MONEY talks, and normally leads to results. In healthcare we are seeing it everywhere. If you want to see an NHS dentist, you may have to wait up to three years. Yet if you are prepared to pay £40 or more to go private, next week is fine, thanks.
The Covid vaccination programme has been a great success in terms of the efficient rollout. What is interesting of course is that the vaccinators are paid on results. How well would it have gone if GPs did not receive any extra money for putting vaccines in the nation’s arms? In fact GPs can earn £12.58 per jab. At an average of 60 jabs per day, four days per week, a GP may have earned an extra £55,000 this year to mid-May on top of normal practice earnings. By late September many GPs will have been able almost to double their annual salary.
Call me a cynic, but is it pure coincidence that it has become even harder to see a GP face to face this year? There are reports of waits of a few weeks even for a phone consultation, let alone a Zoom appointment. Is it possible that GPs are now working six days per week, rattling through as many phone appointments as possible on the days when they are not vaccinating? Be honest, if you were a GP, it would be very tempting. Work harder for longer and earn more rapidly, with no risk. Is it a coincidence that in countries such as France, Austria and South Africa, where doctors are paid per patients seen, I understand face-to-face appointments have continued throughout the pandemic?
Let’s remember however that there are thousands of vaccinators who are not doctors nor medically trained, but who have been specifically taught how to jab. Surely it would be better to boost that group of vaccinators and refocus GPs from jabbing to starting the long catch-up with their patients’ normal ailments. How is it that some GPs still refuse to see their patients in person, yet are quite happy to vaccinate scores of strangers in sports halls and vaccination centres?
In the constituency of Chesham and Amersham (where there will be a by-election this month after the death of Conservative MP Cheryl Gillan), there are 13 GP practices. We checked last week how they are coping. The results were illuminating. No answer from two of the practices, despite multiple attempts. No face-to-face appointments from any of the other GPs within weeks. Some phone appointments were possible within a few days, but most would be in a few weeks. At the GP’s total discretion, you may be summoned to a personal meeting some days after the phone appointment.
If we want to get on top of the health waiting times and see our GPs sooner, the answer is simple. Pay by results. Let me be absolutely clear before people break out in a rash of anxiety: all care should still be free at the point of delivery; this is a treasured foundation of healthcare in the UK.
If GPs were paid by the NHS by their number of appointments, with a bit more for face-to-face appointments, you know what would happen. It is basic human nature and common sense.
Whilst we are at it, what about NHS dentists, consultants, anaesthetists, surgeons? Perhaps they should be paid by results by their employer, the NHS. Would operating theatres be used much more efficiently including at weekends? Would waiting lists plummet? Would we, the patient, suddenly be treated like a valuable customer?
I believe the answer is simple and exciting: Yes.
Someone, somewhere should run a trial, in a GP practice or in a hospital. Please.