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?

[HowBadIsThisPlease]

people who can afford to pay should pay through taxation.

"countless people misusing/exploiting the nhs because it's free.
I have a friend who is a gp - she says approx 95% of her patients didn't need to see her, OTC medicines would have been fine."

this is a big mistake. It's conflating two unrelated things

• people who don't need to going to the GP
  
• what it costs
  

Cost will be a deterrent for some. But it won't magically deter those who don't need to go. It will deter those who can't afford to go. A completely different set of people. Letting the market attempt to decide who needs E45 and who needs a referral for possible skin cancer, is a massive overconfidence in market forces - because no matter how much you love market forces you can't pretend they have medical qualifications.

It may cut down the massive problem we have in getting to see a GP (I was crying about that this week - I commute daily in the half hour that ALL the appointments disappear - I have a lump on my back i have been wondering about getting looked at for months). But it won't sort out who should be getting the attention BECAUSE that in itself is a medical question WHCIH NEEDS an HCP.

It's like saying "Why do we spend all this money trying guilty people in the courts? They should all just be thrown into prison." the whole point is we don't KNOW till the process has taken place. if you think the process is too expensive, you basically don't care about other people.

[BillSykesDog]

I am very, very against charging. But getting people to use it responsibly seems to be very much a losing battle. There are constantly posts on here from people objecting to seeing a triage nurse or being telephone triaged or any of the other methods put in place to deal with it and they get a lot of support.

I'm not talking about the people who really do have an emergency but can't get through some dragon; but people who want things to be set up for their absolute convenience.

I remember a thread on here a while ago where someone wanted an emergency appointment because her daughter had a small rash and no other symptoms. She utterly refused to engage with telephone triage and refused to accept that a child with a rash who was not ill was not an emergency. And she was generally told she was in the right and should have been seen there and then even though it did just transpire to be a minor irritation. That could have been dealt with by a pharmacist.

I mean, when you have people with attitudes like that, and they're being told they're right, what are you going to do?

Perhaps there could be a charge if you refused to engage with triage and were then found not to need an emergency appointment? It's a tough one.

[caroldecker]

Those who would be charged already pay more for the NHS than they benefit from it

[TitClash]

YABU. You already have that potion but you cant be bothered.

No one wants a fragmented NHS, we already fund it. Go away.

[takemetomars]

bakeoffcake - come work with me in my practice for a week and you will see how true that is. I have been a nurse for 30 years, 18 of them in general practice and it is STAGGERING to see the change in demand for services; a total lack of common sense when it comes to minor illness. I would hazard that some days it is closer to 100% of patients who should not have attended.
General Practice is on its knees and its time is limited. We NEED to do it differently before the whole thing collapses.

[Vanderwaals]

I'm on the fence.
My relative has a full time job, brings in a fair amount of money. But relatively not much because lives in an expensive area near London.
But also has 4 different medical conditions which require a lot of hospital and gp appointments. If they had to pay it would cost a ridiculous amount and put them off receiving treatment.
Already pay extortionate hospital parking fees. And occasionally the train fare to specialist hospitals in central London.

[TitClash]

takemetomars then lets introduce basic first aid as a lesson in schools. People already have the option to pay if they choose, and they already fund the NHS.

[ReallyTired]

I think that people who miss appointments should be fined on a sliding scale depending on income. Parents whose children or those on benefits should be fined a fiver. More wealthy people could be fined £200.

I wouldn't mind paying for the GP if prescription changes are scrapped. There was one time when as a young adult (with a partial excemption) a GP wanted to prescribe me three medications. The doctor was very frustrated when I told him that I could only afford 2 medication as I needed to eat. The doctor made me feel as if I had just wasted his time.

I agree that inappropriate visits to a and e are a problem. Possibly a small charge is the way forward for minor injuries. However my mil took a lot of persuading from the policeman in the street that her hip (with the bone sticking out of the skin) really needed attention from a and e and that nice man in the green suit with the gas and air was not over reacting.

[LadyCassandra]

That's kind of how it works in Australia. We don't have health insurance and we are on a low income so we pay little or nothing for medical issues, as long as they are necessary. If you earn over a certain amount and don't have insurance you pay extra tax. If you have insurance, that tax is wavered and you can claim tax back on your insurance costs. As yet, I haven't had to have any serious medical procedures, so I can't comment too much, but I gave birth here in a public hospital and that is free no matter how much you earn.
I also had PND and saw my gp and got referred to a psychologist which cost very little (to me, as it was subsidised) but was quick (I saw her within 2 days).
In contrast BIL in Uk has been suicidal and suffers with chronic depression and has been waiting to see a counsellor for 6 months.
I have always been a champion of the NHS and worked for it until I left the country 6 years ago, but it appears it's just not viable anymore in its current state.

[TheCatsMeow]

There are constantly posts on here from people objecting to seeing a triage nurse or being telephone triaged or any of the other methods put in place to deal with it and they get a lot of support.

Because most triage people are idiots. I've been sent to someone who couldn't deal with my condition several times, had them try to get out of giving me prescriptions, lying to me about availability of appointments. I refuse to speak to them now. I know my condition, I know what I need. I don't need some unqualified jobsworth telling me to call back later.

[TitClash]

Sliding scale of fees makes no sense in relation tho the NHS. Why would wealthier people pay the NHS when they can pay to go private?
This would bring about the end of the NHS in a roundabout way.

[tinofbiscuits]

YABU.

£10-£15 doesn't sound like a "token" amount, that's quite a lot. 50p would be a token amount in my book...

If you're thinking it would save the NHS money I'm not sure. If fewer people see a doctor when they need to, their conditions may worsen and they'll need more treatment in the longer term.

