To think that *some* people paying for healthcare *some* of the time would be no bad thing.

[manicinsomniac]

I am a big fan of the NHS and think it would be terrible if we lost it.

However, I think we could help prevent that happening by it being not quite so free as we are accustomed to, iyswim.

I had to go to my GP today for help with my totally avoidable and self inflicted health condition. I was given an appointment just 3 hours after phoning and the doctor was calm, non judgmental and extremely helpful. I am independent adult with a good, full time job.

I can't see why I, and people like me, shouldn't pay a token amount towards GP appointments, just like we do for the dentist. Even just £10-£15 a visit could make a huge difference on a national scale, surely.

Obviously if you are a) poor b) have an illness or disability that requires frequent appointments c) are a child or d) need expensive treatment/care then the NHS is vital and must remain free.

But I don't see the need for this 'free at the point of use' thing for all people in all situations. If you can pay for standard, infrequent appointments then I think it would be fine to be made to.

AIBU?

"no one chooses to be ill " well plenty of people neglect their own health to the point of illness so that is nonsense

Charging for bariatic treatments does not make sense. If they are successful, they will save the NHS money.

I had cause to reflect on mummymeister's list a few years ago (which is hard to disagree with in principle), when a good friend had his (non-alcoholic, as it happens) drink spiked and his wallet stolen. He was taken to A&E acting as if extremely intoxicated; passed out and had to have his stomach pumped.

Technically, this was an avoidable drain on the NHS resources - they were treating an intoxicated man and removing drugs from his system, and therefore a premium should be paid (along with a slap on the wrists and a stern ticking off). However, to do this to someone who has been drugged without knowledge/consent seems a little unfair - should he be claiming recompense from whichever unknown person drugged him? Or will A&Es need to assess (based on what criteria??) whether a person 'ought' to pay or not?

Similarly, cosmetic surgery - on one hand, hardly anyone would argue that having one's breasts enlarged is a priority for the NHS, but what about breast reduction for someone with serious back problems? Who makes the decision on what is or isn't chargeable at an individual level?

I suspect it would be really hard to administer.

What an interesting thread. The NHS cannot survive like this. We have an aging population. I particularly like the people claiming they can earn more but CHOSE not to..

My sister wanted a job that only demanded 9-5. She could do it standing on her head but didn't want any further responsibility. That's fine but it didn't stop her trying to borrow £10k off me for a house that was over their budget because 'you send your children to private school so you should have stacks of money left over'.

In the last 10 years there seems to be excuses made for everything. Its not their fault they cannot budget and have no money left over at the end of the week, she 'fell' pregnant, they messed around at school and have little in the way of qualifications. Its all someone else's fault.

Agree. In scotland prescriptions are free. I maybe need a few a year. I would happily pay for them. There needs to be a income threshold or max number of payable prescription in a year though but the admin associated with that would negate the income from people like me.

I'm always at the number of people employed by the nhs. that can't be right

I technically missed my last doctors appointment. I went in my lunch hour. I have meetings all day either side. I turned up on time, sat in the waiting room for 45 minutes then had to leave again to get back to work. Never did get seen. Appointments have to work both ways.

I have a medical condition that gives me free prescriptions. It doesn't leave me bed ridden or unable to work and I'm not at home sick. These routine appointments should have out of hours clinics reserved for working people who aren't actually ill. At the same time, I don't need free prescriptions for random things like antibiotics, free prescriptions should be restricted to the condition they are given for.

vlad it might be hard to administer but do you seriously think what we have at the moment is actually working? huge amount of money. huge number of people employed. we just cannot afford it any more.

the example about breast reduction - go back to my original point is it life threatening or life limiting. if the answer is yes then it should be funded.

sorry lampygirl but you should have held on for your appointment. yes it cuts both ways but you want to be seen and want to avail yourself of the service.

if we could get rid of the crap out of the system and start concentrating on the life threatening and life limiting then I suspect more gps and specialists would see people on time.

I remember the good old days where if you couldn't get an appointment with a gp but still needed to be seen that day you would get a sit and wait appointment. You could be waiting for hours to be seen but the doors wouldn't close until everyone who needed to be seen was seen.

They also ran a 8- 12 Sat morning surgery for emergencies as well.

I hate the thought of charging for an appointment it just wouldn't work.

