4 ms·

> make you feel guilty for consulting them While they shouldn’t be making you feel guilty per-se, they’re gatekeepers for the public, finite resource of NHS ca

> make you feel guilty for consulting them While they shouldn’t be making you feel guilty per-se, they’re gatekeepers for the public, finite resource of NHS care, and help stop healthcare spending spiralling out of control.

switch007 9y ago
How much is too much to spend on healthcare?
J-dawg 9y ago
This to me seems like one of the fundamental problems with the NHS. (Compulsory caveat: we're very lucky to have it and it's way better than the American system, etc etc) But the primary care side of things basically has to be a bit shit for the whole thing to work. Because demand for healthcare is so elastic. Almost every single one of us has those little niggles, aches and pains and things that we ought to get checked out. If we could get a GP appointment at 24 hours notice, and be guaranteed an un-rushed meeting with a sympathetic and friendly doctor, demand would skyrocket. The system has to limit demand by never getting too good. There isn't really a private alternative because, in the UK, NHS GPs are the gatekeepers of everything. You need a referral letter from an NHS GP to see a specialist on your own private medical insurance. There are some companies with private GPs but they're extremely expensive, presumably because there isn't much competitive pressure. So the system finds an equilibrium, where it's frustrating but tolerable. Not quite good enough, but not quite bad enough that it's worth paying for a private GP.
- jon-wood 9y ago
  > There isn't really a private alternative because, in the UK, NHS GPs are the gatekeepers of everything. I think this is slowly shifting. I have private medical cover via my employer and one of the things included in that is access to video chats with GPs via a mobile app - obviously they can't diagnose everything without being physically present, but they can do referrals for things where its obviously needed. There are a few services popping which offer this sort of thing for a one off fee for each appointment as well.
  - J-dawg 9y ago
    Thanks for the reminder! I think my employer's medical insurer also recently started offering this. I'll have to give it a try next time I need a doctor. It's interesting that the insurance companies have noticed the weakness in the NHS system. Presumably they sell this service to their clients in terms of reducing the time lost from attending GP appointments. I also don't think that services like this are going to be a satisfactory replacement for an in-person visit. I bet they err very much on the side of caution, and are likely to end up sending people back to the NHS if there's any doubt. But for those situations where you just need a referral rubber-stamped they could be fantastic.
    - jon-wood 9y ago
      The few times I've used them they've been fantastic. My wife has fairly frequent ear infections, on the last occasion we paid for an online GP consultation as it was 8pm on a Friday night, meaning it would either be at least Monday to see our GP or a £20 taxi ride across town to see an out of hours doctor. Instead she was seen within half an hour, and a prescription sent to our local pharmacy and ready to pick up within an hour of starting the process. Thankfully it seems the NHS are catching on and have started offering something similar in London.
arkh 9y ago
And then they chastize you because "Why did you not come sooner? Now your easily cured at a early stage disease has become life-threatening." I'm sure more expenses on early symptoms and making people ask for a diagnosis when in doubt would end-up as a lot less money used to try curing things at a late stage.
- psergeant 9y ago
  So write to NICE, who develop the guidelines GPs follow, and tell them your ideas?
taneq 9y ago
I think it's fair to say that, in the U.S. at least, this has failed.

switch007 9y ago

How much is too much to spend on healthcare?

J-dawg 9y ago

This to me seems like one of the fundamental problems with the NHS. (Compulsory caveat: we're very lucky to have it and it's way better than the American system, etc etc) But the primary care side of things basically has to be a bit shit for the whole thing to work. Because demand for healthcare is so elastic. Almost every single one of us has those little niggles, aches and pains and things that we ought to get checked out. If we could get a GP appointment at 24 hours notice, and be guaranteed an un-rushed meeting with a sympathetic and friendly doctor, demand would skyrocket. The system has to limit demand by never getting too good. There isn't really a private alternative because, in the UK, NHS GPs are the gatekeepers of everything. You need a referral letter from an NHS GP to see a specialist on your own private medical insurance. There are some companies with private GPs but they're extremely expensive, presumably because there isn't much competitive pressure. So the system finds an equilibrium, where it's frustrating but tolerable. Not quite good enough, but not quite bad enough that it's worth paying for a private GP.

jon-wood 9y ago
> There isn't really a private alternative because, in the UK, NHS GPs are the gatekeepers of everything. I think this is slowly shifting. I have private medical cover via my employer and one of the things included in that is access to video chats with GPs via a mobile app - obviously they can't diagnose everything without being physically present, but they can do referrals for things where its obviously needed. There are a few services popping which offer this sort of thing for a one off fee for each appointment as well.
- J-dawg 9y ago
  Thanks for the reminder! I think my employer's medical insurer also recently started offering this. I'll have to give it a try next time I need a doctor. It's interesting that the insurance companies have noticed the weakness in the NHS system. Presumably they sell this service to their clients in terms of reducing the time lost from attending GP appointments. I also don't think that services like this are going to be a satisfactory replacement for an in-person visit. I bet they err very much on the side of caution, and are likely to end up sending people back to the NHS if there's any doubt. But for those situations where you just need a referral rubber-stamped they could be fantastic.
  - jon-wood 9y ago
    The few times I've used them they've been fantastic. My wife has fairly frequent ear infections, on the last occasion we paid for an online GP consultation as it was 8pm on a Friday night, meaning it would either be at least Monday to see our GP or a £20 taxi ride across town to see an out of hours doctor. Instead she was seen within half an hour, and a prescription sent to our local pharmacy and ready to pick up within an hour of starting the process. Thankfully it seems the NHS are catching on and have started offering something similar in London.

arkh 9y ago

And then they chastize you because "Why did you not come sooner? Now your easily cured at a early stage disease has become life-threatening." I'm sure more expenses on early symptoms and making people ask for a diagnosis when in doubt would end-up as a lot less money used to try curing things at a late stage.

psergeant 9y ago
So write to NICE, who develop the guidelines GPs follow, and tell them your ideas?

taneq 9y ago

I think it's fair to say that, in the U.S. at least, this has failed.