Charging NHS patients - is it the way forwards?

[maxpower]

Have we reached a point where patients should be charged for failing to attend appointments, if they don't notify the surgery, clinic or hospital?

Budgets are being squeezed to breaking point and beyond because of the financial climate and we're under pressure to deliver more for less. In order to maximise the efficiency of services, shouldn't patients themselves take some responsibility?

dentists do it.

i wonder how they could make it work, though, would you want treatment to be denied until they paid the fine? because that might cost more, tbh.

how would it be enforced? would you have to leave your card details with the receptionist etc..

i imagine the admin costs of this sort of thing, including chasing up late payers etc would far outweigh the benefits

on the whole, i think people DNA due to an emergecny, or not bieng arsed or genuine forgetfulness

the not being arsed bit is the bit that needs changing, i don't see how a fee, would change that .. if someone was on a limited income, would htey be charged on a sliding scale

how do you decide what to charge?

yes, I was thinking about the difficulty with that, although if it could be linked to your national insurance number, the money could be added to your NI contribution if you work, or deducted from benefits. I suppose that's about the most workable solution.

And what happens when it's the hospital or GP's cock up. They send your appointment to the wrong address, or give you a verbal appointment and then book you in at a different time to the one they've said.

I think there's a lot more money wasted in other areas tbh.

but what if you missed it due to an emergecny.. i.e a bereavement/serious illness/car break down

if that was an excuse that meant you didnot have to pay, then everyone would use it !

i am not criticising , i definitely agree that it is an area that needs addressing, but i don't see how it would work

which is a shame.

Here's a wild, crazy idea - how about we just make the NHS more efficient?

I work for the NHS, and could give you a few suggestions off the top of my head, rather than charging people for missed appointments.

I get very cross when people miss appointments that other people could have used instead - my GP surgery posts notices each week stating how many appointments were missed. It's very annoying, especially when it can be very hard to get an appointment in the first place. Charging could possibly cut down on non-attendance.

Playing Devil's Advocate though, non-attendees have already paid through the NI and tax system - so why should they pay again?

I qualified my opening question by saying if patient's failed to attend without notifying the clinic etc

In the event that the hospital/surgery messed up with the arrangements, of course there wouldn't be a charge to the patient.

People make contributions through tax and NI to provide the service. This idea is based on people being fined for abusing the service. I think that can be justified.

Paolosgirl , go on, what are your suggestions? I'm genuinely interested!

Hmm, my dentist's receptionist complained when I turned up at 4.30, not 2.30. However,

1. appointment was made over the phone so noone could prove anything
2. I would never have made an appointment for 2.30, I'm still at work then
3. I think it was her mistake, she said 4.30 but put it in her diary as 14.30...

I think charging is fraught with problems.

Another time the specialist doctor I was seeing complained that I was 1/2 hour late... well, I saw him 1/2 hour late, after spending 35min at reception while 2 doddery receptionists tried to book a taxi for someone to go home! (Yes, I was tempted to queue-jump, but I'm too polite, and anyway I wasn't the only one waiting. I did grass the useless receptionists up to the doctor though.)

"I qualified my opening question by saying if patient's failed to attend without notifying the clinic etc"

yes and I can think of plenty of circumstances where this wouldn't be done with legitimate reason

bereavement - yes some may suddenly remember they have an appointment and think to ring and cancel it........chances are that will be the last thing on their mind though

dementia (even early stages) - "sorry Mr Jones - I know that you're in the early stages of dementia and didn't remember your appointment - but tought shit - we're taking it off you pension - well I presume if it comes off benefits then it would come off pensions too

people with other disabilities that will affect their ability to remember these things

been involved in an accident...........that's ok you should have remember to call while in the ambulance/A&E

I oould go on............

I get very cross when i get narky letters telling me i've missed an appointment i know nothing about (3 in the last year)

i also get cross when appointments are booked then cancelled 3 times in a row with no reason given (also 3 times in the last year)

i also get crosswhen i have to sit and wait when apointmnts run not minutes but hours late.

