to think that within a few years we will be paying to visit the GP,Conservatives consider limit on GP visits

[MiniTheMinx]

The Conservatives have considered limiting the number of times patients can visit their family doctor in a year, it has emerged.

"Labour health spokesman Jamie Reed told the Independent on Sunday: "This paper, hidden away on their website, reveals the Tories' true agenda for the NHS. After throwing the NHS open to ever more privatisation with a wasteful and damaging reorganisation, it seems the Tories want to go even further.
"It's shocking that they are considering limiting the number of times patients can see their GP - changing the fundamental principle in the NHS constitution that access to the NHS is based on clinical need.
"The Tories have already wasted £3bn on a top-down reorganisation of the NHS and overseen a crisis in A&E - now they are consulting their members on opening up the NHS to even more competition, and making it harder for patients to see GPs in the evenings and at weekends."

A Conservative Party spokesman said: "This was simply a topic to provoke discussion and isn't Conservative Party policy."

Yet.

We all know where we are headed with this don't we? or am I being an unreasonable old cynic?

People on Incapacity Benefit/ESA don't get free prescriptions.

Incapacity Benefit/ESA is slightly more than Income Support, so you are deemed too rich to be eligible.

(Might be different for people on Emergency ESA or other lower amounts. On the other hand, you have to have actually get a benefit - if you're stuck in the no man's land of too sick for JSA, too well for ESA, you again won't be eligible for free prescriptions.)

Thinking overnight, I've realised it's economically potty to restrict GP visits.

Prevention and early detection come out vastly cheaper than treating severe illness and living with disability. Restricting that preventative work would create huge costs elsewhere in the NHS and in social care.

Unless of course you're planning to refuse treatment and care all the way up the system...

Whatever system we have, it will have some problem. That problem can be a GP wastes one appointment every day. Or it can be that we leave people to die or be crippled by undiagnosed treatable diseases.

Which do we prefer?

I took DS1 to the doctor countless times over 2 years. Finally, he was diagnosed with coeliac disease. Should have happened a lot earlier, but doctors are not great at picking this up (like many other conditions). Should we have been limited. Several doctors clearly did think his symptoms were 'nothing' or 'time-wasting'. They turned out to be wrong, but they'll never know.

"Prevention and early detection come out vastly cheaper than treating severe illness and living with disability. Restricting that preventative work would create huge costs elsewhere in the NHS and in social care."

This. A friend of mine and my SIL both developed breast cancer. SIL had the operation straight away and is now in remission: hopefully those are the only costs that will be incurred. My friend's treatment unfortunately was delayed. By the time she died some 3 or 4 years later she had had numerous attempts of treatment: operations, chemo, the lot, not to mention the costs incurred by counselling for her children and social workers to ensure the family was coping.

'Prevention and early detection come out vastly cheaper than treating severe illness and living with disability. Restricting that preventative work would create huge costs elsewhere in the NHS and in social care.'

THIS THIS THIS

Works fine in lots of countries

Like Australia. I pay $50 to see my gp. My dds are bulked billed (which means they bill the Government direct) until they are (pretty sure it is) 16, but many gps won't bulk bill even for kids/the elderly. so you have no choice but to pay.

I can claim back 80% from medicare for any GP fees. However, when I spend $25 on a script, I get nothing back. And that is the same for my children too. There is no subsidised prescription charges here unless you are on a very low income. If you have private health insurance, they will reimburse you a small amount.

There is also no easily accessible affordable dentistry here. For the NHS equivalent, you can go on waiting list (again v low income only & you have to have a health care card) and wait until your name appears at the top. A friend in another state has been told the wait is 6 years. She can't afford to go private, but they are the only options she has. We pay $40 per course of treatment for children (on NHS equiv) or take them private.

We also have to have ambulance cover here, as regardless of the reason - even in am emergency - if an ambulance takes you to hospital, you pay $600+ per trip.

They do - but prevention in terms of health improvement work is long term, incredibly difficult to measure and requires new skills, cultural changes and behvaioural shifts that are often hard (and occasionally, impossible) to achieve. It also means competing with big industries - the drinks manufacturers, the tobacco industry, the supermarkets and so on. And that's before you even start trying to tackle poverty and deprivation! It can be hard to justify health promotion and improvement over the long term when there are patients to treat here and now.

