We are rightly proud that our NHS is free. Let’s keep it that way | Ann Robinson

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

"Seeing our first IVF child born was a proud moment"

‘It can be hard to switch off – each patient has a story unique situations – and you can not assist but get emotionally concerned.’ says Debbie Falconer. Photograph: Matthew Stansfield

I have been an embryologist with Manchester Fertility for almost thirty many years we opened in the mid-80s when IVF was nevertheless in its infancy. I was studying my PhD when I was asked to join the team and seeing our 1st IVF infant born in 1987 was an extremely proud second as the embryologist I would overseen the creation of this minor child boy in our laboratory.

My day begins at 6am, I generally depart residence all around seven.15 for the drive to operate. I’ll check emails when I arrive, and then open up our laboratory. This is exactly where the eggs and sperm are joined with each other, the place we see the quite beginnings of life. It never ever ceases to be particular, it truly is superb to know that by way of our knowledge, our individuals are transformed into parents and to date we have welcomed over 4,000 infants into the world.

Our laboratory is amazingly state-of-the-art, when we moved into our new premises in 2013 we had the chance to layout it just the way we desired it – absolutely everyone on the group had input.

There is a whole lot of interest to detail even the air quality is monitored. The very first point is to do is check all the tools to make positive almost everything is functioning appropriately even although we have remote alarms, 24 hours a day, we nevertheless do guide checks so there are no hazards to our patients’ eggs, embryos or sperm.

We then seem at how embryos have created overnight, no matter whether in our conventional incubators or our new time-lapse EmbryoScope, which aids our staff select the very best embryos to transfer for that patient’s treatment cycle.

We’ll check what patients we have coming in that day, and ensure that their embryos or eggs are prepared for use. We also undertake egg collection procedures in our theatre subsequent door to our lab. Sperm is prepared for individuals – both donor sperm as we are 1 of the UK’s most significant donor sperm banks – or from our patients’ partners. All of this transpires behind the scenes, it’s not anything our individuals see.

Mornings are very occupied, and so I get lunch in the employees area all around a thirty minute break.

In the afternoon we usually carry out intra-cytoplasmic sperm injection (ICSI) procedures – in which a single sperm is injected directly into the egg – embryo transfers and embryo freezing.  We also have staff meetings to ensure everyone has input. We’re a near-knit group and it exhibits, it is a single of the motives our patient suggestions is so large.

As the lead embryologist at Manchester Fertility, I’m at the top of my job. My emphasis is ensuring that we stay at the forefront of successful fertility treatment options in the United kingdom by means of our technologies, tactics and expertise of our staff. We have amazingly substantial standards at Manchester Fertility and so training up embryologists that join our group is also some thing I consider great pride in.

Of course treatment options and technologies are ever-shifting in the discipline of reproductive medication. There is constantly a new remedy which is producing headlines, but as an ethical and Human Fertilisation and Embryology Authority (HFEA)-licensed clinic it is our role to make certain that we only supply these remedies which genuinely can make a difference – not experimental treatment options which could only operate for a tiny handful with quite distinct fertility difficulties. Attending global conferences, retaining abreast of new strategies and remedies and researching individuals we would take into account is a challenge, we constantly overview our methods but often with the patient in mind. We never ever offer you a therapy except if we are completely assured it will assist the patient or give them the ideal likelihood of achievement.

My day typically wraps up with a ultimate check of the lab and then everywhere is tidied up, emails checked. I am usually the last of our embryology staff to leave.

After house, it can be tough to switch off – every patient has a story, unique situations – and you cannot support but get emotionally concerned. Strolling my dog is extremely therapeutic, so is yoga or reading and investing time with family and buddies. Some weekends I operate, of course – we are open each and every day. Ultimate thoughts of the day are usually about our patients. As a staff we all care I hope that embryos transferred that day will implant, that these who are due for a pregnancy test have good news.

