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Bossybabe

Recover £1 billion a year for the NHS

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The Times today relates that dna patients are costing the NHS £1 billion a year. 

I’ve always said that what people don’t pay for, they don’t value.

We should fine patients who don’t turn up and stop wasting doctors’ expensive time. For people on benefit, the amount of the fine should be stopped from the benefit. 

Discuss. 

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Agreed.

Cannot understand why this is not in force.

But knowing just how useless our Lefty MPs are, just how stupidly soft they are, I can understand it.

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We're in a stupid position.

There needs to be some way to 'even out' access to the NHS -- by this, I mean provide NHS service at the level of 'need' rather than 'want'.

A couple of examples (one relevant to the OP).

  • My aunt lives in London.  She goes to A&E if she has an issue.  There isn't really a GP that's open and responsive when she needs it, so she uses A&E.  
  • My sister had some problem with her son (can't remember the details), but she only went to 1/2 the appointments as it 'was inconvenient timing for work'.

These problems wouldn't go away if there were a nominal charge, but at least it would make people think.  I'm almost of the mind that we should get a receipt for all NHS work at the value of the work done.  Eg, when you go to the GP you should get a piece of paper (or email or statement at the end of the year or whatever) with the actual cost (£45 per visit, say) and a line 'paid by taxes'.  This would help people really understand the value of the service received.  

However.  They're* desperate to monetise the NHS, so this would likely be a slippery slope to a full insurance system.  Which would probably be a bad thing for most people.

Anyway, they'll muck it up.  They always do.  Before you know it it'll be a £20 fee to visit the GP, apart from for people on benefits, children, the disabled, the long term sick and the elderly, who'll get it for free -- the income received will be slightly lower than the cost in implementing the fee and all the 'poor behaviours' will still be there**.

[*Tory and Labour alike, despite what they say]

[** for most working people*** the inconvenience of having to miss work is the deciding factor.  When you get the appointment you have to sort out cover etc.  Once that's done you might as well just go.  Also, if you never go to the doctors then you probably have to go, whereas if you go once a month anyway then it is relatively more trivial to miss one and just add it onto the next visit after]

[*** apart from my sister]

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2 minutes ago, One percent said:

We should be charging everyone a small fee for appointments, prescriptions and any other contact with the NHS. 

We should make sure that only those entitled to treatment receive it.

 

The cash handling staff, paperwork, banking cost, will mean it's pointless. 

You need it to be easier than that. Only people allowed to use, get to use, and then look at why people forget appointments.

The company doing my arm on the NHS send text messages before an appointment, as does my GP. Excellent way of reminding people, although it's a couple of days before from the company.
 

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20 minutes ago, Bossybabe said:

The Times today relates that dna patients are costing the NHS £1 billion a year. 

I’ve always said that what people don’t pay for, they don’t value.

We should fine patients who don’t turn up and stop wasting doctors’ expensive time. For people on benefit, the amount of the fine should be stopped from the benefit. 

Discuss. 

Great idea. But it should cut both ways.

What do I get for the 2 hours I spent sitting in a hospital waiting room waiting for a consultant who was late back from lunch?

 

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Just now, SpectrumFX said:

Great idea. But it should cut both ways.

What do I get for the 2 hours I spent sitting in a hospital waiting room waiting for a consultant who was late back from lunch?

 


I'd rather they were late back from theatre rather than leave someone half finished.  Late from lunch or golf is different.

 

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Several of the GPs I've been at have had 'waiting places' - where people wait until a GP is free. It means people who need to see a doctor get fitted in but have to wait.

Allowing people to wait for an appointment would mean that when people miss appointments that someone else could be seen.

What is the "cost" for a missed GP appointment? 
The GP is paid by the hour not per appointment.

So make sure their time is used to maximum efficiency.

A huge cost for each missed appointment indicates that GPs actually sit about and waste time when they have no patients.
 

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Is DNA "Do Not Attend"?

I think part of the problem is that patients are unaware of their appt or forget about it. So what about making them pay a (decent) deposit to confirm their agreed appt which is only refundable if they appear? (Deposit will be lost if they don't cancel in good time or give evidence of a force majeur which prevented them from coming on time.)

I do realise that this will create a lot more admin, but admin ppl shd be cheaper than docs (and other qualified medical staff) who are wasting time hanging about looking for ppl who haven't turned up. And the appts system eventually become more efficient overall?

