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?

Scandinavia doesn't have the same huge poverty problem: people can afford to pay. In the UK there would definitely be people who couldn't afford to go.

With not charging for long term conditions you often require several appointments over a long period of time to diagnose it in the first place. Sometimes this can take many years and various referrals. Would all these appointments be back dated?

That's an excellent question. If it were backdated & the refund taken out of the gps budget, maybe then gp's might be less reluctant to refer to specialists if they were going to lose out as a result of the patient eventually getting a DX?

Channel island residents already do pay to see the gp. £45 s time

In Australia we have a mix. There are GPs that 'bulk bill' which means they only charge the fee funded by Medicare, the tax funded system. There are also GPS that charge a gap payment on top of the Medicare funding. Many GPS that charge a gap payment waive it for students, children and people who are on benefits.

If you go to a 'bulk billing' clinic you are less likely to see the same doctor each time and you probably have to wait longer. But you receive free healthcare that day.

Generally people who can afford it will go to a clinic that charges a top up.

I understand that the NHS has a historical and cultural significance to the UK, and that's why people defend it so strongly. But personally I am always happy to pay for healthcare. I really don't see why someone like me on a good income should be fully subsidised from a common pot, when that adds strain to the system and means that people with less resources and choices than myself have to deal with long waiting lists, rushed appointments and any of the other things I read about on here.

My friend who had a c-section in the UK was discharged in 24 hours with a fistful of paracetamol. That is unheard of in Australia. It's standard to stay in hospital for 4 days here with a c-section and even that felt quick to me.

I am Scandinavian and pay £50 for a visit to a&e and similar to see a GP. I live in London and am shocked how much British people go to the GP. Probably because it’s free. Yes to charging but I think too much poverty in this country.

Obviously for it to work, there would be protections in place for people on low incomes and people with long term conditions

Who decides what a low income is? These things always play out so that A LOT of the most vulnerable of all (who haven’t slipped through the cracks) get things free (as they should do). Meanwhile, those who are just above the threshold but still really struggling get nothing. Like with the PIP payments, if you have to be unable to walk 20m to qualify, it’s somehow assumed that anybody who can manage 30m before falling over exhausted and in pain is able to do any job whatsoever.

Long-term conditions like asthma, do you mean, which, whilst life-threatening (and sometimes fatal), does not qualify the sufferer for free prescriptions now, so why would that change for appointments?

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

Somewhat ivory tower there. All African countries are extremely rich – if you look at the leaders, that is, and ignore the millions in abject poverty.

Yes, we in Europe have much less absolute deprivation, but there are vast amounts of people here in the UK – a lot of them in work – who really genuinely cannot spare £10 (and that’s assuming that only one member of the family needs only one appointment, that is).

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.

Have you no idea how many people go without prescriptions because they simply cannot afford them? Yes, you can pay a tenner or so a month if you have a bank account and are able to commit to paying it every single month – a luxury unavailable to many.

Don’t you realise that being chronically ill frequently means that people cannot work and are therefore forced to live life hand to mouth on top of dealing with their illness? Many miss out on the PIP criteria by a whisker and are therefore officially as good as treated as being in perfect health, when it comes to their employment and earning potentials.

If you don’t have the money for the first few appointments in the year (very likely if you’re in a health position to need several), what use is it to you if the subsequent ones would then have been free? If I went into the street and offered people a brand new 3-bed semi for just £50k cash upfront, they’d be getting an amazing bargain. Even so, for some reason, I wouldn't expect to get many takers.

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.

Yes. I was in a shop yesterday and a woman asked to put £2 on her electricity card. The machine whirred a lot and then failed, eventually generating an error code because it could only accept a minimum of £5. To many people (and no doubt the people who set up the system, which incidentally makes the poorest folk in society pay much more than better-off people for their utilities) a fiver is peanuts. However, I'm guessing that this woman wasn't just randomly asking for £2 because 2 happens to be her favourite number. In fact, I wonder why ever she wouldn't just put a hundred or two on it and save herself the bother of having to come back again so soon….

For the umpteenth time... people on low incomes or with long term health conditions would not have to pay.

This is a lovely idea in theory, but we've seen time and time again that it does not work for many people who are really, truly struggling.

