Our resident US nurse Sara Morgan wonders how do patients recognise the value of the NHS if there is no connection between the service provided and money coming out of their pocket?
They say that you get what you pay for. We all pay for the NHS through our taxes, but it is still “free at the point of service”. So what I’ve been wondering is, how do our patients recognise the value of the NHS if the cost is abstract and there is no connection between the service provided and money coming out of their pocket?
I didn’t think too much about this idea until I started doing occasional shifts in a walk-in center. Along with the strep throats, urinary tract infections and kitchen injuries, I’ve seen some patients with truly minor or even non-existent complaints. On some shifts, I end up sending most of my patients home with nothing more than advice or a bit of education. On days like that, I can’t help but wonder if the PCT’s budget is best used paying me to explain to a patient in their thirties that his fatigue and general malaise is probably not the start of ME, but rather the combined result of his birthday celebrations over the weekend and his body’s decreasing ability to shake off a hangover.
Don’t get me wrong: one of my favourite parts of nursing is providing patient education. I like nothing better than taking the time to discuss with a patient her particular condition and what she can do to manage it. Modern medicine is mysterious to many members of the public and often it is nurses who act as the translators, empowering patients to take charge of their own health.
In the space of just a few minutes and with only a handful of well-chosen words, I can offer comfort, information and the tools that a patient needs to take charge of their own health. But does that mean that my time and the PCT’s money is well spent offering reassurance to every patient who comes through the doors with the opening line: “I’m sure this is fine, but I just wanted someone to check.”
During the election, I was intrigued by a suggestion that a nominal fee be attached to primary care visits. If such a fee, say £5, were required (only from those who can afford it, obviously) to seek primary care, would that save some of these unnecessary visits? Would patients appreciate that there is a limited supply of care if it had to be paid for out of their pocket? Would they more be willing to rely on common sense for common ailments than require a professional opinion, if such an opinion were not perceived as free?
When I lived in the US, I was always fortunate enough to have health insurance. I could visit my GP as often as I wished, but there was a small fee that I had to pay for each visit. It was never much, maybe $5 or $10, but it was clearly designed by insurance companies to keep patients from trying to see their GPs for every hangnail, insect bite or mild cough. It seemed to work, too, as most of the people in the waiting rooms usually looked very ill.
Of course, the inescapable potential downside to this fee is that no matter how low the cost to see a doctor, it will always dissuade some people from seeking care. And then what was a hangnail becomes a paronychia, requiring an I&D to treat.
We all know that in the coming years, nurses will have to do more with less, and deliver care as efficiently as possible. But how can we ensure that patients seek care as efficiently as possible?
About Sara Morgan
Sara Morgan trained and practiced as a nurse in the United States before coming to work in the UK. She has worked as both a nurse practitioner and as a lead nurse on the Productive Ward initiative.