Would you pay to see the doctor?

[justasking111]

The IMF has said that the government will need to raise taxes. One way is NHS charges. This will be means tested I should add. It's being covered in the financial times, telegraph and others but hidden behind a pay wall. I don't know how to archive, if anyone else does please do.

I don't know which one I would choose, it's a thorny problem.

https://www.telegraph.co.uk/business/2025/07/25/raise-taxes-working-people-charge-for-nhs-imf/

I have paid for a private GP, in order to get a second opinion. I knew there was something wrong but was dismissed by my own GP. I was right I had a chest infection. My GP had diagnosed Asthma, over the phone! (Our practice was one of the last to go back to in person appointments after Covid).
I have since tried finding another GP but there is no spare capacity anywhere in our town. However, I do not think that charging for all GP appointments is the answer.

In theory, I'd be quite happy to pay for an appointment, as I've paid for them when I lived on Jersey. But it's supposed to be paid for by NI and free at the point of use.

Apart from that, the service would have to improve drastically. No more left waiting for hours after telephone appointment times before a doctor rings. No more sat in a waiting room 30-40 minutes past time. No more attitude from nurses when you're trying to explain something or are asking about something you don't understand. No more lottery to even get an appointment. No more losing medical notes.

And most importantly, I'd rather like to be taken seriously. I attended my surgery several times because I felt something was really wrong. I kept getting fobbed off. In my penultimate appointment I was even told there was nothing at all wrong with me at all! I made yet another appointment and finally hit on a doctor who listened. My nothing wrong turned out to be ovarian cancer.

If I hadn't been a thorn in my surgery's side (and believe me they were annoyed I wouldn't go away), I'd have gone home, decided I was imagining things, and taken so long to diagnosis, I'd probably be dead.

Like my friend who was similarly fobbed off at her surgery. She was diagnosed with gastritis for two years, until she wasn't.

So yes, happy to pay, but the state of the service right now, and the frankly quite inadequate care that's presented to people, no thanks.

Yes, but people won't know the difference.

💯

I used to work in an adult ADHD clinic.

The Consultant told us we needed to tell everyone that that they needed to inform the DVLA of their diagnosis.

I trusted what he told me.

That isn't what the DVLA says - it says people diagnosed with adult ADHD should inform the DVLA if they have concerns about their condition or medication affecting their driving.

So after a while of doing that, when I just trusted what the Consultant said and I admit I benefitted to the tune of about £200 filling in the forms, I actually looked up what the DVLA said as I'd inadvertently got someone banned from driving.

So i told the Consultant I wouldn't do it anymore as it wasn't actually what the DVLA said and he lost his shit, made me cry in a meeting and wanted me disciplined for not doing what he said, even though it wasn't the DVLA advice.

I stopped doing it after that and he couldn't actually do anything about it so I wasn't disciplined but as the Consultant, he carried on giving the advice so he was the one most people put on the DVLA forms so was raking it in.

I wouldn't mind paying but I think unless it's part of an integrated healthcare system where payment is required to cover several things it would only make things worse.

There is already real health poverty related to actual poverty and life expectancy can be ten years different between different areas of the country. And "healthy life" expectancy even more drastically different.

Even now a lot of A&E attendance is due to lack of access to primary care and good drop in places like a Minor Injuries Unit. For areas that have these, please hang onto them as they are like gold dust. Or lack of good care or long waiting times when people do go to their GP, and things become painful, acute and unbearble. Also we need things like acute oncology services so cancer patients who are very poorly with an emergency don't have to sit in A&E. If people have to pay for a GP, they will hold off even more, putting even more pressure on emergency services.

Logically, no one should value anything more than their own health. Yet there are enormous numbers of people in the UK who would be more prepared to spend money on their pet rabbit's health before their own. I honestly think that, noble as the NHS's founding principles were, this is the inevitable result after three generations of "free" care (it's not free of course). Many, many people have become completely entitled and think the state should look after every aspect of their lives. I think that if GP's were to start charging for appointments, people would see it as an "in addition" expenditure rather than an "instead of" expenditure and as such, they would let health issues slide that need addressing, because in their heads they can't afford it (whereas actually they could, if they didn't spend on something else)

I also think that there'd be such a fuss, that it would be the same old people paying way above and beyond on behalf of the people who say they can't afford it.

