Charging £25 to see a doctor....

[cantheyseeme]

What does everyone think about this stuff in the news today? would you pay?

[GibberTheMonkey]

Actually Vicki
I just haven't been to the dentist

Dh has asthma, we spent enough on meds and inhalers, we jave a card as it makes them a little cheaper. They make him go to regular appointments before giving him his prescriptions.
I can imagine people who were broker than us would end up dying as they would put off going regularly and asthma is a killer.

Paying for missed appointments sounds fair to me, unless the patient was hospitalised in the meantime.

[3littlewomen]

We pay ?50 here (Ireland) to see the doctor. I am often shocked when I read of people waiting weeks to see their GP... I will almost always get a same day appointment, and we do not get charged again if we have a follow-up on the same condition (also not charged if pregnancy related). Also charged less for children and older people.

On occasion child has become ill when out, no money on me - and my GP was horrified I would even query whether or not to bring them in, their health is most important then paying and I could settle up as and when!

It does in my opinion work well here.

[moomoomummy]

Missed appointments in the NHS cost approx 700 million pounds last year according to an article on BBC website . I have worked in the health service for 25 years and am gob smacked at how many people miss appointments. Two hour appointments, general anaesthetic appointments etc and sadly they are most commonly missed by regular people and not those with social problems . Sheer ignorance and bad manners. It makes me mad and we have to do something to make people value the services we provide . The NHS is on its knees and we have to start somewhere by charging for missed appointments. People will soon learn to value it . Rant over ,p!

[lljkk]

In Ireland, is there no problem with the indigent going to A&E when they get very ill? In the US there are lots of charity clinics that will treat for free or very little acute conditions and acute complications of chronic conditions, but otherwise people suffer a lot for not having the right insurance. many stories of people cutting their tablets in half so not taking the right amount of meds, due to costs.

[Meglet]

Really bad idea. I'd be broke within a few months. I've seen a GP about 5 times this year so far, all were for genuine illnesses and 4 of them resulted in prescriptions / further testing. I'm burnt out so catch everything going.

[AnnabelleLee]

In Ireland lots of people have medical cards, so there is no cost to them to go to A&E. Plus you don't pay upfront, which helps.

[RaspberrySnowCone]

Missed appointments could be charged, or further appointments refused for repeat offenders. I don't think charging more generally is a good idea, people will just put things off then become an emergency putting more pressure on A&E with yet again, more financial pressure on those who work and a huge strain on those who work who have a chronic condition or children with a chronic condition.

I do think it would be worth surgeries making it more well known that you don't always have to see a Dr. I asked to see one a while back and they were full but the receptionist advised that the senior nurse could do almost as much as Dr could so i could see them. Now I generally see one of the nurses if its routine stuff. I didn't know I could do that until someone told me. I thought the nurses just did smears/bloods/jabs etc.

[tribpot]

My practice has more or less admitted that they use the DNAs (did not attends) to manage overrunning sessions. A bit like the airline industry overbooking flights to make sure their planes were at capacity for more journeys. They are much more reluctant than the patient reference group to push for penalties for repeat offenders who do not attend.

My DH has been discharged from one hospital service for missing an appointment he didn't even know about - the NHS' ongoing love affair with paper. So there are penalties in place to deal with those who fail to attend, which are fairer than penalising all of those who see a GP regularly. The prospect of disputing what is and is not an ongoing course of treatment for someone with complex and chronic health problems like my DH does not fill me with joy - nor, I would imagine, would my practice relish the prospect of having a billing department to deal with disputes of this nature, chasing non-payers, and paying whacking great insurance premiums to deal with the risk of being sued if care is denied to someone who can't or won't pay.

[JuliaScurr]

www.facebook.com/photo.php?fbid=613704178669499&set=a.455210604518858.102691.185180654855189&type=1&theater

[ReallyTired]

This the article

www.express.co.uk/news/health/417591/Doctors-want-you-to-pay-150-for-an-appointment

I can understand why Dr Shailendra Bhatt thinks there should be charges as works in a local walk in centre where some hyprocontrics really do take the piss. The walk in centre in question triages people and prehaps non emergency people should be refused accesss to the doctor. (They can make appointments through their own GP practice for non emergencies!)

However I fear that a charge would deter those who really need the doctor. We would have a situation like we have with denistry where the working poor cannot afford treatment.

I think that fines for people who miss appointments is far more constructive.

[Snazzyenjoyingsummer]

RaspberrySnowCone It's a good point that you don't always have to see a doctor. My practice nurse can also prescribe a fair range of stuff so I can see her a lot of the time. The difficulty come when the system requires a doctor to do something for the practice to be paid - e.g. a few years ago (don't know whether this has changed) the 'new patient' check up for people joining a new surgery had to be done by a doctor for the practice to be paid the fee earned for that work. In fact, it was almost all stuff that could be done by a nurse or even, tbh, a non-medial professional - e.g. weighing people, taking their medical history down, asking about drinking/smoking habits and so on.

