I've been starting to think that the best way forward for the NHS is co-payment – not as a universal thing, but as an optional for a specific service, for example a different access system or priority access to tests etc.
It's all very Ryan Air, but I'd pay. I'm sure lots currently do pay for video consulting services or home visits – the growth of start-ups such as Babylon (DOI I do sessions for them) or DrNow is testimony to this fact.
But, and this is a big but.
Part of the strength of the doctor-patient relationship is that we both know that any decisions made are not based on either the patient's ability to pay or the doctor's willingness to financially back it. If we introduce a payment then the sense of entitlement and customer service will mean that we, as professionals, fall liable to the charge of 'it's just about the money'.
So I don't know how to resolve the dichotomy.
Well, that's not entirely true, I do suspect that the answer is actually simple. Just be really good, all the time, be transparent in decision making, honest in rationing, clear about motivation, open in deficiencies.
The problem is, to operate at that level all the time requires adequate funding and resources. And to do that requires more money, which we won't get.
Unless we start co-payments...
- Dr Chris Mimnagh is a GP in Liverpool and co-director of clinical strategy at the NHS partnership organisation Liverpool Health Partners