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Health watch: The cost of seeing a doctor

Health watch: The cost of seeing a doctor

Thursday 09 June 2022

Health watch: The cost of seeing a doctor

Thursday 09 June 2022


It's just exorbitant, isn't it?

Let’s examine that statement…

  • Fact 1: It's more expensive for all of us, as taxpayers, to receive the exact same treatments in hospital – particularly when one factors in the cost of a new hospital. 

  • Fact 2: The average price to patients has risen with inflation, not 'medical inflation' - much higher and recognised as 6.5% in the UK in the past year alone, before the war in Ukraine.

  • Fact 3: Save for cervical screening and the introduction of the discounted Health Access Scheme, for a select number of the population, there has been no increased Government support for most patients to seek care in the community for a decade and, simultaneously, there has been pressure on practices to modernise buildings, utilise IT (the predominant reason GPs use paper is the fact the hospital IT systems are so poorly developed by comparison) and increase and diversify the workforce. All that has been achieved, however, has occurred without increasing fees above cost of living.

  • Fact 4: Some practices honourably tried to produce cut-price care, but their financial models didn't stack up and both ultimately failed.

That's all very well, but GPs are fat cats, aren't they?

They are indeed well-paid professionals, but not better paid than their counterparts in the UK and, without an associated pension, they are not being replaced.

Vacancy rates

GP vacancies are currently running at 12%, with a population ratio of 72 whole time equivalent GPs/100,000 people, based on the latest census figures.

This level is already below that in Scotland and only just above England but here there is little by way of a support team of practice nurses and other health care practitioners.

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Pictured: Compare Jersey's GP-to-population levels to the UK, and you may be in for a surprise.

In fact, in terms of patient facing staff, the ratio lags far behind the average in the NHS (82 vs 115/100,000 population) - a system widely acknowledged as failing – and yet even more than the already 90% or so of all consultations are set to occur in the community in future if the Jersey Care Model is to be adopted as it is currently configured.

In Jersey, around 15 GPs are due to retire in the next three years and there are few available to replace them.

There are already four practices with closed lists covering 30% to 40% of the island.

The challenge of recruitment

Healthcare recruitment problems are increasing worldwide, and Jersey is part of a global market where there is a diminishing supply of staff.

Fortunately, through CLS funding, largely made up by the deficit in a rebate increase for 10 years, there is a move to subsidise employment of other health professionals which will provide a long-needed augmentation in services for preventive and long-term condition management but will not address the lack of increase in medical rebate per se.

Unlike the hospital, community medical infrastructure has already largely been brought up to Care Quality Commission (CQC) inspection standards in most practices. Meanwhile, rather than building, therehas been a focus on hospital planning with expensive consultants and bolstering of management rather than frontline care. £52m was spent in 2021 alone.

Like everyone else thinking of moving to Jersey, the lower level of direct taxation is more than offset by the cost of houses and, indeed, the 'housing crisis' denied by some of our current ministers.

So staff, if they come, are increasingly only staying for short periods before they realise their standard of living would be better elsewhere – particularly pertinent in nursing and social care. 

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Pictured: In nursing and social care, some staff come to Jersey only to realise their standard of living would be better elsewhere...

As this crisis unfolds, ask yourself about some of the things Jersey has always taken for granted. Can you still get an appointment with your own doctor? How much longer do you have to wait to do so? How easy is it to be visited at home by a doctor compared with years gone by? Sadly, watch the situation deteriorate into the mess that is the NHS while inaction pervades.

'Doctors' vs 'family doctors'

Continuity of care has been the mantra of local general practice for generations and the beneficial effects of this are confirmed in controlled trials.

As one article in the New Statesman quoting research published in the British Journal of General Practice observed: “Patients who’d had the same family doctor for many years were 30% less likely to use out-of-hours services; 30 per cent less likely to be admitted to hospital as an emergency; and 25 per cent less likely to die than people registered with their GP for under a year. The risk of needing emergency care or dying began to decrease once patients had been with the same doctor for as little as two years, and continued to fall steadily thereafter.”

And consider this quote in an article entitled ‘The difference between a doctor and a family doctor’ published in the BMJ: “GPs hold one of the few remaining pastoral roles that many people still engage with in modern society, and it's incredibly short-sighted for anyone to undermine the role of the family doctor - be that through policy or put downs.”

We need to find ways to augment access to GP care and the benefits that provides rather than erode what, apart from its direct cost to patients, has essentially been one of the jewels in the crown of local healthcare.

READ MORE...

How does Jersey's healthcare system work?

How sick is our health system?

The hospital and its people

How easy is it for staff to raise concerns?

STAY INFORMED...

This article is part of a series by Dr Nigel Minihane, aiming to raise questions and prompt debate and discussion about Jersey's health service ahead of the election.

It continues this next week. Make sure you don't miss it by signing up to Express's daily news email HERE.

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