[Snazzyenjoyingsummer]

The other very important thing not to overlook is that the NHS is supposed to be free at the point of access. If we're having to pay for initial access to the system, then the concept of the NHS is gone. We should be resisting this and asking for a clear evidence base that shows it will improve the system.

[Snazzyenjoyingsummer]

And for that reason, I'd agree (just about) with payment charges for DNAs, but not for all appointments.

[edam]

The Pulse survey that sparked this off was a self-selecting sample of 440 docs who wanted charges of £5-£25 Of course, if you are a GP partner on a salary north of £100k £5 or £25 probably sounds like nothing much. Very different if you are working poor, retired, disabled, or on benefits, though.

Would actually be very expensive, both because of admin costs and because people who do need medical care would be put off going until their condition gets really serious and needs costly treatment. It's a stupid idea, ultimately.

[eurozammo]

moo at least some missed appointments are due to poor administration though. I know of more than one person in the last 6 months who has received an appointment letter AFTER an appointment was supposed to take place. And I have tried to cancel (by telephone) an appointment for a procedure I had had privately through my health insurance (my GP must have received the results from the private procedure weeks before this appointment letter was sent but it was still sent) only to be told it was not possible over the phone - I had to write in. I did bother but I can imagine there are some people who can't be bothered or don't want to pay for a stamp. These points apply more to hospital appointments than GPs, but I think it's important to acknowledge that patients are not always at fault for missed appointments.

[Viviennemary]

Not sure what the answer is. But the NHS is unsustainable as it is now. With resources getting ever more stretched.

[edam]

Even administering a charge for missed appointments would be costly, not least because half the time it's the NHS's fault for sending appointment letters too late, sending them to confused elderly people who can't make sense of them so their relatives find them too late* and so on combined with often making it extremely difficult to phone up and say, hang on, you've stuffed up/I can't make this date.

The various services involved with my MIL all know she is confused and on her way into a home as soon as a place comes up/we can get the £8k deposit required by her favourite home out of her investments. Yet they send her letters, failing to copy in SIL or dh, despite by SIL or DH having requested to be informed so they can make sure MIL turns up for the appointment.

[ReallyTired]

Our GP surgery strikes off people who miss more than three appointment without explanation. This brutal approach is understandable, but can leave innocent children or an elderly person with dementia without a GP. I missed an ante natal appointment due to being in strong labour, but the midwife did say that was totally forgivable. We need a system that is compassionate and reasonable.

I think its perfectly valid to punish adults of working age for missing GP appointments which they have booked themselves. Ofcourse there is a cost with punishing crimes, but it is to act as deterent. Prehaps there needs to be option of commuity service for those who cannot pay fines.

[notfarmingatthemo]

We pay here in NZ but then are prescriptions are reduced a bit because of it so I think it works out very similar to the uk. I have been twice since I have been here (not been here long but have a few long term things) each time I have been seen the same day. The waiting room is not full of kids with sniffles all seen kids in there that have been obviously ill. Each time I have been asked if I minded if they went first. I think it would solve people going to the Drs for silly things. If you have to pay it makes you think

[colleysmill]

As a patient with a compromised immune system when I'm sick, I'm sick. I won't often get better on my own and the "wait and see " approach just means I deteriorate further. Doesn't happen very often admittedly but I dont want the added stress of "can I afford it?" instead of "i.need to.see a doctor".

As a professional who often signposts people back to their GP if we think there is an.underlying condition which needs exploring I would worry people wouldn't follow that advice and not get the intervention they need.

I would be concerned this will only led to higher costs for the nhs - a lot of the time the focus is on catching things early not later for better outcomes but by putting a barrier to accessing health advice or treatment people will leave it too long and ultimately it may cost for the nhs to treat.

[giraffesCantWearSuncream]

Ihave bad asthma, I probably just wouldn't go

[Uptheairymountain]

Like Edam said upthread, £25 is a large chunk of many people's income. A charge would restrict healthcare access to those with more money - unless the charge was means tested, so the financial impact would be equal for whoever used the service.

[purplemurple1]

We have this where I live (abroad) and it works quite well as there is a yearly limit on what you can pay, pensioners and those on benifits get a discount. Also once you have one visit about something you don't pay for followup visiits about the same thing, inc hospital visits if needed. So you just budget this money each year and if you don't need it all then it's a bonus. But the big difference is the benifit system here gives people enough to live on and afford these charges, thats the issue in the UK I suppose - more costs with no more money doesn't really add up.

(They do prescriptions in the same way, yearly limit and discounts.)

[differentnameforthis]

We already pay here (Australia). My dr charges $52 per visit. Or they can bulk bill (they do this for those on a health care card, which you get on a v low income, or for children)

We get to claim about 80% back afterwards.

We also pay full price on prescription charges. The last script I had cost me $64 & that was contraceptives.

[SconeInSixtySeconds]

That's really reasonable for oz, different. I used to get charged $80 and receive $32(? I think) back.