if you can afford private healthcare, should you use it?

you have to offer to do an 11th (and so be on 110% of full time) before you’re allowed to do PP.

https://www.bma.org.uk/advice/employment/contracts/consultant-contracts/part-time-and-flexible-working

The basis of the contract

Trusts can offer part-time consultant contracts of between one and nine programmed activities. For appointments where the request to work part-time is in order that the consultant can undertake private practice, part-time contracts should not normally be for more than six programmed activities. Employers have the flexibility to agree part-time contracts for more than six programmed activities. Where a consultant wishes to work part-time mainly for reasons other than private practice, but still wishes to undertake some private work, they can be appointed on a contract for more than six programmed activities.

How much does a person cost NHS in his/her entire life?

The solution might be simple but it depends on whether people are opened minded about it.

I think once you tip 70 you become part of the demographic that become very expensive to ‘keep running’.

If you don’t use your GP much then as a ‘bloke in your mid-30’s’ demographic your average cost to the NHS is around £1000 per head. I think it’s 3 times that for the 70-74 years old’s and twice again for the 85+ group.

Logan’s Run?

Another thing I think about is ‘will primary care turn private’.
At present there’s no real demand as people just raise voices and complain, and they get seen at ‘a convenient time’ by their GP – shoult loud enough and your GP is likely to squeeze you in in place of having lunch.
These same things don’t happen in specialist care – we accept it’s a 14 week wait for the thing we’ve ‘forced’ our GP to see us about that week.

The situation primary care is in now is where dentistry was 15 years ago and look what happened there.

Right now, if Ethel, a hypothetical 70 year old well off woman want to come and see me, her favourite GP who knows her and her medical history, she’s gotta queue up outside the door at 8am with the rest of them and she still might not get to see me. There is no mechanism for Ethel to get her wallet out and pay to see me at a time and location of her choosing – infact the GMS contract forbids it essentially by the 10% restriction. There is demand we’re just contractually forbidden from tapping into it.

Of course if Ethel could pay to see me, I could do 4 days NHS 1 day private. As I got more senior or more of a “following” I would increase private days. Ethel would be happier, I think I’d be happier. But as Dr P says those with not money queuing up outside the door would have worse health outcomes?

Right now as a newly qualified GP I’ve got the option of a salaried job – which is an effective pay cut for me with a unlimited workload and unlimited patient demand. Tried it for 6 months and its rubbish.

A “partnership” investing considerable amount of my time and capital in a business model its clear the government are trying to destroy. Also with an unlimited workload and unlimited demand.

Or locums – flexible, seeing more of my young family than I ever have throughout the last 8 years of postgraduate training and with more money than the first 2 options (excluding the few high earning partnerships left) This gives me time to develop my skills towards something that will be billable once the inevitable happens to the NHS.

If I was a martyr, I’d choose one of the first two options but right now option 3 suits me just fine. More and more of my generation of doctors are choosing option 3, which will destroy the NHS as we know it.

If I was a martyr, I’d choose one of the first two options but right now option 3 suits me just fine. More and more of my generation of doctors are choosing option 3, which will destroy the NHS as we know it

And like wise so are many hospital doctors. You can’t blame them… unless like some on here suggest, it should be a race to the bottom.

Johnx2, I’d never heard of anyone requesting to go part time to do private work. I suspect this is because I’m not in London where the rules are different.

Round here, the bit of the contract that everyone’s familiar with is:

Under the framework agreement, consultants wishing to undertake remunerated clinical work outside the main contract are obliged to offer their first spare professional capacity to the NHS.

The solution might be simple

Raise tax and fund the NHS and social care properly?

Can you not retire from the NHS and then come back part time and increase private activity?

The elephant in the room here for consultants is the new contract negotiations.

At the moment a surgical colleague of mine is doing NHS waiting list initiative work at the local spire. Better T+C’s there apparently, better kit and most of his old theatre staff. He does his straightforward cases there (lack of ICU/sick person support as alluded to above) and saves his complex cases for the NHS hospital where ITU is waiting if it gets messy. Presumably both paid on the same tariff?

Buy Buy Buy Spire healthcare shares – its like being paid the same price to service a brand new car v and 20 year old banger thats never had any work done on it. Systematic destruction of the NHS.

HoratioHufnagel – Member

The solution might be simple

Raise tax and fund the NHS and social care properly? [/quote]

Isn’t that the tried and tested which has never worked properly?

I am trying to find the data of the average NHS cost of a person per life time.

A quick search only managed to find a piece of news from BBC 2006 regarding the charges …

Anyone has the average cost of a person per life time?

Anyone has the average cost of a person per life time?

