Providing free health care for all is a privilege which I have enjoyed delivering for the 42 years of my working life as a doctor and surgeon. Receiving free health care should be considered a “privilege” by those people living in the United Kingdom, but it is now considered a “right”. As a consequence our society has become greedy in utilising the NHS resources that are available and this is now causing a crisis for the delivery of health care. This crisis cannot be resolved by the health service alone, we need to encourage a sea change in attitudes of everyone in supporting our fantastic health service which is the envy of the world. However, without that sea change the NHS is going to collapse under the strain.

My background is very relevant. My mother and father were both GPs in Scotland in the 1950s to 1980s. My younger brother was a GP in Scotland from the 1980s until he retired earlier this year at the age of 60. I have a daughter-in-law who is a GP in Hampshire and I have many GP friends here in Nottingham. When my parents were working, the GP was a highly respected doctor and their patients were very considerate. The GP surgery was part of our house and the surgeries ran from 9.00am to 11.00am daily, followed by house calls during the late morning and early afternoon. The evening surgery ran from 5.00pm to 7.00pm. My parents were always on call – there was no additional GP night cover. This meant that, for the job to remain reasonable, patients had to be considerate and only call the GP out for serious emergencies – and that is what happened.

In recent years the workload of GPs has changed. There are many more patients with “minor illnesses” attending their GPs. The family unit in which mother and grandmother would provide first-line advice about treating illnesses before contacting the GP has almost gone. Patients have become more demanding and less respectful and the attitude of some patients has become more aggressive and unpleasant. This is only true for some patients,but it has had a very serious effect on the job satisfaction which GPs used to experience and has resulted in many GPs no longer enjoying their job and, as a consequence, seeking early retirement. This experience has now become common knowledge within the medical student fraternity who have taken on board the unhappiness of many GPs in their current posts and have decided that even though the financial remuneration is reasonable, they no longer wish to consider a career in which the job satisfaction of the current GPs is so poor. As a consequence, in the north of England and in the East Midlands, 30% of training posts in general practice are currently unfilled and there is going to be a void of GPs in the UK over the next five years, which is going to create a crisis for our health service.

In most parts of the country patients would either attend their own GP or they would be directed to attend an out of hours (OOH) treatment centre if they could rather than have a GP visit. Lack of transport should not be considered a valid reason for a home visit by a GP - the cost of a taxi is very much less than the cost of a health professional’s time. Healthcare has changed hugely with a greater emphasis on picking things up earlier to change outcomes and this has affected the expectations of both patients and doctors.

There are many advertising campaigns telling patients to call/warning them not to miss things -chest pain/stroke/meningitis/cancer. These campaigns have been introduced without taking into consideration the additional work that would be placed on the GP’s shoulders as a consequence. Many patients do not have the confidence to make decisions without advice - is this rash concerning? Is this chest pain indigestion or something else? They need to be able to access advice as to whether they need to see a health care professional.

The future has to be to harness the power of the internet to educate patients to use online resources to decide if they need to contact OOH or 111 (patient.co.uk or NHS choices’ symptom checker). Although this is taking place and many patients are beginning to do this, it is poorly advertised at present. Every family should have a first aid kit and learn how to use it! A lot of people do seem to think you need a nurse to clean up a graze or a wound rather than do it themselves! Interestingly in countries where there is a charge for health care treatments patients do look after their minor ailments very well by themselves.

Another factor which has seriously damaged the GP’s job satisfaction is the amount of work placed on their shoulders by the NHS quality and outcomes framework (QOF) targets which many GPs consider to be just an academic exercise which, to date, has had very limited evidence base in clinical practice. GPs are currently required to hold registers on far too many (19) medical conditions: atrial fibrillation; secondary prevention of coronary heart disease; heart failure; hypertension; peripheral arterial disease; stroke and transient ischaemic attack; diabetes mellitus; asthma; chronic obstructive pulmonary disease; dementia; depression; mental health; cancer; chronic kidney disease; epilepsy; learning disability; osteoporosis with fragility fractures; rheumatoid arthritis; palliative care.