Here in Ireland we pay 50 per gp visit. Children under 6 are free. It cuts out the time wasters tbh

I'm sure it does. Along with all of those pesky poor people who dare to get ill – some of them just 7 years old.

I think it's not a bad idea but would be tough to implement. And taxes in Sweden are high so they have more to spend on healthcare, which is why you had a good experience.

It's about expectations - when we moved away from the U.K. we took out private health insurance but we still pay on top for stuff that is not covered by or limited by insurance. After a while you get used to stuff not being free.

DH lived in Sweden for a year and personal contributions towards healthcare appointments were capped at around £100. I'm not sure how it works for the poorest people. He paid the first £100 then everything is free at the point of use - GP, consultants, physio, medication. It seems like a pretty good deal to me compared to the U.K where waiting lists are crazy and you can't get a go appointment.

I wouldn't be opposed to a system where you can opt out of paying towards the NHS and arrange your own private healthcare. I'm by no means rich either (minimum wager). I just feel the NHS, in its current state, is no longer fit for purpose.

I avoid seeking medical attention where possible due to some really poor treatment in the past. Eg. refusal by a consultant to do lletz procedure (which had already been postponed by admin fuck ups by a year) because it may affect my chances of carrying a child to term in future. He actually tried to tell me I need to ask ask my DP's permission first. The assisting nurse was nice and apologetic on his behalf, but if I'd have spoken to a client in that way I'd have faced disciplinary action. I feel with the NHS, such issues get swept under the carpet too readily as we should simply be grateful that we aren't been charged at the point of treatment (even though we get taxed to pay for it of course).

I have a chronic condition and have lived in France and The Netherlands on minimum wage and healthcare has been free (or extremely cheap when not related to my condition). Great service, free or near enough... and served by private providers. The healthcare will continue to be a big problem in the uk until they follow other European countries (not Ireland)!

Just looked up Push Doctor.....looks excellent. See people can throw their arms in the air about making some small charges for GP services etc, but I do firmly believe that if government is strangeheld and can not make any legislative changes, then the market forces to meet demand will spot a gap and creep in (Push Doctor). Pragmatically anything that lightens the load on the NHS some might say is a good thing, but then people get arsey about two tiered systems, poaching of staff etc .... so it's a no bloody win situation again! The only palatable solution that people like on MN (and I am generalising) is to uniquely tax the wealthy and corporations more to fund the NHS; I do feel that's all most people would nod their heads in agreement at as a solution.....doesn't matter that the wealthy wouldn't use it anyway, that's irrelevant.

With not charging for long term conditions you often require several appointments over a long period of time to diagnose it in the first place. Sometimes this can take many years and various referrals. Would all these appointments be back dated?

That's an excellent question. If it were backdated & the refund taken out of the gps budget, maybe then gp's might be less reluctant to refer to specialists if they were going to lose out as a result of the patient eventually getting a DX?

Both my and my boyfriend's experience in France was that we were referred to a specialist by the GP immediately (different issues, he to rule things out, me to confirm and get confirmed for 100% free treatment from that point). It seemed a bit extreme to be referred so quickly (my boyfriend had this experience first) as we were both used to the NHS and expected to be told to go away, be patient, see if it get better etc. but I am now very grateful that things did move so fast, and it was a very different story for a friend in the UK with the same condition.

Nothing is perfect - I am not saying there are not things to moan about about the system in The Netherlands and France, but you are far less likely to moan about them if you have experienced the waiting lists and slow process of the NHS.

There are already published studies showing that a high proportion of adults in the UK stopped going to the dentist when they started charging. Tooth decay can affect your heart so it's a false economy.

It took my GP 7 months to refer me to a consultant by which time my bowel cancer had spread into my lymph nodes. Referring me on my second visit could have saved the NHS 12 rounds of chemo.

Referring me on my second visit could have saved the NHS 12 rounds of chemo.

So sorry you went through this and hope you're doing much better now.

As you say it's a false economy long term but I think gp's are starting to not care because their focus is on it not coming out of their budget!

Gp's should have been dealt with a long time ago. They were never really on board with the Nhs holding the govt to ransom essentially when it first came in. They're still doing this in my opinion and they're not operating (in general terms) with the focus being on what's right for the patient, but all govts who've been in power since the Nhs was created are also to blame.

That's why I inwardly do a wry laugh when gp's claim they have no power to effect change when it's for the benefit of patients - they certainly wield their collective power when it comes to anything affecting them especially their budgets!