We pay in Finland (except children, or maternity clinic appointments) and in some ways its alright, its not too pricey, there's a yearly limit to how much you pay so you can't bankrupt yourself and those on income support get the bills paid, but some people do put off going to the doctor when they should because of the price.

I have had mostly excellent care though.

Absolutely but perhaps those who are eligible currently for free prescriptions don’t pay and everyone else pays say £5 an appointment to a max of x amour per year. It’s the only way

It didn't cross my mind at the time I was having so much trouble to go to a private GP. I wish I had the resources to do that all the time because I've so little faith in the NHS branded GPs I'm put off dealing with anything at all now. However (sorry if this has already been discussed) aren't they often the same people?

At one point when I had cancer I was told I'd slipped a disc, but then told to arrange private physio because I'd be waiting so long for NHS physio. I knew I hadn't slipped a disc. I could feel my tumour. It was nowhere near where a disc was!

There are more people getting free prescriptions than there are paying for prescriptions.

Must be just the hospitals I’ve worked in then! Clearly a much higher percentage of women though…

Isn’t it just a way of taxing without adding to income tax? Why is it that much different? Increasing income tax would be easier and cheaper than adding a new system to check who was eligible for free visits? And would avoid the problem of people delaying because of cost.

I can't see a system where some pay and others don't being acceptable to what the government calls 'working people'. People who work are sick of paying for those who don't as it is. You work and pay tax and NI, you don't and you get a free ride. You save and pay tax on the interest, you don't save and when times are hard you get means-tested benefits denied to those with savings. You buy a house and have to sell it if you need social care in old age, but if you don't have one to sell you get the same care free. If you have an occupational pension (which don't come free) you can be worse off than if you don't have one, or if you've never worked at all, as in that case you get pension credit and all the benefits that allows. Where is the incentive to work harder, study for promotion etc when it feels like anything you earn is clawed back by means-testing that gives it all to those who don't?

Also, a two-tier GP system would cost a fortune to administrate. Who would pay between couple A, a working man and a SAHM who has not worked since she married 30-odd years ago, and couple B, who both work, so have more coming in, but pay a fortune in childcare and commuting. The woman in A has no income and pays no tax, but the household is well-off because of inheritances. Couple B have some savings which have all come out of earned income which has been taxed already. As woman A has no income of her own does she go free, or should her husband be obliged to pay for her? If so, what about confidentiality?

Should both couples A and B above have to undergo means-test checks on savings and assets, and what happens if either decides to buy an expensive car, or go on a luxury holiday? Do they get reassessed? All for a tenner or so for an appointment, which they may rarely need? Would surgeries get a say in how many paying patients they take? If free ones carried a subsidy would 'working people' be discriminated yet again?

Honestly, I think it would be more trouble than it's worth.

The first thing that is needed is a forensic analysis of the bureaucracy in the NHS. It seems so top-heavy, with a lot of 'bigwigs' pushing paper around and not nearly enough of the staff at the supposed 'lower' levels who do most of the work and are paid poorly enough to need food banks, etc

Well they'll either have to buy a property or work for BUPA AND SPIRE who will bill them for the use of the facilities. Our population is 3.8 million, fragmented over huge areas. For instance there's a hospital in Wrexham in the north run by Spire and a clinic in Abergele. That's it. I don't know about mid Wales. South Wales has a much bigger population

Absolutely. But there are other methods that work well. Canada has an NHS style system but we have health cards which you have to show for everything.

You have to pay for certain things - ambulances which aren’t deemed medically necessary for example. Or charging for missed appointments (don’t go down that rabbit hole of oh but what if - my parents have cancelled because of hospital treatments and haven’t been charged)

Otherwise it’s about the same but with health cards and cracking down on not taking advantage it works better. Oh and no private hospitals really (you go to the US if you really want to pay) .

I don’t agree with an American system and the NHS isn’t working. All the free prescriptions don’t need to happen. There are better ways.

I believe in Singapore the govt mandates saving into a health account which can then be spent on health services.

Maybe that would work better here. Such an account could be topped up for those in certain categories or used towards private treatments. It would allow people to prioritise what was most important to them without those decisions being made by the NHS.

An example upthread was varicose veins. I was very fortunate to be teaching in a private school which had healthcare for its staff (at cost) so I had several procedures at the cost of the policy excess only. If I'd not had that policy I wouldn't be still teaching because I was in a lot of pain and discomfort (now in the state sector) but I doubt I would have got those treatments on the NHS.

