I'm pretty new to this UK board but I know others from the US are around too.
Our health care systems are totally opposite and I see the good and not so good in both systems.....but have to take into account our 300+million population and the UK 56+milllion.
I know how US doctors make a living but wonder about the UK doctors.... Thanks ....Joy 76 US
Hi Joy. I am not sure the population numbers area key factor in the differences. The NHS is the employer of the largest number of staff in the UK if all the organisational bits and pieces are added together. Again the NHS is the employer of the highest number of doctors. Doctors, particularily the senior ones, Consultants, may wholy or partially work privately ie not for NHS or armed services. General Practitioners who give Primary Health Care services may be salaried or partners in a firm of Primary Health Care Services. They also can do private work. Most of the remuneration comes from the NHS via the Government and ultimately taxes and National Health Insurance contributions..
it is something like that. A doctor, if thereis one on the forum would give you a better answer. George
As George says - population has nothing to do with the way it works, and the UK population is 65 million by the way. There is governance at local level as well as national level.
All doctors working within the hospital sector of the NHS receive a salary - just like any other member of NHS staff - and there are set pay scales for the various grades.
General practice is a bit different and there are two forms of remuneration there. Some GPs set up and run a practice (office to you) in a similar way to the USA. Some may share the costs with another "share holder". They then receive funding from the government to take NHS patients - their services are "purchased". Out of that "salary" they have to pay the costs of running the practice: the building, other staff they employ and so on. They can also employ doctors within that set up and these doctors receive a fixed salary and have no responsibility for the costs of running the practice.
The GPs are also reimbursed in relation to the patients they care for: a fixed amount is paid per head for patients in various age groups to cover the costs associated with providing the service. This is paid irrespective of whether a patient registered on the practice list goes to the doctor multiple times per year or never crosses the threshold. Every person in the UK is entitled to be registered with a practice although in some places there is no choice as to which practice. Where there IS a choice you make that decision and register with the practice of your choice - usually it has to be one within a reasonable distance of your home and you can only normally register with one practice and that is the practice that is paid to provide your care. It is possible to change practice however if you prefer to go to another and they will accept you.
There are also walk-in clinics and minor injuries units you may go to without being registered there for care.
Hospitals also receive funding on a similar basis depending onthe number of beds and the services offered. A hospital providing transplantation or cancer care (for example) will receive some extra to cover the immense costs there for example but otherwise they must budget to cover all costs incurred.
In order to access specialist care you must be referred by a GP. Almost all specialists work within hospitals both for out-patient and in-patient care.
There are also doctors who work privately, some of them work in the NHS and also see private patients. Sometimes you can see a doctor privately and he will then transfer your care to his NHS list where the care does not cost you at point if receipt. Some doctors work purely privately - in exactly the same way as the USA.
There are downsides to the NHS obviously - there isn't a bottomless pot of money. But no one who is ill is left with no cover - if you are employed you and your employer pay contributions to the social services fund. If you become unemployed you are caught by the social services net as you are credited as having paid contributions when you register as unemployed. This covers far more than just medical care though - entitlement to medical care is based on residency. If you are resident in the UK, then you are entitled to care whether you work or not. There are some things that aren't available on the NHS but basically all emergency care needed is covered - from cancer care to accident trauma. And the unemployed down and out is entitled to the same care on the NHS as the company director who chooses to use the NHS on principle. There is no rationing policy because you come under "medicaid". If you need treatment you get it without question - with a few exceptions for very expensive drugs that are only partly funded and special permission is required for the funding. But if you need a drug or an operation or other therapy you get it immediately as required - no contacting the insurance companyfirst to get approval.
Anyone who has the money can opt for private care which they can pay for themselves or they can take out a private health insurance plan. So if you want that - it is no different from the USA. The people with money can have the frills, everyone else gets outstanding care - free at point of service. You can have doctors who are not very good in some way or another - but that can happen in the USA or any other private system too. And we can ask for a second opinion - at no extra cost to us.
There are flaws but generally the NHS is seen as one of the best health services in the world - both in what they offer and also in obtaining value for money.