Imo they should never have been and still shouldn't be allowed to operate like self employed/separate private companies paid for by the state/Nhs.

How much has their poor decisions on such things cost the Nhs?

Imo they should never have been and still shouldn't be allowed to operate like self employed/separate private companies paid for by the state/Nhs

I am curious about this. It was my understanding that this was how they operated in France and, as I said, referrals to specialists are much faster there.

Fatted - 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!

That cannot happen in Sweden as they have a limit of £95 that you pay for all types of medical treatment in any 12 months (GP, A&E, consultant, physio, etc). You get a little booklet and stamp it each time you go and once you hit £95 they issue you with a free card for the rest of the 12 months.

In France they're not working in a completely different way to the rest of the healthcare system there I think?

It's the separation from the rest of the system that's the main issue.

Also how the funding is set up. Costs them to refer to specialists, "incentives" for pushing mirena coils and other treatments.

It's deeply unethical in my opinion.

I for one would be VERY interested to know

1 how many GP appointments per month (let alone per year!) are patients with the SAME symptoms going repeatedly to the GP and the GP is merely treating the symptoms (if you're lucky) rather than working/doing what's necessary to find a DX

2 How much are the treatments to merely mask symptoms costing the Nhs?

3 how many hospital patients admitted per month (again let alone per year!) have ended up in hospital - quite possibly via a&e - BECAUSE a serious condition has been ignored until it's reached crisis point. (The thread I started threw up certain conditions as the ones most commonly misdx/ignored mainly thyroid disease, gall bladder disease and gynae conditions, and shockingly yes certain cancers too - should be a national scandal!)

4 How many working days per month are being lost to the economy because patients are unable to work due to having symptoms of a condition that hasn't been DX and therefore isn't being treated properly.

5 how much fertility treatments for women who were fobbed off with gynae symptoms for YEARS, and who's fertility was then worse affected than necessary has cost the Nhs

6 how much mc and other pregnancy complications for women with undx & untreated gynae conditions has cost the Nhs

And when I say the costs to the Nhs it's not just physical medical treatments but mh treatments too because being gaslit for YEARS by people who are meant to maintain your health is hugely damaging.

I've seen posts on here by patients yes, but also specialists in gynae, oncology etc and comments in msm and SM saying that they're often not seeing patients until there's little to be done! That is appalling and unnecessary.

We pay in Australia, well you pay the gap, most of it is funded.
If you are on low income the gap is very small or the doctor bulk bills so you pay nothing.
Once your medical expenses reach a certain amount your gap gets smaller.
We have a great system and can get in to a doctor the same day.

It would be awful. People would simply die. We see how "well" the UC works, or the PIP/ESA assessments. They literally kill people. GP charges would kill more

That is interesting Graphista - I think (happy to be corrected as would like to understand) you are right in that the whole of the French system is operating privately but is funded by the state through social security and the small excess cost to the "customer" (which does not apply for a whole list of chronic conditions, emergency care etc.) can be picked up by very low cost insurance - certainly low enough that it could be included into a UK system benefits payment for those with very limited funds. As I say, no system is perfect - I seem to remember French friends saying that there are incentives from drug companies for example, but having a friend unfortunate enough to be in the same situation as me in the UK, it was clear which of us was getting faster and - by necessity in this case - therefore better treatment.

As I said, no system is perfect at all but the NHS - which seems so excellent at emergency aid - must reform and I think people will have to shift their perceptions on what it takes to have a decently-funded healthcare system that also does not see waste on layers of admin that do not translate into benefits for the "customer". One of the the biggest shifts will be people being able to think of themselves as a "customer". It is a good thing but it seems to me is so alien to the British thinking... we are not in the 1940s anymore.

All I can say is that I was on minimum wage - in fact my boyfriend was minimum wage and I was below minimum wage - in France and decent healthcare was never beyond our reach but it was also something you thought about not just took for granted, like air.

Ciarcel thanks for responding.

I have friends and family who are living in the eu (and have been scrambling to get stuff like this sorted thanks to the brexit farce!), some live in one country and work in another, mainly tax purposes but occasionally due to the differing systems, so that they can opt for the better healthcare system.

Indeed one family I know

Live on one country
Wife works in a 2nd country
Husband works in a 3rd country.