None of these services have improved as a result of paying for them.

Not really fair for people with multiple health conditions. Also would this be household income or individual income? If they go down the household income route then things like child benefit removal must be for household income too. Fed up with this individual or household income when it suits them. Additionally this will be another disincentive to earn more money. I suspect the cut off will be 50k as it usually is. There are enough disincentive to working already. Means testing to see a GP is another tax on income however they dress it up.

I think it’d only be workable if it was a flat rate for everyone and then there was some separate walk in centre where you could just wait ages for free if really destitute. You’d have to also charge at A&E though or everyone would just go there instead.

anything means tested would be very unpopular among tax payers who are already paying more tax than ever, and clearly GPs are very disproportionately used by people who would not have to pay (children, elderly, people on benefits). I’m not sure there’s any answer that would get through parliament though as this government seems to be unable to pass anything that negatively impacts those reliant on the state, so sort of hamstrung. Not sure what would happen when/if another party like Reform attempts to actually reform anything 😂

In the past I would have said yes because people would make appointments and not turn up - and paying for the slot would certain concentrate minds,

However, now you can't get an appointment anyway. GPs still claim many appointments are being missed each month but I don't think that's true - I think people are missing telephone calls because they are driving/teaching/on the loo which is not the same as not turning up for an appointment at all.

I do think paying for a face to face appointment might free up some more slots.

I also think the age for free prescriptions should be raised to retirement age (in England), but the government has already rejected that.

No they haven't. The one area that does seem to work is eyes - you pay a small amount for an eye test (and many people don't pay at all) and you can get an appointment without too much difficulty.

Yes but realistically not many have eye problems and also you only need to go once a year or more often come back in 2 years. Way less need and they only deal with some eye problems. If someone has more severe eye problems they may be seeing neurology or opthalmology which is NHS.

@dynamiccactus The idea in your post above (forget to quote) is a horrible and callous idea - people will die and get very sick. If you charge for primary care people already won't be able to get treatment for minor issues. Then they also won't be able to afford to go to A&E when they think they're having a heart attack etc, dito an ambulance charge. Many elderly people, deprived children etc live alone and have no means of getting to hospital.

Also the idea that those who are lower socio-economic status, poor, elderly etc can get free care ('if really destitute') but have to wait way longer is horrible. Blatant discrimination. What if they're having a heart attack, stroke, sick, baby, pre-eclampsia, suicidal etc?

Furthermore what if someone has a issues with their bowels being painful, occassional blood. Can't afford the appointment, so they give it time. Months later they get very sick and have to go to A&E - they have stage 3 or 4 bowel cancer. Will cost much more through A&E stay and hospital admission. Had this been dealt with earlier much less cost for the NHS.

The only reason paying for face to face appointments will free up appointments is because those who cannot afford it but still need care and are sick won't be going. This will be because they need to feed their kids, or already work 2 or 3 jobs. So yes you'll probably get an appointment quicker, because you can pay and some people (who may need an appointment just as much as you or even more) cannot. Also what about disabled people - we need to have more appointments often with many specialties. What if they now have to start only going to a few appointments (even though they need to go to others) and get sicker? What if (as many do worldwide) they have to ration medication such as insulin or HIV meds? The distribution of appointments should be solely down to need, I.e triage - which many GPs do. They look through the forms and read about your issues and try and get everyone appointments but prioritise those who are sicker. Who is that more likely to be? Those in deprived communities, we know they have poorer health outcomes, more SEN, more mental health crises.

Then there's the class discrimination. What about the 4.5 million in child poverty, those kids won't see doctors. What about BAME populations more likely to live in deprivation?Also women, particularly single mothers, postpartum? Their mental health will likely worsen, they won't be able to sacrifice food on the table for the doctors - so they will get sicker and it will cost more in the long-term. What about the elderly (yes some are well-off) but othera are very poor abd have nobody to look after them. There's so much research on why this would 1. Increase health inequality massively 2. Cost more in the long-run 3. Lead to more overall inequality and deprivation in communities in general e.g lack of advice on alcohol or nutrition in these communities. I understand we need a better NHS (there are things we can do), and people deserve better service but this would just be a horrible thing to do. You can say only £20 (but would that even be enough, and then the price will just get higher). Right now GP's get on average £110 per appointment. So will it be that much. Also for loads of families £20 per appointment will be too much, they are barely eating or not paying bills