To ask if you would pay for GP visits

[justanotherhappyflunkie]

Been talking with various friends who all agree they would rather pay a nominal sum to see a GP rather than the current system.

I have lived in a country that does this (free for children, disabled people, discounts for beneficiaries and long term sickness) and it was great. Same day appointments, good range of doctors, quick referrals.

The UK equivalent of this would be around £20 per visit.

AIBU to suggest it is the system that could help the NHS? prepares for a flaming!

And what happens if someone turns up at a GP surgery and says they can't pay but do need to be seen? Does the GP just send them to A and E?

I recently had a four month bout of severe illness with chronic condition I have. I managed to stagger into work in horrific pain, taking huge amounts of pain killers and disnt manage to see a GP in all that time. The flare up eventually subsided and went away on its own. I dont have the kind of job where you can just take time off. We see seriously ill patients and we dont have any staff. Im terrified of that happening again. Even if you do manage to see a GP they don't bother looking at your notes or history and just fob you off to physio which is useless. My condition needs to be properly managed. At one point I was taking 8 neurofen plus just to be able to get out of bed (ibuprofen and codeine). Thank God I'm just a few years off retirement.

No I don't want to pay £20 to see the gp. I cld afford to but I'd more likely not bother unless I was really worried about something or very ill. I'm sure lots of folk wld think the same. Plus I think I already pay enough in tax without having to fund a gp appointment.

I can only imagine folk on low incomes wld end up very unwell or worse!

And forget about any check ups. No way am I paying £20 for a smear test or my blood tests I have because of the medication I take. I will take my chances.

With the doctor that is at our practice most of the week, no. That man is a sadist and shrugs his shoulders and refuses to help (disabling back pain for a carer because "they won't change their life" (ie stop being a carer) or prescribe medication for a discharging ear infection that caused the hospital consultant to ring the surgery up and give him an ear bashing (pun not intended) as the frequency and the fact it wasn't clearing up (in part because the rare times he DID prescribe it wasnt a strong enough or long enough course) as it was a meningitis risk.

For the doctor who is there once a week, absolutely. He's booked out with people who wait to see him because of how useless the other is. He's the exact opposite and a lovely bloke. He and the other staff including nurses, hca and admin staff etc are the reason we stay because they are absolute stars.

I'd pay £20 a visit if the system was like France!

@justanotherhappyflunkie It's A solution but not one that doesn't come without it's own problems.
A few issues

• our system isn't regularly set up for taking payments so there would be administrative costs involved in taking payments
• won't stop everyone from wasting or missing appointments as the payment isn't enough to worry them
• will disincentivise lots of people who need help from getting it
• will penalise people who have long term /chronic conditions
• who decides who can and can't afford it

How long and when does the definition long term' cut in? I have a chronic disabling condition but I don't claim any benefits- do I qualify? My condition took 6mths to diagnose (I was lucky many people take years) I have to have regular appointments to monitor my condition otherwise my drugs cannot be prescribed (too dangerous) - do I pay for these and if so when from? These visits generally manage my condition and have meant that I avoid costly surgery so are generally a cost saving exercise for the nhs. Disincentivising people like me from taking up regular appointments would end up costing more not only in NHS costs but PIP

• what about flawed appointment systems - my mum has dementia, initially her GP would text her appointment details (not anyone else as they can't) and funnily enough the woman with memory problems would forget them. We finally realised and managed a work around. Problems with dementia patients both pre and post diagnosis is a huge issue and dementia is a huge problem that's getting bigger.
• what about people in vulnerable domestic situations who are not in control of their own finances?

The people entitled to the free/discounted appointments applied for a card. They would have had to prove income yes. Please don't personally attack me, I just wanted a debate and see other peoples opinions.

My concern is that if charges were introduced in the UK, primary care would go the same way as dental care
Indeed if you can afford 2k you can have a root canal, if not it's 100 quid on the NHS to pull your tooth out, can't afford 100 quid go down to b&q and buy a pair of pliers.
What would that translate to? If you can afford £2,000 we will treat your foot if not give us 100 quid and we'll amputate haven't got 100 quid go down to b&q and buy a saw than a big bottle of whisky in Tesco, maybe get some strong ropes to tie you to the kitchen table whilst other family members perform the amputation?

YABU. So we move to a 2 tier system for accessing GP services and people just above the threshold for free service get priced out!

And no way would my dad have gone to the GP when he suspected he had bowel cancer. Do you know how hard it was to get him to go in the first place?

I would pay if required but I have a problem with the principle of this.

firstly whatever exemptions you put in to ensure people aren’t priced out, people will fall through the gaps, plus it is discriminatory against people with health problems who are more likely to need appointments.

moreover, while it would hopefully reduce missed appointments, it would address the fundamental issue that there are not enough GPs anymore. You would still be trying to shoehorn 100,000 appointments day into 80,000 slots* so the only way it would ease the burden is by people who can’t or don’t want to pay £20 not seeking appointments. That would not be a good thing.