It's also more likely to dissuade the more vulnerable patients who will find it an extra barrier to making an appointment, as well as the more ill patients who will need more appointments and so would pay rather more, like a tax on illness. It could cause a rise in unplanned pregnancies if women have to pay for a contraception-related appointment. And while those on benefits might be excluded from having to pay, those with an income just above that level may find the costs quite hard.

If people can afford to pay for appointments they can always go private instead of asking the rest of us to pay more (we already pay for the NHS via our taxes).

I would also suggest higher taxes on alcohol to try to reduce the 40 per cent of A&E admissions that are alcohol related.

I agree with HowBad that "it won't magically deter those who don't need to go. It will deter those who can't afford to go."

[ReallyTired]

TitClash

I said a sliding scale of FINES for missing appointments. Fining a barrister £5 for missing an nhs appointment would not act as a deterrent. However a £5 for a benefit claim missing a GP appointment is a punishment. Punishing those who make nhs appointments and then don't keep them is necessary.

The abuse of a and e is hard to crack. What us an unnecessary visit is a bit subjective. Sometimes people need reassurance.

[HelenaDove]

The claimant may have a good reason for missing an appointment like not being allowed to leave his workfare placement to attend it.

He is also more likely to live in social housing and the rules state that a landlord only has to give 24 hours notice for things like a mandatory gas safety check or flat inspection.

So notice would have to be given by a certain time on the day prior to the appointment so the claimant would have time to ring and cancel.

[SoThatHappened]

Yanbu

People "like you and me" already pay for the NHS via tax and NI.

If you think that:

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.

So the ones that cant pay, dont pay and the ones that can pay, pay twice via the tax and NI they already pay and then additional charges on top?

Fuck that.

[SoThatHappened]

Also as said by others, if I was made to pay additional charges, I would go to a private GP etc so the NHS wouldnt get the money.

The isnt free. It is expensive. Look at the amount of NI you pay!

I've already paid for it in taxes if they demanded more of my money I'd go private.

[SoThatHappened]

Misuse of services is also a big issue. Did you know that A&E attendances have increased 48% in the last 15 years, with only a 10% increase in population?

Yeah that might have something to do with the botched GP contracts which allowed them not to work out of hours anymore. Ever tried to get an emergency gp over the weekend? I waited hours for a call back and then got a call at 7pm on a Sunday night told an appointment had been made for me at an emergency surgery miles away from my home and I wasnt in any fit state to drive that far.

If GPs covered out of hours care for their own patients again A&E attendance might drop.

[ICJump]

No just no.
We have Medicare in Australia which is similar but... Some GPs charge some don't, it's almost impossible to find a free one near me so I pay$75 a bust but her half back) some blood test cost, some don't, some tests are free, some are paid, some are free at some places some are not, I had a suspected fracture in both feet and because I presented at a GP rather than A&E I had to pay $270 upfront, prescriptions vary widely (so my anti depressants cost between $9- $12 depending where I go), no free scripts for anyone ,and dentistry a teeth clean cost me approximately $300, a check up is $150 ish, I had to fillings replace $600.

The NHS is amazing and those of you in the UK must fight tooth and nail to keep it universal because it wonderful and right and good that when you are sick or sore you don't have worry about the cost.

[Mistigri]

There is no evidejce that making people pay towards healthcare is more cost-effective

You need an administrative structure to conduct means testing, and to collect and process payments - this costs money. There is also an economic and cost if people are unable to receive healthcare.

Most European "social insurance" healthcare systems involve payment by users for a proportion of healthcare costs. The good ones, like the French and German healthcare systems, are also significantly more expensive per capita and as a proportion of GDP than the NHS.

The NHS offers very good value for money - by international standards not only is UK spending on healthcare among the lowest in the developed world, but you also have (or had - will be interesting to see if the next round of comparisons is less favourable) one of the best all round services.

[Junosmum]

Depends how you define 'poor' if it's the same as free child care/free prescriptions and working tax credits then yabu as families like mine, whio are just over such thresholds lose out.

It would prevent people going to the gp at early stages, for things such as lumps or other early cancer symptoms and would prevent people having regular screenings such as smears or for STIs. Meaning more people would have late detection and more people would die and more infectious diseases would be spread.

I don't think you've really thought it through and the overheads on the paperwork for who is liable/ exceptions to charges/ chasing non payment would be huge.

[Mistigri]

By the way, here in France we pay 8% of income as a healthcare "tax" (mandatory insurance payment to the government). No minimum or maximum - if you are employed, in however lowly a job, you pay.

In my family's case, this amounts to close to €10k a year to cover only 70% of our healthcare costs. In addition to this, I pay a separate, non-means tested insurance premium to cover the remaining 30%. My employer pays part of this, but if I were to contract a top-up insurance myself with the same level of cover, it would cost me a minimum of €3k a year (for a family of 4).

I don't resent this money by the way - we get excellent healthcare - but private and semi-private healthcare is expensive and it seems that British people will only realise this when the NHS is no more ...

[Mistigri]

On the subject of increased A&E attendances, the reasons are complex, but no one should be surprised that if you reduce access to primary care in the community, while reducing spending on care services for the elderly and on mental health, you will generate additional demand in emergency departments...

[Rubygillis]

See I think here in Australia it's really good. We have a higher income so have health insurance and so I have birth in a private hospital which was lovely - but I also hear that public hospitals are also really good. I just wanted my own en suite room and choice of obstetrician.

I have a GP who I don't have to pay for but who is absolutely brilliant. My husband had to have a colonoscopy and had the option of waiting 3 months for free or have it the next week and pay - and we knew it wasn't anything serious so we waited.

[Rubygillis]

Big difference here is that we pay a lot of tax and also there are only 21 million of us.