Improve the appointment booking system. make clinics run to time. fire the monkeys that can't do their jobs properly - that might save the nhs some cash.

Ive had exactly the same thing happpen to me..letters in post saying my appointment been cancelled due to unforeseen circumstances..i had two one after the other..yep and when i take my child to appointments and your appointment at say 11.30am and you dont get seen till maybe 1pm..you know its not good enough..not only do the kids get bored but we are hungry and cannot leave until weve been seen..not to mention that i travel everywhere by bus or have to walk...so if im not seen in time and it takes an hr and a half to get to school from my hospital and they finish at 245. Ive also had letters saying i havent turned up to an appointment, even though i had rung weeks before to cancel because of other commitments on that day.

ok, I know the NHS is far from perfect (trust me on that!)

I think the majority of patients do try to use it sensibly, but there are also a significant number who couldn't give a toss if they miss an appointment that someone else would have been desperately waiting for.

the thing is, wasted appointments have such a knock on effect, I genuinely think that if all the appointments could be used effectively (which means co-operation from patients in not wasting them) it would have significant impact. For example, if GP appointments weren't wasted, people could see their GP more quickly, and therefore get treatment or referral more quickly. This might mean that their condition is dealt with/improves much more quickly, requiring less treatment or less invasive treatment - all of which saves on money down the line. Or a quick GP appointment would relieve the pressure on A&E depts, who seem to be a failsafe for many patients who feel they can't wait to see their GP.

if you get referred to hospital, you could be seen more quickly by a specialist and access treatment more quickly.

I know my question is hypothetical as no policitian would have the guts to table it with an election coming up, but I think it would be a good starting point.

i think maybe you could consider charging repeat offenders..sometimes you can genuenly forget..or something crops up emergencies..illness etc But im talking about people that regularly miss appointments without cancelling, and generally do take the piss.

oh gosh yes the waiting times.

I once walked out of the Drs surgery (and therefore missed my appointment that I'd "signed in" for) as having been sat waiting for over 1 1/2hrs I couldn't wait any longer - I had children to pick up from school - and no-one that could have done it for me.

And once - over the course of 2 consecutive mornings (don't you just love it when DC decide to be ill enough for the Drs 24hrs after the previous one has been) - I spent no less than 4 3/4hrs sat waiting in the Drs for them to be seen.

DS3 was a tiny baby at the time and howled through most of the Tuesday morning wait

I also think that the range of communication methods should be explored more - eg text reminders or email reminders to pts, phone calls for pts without mobile phones. Going back to the point about patients with dementia, set up a contact with someone (a realtive, carer - someone responsible) to alert them when the patient is due for an appointment.

I don't think there'll ever be a time you can guarantee everyone would be seen on time, and obviously if you booked in, it was running late and you couldn't wait to be seen, you wouldn't be penalised.

Toccata, tbh, if I'd been working int he surgery and you'd turned up with tiny screaming baby, I'd have exercised some discretion and got your DC seen pdq. Not pleasant for anyone to have to listen to a distressed baby for hours on end, least of all you and baby.

I wonder if there is a reluctance from the public to let the NHS toughen up or if those in power are just too afraid to find out?

oh he was happy enough when we got there, but was positively fed up (as was DS2) after about an hour.

You know I can understand appointments running late later in the morning, or afternoon...........but when you've turned up for the start of the 8.30am (or near enough - usually about 9.10 by the time I get there if I have an appointment first thing) or 2pm "on call" appointments I just can't understand^ how they can end up running so late so quickly.

problem with early dementia is often there isn't a carer, or it's not even been properly diagnosed - they're just "forgetting old granny/auny/uncle"

and indeed sometimes it's not even dementia - it's just old age forgetfulness and general confusion.

totally agree about text reminders, i often thing that would help a lot. with a thing saying 'are you attending? if not, please be aware that your next appointment will be in six mos'.