Monday, 20 July 2009

Waiting Time or Wasting Time?

Now THIS has the potential to kick up a storm. £20 to see your GP? In the supposedly free NHS? There's no way to justify it, is there? Personally, I think that there's some logic to it. More so, there's logic to introducing this idea to ambulance calls. I'd like to propose the following as a suggestion, and ask for your views on the idea. On every piece of paperwork we fill out for a patient, there's a box that says "Unnecessary Callout Fee". If it's signed by the paramedic and by a member of hospital staff, it means that both agree that this was a wasted journey for the ambulance, and the patient should be billed. Even if it's a small amount. Just slightly more than the taxi journey would cost.


Here's a list of arguments I've heard against:

1) This is the NHS - it should be free at the point of delivery

2) The people who call are often those who can't afford anything else

3) The decision would be very subjective, and dependent on the mood of the paramedic or triage nurse

4) These call-outs are the ones that keep paramedics in a job


I'm sure there are many others, but in the meantime, some counter-arguments to the above:


1) We already pay for NHS dentists and prescriptions, and the NHS is on the verge of collapse

2) The elderly, children, and those on things like income support would be exempt

3) You need to have a bit more faith in the professionalism of the NHS staff involved

4) Emergencies keep us in a job - that's what we're there for


This needn't be a money-making exercise. The idea would be to reduce the stubbed-toe call-outs, the paper-cut call-outs, the "I've had a pain in my shoulder for three months and decided that 4am on a weekend night is the best time to call" call-outs. In short, to reduce the pressure on the ambulance service, so that ambulances are available more often and more quickly for those calls where they are really needed. "Needed" doesn't necessarily mean life-threatening only. I fully accept that there is a plethora of genuine reasons to call, and agree that sometimes there's just no other answer. That's what we're here for. And no, I wouldn't want to charge you.

We need to get back to ambulances waiting for calls, and not calls waiting for ambulances.


The Happy Medic said...

Bad news first. We have that model in the US. Everyone is billed no matter the "need" for an ambulance and a great deal more than a taxi ride. The going rate here is $680 plus about $4 a mile.

It doesn't deter them one bit. Not even a thought. I too wish we had a "nuisance fee" for folks that call all the time or a cell phone fee for folks who call, but don't stop, but what's the point?

Maybe in your system it would have a mild deterrent effect, but I can't see how we can change their mind when already in the door.

We need to get them BEFORE they call. But I like what you're thinking!

Anonymous said...

I don't think that £20 to see GP is appropriate, but agree about fining for inappropriate ambulance callouts. One rubbish callout should get a warning letter, second one and it's a fine, about the cost of a parking ticket seems reasonable to me.

A young lady with an - ahem - retained condom whose husband followed in the car, and a 35 year old man with a stubbed toe spring to mind.

But remember the vast majority of those who misuse the NHS fall into the categories you suggested as being exempt from the rule, those people aren't exempt from parking tickets and certainly won't be getting hospital transport home from A&E once I kick them out. The only automatic exemptions should be people with limited moblity.

nickopotamus said...

£20 charge for a GP won't work. People use inappropriate healthcare pathways enough at the moment, if they have to pay to see their GP this will only increase. The ambulance service, A&E, Walk-In centres - all will see their already filled-to-bursting workload rise dramatically as people go for the quickest, cheapest option.

Now fining inappropriate ambulance calls...? There's a plan. Even if it's only used for doctors abusing their GP Urgent privaleges.

medicblog999 said...

I work with a paramedic who used to be a carabinaere (I know thats spelt wrong!!) in Rome (Romes 'Army' police force). He tells me that all patients are charged approximately £40 for each ambulance journey, but if they are deemed as genuine, at the hospital, they can claim it back.
I think it would serve as a deterrent though over here, the difficulty would be in those patients (usually the elderly) who already hold off calling us until it is sometimes too late.

slmiller72 said...

medicblogg999 is quite right about the elderly who for some reason " don't like to bother anyone" and call an ambulance, usually when they are at their most poorly. Should charging for an ambulance come into existence then I firmly believe that the elderly should receive an automatic exemption or indeed, be able to claim the charge back easily and promptly.

It used to be the case that people involved in RTA/RTC's (whatever the " new" word is for them now) would receive a bill for the ambulance... Does this still happen now? If it doesn't, it should do - how many " neck pains" do we go out to? And surely, if these people are claiming from insurance companies then they would be abe to pay the charge for an ambulance and fire crew ( if we have the roof off their car because of said neck pain) and claim it back?

By having these charges would also income generate for the Ambulance trusts a fair few coffers each year - easy money for doing nothing extra...

Leeds Fan said...