What’s that going to demonstrate. I seldom visit hospitals or GPs, a problem I have had is the first time I’ve visited a hospital for treatment that I can actually remember.
I am happy to give up this time which I have paid for in order that less healthy people can have access.
I am still happy to pay into a system that provides help for those who ordinarily wouldn’t be able to afford it.

Nothing wrong with having private medical insurance if you can afford it. Whether the net effect of it is to reduce waiting lists elsewhere, I’m not entirely sure. But at least *you* are no longer on that list. You’re still paying your taxes to support the NHS whether or not you use it.

Mind you, do bear in mind that, even when you do want to use your PMI, you might not be able to. I wasn’t when I needed it. I had to sit in a waiting list for 14 months…

Rachel

How much does a person cost NHS in his/her lifetime?

I seldom visit hospitals or GPs

The more interesting question is when does a person cost the NHS. Spending your healthy working life complaining that the NHS isn’t quick or convenient enough for you is moot. Most people will get by far the largest portion of ‘value’ from the NHS in the weeks before they die. Nobody seems all that interested in the votes of the dying though.

NHS is underfunded Health care costs so how about we have a referendum and see if people are willing to pay a bit more ?

Labour may have bankrupted us but at least they did raise the amounts going into health care over the time they were in power, the conservatives seem to want us to go backwards to a private system like the americans (twice as expensive and worse than ours !)

No, I wouldn’t pay more when the NHS is poorly managed. Look at what is going on:

Britain’s Pharma Bros.

That’s not poor Nhs management that’s multinational corporations having more power than mere nation states. I agree it’s wrong but it’s bigger than the NHS/department of health

yup, nhs is cheap in world term

CG – that’s not the NHS being poorly managed.
That’s drug companies holding the NHS over a barrel.

That’s (almost) similar to blaming crime victims for the crime they suffered!

I’m hunting for the newspaper article written by one of our CCG GPs berating and challenging Phizer for overcharging our CCG for several million for epileptic drugs, and winning!
I think they are having to backdate ‘overcharges’ for quite a bit…

DrP

This is the story, but not his article…

The more interesting question is when does a person cost the NHS.

The most interesting question is why are we doing a cost ananlysis on the NHS.

Did you know..if ‘full seven day working’ in the NHS was a drug, NICE wouldn’t deem it cost effective?

DrP

How true DrP, and yet the promised extra money in the GP forward view is being wasted on it for purely political purposes. I estimated it cost the tax payer £400+ for each contact with the local prime ministers challenge fund service, but it will be deemed a success because a few people saw a GP who wasn’t employed by the preexisting out of hours provider on a Saturday morning. Just not my patients as we work hard to see everyone that needs seeing in the 56.5 hours we are open every week…
The mismanagement in the NHS starts at number 10 Downing Street.

What about a Singapore style system where everyone gets an allowance (say £1000 per year) to spend as they wish on healthcare. If not spend it is kept and the amount in your healthcare account just mounts up until you do need it (when older for example).
This then brings in true patient choice so we can see the value of the various NHS offerings to the people that want them whereas today it is guess work. All at the same cost.

It also acts as an incentive to maybe not rely on healthcare and do a bit more personally to be healthier.

Catastrophe insurance (paid by government) covers the very large medical costs

Not exactly a vote winner tho is it?

Much better to stoke the expectations of the public – ref 7 day nhs, Skype your GP 24 hours a day, demand more all the time, tightening regulation(Cqc) and demonising the workforce in the media, until the inevitable happens – the ” GP led” ccgs have to balance the books with some savage cuts and bingo you’ve got your fall guys for the demise of the nhs.

You have to remember a majority of the electorate believed the brexit pitch so the idea of operating the nhs 24-7 on less money and with less staff that the nhs fails to operate at now seems very reasonable to them.

Turkeys Christmas.

You’re pretty screwed if you’re on expensive medication though.

The most interesting question is why are we doing a cost ananlysis on the NHS.

Because we say we can’t afford it, when what we mean is ‘I’d rather have a bigger telly’ and because most people put the biggest part the NHS will play in their lives outside their frame of reference. Its a service they don’t want to think they’ll need for a person they don’t want to think they’ll be.

^Up there ^ we’re talking about ‘little old ladies’ as if they are someone other than ourselves.

Once the majority of people believe it is acceptable to have to top up the NHS with their private insurance then there will be no one pushing for a better NHS because they already expect it to be ineffective. IMO this is not a good thing.

Also where does it stop? If you have enough cash what else should you pay for? It’s already accepted that the best educations need to be bought (with monetary or cultural capital) once health is segregated like the USA, perhaps people can have their own private police…

If people are prepared to pay for private healthcare then they are prepared to pay more tax for the NHS…

DrP did a long thoughtful piece and then proclaimed not to know the answers.