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7 minutes ago, sarahbell said:

Several of the GPs I've been at have had 'waiting places' - where people wait until a GP is free. It means people who need to see a doctor get fitted in but have to wait.

Allowing people to wait for an appointment would mean that when people miss appointments that someone else could be seen.

What is the "cost" for a missed GP appointment? 
The GP is paid by the hour not per appointment.

So make sure their time is used to maximum efficiency.

A huge cost for each missed appointment indicates that GPs actually sit about and waste time when they have no patients.
 

Hmm.  Management by queue is inefficient.  At the point where you're waiting there it seems efficient enough, but there is still a finite time per patient, and a finite time per day.  The queue system will always result in points in time where the queue 'runs out' and doctors are underused, or where the queue runs beyond the allocated period and the doctor either has to work late or turn away patients that arrived later.

The alternative -- ring up in the morning and we'll work things out -- could be more efficient, but there is this massive problem that people who interact with the NHS learn the system, leaving 'generally healthy but very ill today' people struggling to get an appointment.

IMO there should be a 'healthy person emergency', where the GP computer recognises that a person who hasn't been for ages is calling for an appointment and then tries to fit them in between the throngs of long term appointments for the chronically ill, disabled, aged, etc.  People who call in often wouldn't get that privilege.  

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Hmmm, that doesn't really stack up. When was the last time anyone here went to see a doctor and had the appointment run exactly to time? My guess is that the load factor is at least 125% most of the time. There's certainly administrative cost to rebook the appointment and maybe charging people a few quid for that would be fair but it's hard to see it adding up to 1b a year.

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1 minute ago, whocares said:

Is DNA "Do Not Attend"?

I think part of the problem is that patients are unaware of their appt or forget about it. So what about making them pay a (decent) deposit to confirm their agreed appt which is only refundable if they appear? (Deposit will be lost if they don't cancel in good time or give evidence of a force majeur which prevented them from coming on time.)

I do realise that this will create a lot more admin, but admin ppl shd be cheaper than docs (and other qualified medical staff) who are wasting time hanging about looking for ppl who haven't turned up. And the appts system eventually become more efficient overall?

Before you know it the 'deposit' would only be for working people.  And then they'd stop refunding.

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27 minutes ago, One percent said:

We should be charging everyone a small fee for appointments, prescriptions and any other contact with the NHS. 

We should make sure that only those entitled to treatment receive it.

 

+1000

20 minutes ago, sarahbell said:

The cash handling staff, paperwork, banking cost, will mean it's pointless. 

You need it to be easier than that. Only people allowed to use, get to use, and then look at why people forget appointments.

The company doing my arm on the NHS send text messages before an appointment, as does my GP. Excellent way of reminding people, although it's a couple of days before from the company.
 

No, this can all easily be automated. Pay by smartphone only (for example).

And anyway the savings made by deterring wasters will be so massive it will cancel out any disadvantages.

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2 minutes ago, TheBlueCat said:

Hmmm, that doesn't really stack up. When was the last time anyone here went to see a doctor and had the appointment run exactly to time? My guess is that the load factor is at least 125% most of the time. There's certainly administrative cost to rebook the appointment and maybe charging people a few quid for that would be fair but it's hard to see it adding up to 1b a year.

Prescription fees add up to about 1/2 a billion. So, if they just classed a GP visit in the same way?

The trouble is, 90% of people don't pay for their prescriptions.  So a fee system would only have the impact of encouraging working people to attend, who aren't actually (IMO) the people who are causing the problem.

[Indeed, it could make it worse.  Once you're paying for the GP visit then you could opt to 'just pay' if it were more convenient than attending]

1 minute ago, swissy_fit said:

+1000

No, this can all easily be automated. Pay by smartphone only (for example).

And anyway the savings made by deterring wasters will be so massive it will cancel out any disadvantages.

They'd never do that -- think of all the hopeless old people.

Not that they'd be paying.  But it would, nevertheless, be the reason for only allowing 'cash or card' (with attendant inefficiencies).

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1 minute ago, dgul said:

The alternative -- ring up in the morning and we'll work things out -- could be more efficient, but there is this massive problem that people who interact with the NHS learn the system, leaving 'generally healthy but very ill today' people struggling to get an appointment.

Ours operates very much like this unless you want an appointment in 3-4 weeks time, where they will have limited availability. 