U2. I don't like the thought of charging especially when I have already "paid" as a net tax payer. but something has to change. frank field tried to think the unthinkable and he was shouted down. its like a great big supertanker ploughing on sucking in more and more money and going slower and slower. something has to give.

we have to have a completely blank sheet of paper and ask what an nhs should look like now with the population demographic and money available.

would you feel more inclined to pay for missed appointments if you could be seen quicker at a time and place of your choosing? would you be in favour of getting rid of fertility treatment, tattoo removal and a whole host of other things if it meant not waiting months for a knee replacement?

Why does it have to change? I do not want my family to be treated like relatives in America who have the same condition. They got treatment, but none of the preventative medication or advice we get from the NHS. As a result although I can still work, my cousin who is about the same age is severely disabled and needs a full time carer.

I would agree with the NHS not funding fertility treatment though.

cleaty, it has to change because we cannot afford it. you might be happy with your treatment. lots of people aren't. its the wait to be seen, the endless delays, hospital discharge at stupid times etc. if it worked then everyone would be happy with the service and there would be no calls to put more money into it.

The solution is simple, it needs to be better funded. We spend less per head on healthcare than most European countries do.

And as a heavy user of the NHS, I know everything is far from perfect. But I know that there are not enough hospital beds, not enough social care for people to be discharged on to, not enough nurses on wards. And the Government has also spectacularly fucked some things up with privatisation. Look at Nottingham dermatology centre which was a recognised centre of excellence. Since privatisation it barely manages the basics.

TheCatsMeow I think your knowledge of the U.K. tax system could do with a bit of work.

Tax people more and they will simply stop working, then there will be no one to pick up the bill.

Perhaps if you felt so strongly about it, you shouldn't have had children? You have to charge lots more tax to raise the £1000 it costs to have a baby under the NHS.

U2. I don't like the thought of charging especially when I have already "paid" as a net tax payer. but something has to change.

Yep it does. I work in the hospital as an auxiliary nurse and I was always proud to have the NHS and very grateful for it. I am still pleased we have it but I'm not so sure I should be grateful for some of the shocking care we get and that isn't the fault of the HCPs.

My dh with bipolar lost his psych due to lack of staff and now he only gets to see someone once he has had a crisis A&E is full of people with MH conditions and so much of that could have been avoided if they had proper care before it got to crisis level.

We do some things really well, oncology services are pretty good here. The amount of medically fit elderly patients we have on wards for weeks on end waiting for SS to assess them and find them a home is crazy. We had one medically fit patient on the ward for well over a month.

The NHS is a mess and I can't see how it can go on for much longer the way it is now. It's one of the reasons I decided not to do my nurse training, I don't think the stress is worth it anymore.

I wonder how charging for missed appointments would impact on people with dementia or mental health problems? It was an uphill struggle to get my dad to any of the appointments on time or at all until he got his diagnosis, with that and also the regular sanctions from the dvla for filling out forms incorrectly it would make a dire situation even worse, he may have never been diagnosed.

Even more people would bypass the gp and go straight to A&E.

A better idea would be to raise more tax eg a much higher, but hypothecated, inheritance tax, used exclusively to fund the NHS.

mummymeister if lampygirl had hung on for her appointment and lost wages due to being late back to work how would she be able to afford a charge if there was one.

Make your mind up.

But why should I be kept waiting 4x as long as my appointment takes mummymeister. I work in events. It is very hard to get an appointment that fits around my work. its not just like taking leave from an office job, I'll be meeting people in fields and venues who will also have travelled to be there. I have a duty to keep appointments I've made, if my client needs me on site at 6am on a Sunday then I am. i don't get paid extra for working outside of 9-5 or on a Sunday. And I'm on time barring any actual emergencies. The absolute inability of any GP I have ever attended to run on time really really grates on me. Ive had an 8.30 am appointment 20 minutes late before. The surgery had only been open 30 minutes. It's like they still haven't learned how to schedule appointments.

Also, I attended on time. The fault lies with the other side therefore they should be subject to the fine. Had my appointment been on time I would have been in place to attend.

"I wonder how charging for missed appointments would impact on people with dementia or mental health problems? "

I think there would have to be some discretion. It would unrealistic to punish people with learning difficulties, the elderly or severe mental health problems. I feel that Theere should be the option for persistent offenders. My GP practice de registers anyone who misses three appointments in year, which potentially leaves a vulnerable person without a GP.

So it seems we either can't afford it so more money would solve it.
Or there's enough money but it's being spent badly and wasted within the NHS.
Which is it?

I would say the second...

imo the nhs should be held to account for wages missed due to late appointment, long waiting list (possibly on sick leave due to the health issue etc).