*made up figures for illustration

The government needs to urgently train more doctors and try to retain those that currently are skilled enough to do the job. One way would be get rid of this ridiculous pensions tax which means it isn’t economically viable for a number of GPs to continue to work.

I already pay for the GP. It’s called NI, Income and VAT.

@catmothertes1
There was an interesting piece on the news last night talking about the French system and saying it's generally good in urban areas however some parts of rural /poorer regions of France are really struggling to recruit GPs and the system doesn't work there even if you can pay because they are also having retention issues. There was an example of a region that had no drs and the waiting list for GP appointments was 4yrs. So I don't think it's completely a bed of roses there either.

And it would make things worse as those who paid £20 would not be happy to have a 3 minute GP appointment, many would demand "their monies worth".

Three major flaws with this idea:

1. There is a shortage of GPs, and therefore of GP appointments. Making people pay will not suddenly make more GPs appear.

2. This proposal is a means of rationing healthcare by price. If the GPs (which in the UK are actually all private businesses contracted to the NHS) decide to prioritise those patients paying £20 or so, what happens when all of the GP appointments are taken up by those paying the fee? Where do the other patients go, and what happened to the idea of universal healthcare? How do patients who are not able to pay going to get access to the rest of the NHS, of which GPs are the gatekeepers? This is exactly the problem that has resulted from Hunt destroying NHS dentistry, and the impact of his mismanagement and poor decisions during his 6 years as Health Secretary is now becoming clear.

3. You've already paid once - through income tax, National Insurance, VAT and all of the other taxes that everyone pays. This is the usual Conservative con-trick of taking from you what you already own and then selling it back to you - generating a nice profit for their donors and paymasters.

Well, I wouldn't have a choice if I needed to see the GP.

But, as someone who works in health policy, I would much rather pay higher taxes so that the playing field is levelled for all of us. I can well afford to pay £20 for a GP visit. But not everyone can. And the ethos of the NHS is free healthcare for all at the point of care; it should stay that way.

You can already pay to see a private GP though. Like PPs have said there will be people who on paper won't qualify for free visits but can't afford it and will end up not going when they should, so on that basis YABU.

All appts where I lived were 15 minutes at least. Face to face.

I'm not advocating, just trying to give information as to how I have seen it work.

This is already available.

You can get private GP appointments now

It feels to me as if a tipping point has been reached, the ageing population coupled with a general decline in health means that medicine is significantly more complex and stressful than it used to be.
Additionally healthcare relied on women being available for exploitation, now that there are better paid higher status roles open to women they are no longer willing to work in healthcare enduring exploitative wages and poor conditions.

The issue is that a universal charge would deter people from seeking medical appointments, and a means tested service (free appts f9r children, elderly, low paid and people with long term conditions) would result in only approx 20% of patients paying. Would that help? Probably not.

I don't agree that there should be a fee to see a GP or any other medical professional but I do think non attendance should be charged (unless there is justification). It is easy enough to cancel if you can't attend and perhaps the service would become more efficient if all available appointments were actually used.

£20 is nothing compared to the actual costs and definitely not enough to fund same-day appointments, OOH appointments etc. I assume (hope) many people would be exempt from the costs (quite rightly) but 1. these are likely to be the biggest users of healthcare anyway (e.g. the retired, those with chronic illnesses, young children, severe mental illness etc.) and 2. means testing is complicated and expensive - how much will all the extra admin needed to charge/chase up payments/sort out those who are exempt cost? Not forgetting it's totally against the ethos of the NHS - demoralised staff are likely to feel even more demoralised if they have to hound struggling people to pay.

I imagine that once you exclude all those who would be exempt, you'll be left with very few paid appointments each day (and, of course, there will be those who are expected to pay who cannot afford to, which is a very frightening prospect). I also imagine those who have paid for an appointment will feel far more entitled to the doctor's time, investigations/prescriptions that may not be needed, more frustrated at late-running appointments, more likely to demand to be seen if they themselves are late etc.

Ultimately, whatever system we have, compared to other European countries we do not pay enough for our healthcare and we do not have enough GPs. Charging a nominal price to a fraction of those needing to see a GP is not a solution and it is naive to believe that, if you paid £20 today, you would suddenly be able to see a GP at a convenient time for you.

To save NHS, I would love to pay a minimal fee. But in practice, I'd imagine lots of people ok benefit wouldn't be able to . Then would it be a threshold to make it work? How is it fair?

And people are too proud of NHS to make it a chargeable service. But it's dying because of funding/resources draining plus older age population increasing.