Imagine you have a big, greasy, warty growth on your back. It’s embarrassing, catches on your clothes and means you avoid swimming or exposing your back on holiday. Your GP confirms that it’s not cancer and says it’s a seborrhoeic wart. That’s great, but you’d like it removed. Your GP says you can’t be referred for removal on the NHS because it’s a cosmetic problem.
So what should you do next? Live with it? Pay a private skin specialist to remove it (likely to be over £120 to have it scraped or frozen off)? Or have a stand-up fight with your GP?
There’s another option being proposed by a group of GPs; let your GP do it, and pay a fee. At the moment, NHS GPs aren’t allowed to charge their registered patients for standard NHS care. But charging for non-NHS extras, like sick certificates for insurance companies, reports for health clubs that you’re fit to exercise, diving certificates and other optional extras, is allowed.
The British Medical Association (BMA) explains that GPs sometimes charge fees because “they are self-employed and they have to cover their costs – staff, buildings, heating, lighting, etc – in the same way as any small business. The NHS covers these costs for NHS work, but for non-NHS work, the fees charged by GPs contribute towards their costs.”
But until now, the permission to charge for non-NHS work has been limited to certificates and administrative tasks. The idea of allowing GPs to charge for clinical work that isn’t available on the NHS is much more challenging. After all, we are rightly proud of the fact that we don’t need to take a credit card or cheque book when we go to the GP. It’s anathema to many that this situation may change.
The controversial proposal has been spelled out by Dr Prit Buttar, chair of Oxfordshire’s local medical committee (LMC), who told Pulse magazine there had been discussions about rolling out the system nationally by the end of 2017. Under the proposed plans, GPs would be able to provide private services to their own patients by working through a third party company, which would take payment from patients and pay GPs for their time.
The plan is to extend the scope of non-NHS services that GPs can offer to patients for a fee. So if you want to see your GP outside of NHS-contracted hours (generally 8am-8pm), you could pay to see him/her privately instead of relying on the out-of-hours services that GPs employ to provide cover from 8pm-8am. At the moment, that wouldn’t be allowed. If you want to see a GP for a routine appointment at 9pm, you can’t. If it’s urgent, there are walk-in centres and NHS 111. If you’re mortally ill or wounded, there’s A&E.
As a GP who starts seeing patients at 7.30am, I can’t imagine why a GP would want to see private patients at 9pm. Or have the strength to work a 12-hour day and then keep going into the night. But, more importantly, I think it will taint the precious patient-doctor relationship that relies on trust that the GP is acting in your best interests, free at the point of delivery and unsullied by any profit motive.
You can see where Dr Buttar and co are coming from; people want choice and convenience in all areas, including healthcare. That includes the freedom to have an ugly wart removed or to see your own doctor late in the evening by mutual consent. GPs want to respond to people’s needs and wishes but are only contracted and paid by the NHS to provide a limited range of services. The NHS can’t fund a limitless range of interventions, because taxpayers don’t want to pay huge taxes so that you can get your wart removed.
So where does this leave us? The NHS restrictions are not sacrosanct and can be challenged; for instance, it’s hard to get varicose veins treated on the NHS – but guidelines from the National Institute for Health and Care Excellence (Nice) state that if you have symptoms like pain and aching, you should be referred for assessment and treatment. Your GP is your advocate within the system; helping you to navigate referral pathways and fighting your corner when needed.
What faith can you have that your GP is doing their best for you if they stand to personally gain by offering you a private alternative? It’s a slippery slope all right; the wrong solution to a pressing problem.
We are rightly proud that our NHS is free. Let’s keep it that way | Ann Robinson
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