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?

Haven't got the time at the moment to read this thread completely, so apologies for any duplication, but:

I would understand and agree with a decision that those who can pay should to support the NHS - not private companies

Aren't most, if not all, GP surgeries actually private businesses, run by the doctors for the doctors, carrying out work for the NHS under contract.

Of course society does help you get there - but then, the point of a high salary is to give back. So with my education, I had state schooling until 8, then won a scholarship which paid for everything until I was 21. I had a holiday job at 16 letting flats which gave me the idea to buy one; selling that at 21 paid for further education. I like that my taxes now help others to be educated and of course do not begrudge what I pay now (I begrudge some of what it gets spent on, but that's a different issue!). However, if the greens had gotten in and raised it to 90%, I'd have quit or taken my skills abroad. It has to be worth it.

If you could allocate where your taxes go, I'd pay more, as I could see it going to the nhs or schools. But impossible to do in practice.

I agree with you re nationality - I would like to see what we are spending on treating people who don't live here to explore that point more thoroughly. It would go for Brits who have emigrated too; it's about residency rather than nationality.

Lots of people say they would pay more; plenty of my friends IRL say this. Maybe HMRC should run a voluntary scheme where you could contribute more tax for the service of your choice?

Bet nobody would tick the "MP salary" box...

scared so you don't think that ensuring everyone has a living wage and a better standard of living for all is important? Look to be taxed 90% it's on anything over 100k if I remember that rightly? Why do you NEED that? Why do you think it's acceptable to have that when some people can't afford a basic standard of living?

I do think it is important. That is why I am v happy to pay as much as I do; I am certainly not complaining about that.

But I don't get given my salary for nothing. I worked my arse off from 11-25 to get good qualifications (with part time jobs to support myself from 14), and now I work really really really long hours. OH doesn't work as he does the childcare. When I go back after mat leave, I know I will be missing out on a lot. There would come a taxation point when it wouldn't be worth it to me, and I would quit. Then there would be less money in the pot, not more. That's not going to help anyone! Needless to say, I am nowhere near the £200k+ bracket you mentioned; I would agree with you there as that is what I would call the super rich.

scared, if you didn't work those hours your company would have to employ someone else to do the extra work - thus having two people earning good money rather than one earning excessive money and one earning a pittance.

The "I work hard for my money" argument has a flaw. Take the £150k salary example and compare it to someone on £15k. Nobody works literally ten times harder that someone else. Presuming they are working harder though, wouldn't it make sense to split the workload and salary more evenly? I personally like the idea that within a company the highest earner should only be allowed to be paid a set multiple of the lowest earner. In order for CEOs and directors to earn more they'd have to find a way to raise the salaries of those at the bottom.

As for the original question, I really don't think charging for GP appointments is the way forward. Free at the point of use is important and any charge would set a dangerous precedent imo. I'd also happily see my tax go up, though I'm only a middle earner and a net contributor.

Jessicas excellent post

Not every job could be split between two people that easily. You would end up with a lot of duplication in my role as both people would have to read all the paperwork; legislation; briefs etc. The client wouldn't pay for that.

From a social perspective, I agree that is a great idea. But the idea of the government being able to tell companies or people what they should do is also a slippery slope. They are private companies, not public ones; that means the owners get to make those decisions.

I think people see a salary of £100k and think the person must be super rich, but they're not necessarily.

Take dh. He earns 96k per year, or £8k per month. Lots right? But £4k instantly gone on income tax and ni. He's a surgeon so has to pay £500 per month insurance. He has to do cpd, so that's another £500 gone. He has to pay an accountant. So, we're down at £3k per month already. Chuck living in London in to the mix. I'm not begrudging it, we still have a lovely life on this money, but I don't think it's the luxurious life that people assume on that salary.

are so you get at least 3k a month? That's pretty extravagant compared to what a lot of people get. Even in London.

scared a slippery slope to what?

Private companies cannot be trusted

I know it wouldn't be that easy - but it certainly would be possible. Multiple people reading the same paperwork was fairly standard when I did engineering consultancy. We had set tasks and specialities, but on a design team there was a lot of people who had to know the same stuff. But then I worked for a company who frowned on overtime, and if managers were expecting staff to work excessive hours they were bollocked for not assessing the staffing requirements of the project properly.

