Why do people think the NHS is so special?

[SnowBells]

There are always people around who proclaim the NHS is some sort of holy grail. It can't be touched, and don't even think about reforming it. The government may be offering free healthcare through the NHS, but nothing is really free, is it?!

My gripe with the NHS is that just like most institutions funded by the government, it becomes a big bureaucratic mess, where people are more concerned about ticking boxes than the actual patients. Most other developed countries have some sort of free healthcare that can actually be more effective than the NHS. I have lived in countries where, for example, health care insurances are mandatory, so that everyone has one (and a lot of times, employers contribute the bulk or the government subsidises it). Hospitals may be subsidised by the government, but GPs run their practice like a business, and rely on clients to earn their living (this means, they actually have to provide a bit of "client service" that's almost elusive here in Britain). You can make appointments with specialists directly - no need to waste time at the GP's practice when really, you needed to see, say, a gynaecologist.

Why is it that some hail is as the holy grail?

I'd imagine a small fee to see the gp would keep a massive amount of time wasters away.

As well as a massive amount of not-very-well-off people who need preventative care or early intervention, or need four visits before the GP arrives at the correct diagnosis/treatment because that's just what happens sometimes.

Hence why the NHS is so good PausingFlatly.

Because it's a bigger beuraucratic mess in other places too, the difference being you have a whacking bill at the end of it
Friends who live in USA and Ireland marvel still that sick child gets seen same day with any required prescription free, rather than at least 60euro or $100 excess
It removes the concern for cash coming before treatment
There is still the option to pay if you'd prefer- also at good rates, only because the nhs is a viable alternative for most people

Can I examine a little closer the "GP fee/ timewaster" thing, because it keeps coming up.

Almost everyone who suggests it says it should be a small fee, and not applied to the very poor.

So it would have no impact on the comfortably off. And no impact on the poor.

It would have an impact on people with middle income, particularly those with more children or poorer health, including pensioners. This group would show a drop in GP appointments across the board, timewaster or not.

Meanwhile, timewasters in the other two groups would continue to waste GPs' time.

Are those two outcomes what we want?

BTW, I'm not a fan of missed appointments either. But I don't understand why a "remedy" is being suggested that doesn't actually target missed appointments.

What classes as wasting a gps time? Mental health when someone just needs reassurance, someone who is elderly and actually just wants someone to talk to, an over anxious parent worried about their baby's temp ...? Are you going to charge all of these people?

No PausingFlatly it isn't at all (I was playing devil's advocate regarding the fee charging)

I live in Ireland now (though I'm English so have used the NHS up yo my mid 20s). If I went to my gp right now I could walk in and see in in about 30 mins. But I'd have to give him €55.

I'm just over the level that means I'd get a gp card, so have to pay. I have not taken my sick child to the GP because I hadn't the money (though I might say to my gp I can pay you next week, the antibiotics I needed for my son's strep throat I didn't have the €27 for). It's a horrible situation - and this is a country that has health care for all. Seemingly.

Oh as my gp doesn't take on patients with gp or medical cards (which makes visits free) which is why I don't wait long to see him. The gp down the road does, waiting time for an appountment is much longer.

Of course the rich in Ireland (I include those that think they aren't but actually are because they can afford the health insurances that aren't just the bear mininal) get priroty over eveyone else. Even in the public hospitals. Money talks.

The GP is a gatekeeper, yes, but also a generalist who should be particularly skilled at diagnosis. For many common things, the GP can do the whole treatment. For less obvious diagnoses, the GP should be able to narrow down what it might be and what it probably isn't.

I generally think the NHS is a good thing and works very well as it is but this is what I dislike most about it.
Gp's have failed and put two of my family members lives at serious risk by not referring either at all or fast enough. My dmum has visited 5/6 different Gp's over a 6/7 month period with some pretty dodgy symptoms and got sent away.
She's currently today sat on standby waiting for the hospital to call her to have brain surgery to remove a massive brain tumour.
Since she got rushed into to hospital almost 2 weeks ago and the BT was diagnosed - the consultants, Dr's and nurses have been great and she's had fantastic care and I'm sure she will continue to do so during her op and recovery too.
For me it's the gatekeeping part that needs hugely improving.

