried about AE incase they are judged for ‘wasting time ‘ !

On the link above re private school it says
"The average private school fee (not including boarding schools) was found to be £13,700 a year, compared with £7,100 in spending on each state school pupil."
That is not quite as big a difference as that suggested above - it is about double although in both sectors the very biggest cost is actually pretty much the same - teachers' pay.

@Parker231

If the U.K. were to go down that route, would the same apply to those who pay for private schools?

It's not as simple as that though is it.

A lot of the larger capital expenditure and staffing costs are funded from a small percentage of each of the payments that the organisation receives.

So, if say the organisation has just enough income to purchase, staff and maintain an MRI scanner, but 10% of the population goes private and takes 10% of the funding with them, then the other 90% don't get an MRI scanner because you can't just buy 90% of one.

As both the NHS and state education needs significant additional funding I would be fairly confident the government isn’t going to apportion any of it as a contribution to a private sector . The Tories will do it the crooked way by leaving vital services so cash strapped that people will, where they can afford it, pay for private services. The Tories will continue, by the back door privatise services so your tax contributions are benefiting a private company with shareholders rather than for the benefit of users.

Meanwhile, private schools have charitable status for tax purposes, as I understand it so effectively get a state subsidy for their businesses, and BUPA also has some sort of charitable links (not sure how that pans out tax wise).

@FixTheBone So, if say the organisation has just enough income to purchase, staff and maintain an MRI scanner, but 10% of the population goes private and takes 10% of the funding with them, then the other 90% don't get an MRI scanner because you can't just buy 90% of one.

Granted that applies for scanners owned by the NHS, but what about the mobile units that they regularly rent from private firms to tackle backlogs. If there was a 10% fall in demand, they wouldn't need to pay to rent the private scanners so would save money.

@herecomesthsun

Meanwhile, private schools have charitable status for tax purposes, as I understand it so effectively get a state subsidy for their businesses, and BUPA also has some sort of charitable links (not sure how that pans out tax wise).

BUPA is a charity and has no shareholders, profits being reinvested.

en.wikipedia.org/wiki/Bupa

@Xenia

On the link above re private school it says "The average private school fee (not including boarding schools) was found to be £13,700 a year, compared with £7,100 in spending on each state school pupil." That is not quite as big a difference as that suggested above - it is about double although in both sectors the very biggest cost is actually pretty much the same - teachers' pay.

Yes, an average of about 93% more than the average state school cost going on the average fee to a private school.

The differential is a lot higher on the more expensive schools, for example Eton charges approaching £49k, albeit that presumably includes some boarding expenses.