From where we stand now, further improvements in prevention are hard because the low-hanging fruit have already been taken.

But roll back access to GPs and we'll immediately see the cheap, easy gains lost again.

You're right about Oz differentname. A friend of mine lives inQueensland. They have been nearly bankrupted by the medical costs of a disabled child. The prescriptions, the therapies that arent covered, the GP visits, the ambulances every time their daughter has a seizure. They panic about whether can afford another visit if she seems 'off' or maybe it will pass. Is it a cold or has it gone onto a chest infection. Do they wait and see or do they cut back on food again. On the surface they are middle class Australians but the misfortune of having a chronically sick child is destroying them financially.
The US too. I've seen the queues when a 'free clinic' is staged. People with easily dealt with conditions that have become serious because they couldnt afford a doctor queuing desperatly for hours. Some in terrible pain. Others to be told that nagging ache that could have been treated in now untreatable cancer. Others whose 'cough' is TB ffs. How many have they spread it too?
What a fucking awful way to live.

Our NHS is something to be proud of and was set up after the war when this country was in ruins and dire financial state. We are nowhere in that condition now. The Tories are privatising it for ideological reasons IMO. They opposed it back then and despite Cameron and co making use of it because you can bet your knickers BUPA didnt cover his child, they are getting rid of it now.

Agree - access to GPs should not be made harder for those who need it, but health prevention is about much more than GP access. Increased personal responsibility linked to healthy lifestyle choices would reduce a lot of the burden on the NHS - I see it every day in my work - but we're not very good at listening and acting on health messages, we tend to take a 'worry about that later' approach in many cases (not all, obv.)

Private health insurance won't get you very far if you need more than about 3 or 4 outpatients' appointments a year, I can tell you that now. Premiums have gone up massively over the last 2 decades but the total amount covered has largely stayed the same, so we are looking at 1990s levels of provision at 2010s prices.

I put off seeing the GP with a bit of a cough after a (with hindsight) patronising public information campaign about avoiding wasting GP time, and I turned out to have double pneumonia, which ended up needing lots of relatively expensive treatment and hospital visits. I'm quite well informed and look after myself, so if this can happen to me, I am sure it could happen to anyone. It would be daft to put people off seeking primary care. Better that the GP has a quiet word if patients are not using the service properly.

Sirchen- good points.
I also think that more needs to be done to meet the needs of elderly lonely people who might be using the GP as a way of contact when actually another service might fulfil that function properly. It doesn't make economic sense for doctors to meet that need.

The NHS certainly needs a total overhaul. It's a personal bugbear with me, because while I totally believe in the principles of it, and god knows I could be struck down with some god awful disease tomorrow, it definitely is abused by some people. Personally I pay a visit to my surgery once in a blue moon for smears, even the births of my children must have been far cheaper than average (not in hospital, no expensive drugs) and have to pay for my dental treatments in full, so it does grate when you see people who are constantly down at the GP ... Disclaimer : not people who have legitimate concerns about health, but people like my ex neighbour who rushed down every time her kids had a cough or sniffle, yet blindly refused to make the connection between her own smoking and their health

Absolutely Janey. I don't know what should be done with the NHS (I'm not paid nearly enough to worry about that!), but I do know that it cannot be sustained at the level we want it to function at without a major overhaul and redirection of effort and funding, coupled, I believe, with a change in attitude and increase in personal responsibility.

And reading Boffin's post, supposing her cough had not been pneumonia but TB- that is an awful lot of people who could have been put at risk.

I think it's high time people could be offered the choice. It would remain free for most people anyway and if someone chooses to pay and have a better service, who cares. It's not as if there won't be exemptions for people on benefits or chronic illnesses is it? Healthcare is bloody expensive and someone has to pay. Better charge than have the rationed shambles of current time or the hideous overspending, borrowing and waste of the last twats.

The NHS overhaul is long overdue, we have too much waste and too many procedures that should only be done privately.

Charging for missed appontments is a start and im on the fence re limiting GP appointments. So many go for calpol, head lice treatment etc when they can simply pop to Tesco. Maybe a set small charge for all would be better regardless of being on work or not, we dont need any more incentives for people not to work.

Many people couldnt afford 'a small charge' happymummy. Carers, disabled people, unemployed people. But given your final sneer about those not in work I'm can anticipate your answer to that.
You do know that epidemics of TB, cholera etc start in slums. Amongst the poor unable to see doctors and too afford decent living conditions and medicines dont you? The same will happen with the next swine/bird flu pandemic. Do you honestly think the rich will be immune?

