London doctors are in, just not available to patients
Monday, 22 October 2007
Andrea Gerlin and Kari Lundgren
When Katie McDermott's stomach and pancreas ailment flared in June, she looked into seeing a private physician near her office in London's financial district. She decided the 55 pound ($112) fee was too much.
Instead, the recruitment consultant travelled an hour to her designated National Health Service family doctor. Britons are restricted to using one physician near their homes, or must pay to be seen privately. McDermott needs a checkup and drug refills every three weeks to treat her chronic ailment, so going back and forth to her designated doctor creates a conflict with work.
``It takes a good couple of hours to do it and by then you've missed out on something and you have to come in and catch up'' on work, McDermott, 23, said. ``I pay my taxes so I'm entitled to health care. I don't have enough money to burn.''
U.K. businesses lose four times as many hours of productivity to doctor visits as they do to strikes, said the Confederation of British Industry, the country's main employer group. Rising complaints about the lack of access led Prime Minister Gordon Brown's government to order health authorities to offer patients more convenient appointments and choice of general practitioners by December.
The taxpayer-funded NHS provides health care to all Britons, with no direct payments for doctor consultations or services when they go through their registered general practitioner. The requirement is a legacy from the days when physicians were expected to pay house calls.
However, delays and inconvenience mean U.K. workers spend 3.5 million working days a year traveling to and from NHS family doctor visits, at an annual cost of 1 billion pounds to employers, the CBI says.
``They should be able to register with a place near work,'' said Adrian Bull, chairman of the CBI's health-care panel and managing director of Carillion Health, which builds and operates hospitals for the NHS. ``It is about providing services which are responsive to where people want to go see their GPs.''
U.K. spending on all private care grew 63 percent from 1995 to 2005, according to Organization for Economic Co-operation and Development statistics. In London's financial district, employers have set up in-house medical clinics and pay for workers to see private general practitioners to cut down on lost time.
Deutsche Bank AG accountant Tim Cross hasn't bothered to register with an NHS doctor near his home, a 70-minute train ride from his office. His employer pays for him to see a private physician five minutes from work.
``If you think of the amount of time a staff member takes off, it does pay for itself,'' Cross, 33, said.
The government gave family doctors the option of dropping night hours and weekend care in 2004 if they gave up 6,000 pounds in annual pay. Nine out of 10 physicians accepted, attracted by shorter work hours. While the average annual income of a general practitioner has risen to about 100,000 pounds, health authorities have been forced to fill the gap with call-in centers for out-of-hours emergencies.
Scheduling routine exams and treatment for recurring problems has grown more difficult since 2004, when the government required doctors to offer appointments within 48 hours to patients who request them. To comply, many NHS clinics have stopped scheduling visits in advance to handle the daily flow.
Many NHS physicians do offer flexible appointments to working patients without advertising the extra hours, the British Medical Association said. The doctors' union, the business confederation and the opposition Conservative party have supported allowing residents to also register with NHS doctors near their workplaces. The proposal went nowhere under Brown's predecessor, Tony Blair, because it was deemed expensive and unworkable.
Local health authorities probably won't be able to implement Brown's initiatives by December, said Nick Bosanquet, a professor of health policy at Imperial College in London.
``The NHS is a big, nationalized industry,'' he said. ``To offer a lot more services they'll need a lot more money.''
Almost three-quarters of about 11,000 GPs surveyed in June and July said they didn't believe extending hours to improve access was a good way to spend scarce resources, the BMA said.
``We're not convinced it's a good idea,'' Dr. Laurence Buckman, chairman of the association's GP committee, said at a press conference today.
One in four Londoners is dissatisfied with the NHS, and limited availability of general practitioners is among their leading complaints, according to a poll of 7,000 residents by research firm Ipsos MORI.
Fourteen walk-in centers near London rail stations or hospitals help address the need for longer hours, said Amanda Waller, a spokeswoman for the health department. Unfortunately, only four in 10 people know the centers exist, a U.K. consumer watchdog called Which? said a survey found last year.
McDermott has visited a walk-in center and is still dissatisfied. The centers don't have access to her records, she said, so she has to repeatedly explain her medical history to a nurse or doctor she's never seen before.
The government plans to fund 150 new health centers, open seven days a week, and 100 more GP practices by 2011 to improve access to medical help, Chancellor of the Exchequer Alistair Darling told Parliament Oct. 9.
The London offices of law firms Allen & Overy LLP and Clifford Chance LLP and banks HSBC Holdings Plc, Morgan Stanley and Barclays Plc are among those that pay for employees to see private doctors on their premises or nearby.
Rood Lane Medical Group, a private clinic near Liverpool Street Station, counts Deutsche Bank employees among its patients. Business has ``virtually doubled'' since 2002, said Geoff Earnshaw, one of the center's two dozen doctors.
One drawback of going outside the NHS is that some prescriptions may cost employees more than the government- subsidized rate of 6.50 pounds, said HSBC spokesman Neil Brazil. The bank's employees pay 20 percent of the cost of seeing a private doctor at its headquarters -- and the full price of medicines.
Brayner Firth, a 36-year-old information technology consultant, refused to pay the full price of prescriptions written by his previous employer's physician. When he suffered a migraine and a cold last year, he took off a half day to get an appointment with his NHS doctor and another half day to be seen, saving most of the medicine's cost.
``I was tenacious and I waited,'' Firth said.
After Londoner Jason Azzopardi developed cold and flu symptoms, he skipped going to a doctor. Visiting his NHS physician would have meant a 30-minute subway ride each way during the workday. A private doctor near his office in the financial district charges 100 pounds a visit, a ``ridiculous'' sum to the Schroders Plc accountant.
``I diagnose myself,'' Azzopardi, 30, said. ``I get some cold and flu medicine at the drugstore. It's terrible.''
