For many of people the real crisis in the NHS (on a day-to-day basis) is one of convenience. GP surgeries are at breaking point and a study published in the Lancet medical journal earlier this year, suggests that up to four million people have to queue up outside surgeries for a same-day medical appointment.
We've all been there. You go to bed one night with a sore throat hoping it's not tonsillitis. By two in the morning you have a fever and looking down your throat in the mirror there's your tonsils; ruby-red with white spots. At 8am you call your GP and explain you need an 'urgent' appointment. You're offered a phone call or an appointment sometime later that day or you may be asked to come down and be seen on a first-come first-served basis. When you arrive you'll have to wait, it's busy, you'll need to take the morning off.
In the end you are told you have a virus and are prescribed some Lemsip and apologise for having wasted all those dedicated hard-working NHS employee's time on your trivial health needs.
As an NHS doctor and private practitioner myself I have no doubt the institution provides an incredible service to patients, particularly those suffering from chronic illnesses. However, when it comes to providing quick appointments to people at convenient times that fit in with their schedules there is a clear issue.
This crisis of convenience is caused at least in part by capitation. This is the way GPs are paid in the UK. It means your GP gets paid for the number of patients registered with them not for the number of times they see you.
If you are a male below the age of 45 your GP will get paid about £80 per year if you never go to see them and nothing more if you go 100 times! Over many years the number of times you need to see your GP has been worked out fairly well so the numbers are kind of ok financially - so long as the GPs manage their access rigorously. Which means that customer service and patient convenience have to be sacrificed - at least a little - even by the most well-meaning and conscientious GPs who are doing their absolute best under very difficult circumstances...
Almost every other health system on the planet involves an element of doctors getting paid every time they see a patient - i.e. a fee-for-service system. This is why it is easier to see doctors in other countries. The harder they work the more money they make. Here, the only thing a doctor accumulates with working harder and longer (other than the nobility of service to mankind) is resentment.
I am however not advocating for a second that the NHS moves to a fee-for-service system. It would fix access issues overnight but would bankrupt the NHS over the same night and it would unlikely make any difference at all to health statistics. In New Zealand and Australia, for example, they operate fee-for-service systems which bring their own different set of problems - not least huge spiralling costs to the government and ultimately the tax-payer - and while patients are often happier none of them live any longer or have significantly better health outcomes. In comparison in the UK we live as long as comparative countries and longer than some.
But while we must protect our healthcare system with rigour and passion I am doubtful that the solution to waiting lists will come from within the service. Instead we need to nurture a system where NHS GPs and private doctors are both an accepted part of mainstream care - working with each other not against each other.
Private healthcare is ideally suited to providing convenient access to doctors. The recent establishment and growth of chains like London Doctors Clinic has meant you don't have to be super rich to see a private doctor and in an emergency you can book a quick appointment for around £50. You can also pop in to organise things like GP letters saying you are fit to run the Paris marathon, jump out of a plane or fly at 28 weeks pregnant etc. Typically, appointments like that are not covered by the free NHS and increase the strain on the already very overstretched resource.
For us to move towards a situation where the NHS and private practice work side by side then there are some big cultural barriers to overcome. It is right that we love our NHS and many would have it that all doctors should work as GPs doing 10 hour days and seeing 40 patients at 10 minute intervals. I do not believe this is practical or advisable. Instead both patients and doctors need a choice of two systems that complement each other. The precise details of this need to be worked out, but if we want to see change the debate needs to happen now.Suggest a correction