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- Page navigation anchor for RE: Patient co-payment for general practice services: but what about the less fortunate?RE: Patient co-payment for general practice services: but what about the less fortunate?In a thought provoking editorial, Professor Toop discusses patient co-payment for general practice services.1 One group who could be adversely affected by such proposals are people who need to access food banks.2 In May 2015 for a medical student project, we conducted an anonymous questionnaire survey to explore characteristics of attenders at the Vineyard Church food bank in Kent. The food bank has a café and is open for two half days each week, one session mainly for mothers with children, the other for single people.People attending the food bank were approached by IB and asked if they were willing to complete a brief anonymous questionnaire. Those who agreed were offered help to complete it if necessary. The response rate was 91% (61/67) and 53% were women. Responders’ mean age was 47 years (range 21-74). Only 18% identified themselves as from an ethnic minority and a large number (77%) of all responders had at least one child (median two children, range 0 to 5). Most (82%) came to collect a food parcel every week. Nine percent said their highest qualification was a university degree, 10% had A levels or a BTec, 27% had GCSEs and 32% had NVQs or similar. Only 22% said they had no educational qualifications.The majority (79%) of responders said they were receiving social benefits. Of 59% (36/61) who answered the question about employment, 83% of responders said the...Show MoreCompeting Interests: None declared.
- Page navigation anchor for RE: NHSRE: NHSIt is unlikely that any real reforms of the NHS will appeal to politicians since they have reasons for keeping the status quo. Why not set up an independent expert body as the main overseer of the NHS, with satellites in all major areas? This would rid the government of the millstone round its neck.This country is awash with money. Charities raise huge sums of money for good causes. What better cause than the NHS? Taxes on the causes of ill health such as alcohol, tobacco and excessive sugar in food and drink could be fed straight into the NHS budget. Gambling has a huge financial turnover and taxing winnings could raise millions. Everyone in a hospital catchment area could be invited to subscribe to a hospital fund. Industry benefits directly from an efficient health service and could subsidise local needs from tax free profits. During WW 2, even small towns had “thermometers” depicting progress towards the purchase of a Spitfire. If the population as a whole felt the NHS belonged to and was supported by them, hospital closures would become a thing of the past.National Insurance never did pay for the NHS. A true national insurance scheme would create a core for the main expenses of the NHS. Add government backed insurance with all the insurers in the UK. A dedicated lottery and local fund raising would remove the money worries of the NHS.Limiting the unrea...Show MoreCompeting Interests: None declared.
- Page navigation anchor for RE: Patient co-payments for general practiceRE: Patient co-payments for general practiceI was pleased to see the taboo topic patient co-payments being discussed, although it is was interesting that the two health systems discussed were Antipodean destinations for emigrant GPs, rather than the many successful European health systems, including Holland and France, that include such payments.We are missing something in the UK by not enabling patients to contribute towards the cost of accessing the front door of the NHS - GPs. The talk about access is admirable, but why not capture some of the benefit of this to patients and employees by allowing GPs to offer co-payments for extended hours, online pre-booking and untriaged urgent appointments? It is wrong that a self employed plasterer, for example, has to take time off to get an urgent appointment, but this is the reality of a stressed system with funding derived from one source only. Allowing this patient to book a timely yet convenient appointment with a co-payment is obviously beneficial, and can bring in more money that it costs to provide. Similarly employers may offer to pay for this service for their employees. Bringing in more finances to NHS GP practices in this way would support, rather than undermine, free at the point of use GP care for the population.The oft misused example of aeroplanes can be useful if this case. All those on a flight arrive at the same destination, captained by the same trained pilot, and equally safe, yet so...Show MoreCompeting Interests: None declared.
- Page navigation anchor for RE: Charging for NHS general practiceRE: Charging for NHS general practiceToop and Jackson raise again the idea of charging for GP services (or as they call it , co-payments).They correctly highlight that there has been little debate in the UK even in an election year , or perhaps because it was election year. They state it is “not a stand-alone solution” so has to be considered within the marketization of healthcare in general. This “elephant in the room” was not discussed either.The authors state the mismatch between GP supply and demand is unsustainable so the debate on targeted first point of care co-payments is necessary but this is not the answer as realized in Australia.1The evidence shows patient charges widen health inequalities because of reduced access to care for the most vulnerable who need it most, whilst the healthy, wealthy, worried well overuse the service. Hence Germany abolished its Praxisgebuhr fee system after a failed 6 year experiment increased costs.2Charges are not necessary because the NHS is “unaffordable” , it is underfunded with the least spent in the G7 nations3 The longterm sustainablility of the NHS is a political choice as is introducing charges . Co-payments will not address the issue of GP underfunding with the share of the NHS budget falling to an all-time low of just over 8% , cuts of nearly £1 bi...Show MoreCompeting Interests: None declared.