Dr Debbie Falconer is lead embryologist at Manchester Fertility

If you would like to be featured in our “day in the lifestyle of…” series, or know somebody who would be wonderful to contain, then please get in get in touch with by emailing healthcare@theguardian.com

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"Seeing our first IVF child born was a proud moment"

"Seeing our very first IVF infant born was a proud moment"

‘It can be difficult to switch off – each patient has a story special circumstances – and you cannot help but get emotionally involved.’ says Debbie Falconer. Photograph: Matthew Stansfield

I’ve been an embryologist with Manchester Fertility for almost 30 years we opened in the mid-80s when IVF was still in its infancy. I was studying my PhD when I was asked to join the staff and seeing our first IVF baby born in 1987 was an exceptionally proud moment as the embryologist I’d overseen the creation of this little infant boy in our laboratory.

My day commences at 6am, I typically depart home close to seven.15 for the drive to operate. I will verify emails when I arrive, and then open up our laboratory. This is in which the eggs and sperm are joined with each other, the place we see the quite beginnings of life. It by no means ceases to be specific, it’s wonderful to know that by way of our expertise, our patients are transformed into mother and father and to date we have welcomed above four,000 infants into the world.

Our laboratory is incredibly state-of-the-art, when we moved into our new premises in 2013 we had the chance to design and style it just the way we wished it – everybody on the group had input.

There is a great deal of focus to detail even the air quality is monitored. The very first issue is to do is check all the tools to make certain almost everything is working accurately even though we have remote alarms, 24 hrs a day, we nevertheless do manual checks so there are no dangers to our patients’ eggs, embryos or sperm.

We then seem at how embryos have created overnight, no matter whether in our traditional incubators or our new time-lapse EmbryoScope, which assists our team decide on the best embryos to transfer for that patient’s treatment cycle.

We’ll verify what individuals we have coming in that day, and make certain that their embryos or eggs are ready for use. We also undertake egg collection procedures in our theatre up coming door to our lab. Sperm is ready for individuals – both donor sperm as we are 1 of the UK’s most significant donor sperm banks – or from our patients’ partners. All of this happens behind the scenes, it’s not one thing our individuals see.

Mornings are very occupied, and so I get lunch in the staff room all around a 30 minute break.

In the afternoon we generally carry out intra-cytoplasmic sperm injection (ICSI) procedures – exactly where a single sperm is injected straight into the egg – embryo transfers and embryo freezing.  We also have team meetings to guarantee every person has input. We’re a near-knit staff and it shows, it is one particular of the causes our patient suggestions is so large.

As the lead embryologist at Manchester Fertility, I am at the leading of my career. My concentrate is ensuring that we remain at the forefront of successful fertility treatments in the Uk through our technologies, methods and skills of our crew. We have amazingly high standards at Manchester Fertility and so instruction up embryologists that join our group is also some thing I consider wonderful pride in.

Of program treatment options and engineering are ever-altering in the area of reproductive medication. There is often a new treatment method which is producing headlines, but as an ethical and Human Fertilisation and Embryology Authority (HFEA)-licensed clinic it is our position to ensure that we only provide those treatment options which genuinely can make a difference – not experimental treatment options which might only operate for a small handful with really certain fertility issues. Attending global conferences, trying to keep abreast of new strategies and therapies and researching these we would consider is a challenge, we continuously overview our techniques but usually with the patient in mind. We by no means provide a treatment unless we are entirely assured it will help the patient or give them the best possibility of success.

My day typically wraps up with a ultimate check of the lab and then all over the place is tidied up, emails checked. I’m normally the final of our embryology group to depart.

As soon as residence, it can be difficult to switch off – each patient has a story, exclusive situations – and you cannot assist but get emotionally involved. Strolling my dog is really therapeutic, so is yoga or reading and paying time with family members and close friends. Some weekends I function, of course – we are open every single day. Final thoughts of the day are often about our patients. As a crew we all care I hope that embryos transferred that day will implant, that those who are due for a pregnancy check have very good news.

Dr Debbie Falconer is lead embryologist at Manchester Fertility

If you would like to be featured in our “day in the existence of…” series, or know a person who would be excellent to incorporate, then please get in contact by emailing healthcare@theguardian.com

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"Seeing our very first IVF infant born was a proud moment"