“Doctors call for the NHS to introduce top-up fees”

The Times Doctors call for NHS to impose topup fees

I think the Doctor’s presenting this motion are going to have a very hard sell and I can’t see how they’ll get a fair hearing by the tabloid press because most people in the UK consider the NHS to be a system based on universal tax funded care and although premium rate call services and postcode lotteries have already run rings around the principles of it being unrelated to your ability to pay for most the idea of being asked to pay their GP for visits will be the same as being asked to pay twice for something.

Confusingly I imagine the new top up fee GP services would presumably run alongside the new 111 service (that has been introduced as a completely free replacement to NHS reDirect – a service that has been consuming more than £100M a year of healthcare budget providing Patients with access to script/checklist reading medically unqualified call handlers) even though it’s obvious that GP consultations are more effective and can help shift focus to long term preventative care rather than the much more expensive reactive services that Patients will use when access to their family doctor is made more difficult/expensive.

Ever the optimist I wonder if there might be some positive contributions from an initiative like this:

> Customer focus

While I don’t think we should ever seek to consumerize healthcare I could imagine this might make GP services becoming more customer focused. I think this would further encourage healthcare providers leverage consumer technologies and make themselves more accessible.

NHS GP efforts with Video Consults have never got beyond the pilot stage but I imagine remote consults would become more appealing if they had payment associated it would really incentivise Family Doctors to provide such remote services (Patients would presumably be willing to pay more for a video consultation at a time/place that suits them) and GP practices could provide these consultations at a lower cost (opening up a wide range of opportunities for home working Doctors).

> Documentation

I think the increased expectations of paying customers would be the biggest challenge to this proposal. In the last year claims against Doctors rose by 40% making Doctors more likely to be sued than ever before and it’s not hard to imagine that Patients who are used to not paying are going to find this provides further motivation to initiate a complaint.

Evidence shows Patients can’t accurately recall most of the info that Doctors share with them in a time pressured consultation and while this might be tolerable when you’re not paying and can go back and have another consultation for free but if you’re being required to pay every time (and think you’re being asked to pay twice in the first place) you’re going to want the consultation documented.

If this proposal went ahead I’m certain that MedicoLegal insurers would quickly realise that their costs will spike and GPs looking to keep their insurance rates affordable will quickly see the opportunity that fully documented consultations provide them to maintain an accurate record of what was said or wasn’t said (and reduced premiums from their indemnity providers).

Is it all bad news for NHS Patients? What do you think?

About David Doherty

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