Bloomberg
When Katie McDermott's stomach and pancreas ailment flared in June, she looked into seeing a private physician near her office in London's financial district. She decided the 55 pound ($112) fee was too much.
Instead, the recruitment consultant travelled an hour to her designated National Health Service family doctor. Britons are restricted to using one physician near their homes, or must pay to be seen privately. McDermott needs a checkup and drug refills every three weeks to treat her chronic ailment, so going back and forth to her designated doctor creates a conflict with work.
``It takes a good couple of hours to do it and by then you've missed out on something and you have to come in and catch up'' on work, McDermott, 23, said. ``I pay my taxes so I'm entitled to health care. I don't have enough money to burn.''
U.K. businesses lose four times as many hours of productivity to doctor visits as they do to strikes, said the Confederation of British Industry, the country's main employer group. Rising complaints about the lack of access led Prime Minister Gordon Brown's government to order health authorities to offer patients more convenient appointments and choice of general practitioners by December.
The taxpayer-funded NHS provides health care to all Britons, with no direct payments for doctor consultations or services when they go through their registered general practitioner. The requirement is a legacy from the days when physicians were expected to pay house calls.
However, delays and inconvenience mean U.K. workers spend 3.5 million working days a year traveling to and from NHS family doctor visits, at an annual cost of 1 billion pounds to employers, the CBI says.
``They should be able to register with a place near work,'' said Adrian Bull, chairman of the CBI's health-care panel and managing director of Carillion Health, which builds and operates hospitals for the NHS. ``It is about providing services which are responsive to where people want to go see their GPs.''
U.K. spending on all private care grew 63 percent from 1995 to 2005, according to Organization for Economic Co-operation and Development statistics. In London's financial district, employers have set up in-house medical clinics and pay for workers to see private general practitioners to cut down on lost time.
Deutsche Bank AG accountant Tim Cross hasn't bothered to register with an NHS doctor near his home, a 70-minute train ride from his office. His employer pays for him to see a private physician five minutes from work.
``If you think of the amount of time a staff member takes off, it does pay for itself,'' Cross, 33, said.
The government gave family doctors the option of dropping night hours and weekend care in 2004 if they gave up 6,000 pounds in annual pay. Nine out of 10 physicians accepted, attracted by shorter work hours. While the average annual income of a general practitioner has risen to about 100,000 pounds, health authorities have been forced to fill the gap with call-in centers for out-of-hours emergencies.
Scheduling routine exams and treatment for recurring problems has grown more difficult since 2004, when the government required doctors to offer appointments within 48 hours to patients who request them. To comply, many NHS clinics have stopped scheduling visits in advance to handle the daily flow.
Many NHS physicians do offer flexible appointments to working patients without advertising the extra hours, the British Medical Association said. The doctors' union, the business confederation and the opposition Conservative party have supported allowing residents to also register with NHS doctors near their workplaces. The proposal went nowhere under Brown's predecessor, Tony Blair, because it was deemed expensive and unworkable.
Local health authorities probably won't be able to implement Brown's initiatives by December, said Nick Bosanquet, a professor of health policy at Imperial College in London.
``The NHS is a big, nationalized industry,'' he said. ``To offer a lot more services they'll need a lot more money.''
Almost three-quarters of about 11,000 GPs surveyed in June and July said they didn't believe extending hours to improve access was a good way to spend scarce resources, the BMA said.
``We're not convinced it's a good idea,'' Dr. Laurence Buckman, chairman of the association's GP committee, said at a press conference today.
One in four Londoners is dissatisfied with the NHS, and limited availability of general practitioners is among their leading complaints, according to a poll of 7,000 residents by research firm Ipsos MORI.
Fourteen walk-in centers near London rail stations or hospitals help address the need for longer hours, said Amanda Waller, a spokeswoman for the health department. Unfortunately, only four in 10 people know the centers exist, a U.K. consumer watchdog called Which? said a survey found last year.
McDermott has visited a walk-in center and is still dissatisfied. The centers don't have access to her records, she said, so she has to repeatedly explain her medical history to a nurse or doctor she's never seen before.
The government plans to fund 150 new health centers, open seven days a week, and 100 more GP practices by 2011 to improve access to medical help, Chancellor of the Exchequer Alistair Darling told Parliament Oct. 9.
The London offices of law firms Allen & Overy LLP and Clifford Chance LLP and banks HSBC Holdings Plc, Morgan Stanley and Barclays Plc are among those that pay for employees to see private doctors on their premises or nearby.
Rood Lane Medical Group, a private clinic near Liverpool Street Station, counts Deutsche Bank employees among its patients. Business has ``virtually doubled'' since 2002, said Geoff Earnshaw, one of the center's two dozen doctors.
One drawback of going outside the NHS is that some prescriptions may cost employees more than the government- subsidized rate of 6.50 pounds, said HSBC spokesman Neil Brazil. The bank's employees pay 20 percent of the cost of seeing a private doctor at its headquarters -- and the full price of medicines.
Brayner Firth, a 36-year-old information technology consultant, refused to pay the full price of prescriptions written by his previous employer's physician. When he suffered a migraine and a cold last year, he took off a half day to get an appointment with his NHS doctor and another half day to be seen, saving most of the medicine's cost.
``I was tenacious and I waited,'' Firth said.
After Londoner Jason Azzopardi developed cold and flu symptoms, he skipped going to a doctor. Visiting his NHS physician would have meant a 30-minute subway ride each way during the workday. A private doctor near his office in the financial district charges 100 pounds a visit, a ``ridiculous'' sum to the Schroders Plc accountant.
``I diagnose myself,'' Azzopardi, 30, said. ``I get some cold and flu medicine at the drugstore. It's terrible.''
Bloomberg