Should GPs charge for letters?

[Lanchester]

GPs are semi-independent contractors to the NHS.
They were trained at huge cost to the taxpayer.
Most of the older GPs made precisely Zero financial contribution to their own training.
They do not have to provide out of hours cover.
They earn SO much that many of them can afford to cut their hours to part time - and STILL have a handsome standard of living.
That part time working is a major cause of the 'shortage of doctors at the NHS coal face', and of the 'hard pressed' feelings of (presumably other?) NHS staff.
(Ironically therefore, it could be that if the GPs salaries were halved, there would be more GPs working hours available to the NHS?).
The GPs final salary NHS pension arrangements are fairly legendary ....even within the NHS.
Do the GPs refund the NHS for the use of resources used to provide a letter??????
E.g. if a Typist is a full time member of surgery staff funded entirely by the NHS, then would it not be a FRAUDULENT activity for the GP to use the typist's time for 'private earning' purposes for the GP???????
If the GP wants to charge for a non-essential letter (e.g. for a holiday company) then that may be a fair charge if the GP tells the patient in advance that the letter will incur a charge.
For any ESSENTIAL letters (e.g. medical letter for a court) the GP should regard that as an important part of the 'doctor-patient relationship' which the GP is already well paid for via the state funded NHS by the patient's taxes. The GP should NOT charge for essential medical letters.
Also, most patients earn a small fraction of what a GP earns, and many unwell patients may have an impaired earning capability and so may be on only £70 per week benefits.
Therefore, the GP should not assume that all patients are able to pay £25 for a letter.
If that letter takes the GP about 10 minutes,
then he/she is paying themself at the rate of about £300,000 per annum for that letter...... on top of their already excellent salary.

BUT....Money going to the "practice" goes towards the net distributable profit to be shared out amongst GP partners ... ?

I think that if you have a GP who knows you so well that it can knock out a letter about your medical history in ten minutes, without having to spend at least half an hour going through you notes, he/she is worth their weight in gold and deserves every penny of your £25.

What exactly is it you're butthurt about?

OP, I don't know how GP surgeries are funded, but I am certain that no GPs are diving into piles of cash Scrooge McDuck style as a result of the letters they charge for.

It's not only GPs who charge for various letters, consultants do too. I had a friend who was secretary to a consultant and she received a percentage of the fee for letters eg to lawyers or insurance companies.

Of course they should charge for letters not medically necessary. So sick notes free because the doctor believes it would harm the patients health to work, referrals to consultants free because doctor believes this is needed. But charge for fit to fly, insurance claims etc definitely!

It helps pay for things like staff, consumables used by the practice. It also helps pay for locum doctors if they are needed.

Recently, I tried to pay one of the GPs at our practice for filling in a form (basic medical form, needed counter-signing by a medical doctor) - she laughed at me, and without thinking, I said, "Oh, last time Dr X did it and I paid, so I thought it would be the same." GP (very interesed) "Ooh, how much did he have off you then?" When I told her it was twenty quid, she rolled her eyes - though actually, I was perfectly happy to pay him, and her: it's something extra to their NHS role, that they don't have to do.

She has told me now that I only pay for something that I collect from the front desk

What sort of letters do you mean OP?

NHS Consultant referrals, no you shouldn't pay.

Letters for school, court, holidays, etc of course you should pay.

GPs have enough to do without that nonsense.

I think that I think they should Look charge for private referrals too, but I could be swayed by circumstances.

I know a GP who charged the police £200 to write a letter about a patient's medical records to be used in court for the prosecution. That seemed a bit high, would have been interesting to know how they got to £200.

Suppose say:
the patient is a woman who has herself been a tax payer working full time for many decades and has rarely visited the Doctor until her late 50's.
The woman feels that she has a good doctor/patient relationship with her GP who is always friendly and who knows her condition well.
The woman has paid for the GP's valuable medical education, his surgery rent, his staff, his consumables, his locums, etc etc - all to the NHS through her taxes whilst working full time for many decades. She is happy to have always been a supporter of the NHS financially and morally.
Now she has encountered poor health and needs to use the NHS herself.
--Suppose that the letter specifically relates to the necessity of her treatment and medication by the GP and its likely incapacitating effects in court.---
Suppose that the Judge has actually requested that she obtain this letter for the court from her GP and that she has explained that to the GP.
Suppose that when picking up the letter from the reception desk at the surgery she is asked for £25 for that letter.
Suppose that the GP knows that she has in recent months lost her job because of her health problems and has only £70 per week benefits to live on.
Shouldn't the GP regard it as part of his NHS job to provide that letter?
GPs have objected to the government trying to open up primary care to competition from the 'private sector' because the GPs say they want to maintain the closeness of the doctor/patient relationship.
BUT surely by charging £25 in a situation like the above the GP is acting like a private company himself.

