Funny, they used to have a 10€ fee, here in Germany, which you paid once a quarter to cover administrative fees. If you had to see another doctor, for example a specialist, then you would get a transfer note, so you didn't have to pay again in that quarter. But they scrapped it this year, because the various insurance companies made so much profit.

I can see the reasoning behind the idea. It is a way of rationing access. Though all that it will do is create a multi tiered system. The middle classes will effectively be taxed, the very poor will get free access but will possibly have other restrictions and the rest will simply have to go without until they are seriously ill and become hospital admissions.

Balls to that. If I'm ill enough to see my GP, I'm ill enough to go to A&E....... and they're busy enough these days.

Umm... Penalise the DNA culprits? Job done.


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1. How do you go about chasing DNAs? Administration of it would probably cost more than the DNAs.
2. It still doesn't address the problem of people failing to manage self-limiting illnesses.

It also does not answer why people did not attend. They may have realised that it was not as serious, or that they had to get back to work. Their absence will also create gaps in the surgery for last minute cases. I do agree about your second point, though not many are capable of diagnosing their ailments that is why they go to their doctor. The public message is always go and see your doctor if you are not sure. Also too many demand antibiotics for viral conditions. Doctors should be allowed to prescribe placebos for those that demand inappropriate treatment.

The problem with placebos is that if you give them without the patient being aware, you are deceiving them and this can break down the doctor-patient relationship.

I think the doctor patient relationship is pretty shaky if you give them drugs for a condition that they do not have.

The problem here is hoping the person knows it's a self limiting illness, and not something else. I find it odd that you put self-diagnosis above seeking professional opinion. If someone thinks they have something self limiting and stays away, but fact has made a condition far worse by presenting it late, what then?

I did comment that "not many are capable of diagnosing their ailments that is why they go to their doctor" and yes catching many conditions early are preferable to an expensive hospital visit. The problem is that GP's are trying to put off patients for whom they are being paid for and leaving it to hospitals. If those hospitals could then bill GP's budget emergency rates I do think that the GP's will find a way to fit them in. The same is true of social services. If they can get a person classified as a mental case it no longer becomes a liability to the social services budget it becomes an NHS budget problem. Which is why there were so many elderly bed blocking in hospital.

This is why I said that there's a lack of common knowledge. I've people who've turned up with a cough or runny nose for a total of less than one day. No other symptoms. Or what about a headache. You get a headache and what do you do? The majority of sensible people would take a painkiller and if it wasn't settling or if it was getting worse, it would be reasonable to seek medical attention. If you've had (by your own admissions) a mild headache for half a day, and you've taken nothing, what do you expect me to do? I'll tell you it's a headache. The problem is that from a medicolegal point of view, I just can't tell you to bugger off. I have to take a proper history and examination and then tell you to bugger off.

Contrast this with one of my patients who had diarrhoea for two months and didn't do anything about it. Turned out to have cancer. Even if they had presented after two weeks, the most I could have done would be stool sample and bloods. You need to have six weeks of diarrhoea before you could be referred.



They could do that. Then we could bill the hospitals for all the crap they dump on us and it would massively outmatch the amount we would owe.

The problems that the GP's are the fund holders now and so if the hospital returns a patient to the GP it was the GP who should have treated them first. That could have been done by a nurse in the practice rather than pay the hospital to do it. The government are deliberately starving hospitals of funds so that ultimately they all go private. GP fund holders can spend their money anywhere.


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Effective triage done at the front desk of Emergency Departments will filter out the unnecessary. But then that has an impact on department income. The cost for A&E attendance is something like £84. That's just for turning up and being registered on the system.

If GPs really are in charge, how come I have fudge all influence? The problem is that the Govt was in charge of a trainwreck and they've now forced the reigns over to GPs (most of whom don't want to be involved), so that when it all goes tits up, GPs get blamed.

I am not blaming you or GP's at all. The issue of triage could be cheaper if seen at the GP surgery. Once you have assessed a patient then it should not be necessary to duplicate at A&E. There will be people who are unable to get to their GP because of work hours, they may have no opportunity to get to a doctor during normal hours. Though if a person goes to A&E after being turned away by their GP should the patient be billed for the A&E visit. It all depends on the outcome. My brother was told by his GP it was just a bad back and to go away, and then was admitted to A&E paralysed some days later. In that case should my brother have been billed £84 for a doctors error?

I think we've had this convo about your brother before. What if the doctor had assessed appropriately and deemed it was all muscular? Should the doctor be forced to pay if they did the appropriate thing at the appropriate time? Quite often the picture changes and someone who appeared well five mins ago can collapse on the floor.