Like council run services (e.g. leisure centers), the whole system seems designed to suit those not working... and to hell if you have a job and need to make use of the services you pay taxes to run.

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Just now, dgul said:

Prescription fees add up to about 1/2 a billion. So, if they just classed a GP visit in the same way?

The trouble is, 90% of people don't pay for their prescriptions.  So a fee system would only have the impact of encouraging working people to attend, who aren't actually (IMO) the people who are causing the problem.

[Indeed, it could make it worse.  Once you're paying for the GP visit then you could opt to 'just pay' if it were more convenient than attending]

Yeah, it would only work if everyone had to pay it and, also, if it was administered fairly and consistently. A much better place to start in my book would be to totally change the rules about who gets free treatment to start with. Something like this would be a good place to start:

http://www.health.gov.on.ca/en/public/programs/ohip/ohipfaq_mn.aspx

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1 minute ago, dgul said:

Before you know it the 'deposit' would only be for working people.  And then they'd stop refunding.

OK, you could get a "black mark" on your NHS record for each missed appt (or other similar 'misdemeanor') and then after so many blackmarks (to be determined) you will have to pay a fine or else not get any more appts. If you are not responsible enough to understand this/behave properly and/or not able to pay the fine for any reason, you need to be put on another list of vulnerable ppl and handled differently from 'normal' ppl?  

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The NHS GP service still exists? I thought it ended a few years ago. There certainly isn't one in our local town, so far as I am aware. The buildings still exist, but there aren't any appointments to be had.

I pay £49 a month for a private GP service.

If the NHS starts charging for the same thing, the effect of that would surely be to create a much larger market for private GP services. 

Which would mean I could find a private GP nearby instead of having to drive for half an hour to Winchester every time. That's the nearest one.

I can only assume that the reason they're not literally everywhere in every town now is because people "don't want to pay twice". Indeed, we all still have to pay the NHS, even if it isn't available to us. It is only free at the point of delivery.

If appointments are to be charged for, then logically, NHS contributions should be reduced. But that's not going to happen, is it.

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23 minutes ago, dgul said:

Prescription fees add up to about 1/2 a billion. So, if they just classed a GP visit in the same way?

The trouble is, 90% of people don't pay for their prescriptions.  So a fee system would only have the impact of encouraging working people to attend, who aren't actually (IMO) the people who are causing the problem.

[Indeed, it could make it worse.  Once you're paying for the GP visit then you could opt to 'just pay' if it were more convenient than attending]

They'd never do that -- think of all the hopeless old people.

Not that they'd be paying.  But it would, nevertheless, be the reason for only allowing 'cash or card' (with attendant inefficiencies).

That's why I said above that everyone (and I mean everyone) should pay a small fee. As it is, it is only the fools that bother to work who have to pay for prescriptions. Thus, the sap taxpayer pays twice, once through their taxation and again when they need a prescription. The clever ones in receipt of benefits pay nothing towards it. 

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52 minutes ago, sarahbell said:

What is the "cost" for a missed GP appointment? 
The GP is paid by the hour not per appointment.

I thought everyone understood how GPs are paid?

Missing a GP appointment costs the taxpayer nothing.

A hospital appointment is an entirely different.

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51 minutes ago, TheBlueCat said:

Hmmm, that doesn't really stack up. When was the last time anyone here went to see a doctor and had the appointment run exactly to time? My guess is that the load factor is at least 125% most of the time. There's certainly administrative cost to rebook the appointment and maybe charging people a few quid for that would be fair but it's hard to see it adding up to 1b a year.

Well my last appointment with a GP was on the phone. Brilliant, as I wanted to be referred not poked by them again. 
She rang up a little early, spoke to me briefly, and set the wheels in motion.

The one prior to that was with a non english speaking lady who I couldn't understand and after being embarrassed at asking her to repeat herself several times I just nodded after that and left with a prescription for something I did not need.

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2 hours ago, Byron said:

Perhaps it would be better to charge the Labour Party for all these missed appointments.

It would help to clarify their thinking.

That’s a brilliant idea, Byron. I’ll start making up the bill for my small part of the NHS...

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1 hour ago, Cunning Plan said:

I thought everyone understood how GPs are paid?

Missing a GP appointment costs the taxpayer nothing.

Yes.  Charging would be a source of additional funding -- which is probably why they'll do it.

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