Others have steamed in with solutions.

I suspect DrP would get to a sensible answer sooner than some of those who steam in.

And I certainly don’t know the answer to this one.

I have not read the whole thread.

Overall no – the private sector leeches of the NHS because it does not pay for the trained staff it poaches and often outcomes are worse – and if you get complications you end up in the NHS anyway.

some consultants also game the system – deliberately racking up delays or telling patients porkies to get them into the private system as the consultant makes more money

However for individuals it can often be a very good thing – my mother had her hips done privately after having her NHS date moved back 3 times. she was reluctant for ethical / moral reasons but I persuaded her to do so as at 82 she doesn’t have much time to spare and delays lead to muscle wastage and slows recovery and she had the money – £25 000 for two hip replacements

Sometimes pragmatism trumps ethics

You’re pretty screwed if you’re on expensive medication though.

Indeed or even quite basic care. There should be no limits.

Haven’t read through the whole thread but what the OP is asking about (and it’s an excellent question to debate) is means testing of health care (voluntary or otherwise).

The problem with means testing is that there will always be a large number of people on the margin of “qualifies for free health care”/”pay for it yourself, you scrounging bastard”.

This would lead to a large degree of preventable suffering among those people, huge opportunity costs – “I couldn’t go to university because Dad needed a new kidney” – leading to wasted potential and stunted lives.

On a national level, such a policy would lead to worse health outcomes, particularly among the “squeezed middle” who would most likely be on the margins of the means test.

This would then provoke a very divisive debate:

“Why does that chain-smoking, sedentary unemployed person get free health care, whereas I lead a healthy life and pay my taxes and NI but get nothing?”

It would be an enormous step away from the principle of universal health care.

kerley – Member
What about a Singapore style system where everyone gets an allowance (say £1000 per year) to spend as they wish on healthcare. If not spend it is kept and the amount in your healthcare account just mounts up until you do need it (when older for example).
This then brings in true patient choice so we can see the value of the various NHS offerings to the people that want them whereas today it is guess work. All at the same cost.

It also acts as an incentive to maybe not rely on healthcare and do a bit more personally to be healthier.

Catastrophe insurance (paid by government) covers the very large medical costs

That’s what I have in mind but must be customised to the British society because Unions will go up in arms citing danger to lives etc … defend their jobs whatever.

If this looks viable then all parties will want to claim credit or try to sabotage it depending on whether the idea works well and usually nobody should come out smelling full of roses because nobody should succeed. NHS is everyone’s political football where it is both their strength and the weakness.

Therefore, the must be very strong political will as well as letting the people see the benefit of another system otherwise nothing change.

Besides, there should be a number somewhere that shows the amount a person cost in their entire NHS lifetime. Funny this is not available.

I think that’s the way it’s going.
I have private health cover as a work benefit. I’ve used it twice and each time, I reasoned that someone else would get the benefit of “my” nhs time if I went private.
I also pay extra for my family.
Sadly, a work colleague hasn’t and is now regretting that decision .

You’re pretty screwed if you’re on expensive medication though.
Indeed or even quite basic care. There should be no limits.

But there are limits though. I have a client who works in the medical supplies industry and according to him there are a lot treatments routinely available in Germany that aren’t in the UK becauae of cost.

Yes – but only if there are alternative treatments that are available and work.

When you have a system that provides care to everyone at no cost to the individual then there has to be some mechanism for capping costs otherwise it would be completely unmanageable – and those decisions are made on a clinical basis. For example some of the cancer treatments that are often mentioned in the papers – the drugs an be tens of thousands or hundreds of thousands for something that is not a cure – but prolongs life / dying by months only.

also Germany spends more per head of population on healthcare – significantly more. 12% of ( a higher) GDP compared to our 9% of GDP

Ideally I would like to see us matching German levels of spending on healthcare. this would lead to a vast and noticeable improvement in the NHS. then some of these rationed treatments could be made available. But in a cash limited system then if you spend £250 000 on one persons cancer treatment thats 25 hip replacements you cannot do. Thats the sort of horrible judgement NICE has to make

But there are limits though. I have a client who works in the medical supplies industry and according to him there are a lot treatments routinely available in Germany that aren’t in the UK becauae of cost.

Did he also tell you that there are often cheaper alternatives or that there may be no benefits to these routine treatments?

Having said that my brother in law had prostate cancer treatment in Germany that is not available on the NHS and has are better outcomes than the NHS treatments. But then if the NHS budget increased by 30% to meet german spending levels we could have the latest state of the art treatments as well.