To think if the Scandinavians charge to see a GP maybe we should too?

[Pickleup]

We’ve just spent twelve days in a Scandinavian country, during which time my DC and I fell ill and we had to get medical help.

We went to the local state-run health centre, took a ticket from a machine (like a deli counter) and waited our turn for an emergency appointment (Ie one where you haven’t booked). They run these emergency sessions 7 days a week!

We saw lovely GPs in an impeccably clean surgery. One of them said I needed a blood test and I was expecting to have to come back another day but she took us over the hall and did it herself with a thumb prick - then they tested the blood in their own lab there and then and told me I was good to go. The whole thing took maybe seven minutes.

On your way out you pay at a machine - it was just under £10 to see the doctor, and £5 for the blood test. Children under 16 are totally free.
No charge for doctors certificates.

We had to make a follow up appointment on our way out and there was reasonable availability - we chose something three days later.

Compare to the our GP surgery...at home in the UK, there is currently a ten day wait for ANY appointment with a GP. If you want a specific GP it is 14 days. There are no emergency appointments at all now. Blood tests - you are talking a week wait for results, minimum.

Isn’t it time we started levying a small charge for the vast majority of adults who could pay?

Please read this by Kingsfund. It basically sums up all the arguments why it's a bad idea! www.kingsfund.org.uk/reports/thenhsif/what-if-people-were-to-pay-10-to-see-a-gp/

A lot of GPs are complaining about the number of parents bringing children for appointments with trivial ailments since it became free for U6's. I'm finding it takes longer to get an appointment since then
It is horrendous to get an appointment since U6 was introduced, DC are prioritised for appointments which I agree with, but bloody hell I can't get an appointment.
We definitely need more GPs.

It doesn’t have to be all or nothing. Here in France, we pay 25€ per GP rdv. Most of it is reimbursed by social security, the rest reimbursed through insurance (which everyone has and is subsidised by most workplaces). Yes there is a mental shift to paying up front, but I hugely prefer the French system now: it is faster, far more personal choice. I choose my GP, my physio, dermatologist, gynae etc. I make my own appointments for blood tests / x rays / physios sessions / smears etc when it suits me (usually within a couple of days of seeing the dr) - not when I’m Summoned.

There are schemes to provide cover for those on low incomes. But I don’t get the sense here that anyone puts off going to the Dr - if anything its the opposite !

There's a GP near me (I'm in ireland) who doesn't take free under 6s nor medical or GP card holders. It is very easy to get to see him (just walk in and wait for your turn)

€60 a visit.

Tax rates are high in Scandinavian countries aren't they? (Fyi taxes in Ireland support the health service too but rates aren't as high).

What if you had a long term health problem that required frequent trips to the GP? Fancy shelling out £10 a week? Nah, neither do I!

I think we just need more GPs. I don't actually believe the reason we have to wait is that there are loads of people in there who don't really need to see a doctor

This!!

Every time I go in my surgery it's empty, 2/3 people max. Yet if I ring up for a routine appointment it's almost 3 weeks!!

There are only 2 GPs and one is part time.

No emergency appointments either, I have to ring my surgery who have access to a booking system at the local access centre where they can allocate the next available on the day appointment. But the access centre serves a large area, so by 9.30am all the appointments are gone.

I don’t think charging for appointments is the way forward as it would put a lot of people off. Charging those who don’t show however, (minus medical reasons eg dementia) I am all for.

No, there used to be a quarterly 10 EUR charge in Germany (in addition to the income-related public health insurance) which was very controversial and abolished after a few years.

Impact studies showed that the charge did indeed result in overall less GP appointments being made, but only by the less well-off who very often actually needed to see a doctor whilst the affluent 'worried well' were not deterred.

BTW, I do think that the NHS is shit compared to other Western European countries such as France, Germany etc. and it is certainly not the envy of the world unless you mean by this the less developed, third world countries.

So whilst I agree that the NHS does not perform as well as it should and needs more funding, I would suggest that this Is best achieved through extra ring-fenced taxes and/or national insurance contributions rather than by the charges you propose.

As several other posters have explained, you don't pay for every single prescription/ visit if you've got an ongoing condition.

Ridiculous. Not everyone has ten pounds.

There are nearly 70 million people in the UK, compared to just under 10m in Sweden, just over 5m in Finland and Norway and just under 6m in Denmark.

You cannot compare the health services for such small populations with the groaning NHS here in the UK. Do we even know if they have the same demographics and ageing populations?

Either we accept that we are a welfare state in the UK and pay sufficient tax to fund that, or we accept that we are not and privatise. They hybrid we are trying to make work at the moment, doesn't IMO.