Governments tell private companies what to do all the time. They impose health and safety laws, tax policies etc that companies (supposedly) abide by. If they took the working time directive seriously you'd find a lot less people working the hours you describe and (perhaps) a lot more people employed. Maybe, just maybe, we'd end up in a situation where having a decent work-life balance was recognised as being a Good Thing.

"I expect lots of people would put off seeing the gp for the sake of a £10 apt and end up seriously ill."
Usual claptrap wheeled out every time.

It won't happen, because to too many English people, the NHS is like some kind of religion / God.
A small charge would make many people wake up and start taking responsibility for looking after their health, not to mention reduce the amount of missed appointments..

I have a British council passport.
At the moment, due to having residency elsewhere, I should not be allowed free NHS care, but I can get it.
I have a friends, living and working in the UK, on Polish, Malaysian and German passports. They should be able to claim free care. How would eligibility for free care, and residency in the UK be determined?

Would increasing prescription charges work? Or is the cut off for free scripts too low, and would affect too many working poor?

Yes to increasing tax /NI to fund the NHS, but it needs to remain free at point of use for those who are eligible (which should be anyone living in the UK perhaps we need a national ID card)

All that would happen is some people would put off going to the Dr, and get more ill. I already have problems getting my DP to go to the Dr when there is clearly something wrong. If there was charge, DP simply wouldn't go. Useage of A&E would also increase.

The Dr is also the first port of call for nearly everyone with mental health problems. It is already extremely difficult for many people to make that first appointment. This would put another barrier in the way.

And £10-£15 is still a lot for many people who I am sure would not be classed as poor.

Oh, and (when paying tax and NI) the service we received from the NHSvwas outstanding, with the exception of the midwife for DS1 community care.

I did phone the surgery when DS2 was young, not really himself, and had a rash on his tummy, which spread from the size of a 50p at lunch to all over his tummy when I changed his nappy. Reception: explained I was concerned, the above explanation, and that I didn't know what to do. Asked if I'd consider a nurse appointment? yes. Could I get there in 20 mins? yes. She spent about 20 mins with us, and then went to get a GP. There is no way they had that gap in the appointment schedule, but they fitted us in. Reception and triage nursing fantastic, because I was able to tell them what was up, and trusted them to make appropriate decisions.
And this is a surgery where if you are requested to make a follow up appointment in 3 weeks, its impossible to get in with the same GP if you work.

Private companies cannot be trusted

Tinfoil hat time.

Neither can the government or anyone else for that matter if you go down that road.

solmon - The phrase "taking responsibility for your health" is always said by people who have absolutely no understanding of why some people don't. People with enduring mental health problems often live a far unhealthier lifestyle. Because when you are coping with periods of psychosis and heavy drugs, popping down to the gym regularly is not your first priority. And depression is so so common, and affects how people look after themselves.
Charging would make no difference.

I had never missed any appointments till last year, and then missed a hospital appointment and several GP appointments. I was very ill, and had lots of appointments, and struggled to keep track of them, or sometimes to even remember what day it was. I don't think if you have not been really ill for a long while, you can understand the impact. Charging me would have made absolutely no difference. It would have just made my life harder.

Arethereanyleftatall can your DH offset his insurance and his CPD against his taxes? (Nothing to do with the thread- just interested!)

I don't grudge people who have large salaries at all - and I do agree that many of them work very hard. However, I am a basic rate tax payer, in a job that requires a minimum of 4 years post-graduate education, and I work between 70 and 120 hours every week, 7 days a week, week in and week out. I have never been able to take more than 10 days annual leave in a year, and we don't get reimbursed in any way for that we are unable to take. I last took a holiday in December 2007. A lot of people have qualifications and work exceedingly hard for their money - but salaries don't necessarily reflect that reality.

That said, I don't think someone on a salary of £100k is super-rich - once you've taken off taxes, there isn't enough left to, say, run a home, a family and pay for school fees. 20 years ago, plenty of regular middle class people could scrimp and save and send their kids to public school without their children having bursaries or scholarships: nowadays, with boarding fees at upwards of 30k in post-tax income, that's simply not possible.

