Views & Reviews No Holds Barred

Paying to see a specialist: welcome to the two tier NHS

BMJ 2014; 348 doi: (Published 09 April 2014) Cite this as: BMJ 2014;348:g2706
  1. Margaret McCartney, general practitioner, Glasgow

The healthcare company Better has a vision: “Your dream NHS, made a reality.”1 Sadly it doesn’t include George Clooney; it’s a new scheme in which people pay a few hundred pounds a year for insurance that entitles them to one or two “free” specialist consultations a year. The website says that no one is turned down and that “ is responsible for your medical welfare from diagnosis through to full recovery. We arrange all tests, procedures and treatments to ensure your complete peace of mind.”

With “no waiting for your GP,” it says, you can see “top consultants” who have been “peer recommended.” Within five days of contact the company promises a phone call from an “on-call consultant triage team” and “essential tests arranged for you quickly.”

So you don’t need to bother with primary care and can go straight to a consultant. However, you’re likely to go back to the NHS for the tests. Better says that if these are “available on the NHS there is nothing for you to pay including follow-up visits with your consultant. 98% of tests are available on the NHS.”

It goes on to say that GPs often delay referral with watchful waiting or maybe a prescription “to see what impact this has,” and that signing up for Better’s service will result instead in a “fast track to treatment on the NHS.”

But this proposition undermines the entire construct of the NHS. Primary care is not the slovenly enemy but a solution to increased demand, rising costs, and overtreatment. General practice protects colleagues in secondary care from unnecessary referrals and provides care that does not require their input. Each needs the other. Getting rid of primary care would simply lengthen hospital waiting lists, meaning that patients who needed to be seen sooner would miss out.

More troubling is Better’s insinuation that the NHS should take the strain for interventions recommended in a private consultation. Why should the NHS have to bear the costs of sorting out non-evidence based interventions that began in the private sector?

Some patients pay to be seen privately in the hope that any tests or treatment covered by the NHS will be done more quickly. The truth, though, is that patients who cannot pay will have to wait for longer behind those who can. The Better business model attempts to put its patients at the front of the NHS queue, and doctors are playing along with this arrangement. This is contrary to the spirit of the NHS—that is, it allows the ability to pay to trump need.

Companies like Better may divide and fracture the NHS.


Cite this as: BMJ 2014;348:g2706


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