We need to start charging for NHS services

[Fragmentedbrain]

£15 for the GP
£20 for A&E
NHS routes to paid-for fast track treatment
Options to pay for nicer rooms

We need to stop putting working people on disability benefits for want of a functioning health service it's barbaric

As someone who works in the NHS, I feel torn. There are countless opportunities where the system could cut costs and reduce unnecessary spending but for some reason, those changes aren’t being made.

• I genuinely believe there should be a small charge for GP appointments, something nominal like £2 to £5. A fee of £10 for missed appointments could help tackle the issue of frequent no-shows. It might sound controversial, but even a minimal charge could help deter time-wasters and encourage more responsible use of appointments. And yes, I do believe most people on universal credit could manage this.
• Another huge area for savings is the prescribing of basic over-the-counter medications like paracetamol and ibuprofen. GPs routinely prescribe these when they are widely and cheaply available elsewhere. During my prescribing course, I was shocked by how much money could be saved simply by reducing this practice.
• In A&E departments, I think it’s time to move away from having non-clinical reception staff at the front door. Instead, trained nurses should be the first point of contact, able to assess and, when necessary, redirect individuals who do not meet emergency care criteria. Some hospitals have already started implementing this, and it significantly cuts down on unnecessary investigations and inappropriate use of services.

I don’t see a problem with the suggestion of the option to pay for nicer rooms, but I assume that is already available in many places.

When my first child was born 28 years ago I asked for a bed in a private room, if one was free. The hospital wouldn’t guarantee it in advance, because someone else might have had a medical need for a private room, but as it was I was able to have a room to myself. The room wasn’t particularly nice, but it was private, which was what I wanted. I have forgotten how much it cost, but I thought it was well worth it.

Not all people can afford those things ffs. There are people in this supposedly wealthy country who can’t afford food at all, never mind Deliveroo or Uber Eats. You sound like your head is well and truly in the sand.

What people? Oh you mean people on benefits, riiiiiight 🥱

Which cultures would those be, then?

Should work it like a library card.

Free at the point of use unless you have any outstanding fines on your record.

£25 fine for missing an appointment / failing to cancel in advance.

£50 for ED attendance for drunkedness

£100 for abuse / violence toward staff.

It would probably also ensure hospitals organise sending appointments out...

£100 for abuse or violence against staff? Violence against staff should carry a lifetime ban from using NHS services. Abuse against staff should carry a fine a lot bigger than £100 and a lengthy ban.

I also think it's really easy to undestimate the impact on preventative health and early diagnosis from introducing charges up front.

I'm a doctor, well educated, pretty well off, but I'd definitely wait longer to see a doctor if it cost even a fiver... If you consider that across an entire population, you'd definitely see a spike in worse outcomes from later diagnosis of things like cancer and heart disease.

This entire debate is focused on the wrong area - we need to tackle inefficiencies in NHS first, this will save a lot of money. Recent threads about absenteeism and inability to get rid of p..s takers were enlightening.

Secondly, we need to rebalance the books in terms of welfare so money can be redirected to public services available to everyone.

Its effectively the same thing in central manchester, none of the people behaving like this can or ever will pay it off.

I do agree with you though, we're far too soft on people taking the piss.

Ditto 100% to fines for people who end up in A&E purely because they’re pissed. And double fines if they’re also obnoxious to staff. IMO we’re far too lenient about public drunkenness in the U.K. There should be hefty fines for people getting drunk and fighting or throwing up in the street.

What happened to the offence of being ‘drunk and disorderly’? Is anyone ever charged with that any more?

If you were creating the NHS from scratch, in 2025, it would look a lot different from the NHS as it is now.

It’s not set up for this. Would cause more problems for staff

People are still charged with drunk and disorderly and locked up for the night but not as many as should be. They should bring back the Black Maria and pile the drunks in the back en masse.

That’s exactly what the King’s Fund says. It adds that the cost of changing the funding model would be astronomical in terms of time, money and lost productivity.

No.
I know to many American friends that have died because they were trying to avoid hostipal costs.
What should happen is fines for those who waste a&e time or violence. I.e those turning up who could of seen a pharmacist or GP.

One problem with charging for A&E or GP appointments is that it creates an expensive bureaucracy processing payments, chasing fines and evaluating means-tested exemptions. One reason the French system is so costly is that they do this: pay and get reimbursed. Also, if people are put off seeking medical advice, a relatively small problem can become a very big one which would cost the NHS a lot more money. As for add-ons like better rooms, that takes beds and staff away from the main wards - how does that help? Re food, if you don't like it, get friends and family to bring other stuff in. Again, a different menu would have to be contracted out (little benefit to NHS) or involve expensive duplicatsion of kitchens ans staff.

This absolutely. We travel a lot and, believe me, the NHS is considered a joke across Europe. DD received incredible medical care when she was suddenly taken very ill in Prague. The Czech consultant she saw (at near midnight on a Friday, can you believe that?) was shocked at the poor levels of care she'd received in the NHS (cancelled appointments, long wait for referrals etc).

He explained that her condition 'had been allowed to become chronic and embedded' due to lack of prompt care and attention from the NHS.

I have a lifelong autoimmune disease. I see my GP regularly as if I have the slightest hint of an infection I need to be seen. Also other issue which need to be monitored. I also have bloods checked fortnightly because of the immunosuppressive medication I'm on.

If I had to pay to be seen I simply would not be able to have the treatment I need. I would have to stop taking my medication, which would lead to me being far more disabled than I am now in very short order. And death in a few years.

In short, bollocks to that.

Is this not what my NI contributions are for?
If they stop taking that I will happily pay £10 for a visit to the GP a couple of times a year, sure

I mean, it's a great way of killing off those on lower incomes who would need to make the choice between a tenner on the gas meter or a tenner to go the GP to get that lump looked at. So if that's the aim it's a great plan 🙄

Then why do cancer survival rates in the UK lag behind much of europe ?

This is nonsense. The culture in the UK has seen illness and being unwell embedded in society. This is straining the system.

I’m very curious how everyone from other countries know all of these dead Americans. I’ve never known anyone who has died because of medical costs.

Gosh, there are a lot of people who really can't cope with any discussion around NHS funding, aren't there? Unless of course the proposal is just to chuck more and more money at it.

The same people who can't see any shades of grey between the (amazing, saintly) NHS and the (evil, sociopathic) American system.

Things have to change. Things WILL change. So the sooner these people get their heads around that fact and start engaging in the debate rather than shutting it down with stupid phrases like "NHS should always be free. End of" then the sooner we start getting a decent discussion about the best way to do this.

I don't think Keir Starmer is brave enough to take it on, to be honest. He knows it's a toxic vote-loser. Nigel Farage probably is brave enough, but will send the whole country to hell in a handcart in the process.

Just charging people for not turning up would be a start. I had 3 people not turn up to agreed appointments last week (they're phoned and a time date and location agreed). One of these people has since put in a complaint that they had to wait for their initial appointment 12 weeks. So I have to formally respond to that.