I have little doubt that the Tories will eventually lead this country towards a charged-for NHS. Discussion of GP charging is already commonplace, not least amongst GPs, as a way to ration services. In that context it's easy to compare the UK with Jersey, a place that is the same as the UK in all but dubious constitutional status. As the Jersey Evening Post has reported today:
The use of antibiotics in Jersey is falling, with prescriptions down 10% in the past five years to 0.82 per person per year.However, the fall in the UK has been much greater — 60% — to an average of 0.52 prescriptions per person per year.
Dr Philip Terry, chairman of Jersey Doctors on Call, said the cost of GP fees was one contributing factor to higher prescription rates, as patients want to ‘get something for their £40'.
It is widely known that excessive antibiotic prescribing is bad for patients, for populations and long term drug resistance that undermines public health. And yet it is prevalent in Jersey where the only really likely factor to explain the difference in prescribing is charging (and I have noted the other arguments in the article and think they are extraordinarily unlikely to be relevant across the population as a whole, to which this data relates).
Giving people a prescription to justify their fee is bad medicine, but all too easy to succumb to. Charging leads to bad medicine. It's an easy, and in this case, very obviously correct conclusion.
But it keeps drug companies happy.
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…If they paid for their prescription as well, and told it is a waste of money?
But anyway, Bad medicine is bad medicine!
Who is calling out these doctors?
We used to educate doctors. Or at least they were recruited from a ‘class’ of educated people. Many probably knew enough to practice from hereditary learning from one or more parents.
We don’t do that any longer we train them.
I’d guess 90% of the work a GP does in the average day could be done by any reasonably educated person with ‘people skills’. A well educated triage nurse would be an improvement on the average GP.
Anything technical goes to the lab for tests. Most know bugger-all about pharmaceuticals …..if you read the leaflet you get with your medication you’ll know more about it than the average GP.
We pay them astronomical amounts of money and most of them don’t actually earn it except in terms of the shite an pressure they tolerate in the working week. In short we are bribing them to turn up for work.
They no longer have any real status because their decisions about the health of a patient can be overruled by a bimbo or superannuated GP who couldn’t hack a proper job employed by ATOS.
Having said that, I’ve had some very good GPs …… the ones who listened and were perceptive enough to figure out I was a bloody mess at the time and persuaded me my condition was not terminal. I owe them for that, but I don’t owe the system that created their ‘professional’ status. And I owe the parasitic practice managers nothing. Except my curses because all the good doctors I’ve know in the local practice have run away to work somewhere, anywhere, else.
Andy
Sorry, but you seriously misjudge what a GP needs to know
I was married to one
Nurses are great. But they don’t manage uncertainty. That’s the hard but.
Richard
I will echo Richard here. I have a BSc and a PhD in Physiology. My undergrad degree included Biochemistry and Anatomy so I have pretty much a full pre-clinical medical education. Yet I am no medical doctor and nowhere near fit to be a GP. I have not been trained in diagnostics, my pharmacology is basic and while I can use a pharmacopeia I don’t have one in my head.
The difference between us is that I have enough knowledge to have a reasonable inkling of all that I lack to fulfil that role while you seem to know too little to make the assessment you are trying to make.
Doctors need to be both educated and trained. Medicine is a practical profession requiring manual skill and dexterity and practice, training. Do you want someone who has never used a syringe to try and penetrate a vein in your arm and not push it right through the other side* to get blood for a test? or someone who has been trained to do so?
*I have had that happen from a practiced professional, my arm filled with blood and that vein become unusable for donation. I have got a needle (27gauge) into the tail vein of mice and drawn blood. Usually about 200microlitres, 0.2ml. So I am practiced at the art.
Doctors know better than anyone the dangers of over-prescribing anti-biotics. However, they are human and just as much open to pressure and persuasion from forceful individuals (and time constraints – needing to get on to the next patient) as the rest of us. Morale is low and paperwork is high. This is not a justification, more a ‘that’s how it is’ take on the situation.
The concern that I have in relation to the introduction of charges for routine GP consultations, is that patients simply will not go. In some instances this might be a good thing – I’m thinking of the ‘worried well’ – but in others, not so. Fees, even if there is a ‘sliding scale’ based on income, are a disincentive to those who are struggling to get by and who are unlikely to make what are necessary visits to their GP.
It can also lead to sub optimal patient takeup. I grew up in New Zealand where it costs to see the GP. We were students who were married with kids. I know what it is to creep out of the GP surgery because we only had enough for the prescription for the sick kid and hoped we would have enough for the GP when the bill came through the door (you were supposed to pay up after the consultation).
Here in Scotland the SNP gov removed prescription charges because they were persuaded by the evidence that it saved money down the line. It works like this, Mrs Smith is elderly, she has Type II diabetes, arthritis and high cholesterol. She sees the GP for a repeat prescription and is given an extra for an infection. She needs to save money or she wants to (the elderly can be very cost sensitive on limited pensions) so she decides not to get some of her prescription. Not being a professional she chooses on the basis of which one makes her feel the worst.
The lack of this drug causes a crisis, an ambulance is called, she is assessed and admitted until she is stable again. Several days in hospital, health visitor afterwards. The cost of all this is orders of magnitude more than the total cost of the prescriptions to the health service. So if you can avoid this scenario by patients having no economic reasons not to get their full medicine you save money.
Scotgoy also saved £1million per year as the cost of running the exemption scheme for heavy users. The finance secretary John Swinney was so persuaded he came up with £1million for the costs of the changes and advertising it etc.
I’m not aware of any evidence suggesting Scottish GP’s over prescribe as a result. I think the opposite is true as they are now aware of how much it costs the taxpayer. So you are now less likely to be given paracetamol by prescription as used to happen. Generic paracetamol costs pennies. I’m male so I prefer ibuprofen.
Your analysis is spot on Peter
And that is commonplace – although not amongst pensioners, I think. Don’t they have free prescriptions?