I, by the way, don't live in the UK now. The system here is similar, just much smaller.
Thank you Eileen for that splendid reply. Beautifully clarifies what I 'sort of 'knew. George
iv never seen a poor one hun. going by the cars they drive.
they are salaried but have bonuses as well. i dont think your ever see them at a food bank .haha
Hi Tiswas,
But they are worth their hire? George
thats a matter of opinion hun .
most i wouldnt give house room .
specialist and surgeons are great at putting people together after accidents and specialist come up with some amazing ways of helping people like the panorama programme i was watching on growing a whole new nervous system from cells stored in the base of the brain used for the sense of smell
, it was a fascinating programme and i know that these people dedicate there lives to finding answers .
but the general practioner no ,you cant do anything for a patceint in 6mins the whole system needs overhauling people are being misdiognosed and ignored and fobbed of to much by gps . lets face it if you employ an electrican you dont expect him to ask you whats wrong .thats his job .
I'm not defending GPs to the hilt, I have also met the odd one who could do with retraining at best - but overall they do a not bad job. They are expected to know a bit about most things - enough to know which specialist is the right one if it needs that. They spend 5 years at medical school acquiring a life-time debt, another 6 years learning a bit about gynae and obstetrics, orthopaedic stuff, geriatric medicine, general medicine, surgery psychiatry and a few other specialities and then have that 6 minutes to identify the problem and decide what to do with you. They are not mind-readers but many patients don't tell them the half of the story when they do go to them. And other patients turn up with a bit of a cold and demand antibiotics - which won't do anything for a virus anyway - and become abusive when the GP says no. The vast majority do a pretty good job - and I knew plenty who drove 10 year old tatty cars.
You wouldn't call an electrician, hand him the door keys and leave him to find out what was wrong for himself would you? You would at least tell him the light in the bathroom wasn't coming on or whatever.
thank you tiswas. Yes, service can be a mixed bag as I know. Some have found it hard to credit my veracity as to my route to first diagnosis of loacal advanced agressive prostate cancer, It is fruitless now to wonder what my situation would now be if the investigation had been done four years earlier when there was the first indication of significant risk of PCa. Almost certainly I would have had a better chance of a cure. Well that was only the third medical disaster. One concerned a young newly qualified doctor left on his own while the consultants took their well earned weekend break. The third was a mix between GP indiference and a consultant's intransigence with a Professory of Psycology desperately trying to inject some medical common sense into the situation.
On the other hand a surgical team saved my life decades ago. More recently hospital staff saved my wife's life. Hospital staff also saved the life of my wife when she had meningitis and that of my youngest boy when years earlier he had also had meningitis.
It seem in this sorry world we have to take the rough with the smooth and thanks to the NHS the price is the same for both - in contribution and tax terms..In personal terms? We each have to judge.
Thanks Eileen. There are slight suggestions in the tail end of your note and in tiswas's npte that bring to mind the tasks confronting vets. I think tiswas might say that if vets can deal with dumb animals why not GPs. I think Eileen migh reply we don't need vets we need co-operative patients for GPs
But I should not put words into your mouths. You are so well able to speak for yourselves. I look forward to your further comments.
i have a wonderful vets all 3 of my dogs have been taken great care by them , making sure if they are highly strung like my terriers that if they have to go in for an op that they come in as late as poss to reduce there stress, my boxer when i had her was really down in the dumps i couldnt see or find anything wrong with her , she gave her one injection vitamin one i think she was bouncy and her old self all most instantly ,i was suffering with a chesty cough at the time ,i said can i have one of those .unfortunatly not she said .
On doctors, there are many very very good ones here and there are many of the other....some push push push drugs too much and haven't taken time to work on the WHOLE BODY....that is why I see only integrative MD's finally at this later time in my life.....
Here many are on the payroll of pharma companies in many ways, won't go into all I've seen and hear.....
Many are life savers and I'm thankful and many have destroyed lives...
