I’m a GP – if Sajid Javid thinks charging patients will help us, he’s wrong
Miles from land, working as a cruise ship doctor in the middle of the Atlantic, I was treating a patient having a heart attack.
He was in dire need of a clot-busting injection, but as I opened the cupboard to draw it up, the chief nurse took me aside and whispered to me: ‘have you asked their partner if they’re happy to pay for this?’
The medicine cost $7k a vial. I then had to go and have that conversation with an already incredibly stressed relative.
The main thing I learnt from all this was just how important travel insurance – and, on a larger scale, free healthcare – is. It’s why I fiercely oppose Sajid Javid’s proposal to introduce fees for GP appointments and A&E visits.
His idea isn’t new. Debates over NHS payments have raged since the creation of the service, and the evidence we have for charging patients shows that, even with exemptions in place, a fee to see the doctor widens health inequalities by deterring the poor and vulnerable from seeking help.
It’s something I encountered in my many years working as a cruise ship doctor, on and off between 2008 and 2018. I travelled the world dealing with quite a lot more than a spot of sea sickness.
People get unwell at sea in the same way they do on land. From coughs, colds, dislocations and stitches, to heart attacks, strokes, and critically-ill patients needing intensive care level support.
To the dismay of many British guests, medical care on cruise ships comes with a hefty bill.
I recall the elderly lady who shuffled to the nurse’s station onboard the ship looking fairly well. She asked about the consultation fees, then decided against a visit.
24 hours later, the whole medical team was summoned over the tannoy to her cabin, to find her in extremis from a condition that could have been prevented had we only seen her earlier.
Then there was the patient who needed to be medically disembarked from the ship with an acute abdomen, for surgical care on land. The ambulance was waiting on the pier to transport her to hospital, but she flatly refused to get on board.
We were in the States, and being American herself, she knew there was a fee for ambulance transport that her insurance didn’t cover. She took an Uber instead.
A cruise ship is a microcosm of society and I believe all these examples will play out on a wider scale if fees are introduced to the NHS. The unintended consequences will far outweigh the financial gains (which will need to be offset by the huge costs in policing and administering a payment system).
A recurring argument in favour of charging in the UK is the one that presumes a fee will reduce the ‘unnecessary’ presentations. The patients that ‘don’t need to be there’ – that people ‘will think twice’. Well, I would disagree.
I remember many patients happily paying at least $100 to see me on board the ship, when their money would’ve been better spent elsewhere.
The lad in his 20s who worried about a black mark on his fingernail – which turned out to be dirt, and which I removed for him (for no extra charge). For me it may have seemed unnecessary, but who is the judge of that? If he felt reassured that the black spot wasn’t cancer then to him it was money well spent.
But the fact a fee is in place does raise ethical questions. If a doctor asks for a follow up visit, are they being caring or will they be branded money-making?
We all heard rumours on board about the early days of cruise ship medicine, where staff worked on commission. Stories of patients attending with a cold, and being offered x-rays, swabs and bloods, and a host of expensive treatments, all for a substantial bill.
Paying customers may want the reassurance of a barrage of tests – but unnecessary tests can have harm attached. Assigning a fee to healthcare changes the dynamic completely.
Javid advocates introducing these fees, to ‘help with the allocation of what will always be limited resources’.
‘What frustrates people,’ said Javid, ‘is having to wait for GP appointments.’
When I had a busy clinic on board, and a waiting room full of sick, paying passengers, they still all had to wait to see me. In my experience, a consultation fee doesn’t help with waiting times. Just look at the waits for NHS Dentistry if you’re not convinced.
What the UK is desperately in need of is more staff. We need to retain those we have left.
I’m a GP these days, and co-chair of Doctors’ Association UK. We urge the Government to speak to groups like ours – made up of frontline staff who have lived experience of the system – to seek solutions that do not disadvantage people by making them pay.
If they don’t, and proceed with introducing fees, I can’t help but think: ‘at what cost?’
Patient details have been changed to protect confidentiality
Do you have a story you’d like to share? Get in touch by emailing jess.austin@metro.co.uk.
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