It's still not the responsibility of the NHS to provide letters for the court

"the patient is a woman who has herself been a tax payer working full time for many decades and has rarely visited the Doctor until her late 50's".

The NHS (and other public services) do not work on a "you get out what you put in" basis.

Suppose that the GP pays £10,000 per year in litigation insurance and letters like this are medicolegally risky.....

I wouldn't write a report for the court I'd suggest that they got an expert witness.

I have more of a problem with the need for constant letters. I didn't choose to be diagnosed with diabetes as a small child. A large amount of £25 letters over my life add up. To take my needles on a plane (including for work, not all flying is luxury), needs a letter, nothing to do with fit to fly, just nit picking, the airline wants it they should pay, or they could take my word for it. I certainly don't prod myself with needles for fun. To join a gym needs a letter, yet again I can't make decisions for myself but my GP who I see twice a year for a routine check can say I can join the gym 'safely' for a £25 fee. Really really boils my piss. It's not the GPs fault mind.

It seems that you are looking at this question from a legal point of view...?
BUT....Some reasonable terms to a contract can be implied.

I was looking at it from the point of view of what we can REASONABLY expect from the NHS - considering how well we fund it.

The NHS is definitely nowadays feeling short of money but that is partly because it wastes so much of the money we do give it.

At the moment some (1995 scheme) NHS nurses can still retire at age 55 on a full pension with a net present value of their expected pensions over the following 30 years of ..... npv = well over £1million.

They can then continue to receive the FULL pension AS WELL AS continuing on in their job (so long as they make sure the job is converted onto a non-NHS contract).
So a senior nurse might receive £32,000 pension + £60,000 salary = £92,000 per year.

Doctors' pay and pensions are far superior even to that.
Very many GPs are reducing their hours / retiring early
BECAUSE THEY CAN AFFORD TO DO SO.

We taxpayers / patients / prospective patients are paying the NHS enough money to have their staff on great working conditions

• multiple weeks holidays beyond normal expectations - multiple weeks off and funding for training, final salary pensions INDEX LINKED for future inflation.

Obviously all of the above is nice for NHS staff - ut is unaffordable for the country. It is particularly offensive to patients who are private sector workers who are hard working taxpayers - (some of them at an ACTUAL 'COAL FACE') who over the years have had much less security of employment than public sector workers like NHS Staff (at the much talked about 'NHS coal face'), and who can only dream of final salary pensions - long ago abolished for most private sector 'hard working families'.

Only now belatedly ...is the NHS realising that they MUST NOT waste money on things like triple paid agency doctors and nurses etc.

If someone in the NHS pension scheme became unwell they could retire on a good income for life -unlike the lady in our example.

No surprise then that the hypothetical sick lady on £70 per week sickness benefit to live on
in the example was not happy to be asked for a £25 fee - even if it was to go into 'practice' funds.
(but probably not even ringfenced as additional funding - and therefore forming part of distributable profits amongst the GP partners)

GPs in England are the second best paid GPs in the entire world apparently.
USA is apparently the top payer, but there the GPs have to pay megabucks for their own medical training, so taking that into account UK GPs are possibly the best paid in the world.

Some GPs are earning literally many hundreds of thousands of pounds per year from the NHS. This is well documented in the media.

GP Medical Practice funding is already provided to the practice by the NHS but If the GPs are so worried about funding the running of their practice why don't they take a salary cut?

The £25 charge is rather obscene.

Literally no one agrees with you.

A letter to court is not medically necessary. GPs are not making millions out of this and lying around in baths of money as we speak.

You paint such a desirable picture of general practice that I'm surprised we are not inundated with medical graduates desperate to be GPs

Sorry, I did not notice the latest two posts whilst writing the long post timed at 22:23:25
It was supposed to be a reply to ScOffasDyke

YABU and ridiculous.
You seem to have very little understanding of the way the NHS works in relation to GPs and a large chip about GPs pay/ conditions, etc, etc which are frankly irrelevant.
I'm not grasping why you think that a GP should carry out private work for free simply because some of their training was funded by the tax payer or because you clearly feel that they earn too much.

Would you expect that of a solicitor or any other professional person whose training has also been funded by the taxpayer?

For your information, charges are indeed sometimes waved for people on benefits, etc

OP, do you need a bullet point function?

If you can find me 2 nurses on pensions of £32000 and salaries of £60000 who will ring me up and confirm it, I will pay the letter fee for your hypothetical person.

I agree that it's very tough on a person on a low income to pay for things like this. However, good luck getting a better rate from a private GP.

and clearly General Practice is so marvellous that we are facing a national shortage of GPs with applications for training places decreasing rapidly.

Well Dr Foxtrot, from your reply maybe you are a GP yourself?

So being 'in the trade' perhaps...
If you know where anything I stated was incorrect then please do point it out for everyone's benefit.

That would actually be helpful.
Otherwise the facts as stated might be assumed to be correct?

Thank you.
:)