Also, punitively taxing the super-rich doesn't work - look at France: it just leads to capital flight. The top 9000 tax payers in this country pay more tax combines than 50% of the rest of the tax paying population combined: we need their tax income - and shouldn't aim to hammer them as it will have bad effects on the country as a whole.

I wonder if the NHS suffers from a similar issue as my sector: they are so terrified we are going to fiddle our expenses, everything can only be ordered or bought through certain purchasers. £9.99 Samsung 'phones, needed for a field trip, ended up costing £89.99 each; a hotel I could find online for £45/night costs £90/night (and, incidentally, over what we are allowed to spend as a result) because we can only book through certain travel agents, and are not allowed to book for ourselves and claim back. It is cheaper to order a delivered sandwich lunch from a poncy deli than it is to have in-house sandwich catering. People get pissed off when I point it it's public money - but it is. Just as, if a similar thing is happening in the NHS, it is also public money.

Why are there such large payouts when a chief exec leaves before the end of their contract, with huge pension benefits to boot? Why is there so much emphasis on form-filling and box-ticking at the expense of healthcare? Why are nurses feeling so over-worked and under-appreciated that they are leaving the profession, or going to the private sector/overseas? The NHS is one of the largest employers in the world - how can this be, when we only have a population of 65 million in the first place? At the moment, the NHS seems - to an outsider- as an inefficient, bottomless pit for cash: this has to change (both the perception and also the reality).

YABU. It will penalise people who work and they are already paying taxes to fund the NHS. It would effectively be another tax on work. The problem with people going to A&E or surgeries for minor ailments would not be solved by charging some people more. They need to educate everyone as to what is appropriate and where to go according to your needs. And a lot of people who work already can't get to appointments because they work full time, charging them (by assuming they can afford it because they are not entitled to free prescriptions or whatever) is just going to make things even more unfair.

"solmon - The phrase "taking responsibility for your health" is always said by people who have absolutely no understanding of why some people don't."
So I should have to pay for those people who are reckless? Yeah sounds very fair

"

Why are there such large payouts when a chief exec leaves before the end of their contract, with huge pension benefits to boot? Why is there so much emphasis on form-filling and box-ticking at the expense of healthcare? Why are nurses feeling so over-worked and under-appreciated that they are leaving the profession, or going to the private sector/overseas? The NHS is one of the largest employers in the world - how can this be, when we only have a population of 65 million in the first place? At the moment, the NHS seems - to an outsider- as an inefficient, bottomless pit for cash: this has to change (both the perception and also the reality)."
You wouldn't get answers to those questions because the NHS is a sacred cow to far too many people

Sometimes taking responsibility for your health means seeing an HCP.

I see all the time on here "get help!" or "he is being unfair to everyone around him, he needs to get help." yet how? What happens when you try to do this?

I would love to understand more about the assumption of many on this thread that NHS services, GPs surgeries in particular, are overstretched because people don't know when to deal with it themselves.

Has this changed over time?

What other factors might have led to the difficulty of getting appointments? the most obvious possible other cause is that there are fewer appointments available per head. Do we know the numbers on this?

Don't forget that the infuriating practice of only opening up appointments a week into the future, and taking no records of failed attempts to get appointments, is clouding the numbers here, as there is no record of how many people may have wanted an appointment and not got one.

Even if more people are going to the GP - maybe they should be. Maybe the often bemoaned male culture of dr-avoidance is finally, after decades of the NHS, being challenged; and maybe this is a good thing. for instance.

Any proper analysis on all this available? I mean numbers, thinking, etc, not spouting off about The Great Unwashed and stressed anecdotal moaning by those in the front line

solomon this is exactly the question, though, isn't it?!

How can we not have enough doctors and nurses when the NHS has taken on 300 000 new employees over a period of 5 years? That's 60 000 people a year, or 5000 a month, or over 1000 people per week - week in, week out, for five years. So it can't just be a question of more money - there have to be issues in there over efficiency, staffing, or procurement.