That is WHY people need to take charge so much of their lives....I have been doing that for some 25 yrs and avoid doctors a LOT....see mine once a year for a check in and annual labs and then there is the hip replacement misery I went thru in 2010....won't go there here, that is why I arrived here due to hip replacement and wanting to hear other's stories.... Joy
PS: Before pycnogenol in 1995, I was a mess with allergies and sinus and drugs that did NOTHING....nor did the allergist I saw for a couple yrs.....so I speak from my experiences.
Yes, I admired the vets we have used. They really have to pay attention to the animal patient to pick up all the nuances of body language. The owner can give so little information about the symptoms. These days too much time is spent by GPs looking at the computer screen and so too little looking at the patient.
My present GP, turns in her chair and looks intently at me. That scrutiny builds my confidence hugely in her ability.
i think its because vets actuly go in to being a vet because they like animals and want to care for them .in fact my vet spends more time checking my dog over then ever my gp has me .
i only go once or twice a year for bloods this year i went i had hardly sat down i felt he was getting ready to show me the door .the first thing he mentioned was my weight , i said its not what i eat and it really isent its because i need to be more active ,but fatigue restricts so much .
i got up and walked out in desgust i am not there every week moaning on about thia that, i deal with the pain myself and try to manage the fatigue, and the first thing is not how are you its what you doing about my wait ,
funny how when they stuff people full of steriods which them hughe they dont think thats a health risk .
if your talking decades ago then it shows how bad things have now got ,the worst hospital iv come across is the leicester royal and general .but on saying that , they saved both my brothers after a previous surgery eles wear on my middle brother hadnt reconnected tubes right after removing the apendix ,meant the intentines overlaped and food could not pass thru ,the pre care at the hospital was terriable but the skill of the surgeon saved his life. my other brother got phobed of with its a pulled muscle from his gp.
untill his toes turned black then he was rushed in and once again the surgeon skill saved his leg. from a gaggaling that had grown up his calf muscle restricting blood supply he lost most of his calf muscle but not his leg . but gp and hospital care should not be a lottery .i hope you agree .
doctors in the 50/60/70s and even into the 80s actuly cared about there patceints now its just numbers , and targets , thats not to say its all there fault the system is all wrong , 6mins as you say is not enough time to find out the problem, so that in its self is a worry , patcients arent getting getting the proper care .and council. and people are dying because of it,
when a man of 39 dies of throat cancer after being diognosed with acid reflux theres something wrong. try telling his widow and sons your sorry you got it wrong .
yes and i do know the family in question its not just a case iv heard about, devasted there lives ,
when i was a kid and a teenager our doctors surgery was an old big house they had a morning surgery and an evening one you didnt have to ring for an appointment you turned up in the opening hours checked in at reception and waited your turn
, doors were shut at end of surgery hours .but if your were in you were seen if you needed 5mins you got 5 if you needed more you got more the,doctors came out on morning and evening calls , it worked fine . so why did they change it . ?
I saw a chiro the other day I hadn't seen since before hip replacement 4 yrs ago....she does muscle testing and is a pretty wise lady.
Since I have Medicare which we are entitled to in the US at 65, some chiros still take Medicare and some have opted out....they just feel they don't make ENOUGH money with their Medicare patients....
Well, this lady spent 1 hr with me and I paid a $10 copay, she muscle tested some supplements I took in and we talked about my OA mess and hip replacement...and she did ultra sound on knee and some very light activator work on shoulders and foot....
She will end up with about $50 for this work after all is said and done when Medicare pays her....
I will go in every other week for ultra sound work and some light body work....the trauma of surgery plays havoc on the body.
So there are docs, chiros who are not that money driven. Joy
There were plenty of numpties in the 70s and 80s, believe me. And in the 70s and 80s medicine was far less complex than now.
But the original question was about how UK medicine is funded - and however you want to look at it, in the USA (and other countries too) people die of simple problems because they don't have the money to even go to the doctor and get an antibiotic. That is NEVER a reason in the UK.
well we will have to agree to differ i had flu back a few years i got over the high temperture the worst of the aches and pains and shivers at home with old fashioned remedies,but the cough was still hanging on after 10 days , i couldnt get a an appoinment for a fortnight, hence to say i didnt bother .
luckly it did go on its own accord. with no help from the doctors