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/

Discovered last night that the Spire Group were bought by Ramsey Healthcare a few years ago. They're Australian and provide health care worldwide. 👋👋 To our antipodean friends.

@strawberrybubblegum yep, we are key funders. Unfortunately because everyone who uses the NHS is treated as though they are as thick as sh1t as well as as sh1t, personal patience is running thin.

I just can't see it working as many (most?) people would expect better service if they had to pay, but as this is money that's needed to plug pre-existing holes across the entire economy then at best it can surely only keep services the same.

To my mind the dealings I've had with the health service in recent years (effectively pregnancy/birth related) have been pretty poor value for money just for the tax paid, let alone further fees on top. If a charge were introduced I'd have to start looking at it more critically and probably at private providers, meaning no additional funding for the NHS. That's not out of spite - it's just that my budget is finite and so if something is taking more of it I need to ensure value.

Well in my country where we do pay, I've never been limited to talking about only one issue at a time at the doctor. Plus we have indepth check ups (through occupational health for workers, student health for students, school health for children, and the unemployed are entitled to one every 5 years I think in public health) where you are encouraged to mention every little niggle and pain you have and everything gets discussed and blood tests and other tests ordered, hearing, vision, height, weight, blood pressure etc. checked. I spent over an hour with the student health nurse last year talking about every single health related thing (including mental health), then more than half an hour with the doctor, and got my anaemia treated properly with iron infusions and a referral to the gynaecologist (without a long wait). Reckon its worth paying a bit when you get decent treatment like that (though for the student health I didn't pay anything)

have you got a local sexual health clinic? You can get a smear test there.

Yes.
And it might help with the fact that so many people currently make unnecessary visits to the GP or A&E.
The only issue with it is the cost of administration and debt collection.

I'd definitely pay if I could see a doctor quickly at a convenient time. I think my MIL would also think twice about her trips to the doctor if she had to pay even a nominal fee.

It does need to be compulsory if you want anyone to pay.

Oh, another issue I just remembered. What if they start charging for missed appointments that are not your fault? But can't prove it yet?

I was once told they will stop referring me to attend a dafne course. It is a diabetes course that teaches people how much insulin to inject for the meal you are eating.

As a type 1 diabetetic I was very interested in attending this course. It took years, to understand what the issue was. It was an admin error. All the appointment letters related to this course were going to my old address and all my other letters were going to the correct address. My consultant noticed the error himself. Because he printed the letter out that was sent to me. He noticed it before me, he apologised and said he will ask them to call me when an appointment becomes available. I got the next appointment both via letter and a telephone call. He was my all time favourite doctor

This happened few years back, before text message reminders and the nhs app, where you could see any upcoming appointments.

If they want to charge then they’d need to spend a bit more effort proving you were told. If appointments came via NHS app then it’s unlikely the same issue would arise.

We are only allowed to discuss one problem per appointment.

On the anemia issue, my son has been anemic few times. The doctor perscibes iron tablets, my son gets better. They take a blood test after three months. They then stop perscibing it. He gets symptoms, I take him back to gp, the same thing happens.

The third time, gp has sent me text message saying to buy it over the counter. I already give him the multiple vitamin well kid. Yet, his ferritin is low. He clearly needs a stronger dose. No one has investigated the underlying cause. I'm hoping to get a gp appointment for him, next week. To discuss this issue.

I wish the triple lock wasn't so untouchable.

I can't help but wonder if this would be a false economy. A group of people would avoid the cost of primary care and things like infections would end up needing hospital treatment when an appointment and antibiotic prescription would have sorted it.

I wish the triple lock wasn't so untouchable.

I can't help but wonder if this would be a false economy. A group of people would avoid the cost of primary care and things like infections would end up needing hospital treatment when an appointment and antibiotic prescription would have sorted it a week earlier.

In Ireland we have to pay for a GP visit if you don't have a medical card. It does put people off. I remember about 20 years ago, money was very tight with two young kids, we just didn't have €70 for the doctor visit and another €30/40 for the prescription. So we had to wait till we were really bad and had saved a bit of money to be able to go. We were less than €100 over the limit for medical cards at the time. If kids were sick we would have to borrow from family to have them seen straight away. And some of those with medical cards would take the piss because they didnt have to fork out the best part of €100 for every viwit, showing up at the doctors office for every little sniffle and cough and ache.

We're in a much better financial position now that we could afford it straight away if needed, but now we also have a free GP through dhs work.

I do think in Ireland, there should be a nominal fee (€10/20) for everyone instead of some paying nothing while others pay a lot. Like my family years ago, a lot of people today would be over the threshold for a medical card but not by much and would struggle to pay.

I hope the GP will investigate properly this time. I know with women and girls they often just blame periods and don't investigate further but they can't blame it on that with boys so very odd they haven't investigated yet.

I bet the people who do that would be exempt for charges though.

Smoking is more prevalent in the lower earners and deprived areas though

I wonder if cover could be provided on a universal basis for all. NHS in a form similar to now; then silver and gold levels with access to more convenient appointments, etc.

From seeing my own patients, people absolutely do go because they are lonely or enjoy the attention/ sympathy from HCP. They don't say that's why they are constantly booking appointments, they make up other trivial things.

Probably balanced out by the people at the opposite end of the scale who wouldn't go to the doctor unless limbs were hanging off. In my experience, there will be both these types of people in every community but the majority of the public will be a sensible middle ground.

I think a small fee would be a good idea. Affordable but also make the time-wasters stop and think. Perhaps also make those on the opposite end of the scale who don't want to make a fuss (but really should go) feel like they are paying for it and therefore not wasting a doctors time/ their problem is unworthy

That's really interesting @Iceplanet.

Sounds like the Behavioural Insights Team should be trialling some of these ideas.

I think the "Nstional" part of the NHS is an issue. Different areas have very different problems and nothing can ever get solved if it's got to work for nearly 70m people.

But we have got local trusts who (if reformed better) could do that can focus on local areas needs - more elderly people, more children, any high levels of a certain condition. To some extent, many trusts already do this. Plus the 10 year plan (if it goes to plan) has a massive component being hospital to community and local care. More minor injuries, services for mental health (whether that be children, or elderly etc) and services which focus on each community would be better. I agree with you, different areas have different needs. Also hopefully if we begin to reform social care properly, we can help with the backlog in hospitals (of being who wait ages to be discharged because they have nowhere to go) and primary care (who need support and someone to talk to).

the problem with the small fee concept is that it costs more to administer than the fee is worth.

If the National part is no longer working, the Service part certainly isn't. That leaves us with Health. What are our options:

Local Health Board
District Health Board
Local Health and Wellbeing Facilities
Integrated Healthcare Foundation Trust, x District

Should we also bring Ambulance, MH into those local services too. If I live in x District, does that mean I can attend any hospital in that District because the one 30 miles away is a heck of a lot better than the one three miles away? How about within that District service, the ability to have a portable, digital health record so people can see any GP of their choice?

I think charging for missed appointments would be a better idea. I read somewhere recently that there are 15 million missed appointments a year, costing the NHS 216 million pounds a year.

Yes, it seems sensible to me.