Mil used to visit the GP weekly. she had rather a crush on the poor fellow. she once went to ask if it was all right to go in the jacuzzi on holiday, and another time to seek advice on her hair going white (she was 80 at the time).

Unfortunately many, many elderly people become absolutely obsessed with their own health. Mil would go on and on about her ailments. She is now in a home with senile dementia - ironically the full health assessment she had on admittance revealed that she was in fine physical health. So she had wasted hours of doctors' time over the years.

People forget or don't know that the NHS has been rated as one of the most effective healthcare services in the world £ for £.

Yes it can be improved etc etc but ultimately it does a good job.

All this shit about restricting GP access etc is just a way o getting people to talk about what's wrong with the NHS instead of what actually works well.

We all have negative anecdotes but ultimately I am grateful for the fact that I can ring 999 and not worry about being invoiced for it later. It's funded through taxes, it's more efficient than say the US, and it does a good job.

And another thing, restricting GP appointments smacks of nanny state to me.

YY, creatureretorts.

We all have stuff to do that we would not have to do if everyone was rational and efficient. They aren't. managing other people's irrationality and inefficiency is at the heart of getting a good job in a short time. GPs should know how to limit this as much as possible, and I am sure they do, and like everyone they like to moan after a hard day's work that it would have been easier without having to work around other people's inefficiency and irrationality, but you know what, this is so so so so so not the answer.

Why? because applying a cost is not weeding out the pointless. It is weeding out those who can't or won't pay, WHICH IS A COMPLETELY DIFFERENT SET OF PEOPLE, ONLY PARTIALLY INTERSECTING, BY CHANCE

TB is on the rise in the states now. Read about this a couple of weeks ago.

The Tories have been in talks with the big american insurers for years before they came to power.

I agree with those saying that limiting access to primary care will have costs to the economy in other areas.

I have known people to take their kids in to see if they can get a script for calpol. A friend tries to get over the counter drugs/treatments on script because she is on benefits. However one could argue that whilst I can afford to pay for calpol she can't. I wouldn't want to see her children in pain for want of money.

What incentives do people have not to work HappyMummyOfOne most of the welfare bill goes to people IN WORK.

Like most GP surgeries, our receptionists kind of triage you and try and direct you to the most appropriate service (ie pharmacy, walk in centre, A&E, different clinic), and there is a lot of clear information all round the surgery and local pharmacies about what they can help you with, so you would have to be pretty oblivious to continue to go to the GP for something like head lice treatment, in fact I have a feeling if I made an appointment for that I would a) have to lie to the receptionist about why I wanted to see the Dr, and b) would be told by the Dr to go to the pharmacist and buy the stuff (or given a prescription for DS and told firmly not to darken his door with head lice ever again). Our GPs are lovely, but they aren't shy about pointing out when a different service would have been better all round.

If an elderly person is coming in every single week with non-illness because they are lonely, then the GP is not doing a very good job - they need to be signposting people to other local services and making referrals to other agencies (befriending, luncheon clubs, day-services etc Well, the ones the government hasn't axed) and gently talking about why it isn't appropriate to come just for a chat. There is a fine line to be walked between discouraging unnecessary visits and avoiding making people feel bad about needing to see their GP.

As far as charging - well we already pay for prescriptions, so there is already probably a charge attached to seeing the GP.. I think it would be very very wrong to start charging people, and you don't have to look any further than here to see that a £20 charge for GP's appointment would prevent people from seeing their Dr until it was absolutely life or death and their treatment would then end up more expensive. And routine tests and treaments? Do I get charged for smears and blood pressure checks? Or does the government absorb this costs, get rid of the ludicrous layers of middle management and restructure costs and remind themselves that if they want everyone in work, then they need people to be fit and healthy and not put off seeing their GP for something totally treatable because they can't afford it. I know people in the US who have had unassisted homebirths and no pre-natal care because they cannot afford it, who put off seeing the Dr because they can't afford the insurance/co-pay and it has turned out to be very serious, and people who are losing their homes because of medical bills. We are all just one serious illness or accident away from being totally and utterly screwed, the NHS is amazing and we are very very lucky. We would have to be utterly and completely stupid to give it up without a fight.