We're far too worried about offending people's sensitivities in this country. Of course we should charge for abuse of the system.......(almost) no exceptions!! Zero tolerance in many areas of society would make this country a more tolerable place to live!!

Ben Yatzbaz said...

Thank you all for your comments! Keep 'em coming.
I know that it would take a lot of thinking by some very important people (ie, not the people who actually do the real work...), but I still think it's worth looking in to. SLM72, As far as I know, RTAs are still charged, and it still goes through the insurance. In my world, the elderly and those with mobility problems would be top of the exemptions list, with others possibly to follow. And clearly, if you've called an ambulance for a genuine reason, then there is no charge. Maybe, M999, the Rome idea is one to look at. I must admit that I hadn't thought of it as a speeding ticket type fine, so my list of exemptions might change. Anonymous (I presume you are A&E staff...), I don't necessarily agree that the only ones who abuse the system are the ones who'd get out of paying anyway. Too many times I've been called to what I would call (at the risk of causing much unintended offence) "normal" middle class families who just refuse to think for themselves. The classic being "I know he's had a sore shoulder for three weeks/only got a bit of a cold/etc, but he'll get seen quicker if you take him in, and I'll follow behind in the car". And Happy, you're right too. We STILL need to work on education as well...
Nickopotamus - with you all the way...
Leeds Fan - I know you've been one of my "followers" for a while, so I'm glad to see that I've finally riled you enough to make you comment...

stuart said...

I think it would be much better starting off as a fee who use an ambulance as a booze bus.

You get the police called because you're overly drunk and you get hit with a public order, drunk and incapable or drunk and disorderly charge.

If someone is forced to call an ambulance for you because you've had so much to drink you're vomiting it out your nose, then you should be charged for the priveledge of splattering the ambulance staff that have been forced away from potentially more urgent cases

Anonymous said...

I wanted to comment about something related to this on another blog but it was one where you have to have an account and I can't work out how that works (OK I'm useless!).
To add to the Italian reference: here in the north, an autonomous region called South Tyrol, health care is also free at point of receipt - as long as it is the GP, who will refer you as required. A couple of years ago they were forced to start charging 15 Euro if you appeared at hospital for emergency treatment and if you were admitted. It has successfully stopped the "I need a plaster" consultations. You can have insurance for other bits or pay yourself. And an added extra is the concept of giving a donation to the White Cross, the Red Cross/St. John's equivalent which provides the big white taxi service. For about 70 Euro a year your family is covered for up to 5 ambulance transfers AND an air repatriation if needed whilst on holiday! (Or up the mountain, skiing or climbing). And all the parking is to be paid for. No-one seems to mind - and the people I've talked to here cannot understand how we in Britain cannot see that a totally free service is going to struggle. But I don't feel the presence of an "it's my RIGHT" society here. That's why we choose to be here more than in Britain now my husband has taken early retirement from the NHS and we're both self-employed so it's less important where we live.

Steve'nLubbock said...

Here in the states, some localities have started charging 'households' for frivolous emergency calls, but the enforcement is very lax. As for tying up an ambulance, last month I fell and broke my lower rt. leg. Rather than call 911 and get a fully outfitted ambulance, I made the call to an ambulance transport company... they provided the necessary service at a much lower cost, and the heart attack patient or MVA victims had access to the ambulance I would have taken up. But I am not typical.
I used to work with a fellow who wouldn't take his daughter to his GP when she was extremely ill, but he would wait until after 5pm and then take her to the emergency room. Why? He had a $10 copay for doctor visits, but ER visits were covered 100%... DUMB.

Anne-Marie said...

I am a brit, now in NZ. GP charge is about $45 (approx 30 pound), more at night to see out-of-hrs gp at hospital. no charge at hospital for emergency care. Ambulance sur-charge is $50 in my area. We still get non-calls (small cut, not bleeding, live round corner from hospital, 3 cars out front & several drivers around), but not too many - rural people get themselves to a&e even for serious stuff. People DO think before going to GP and paying though.

Chronic Chronicles said...

I know I'm late to this, but i very much disagree with being charged to see a GP. As someone with multiple chronic illnesses I find it hard to get the energy to go when I should, and if I had to pay out of my already strapped low-income vs paying for bills and treatment the NHS doesn't cover? No chance.

However, I very much agree with fees for abuse of the ambulance service with no exceptions. An elderly person abusing the system is still abusing it. As a wheelchair user - I shouldn't be exempted if I call because I have a sore throat.

I'd hope staff would use this wisely, and perhaps publish more guidelines. A lot of people would think it's right to use an ambulance if in labour - so they need to be told that if it's a normal birth to find their own way to hospital unless something is going wrong, it's early, the patient has other needs, etc.

It is difficult, and there will always be lots of grey areas and what ifs.