How they keep themselves right with all the tax laws etc I don't know!

What I've yet to have answered to my satisfaction that I've asked on numerous threads (and I understand posters may not know immediately as if you're living as an expat rather than a full emigree you're far more likely to be a worker) is - ok you say the system in X country works well for you, your family and for low paid workers. How well does it work for people who can't work? Especially the sick/disabled who are also going to be the main users?

"As I said, no system is perfect at all of course but the NHS - which seems so excellent at emergency aid genuine question do you really mean emergency or secondary and tertiary healthcare? - must reform personally I think primary care should be brought properly into the Nhs and that the main reason Gp's are resisting this is the same reason as why they refused at the inception of the Nhs - scared they'll lose their personal high salaries and I think people will have to shift their perceptions on what it takes to have a decently-funded healthcare system i do agree it's underfunded but not because the populace is underpaying but because this govt has an agenda for defunding it that also does not see waste on layers of admin that do not translate into benefits for the "customer" i agree to a point but administrators are very important to the Nhs but yes there is unnecessary bloat in some areas eg consultants having a full time personal secretary each even if they themselves don't work full time One of the the biggest shifts will be people being able to think of themselves as a "customer" yes I think we should be doing this anyway BUT a HUGE problem - again primary care - is that it is INCREDIBLY hard to formally complain about a GP it can and often does result in patients being blacklisted though this is denied I've known it happen in real life and read many posters on here who have been through this and been left without a GP for many months until the body that oversees Gp's which varies around the uk steps in to allocate a patient to a GP. It's supposed to only be possible to remove a patient from a gps list of they're abusive but its amazing how many patients after years of being with a GP are suddenly accused of this after they start a formal complaint It is a good thing but it seems to me is so alien to the British thinking... we are not in the 1940s anymore." No but as per my previous highlighted comment too many GPs think it is! That patients should be deferring to gp's as demigods

I've had situations where my simply asking not to see a particular GP within a practice (because they were incompetent arses who didn't believe mental illness was "real" and actuality said so! But of course I couldn't prove) even though there were several others available being put on my notes as "refused to engage with services"

That's the kinda shit patients are dealing with in primary care every day.

Ffs typos galore hope you can still read that ok

yabu
the nhs is not free, it is paid for in taxation. I personally am not prepared to pay a dime more until large corporations pay their share of taxes for the educated, healthy workforce they expect to do their jobs and they pay towards the road infrastructure, internet development etc. If Amazon's warehouses are broken into, I would think it a fucking cheek if they call the police when they pay barely any taxes in this country.

@emeraldshamrock Why is that disgraceful?

I’m a midwife. Today my clinic started at 9am, I had to be there at 8.30 am to set up but I don’t get paid until 9am when my first patient walks through the door. Appointments are 15 minutes long which is impossible, all it takes is a first time mum to ask a single question about labour etc. and I’m running behind.

My lunch is allocated as 1pm until 1.30pm but by 1pm I was running 20 mins behind as the appointments simply are not long enough for all that needs covering. So I’ve now got 10 minutes left of my lunch before my next patient comes. And I’ve got 2 referrals to fax, some blood results to look up and a patient to phone back in that 10 minutes. And despite working through my whole lunch I’m not paid for that 30 mins.

My last patient is booked in at 16.45, and the children’s centre locks their door at 17.00 but by now I’m running 40 mins behind after 1 lady was upset regarding a condition her unborn baby had been diagnosed with and needed more time. So no one is going home on time. But I’m only being paid until 17.00 regardless.

If someone doesn’t turn up I thank my lucky stars that I can now use that time to catch up and maybe get to eat today, have a drink or even go the toilet.

If you think NHS get their allocated breaks than you are very very naive i’m afraid. We work unpaid hours every single day, 1.5 for me today, some days it’s 2. After 5 days in work that’s 8-10 hours. At the end of the month that’s 32-40 hours, which is an entire weeks wage, that I have worked unpaid. Every single month. But tell me again how it’s disgusting to use the 10 minutes free time you get when a patient doesn’t turn up to grab a drink again.

@FrowningFlamingo doctors surgery’s close in Ireland for 45 mins around 1-2 (the phones get out to answer machine and the secretary hatch closes and they have lunch. I’m assuming (and I could be wrong)that the gp also has lunch then too.