I'm in Eastern Europe and here I can access free (NHS) healthcare with a GP quite quickly. Referrals through their NHS system can take quite a long time though depending on who it is you need to see.
I found a lump in my breast and went to the GP, he said I needed to get a scan done and would refer - the appointment was for 12 weeks ahead.
I didn't want to wait that long so I bought private healthcare and made an appointment for 5 days later. It gives me fast access to all specialists that I might need to see but I still see the GP first to get his opinion/diagnosis before rocking up to see the Gynaecologist or whoever, without really needing to.

I love the NHS and would happily pay more NI to fund it

The nhs shouldn't be charged for but missed appointments should be charged at £50 session; watch efficiencies sharpen up then

I fear gatekeeping will get worse under the recent restructuring (Health and Social Care Act 2012), as much more power has been put in the hands of GPs.

BTW, does anyone here understand Clinical Commissioning Groups? Can you explain something that's been puzzling me?

How does GP pay get worked out under CCGs? From the profitability of the practice? And is it the case that referrals cut into that profitability? Or not?

I'm just wondering how the incentives work.

CarbeDiem, I'm sorry to hear that. In any system there are going to be some GPs (or other health care practitioners) who aren't as good they should be. The answer to that is better training, better CPD and better monitoring of performance, although that's a very tricky one, given the complexities involved. I hope there's a good outcome for your mum.

Kewcumber, that made me smile because it was rather reminiscent of my husband last year. For years and years he had been having mild pain after exercise and sometimes after meals. He thought it was heartburn. When it seemed to be getting worse/more frequent, he saw our GP who sent him for an ECG to check in case it was angina or some other heart problem. All seemed fine so then they went down the route of looking at acid reflux. My husband had convinced himself that was what it was and was self-dosing with antacids, trying out dietary changes etc etc - but one endoscopy later it seemed it wasn't that at all, so the GP referred him back to the cardio team.

He was about to be taken in for an angiogram when he had a heart attack. The pain had been angina all along. He is so fit and so stoical that he had simply not realised, even though there is a family history of cardio problems. One stent and a lot of prescription drugs later and all is fine, I'm pleased to say. I doubt very much if it would have helped him in any way to be able to self-refer, as he didn't have the knowledge to do it. Google is not enough!

I love the NHS and would happily pay more NI to fund it
My dmum would probably have agreed with you a few weeks back, she's worked all of her life so therefore paid NI and taxes. Just how much more is needed to be paid to ensure that you are given the right referrals and treatments.
My dmums case goes way beyond 'gatekeeping' because there was 6 or 7 of them that refused to refer - that is not a simple case of a mistake or an oversight made by the same GP. Imo -it's screaming a very different message and one that is not fair nor acceptable.

The problem with paying upfront and then claiming it back from your insurance company is that it will put some people off from seeking treatment if they don't have the funds available. Not everyone can afford to wait for a refund.

My DH and I both work but we also have chronic health conditions and it would be very hard to pay for every hospital visit, GP consultation and medicine upfront. This past year we would have needed to pay for minor surgery, physiotherapy, orthotic footwear, an MRI scan, numerous GP consultations, several routine hospital appointments, regular monitoring blood tests, an ECG and cholestoral tests. That's not even thinking about the medications we both need to control our illnesses. I honestly don't think we could afford to get treatment even with a refund.

X- posted.
Thanks Allmims
I understand that there will be some GP's that need better training but I don't accept that 6/7 within the same practice, of all different ages and experiences are THAT inept. No chance.

Okay - so maybe say the first 2 that she went to genuinely believed that her symptoms were actually menopause related and gave her meds to try and treat her. It's the Gp's after that who should have thought ''oh hang a minute this isn't working for this lady let's investigate further and send her off to hospital'' but they didn't.
I don't believe for one minute that none of them didn't question the symptoms she was presenting - no matter how rare brain tumours are - the symptoms were staring them in the face.

I do not WANT transparency of cost
I want best possible care

anything that involves calculating every billing item will increase the cost - more people on fat salaries with clip boards tallying how many minutes I spend in each room.

My husbands Uncle lives in the US. He's had 2 stokes and has medical insurance. However, the insurance has basically been used to the max now after 2 major health issues. He can't afford his stoke medication. He can't afford physio. So he's not getting treatment.

I know of women in the US who don't have all the scans they require in pregnancy because they are not covered by insurance and can't afford them. They also dread the cost implication of having an emergency c section, leading to a lot of stress during pregnancy.

Neither situation would happen on the NHS. It's free at the point of delivery. If you don't like it go get medical insurance- but good luck with that! It's incredibly expensive to be comprehensively insured in the UK