No I dont agree. someone on beneifts living on £50 a week (or whatever it is) wont be able to afford it. And before anyone suggests it should be free for people on benefits my sister already moans how “unfair” it is that people on benefits get free
prescriptions whilst she has to
pay so I imagine there will be people moaning about that!

I said “vast majority of adults who can afford it.” Because we are a rich country, frankly, and most people can.

Obviously children and the poorest would be exempt from charges - a bit like prescription charge exemptions. There are ways to help the chronically ill too - the country we were in (Norway) has a system where you only pay for your first few appointments a year then after that it’s totally free.

For all those who claim that the effectiveness of the current NHS totally free system is so great that we’d go to hell in a hand basket if we started charging a limited nominal fee - it’s worth noting that Norway has the joint best health outcomes of any country in Europe. And it ranks third in Europe in the overall consumer health index which looks at things like drugs and waiting times.

I know it’s only a small sample size but in in our four visits to the Norwegian GP, not one person failed to show up for their appointment. And I didn’t see anyone at all mutter and moan about paying at the machine on their way out. The patients all seemed pretty happy actually - they know the service is heavily subsided for everyone and the standard of care was fantastic.

For all those who say general taxation should be higher to improve the NHS - well maybe it should be. But in Norway their taxes are much higher than ours AND they still charge a nominal fee for health services. Perhaps they think this way that patients are encouraged to take a bit more responsibility for showing up to appointments and following medical advice, and doctors surgeries are encouraged to treat patients a bit better...

Definitely think no shows should be charged. It's not difficult to phone/email the surgery and say you can't make it.

Exceptions could be made for those with dementia etc.

Anything that is Free at the point of use gets abused.
I was at a meeting at our local surgery where they highlighted the problem of 'No Shows' (people who book appointments and don't turn up). It may well be because the problem has cleared by the time of the appointment, often some days/weeks ahead.
Maybe a percentage of 'No Shows' should be accounted for within the booking system.

Someone suggested here as an idea that when you book an appointment, you pay (say) £10, which is refunded if you attend. I think that's a good suggestion.

Maybe a percentage of 'No Shows' should be accounted for within the booking system.

Or maybe people could take their appointment seriously ?

YABU. You clearly have no understanding of what it means to be poor. £10 may be nothing to you but that is the difference between eating food or not for a lot of families. They wouldn’t go to the doctors to avoid paying and the results could potentially be catastrophic.

I didn't collect a hospital prescription for anti biotics after being seen at out of hours walk in centre for an infection when I was a student because I couldn't afford it. I had walked 2 miles there and as it was a hospital prescription it didn't qualify for my student exemption (the receptionist was pretty horrible and didn't explain very well why but refused to issue it, and said it wasn't valid at other pharmacies). I had no money on me at all, was over my overdraft limit, and by the time I would have walked home, got money from a friend, then had to walk back it was all just too much.

I was very poor with money management and later found out I could have got a hardship loan from the uni. But It terrifies me to think other vulnerable people wouldn't seek treatment for similar reasons. Plus it's a public health risk if people opt not to seek treatment for infectious diseases such as TB

Someone suggested here as an idea that when you book an appointment, you pay (say) £10, which is refunded if you attend. I think that's a good suggestion.

^^

Yes. But the admin involved in this process simply would not work. The NHS is on its knees because of poor processes (and lack of funding, obv) , this would add another straw to the camels back, as it were.

There's another reason why this works in Norway and not the UK : fewer people. Easier to manage.

Another point will will no doubt end up in me being flamed alive : for some bizarre reason Brits tend to have a sense of entitlement when it comes to health care and self care that other Europeans do not have. As if the state is totally responsible for all ills : alcohol induced, smoking induced, junk food induced....

Here in Ireland it is €60 a visit even for a child.

So the reason why some GPS aren't like that, needs questioning

Some areas of the country have few good schools and limited amenities like theatre, good restaurants. Why should young GPs move to such an area when there are better options?

I’d Be happy to pay if my wage was comparable to Norweigen Salary levels.

Im Denmark we pay 38 % tax, and doctors are therefore free to visit. If you dont show up, you pay about 40 euros in fine.

But you can't compare Pickleup. Norway is one of the wealthiest countries in the world and has a population of less than 6 million! They have a completely different taxation system and vast amounts of income from oil.

You can't just tinker at the edge of the car crash that is the NHS in the UK. Trying to charge a small fee to patients for appointments would be costly in itself to administer and is like putting on a small band aid at the scene of a horrific road traffic accident.