They are also encouraged to hold registers on six other conditions: cardiovascular disease - primary prevention; blood pressure; obesity; smoking; cervical screening; contraception. This means they have to hold up to 25 different registers and they have to keep them up to date. This is a huge administrative load and is now harming the ability of GPs to deliver direct patient care to their patients.

The general public have been critical of the “out of hours” service provided by GPs, but when I speak to current GPs I hear a different story. They are trying to provide a good “out of hours” service but too often they are called out by patients who have “run out of paracetamol” or “cannot attend the surgery because the father is going to a football match”. The free NHS service is being abused by some irresponsible patients and we will all suffer as a consequence. There is no other service that is provided free of charge. If you need a plumber at home for a water leak, you can expect to pay £70 to £120 as the call-out charge. If you need an electrician for a power failure at home, the call-out charge is £60 to £100. The call-out charge for a GP attending your home is £0 with the result that the out-of -hours medical service is being grossly abused and manipulated by a significant group of patients.

How should the politicians address this situation? The NHS is trying hard to change the attitude of the public and is providing better guidance on using the 111 telephone service and walk-in centres and training pharmacists to provide the advice that used to be provided by grandma, but this is only partially effective. The attitudes of the general public will have to change if they wish to retain an NHS free at the point of delivery. If it does not change the politicians will have to consider some alternative ways of managing the situation. It may be that we will see the introduction of a £100 call-out charge for a GP consultation at home reimbursable only if the call-out is considered to be appropriate. This is very like the French system in which the patient pays their doctor and subsequently reclaims the bill from the government. Many doctors are concerned with charging people. They feel that the truly needy won’t call for help because they are intimidated by the thought of a charge and may then present later and end up being admitted to hospital or even dying. In addition there are always those that know how to “work the system” who will avoid the charge that is probably appropriate for them.

The NHS needs to seriously review the administrative demands being placed on GP’s shoulders – I just do not believe that the current 25 different disease and treatment registers are cost effective. They need to be re-evaluated and some need to be abandoned. But most importantly we need to change the workload of the GP so that these doctors can start to enjoy their job again and can have effective consultations with their patients without excessive waits for appointments. We all need to contribute to turning things around in order to save a service which has been so successful in the past.

There is no other service that is provided free of charge.

It's free at the point of use.

Those of us who are able do so pay taxation a fair chunk of which goes to the NHS every year. We have some right of expectation of getting a service for that taxation.

The use of NHS services for trivial reasons may well have increased - I suspect that's an anecdotal statement but anyway I'm willing to accept that is true, or at least the perception is there amongst GPs

His arguments that up to this date reforms have increased the burden on GPs and made the job less attractive, we have to accept that is true given the position he's in to observe it.

However basing an argument on the logic of 'you don't pay for it, so you should be more careful how you use it' is a fallacy.

Let's not forget why the NHS was created in the first place - because previously many people could not afford medical care and suffered pain or even died because of lack of wealth. "free medical care at the point of delivery" is possibly the greatest social innovation the UK has ever come up with.

In the medical world, we now refer to this as "free at the point of abuse" because you get a lot of people misusing the NHS services.

He's trying to say the right thing albeit in the wrong way. Look at other systems where co-payment is based and look at how people utilise the services. Look at the past. I've spoken to GPs who worked under older systems. They were called maybe once or twice a night max, and sometimes not at all. Compare this to current demands and it becomes a struggle.

And it's something that will disappear within the next ten years.

There needs to be a way of rationing what we have because the infrastructure just isn't there. Departments, wards, hospitals are being shut. Funding is being cut. The NHS is being strangled slowly.

I was gonna post some stuff about the original article but I'll do tht another time.

As far as I can see, the only way to decide this is hard numbers. What are the numbers in terms of wasted GPs appointment slots by complaints that could be easily self-treated? What percentage of A&E visits are for minor injuries that would heal of themselves within time? Do we keep these statistics? I'd imagine not, as some of that is pretty hard to quantify objectively.