Kind of unimpressed with NHS. Am I missing something?

Now I admit I've only used it twice. Once for dentist and another time for a doctor. So my experience is low and I could be talking out of my butt. But my first impression is "meh".

I know NHS has better coverage than the states. I'm probably not going to risk going bankrupt either. It has clear benefits. But at the same time I'm left with a somewhat bad impression.

First off my appointments felt rushed. Apparently there's a time limit? They even told me this (they said roughly 10 minutes so they could get everyone).
Already I'm put off. My health has no freakin' time limit. Stop rushing me. Why do I need to have follow up appointments? Oh, it's specifically because my stuff takes too long...  A two week wait for something that could be handled within a day or two in the states (from my experience in healthcare there, which might not be standard since I have heard of long wait times but just never experienced them).

I'm the kind of person who wants to solve all my issues (health or otherwise) asap. This needless waiting feels needless.  I thought all those "waiting line" things were exaggerated but so far they don't feel like it. Again though, I've only been to two appointments.


Then there's the service. They weren't mean or anything. But like basically all service in this country it kind of lacked. The doctors seemed colder (especially when informing me of time limits and giving me tips on how to speed things up).


Lastly are the facilities. I don't know if it's this way everywhere in the UK (I'm in London) but I'm used to rather large "do everything" hospitals. Basically I go to a hospital, they do some standard tests for blood pressure, weight, etc right before all appointments. If I need tests they're done literally same day same hour. The emergency room is there. The MRI machines are there. The pharmacy is there. Everything is there. However here all of it here is like... totally separate. If I've got an emergency I have to go somewhere else entirely. The pharmacy is unconnected and way over there. Tests? Same day seems out of the question.

Then I'm not sure if it actually matters but all these places feel extremely unspecialized. I sweat they're just hospitals and dentists that they stuck into random buildings .  Probably because they did. But I'm not sure that matters at all.



Idunno I'm really unimpressed so far. Yeah, I've barely taken advantage of these things... and yeah, some of my American friends seem to suggest they've  experienced similar in the US (I guess it's a hospital by hospital basis?). But still...  unsure. I got the best rated place (by far!) that's a bit out of my way just to get the best rated place. And still I am met with cold doctors, frustrating time limits and waiting lines.

I'm used to doctors being friendly, maybe striking up casual conversation and NOT rushing me. And though waiting lines can be a problem in the US I could usually get them to give me a next day appointment with prodding (or same day if I felt sick enough).



Tell me I'm wrong or something. I'll give it a year or so of experience. I just don't want to feel like I need to buy private insurance. My new, much higher tax rate isn't feeling like it's being well spent right now. At this point I'd rather have my lower states tax rate and pay for private insurance to get some higher quality care. But... these are only first impressions from very very limited experiences.

I know how you feel.  My first impression of the NHS was kind of a let down.  Due to some medical problems I had in my teens, I am accustomed to health care as it is performed in the US.  I live an hour from the Cleveland Clinic and was a patient at the Mayo Clinic, both offer world-class care.  I now know that I have to be my own advocate in the UK.  I think my biggest issue is that I have yet to find a doctor that I like.  The last one I saw in the UK basically told me that my doctor in the US knew nothing about my medical history (US Dr. met me the day that I was born).  However, I do like that I don't have to worry about insurance.  I'm coming up to that age where I can no longer be covered on my parents' insurance.  The NHS has TONS to do!  Give it a bit longer, see how it works.  I don't mind the short visits when I have a quick problem.  If you are still unsure, go private.

It's different to what you're used to, but that doesn't make it wrong or bad. 

If you have an issue that you think could take more than 10 minutes to discuss, you should book a double appointment.  I've done this a few times.

And I am HUGELY grateful that my doctors dont try to strike up a casual conversation or make chit-chat.  I'm there for a reason, and it's not to make a new friend!

From my perspective, pros to the NHS:
- free - for appointments, hospital visits, test, everything but meds and dental. No worrying if it's covered. Obviously, we're paying for it with taxes but there's no worry how much an appointment or procedure will cost.
- short appointments - I always felt the chit chat wasn't sincere from my US doctors. I'm a fan of the quick appointments.
- no unnecessary appointments - US doctors get more money from you or your insurance the more appts they get you in for. Maybe I'm cynical, but I think my US drs scheduled appts that weren't always needed.
- short appointments mean it's easy to get in - since appointments are short, it's easy to book something soon. No need for them to plan a full day of 30 minute appointments; 10 minute slots mean they can get more people in the door.
- things that you pay for cost the same regardless of where you are - in the US, the cost of tests and procedures vary between hospital and practice. No worry about that here.

I know there are cons, but for me the pros definitely outweigh them, especially knowing I don't have to pay for a thing (besides meds and dentist).

If you're really not a fan, there's always private insurance.

I've had a really good experience. After having lots of different doctors on the U.S., I'm glad to bring it down to one main doctor with referrals only where absolutely necessary. My GP's office is quite nice and literally just upstairs from a co-op pharmacy so I have no complaint there. Since I'm in Wales, my prescriptions are free as well. I've been really impressed so far. I think things just vary greatly between GP's.

Since asked, I will say gently, you are wrong about the NHS. Or at least, I don’t think you can have an informed opinion after two visits.

I loved my last doctor in the US. Why? Because she rushed me and every other patient out the door in 15 minutes. This meant that when I showed up for a 9.30 appointment, I was seen pretty much at 9.30 and didn’t have to wait around for hours.

If my doctor could treat me in the time allotted for the appointment she did. If she felt my symptoms warranted further tests, she scheduled them for another time or referred me to a hospital or testing facility, not always the same day or next day. This is what a GP does -- they serve as gatekeepers.

My doctor was friendly, but no non-sense, which didn’t suit everyone’s taste. A friend who also went to the same doctor often felt rushed (as you do with your NHS doctor) and changed doctors, so I can understand how you feel. But this is more to do with personal preference I think.  Can you really say you received friendly, hand-holding service from most doctors you visited in the US? You are very lucky indeed if you have. That has not been my experience.

Maybe it was just the practice you registered with. Find another one if the one you chose doesn’t suit you. I don’t think you can indict the healthcare system of an entire nation based on one interaction with a GP.

It seems to me that part of the problem is that in your experience you’re used to being treated in a large hospital setting, not in a traditional GP practice. If you are used to an all-in-one facility, maybe it’s best you find a large GP practice that combines treatment and testing under one roof. They do exist here.

In the end though, I think you’ll have to adjust your expectations. If you want same day or next day results, you have to pay for it. This expectation of on-demand medical services is one of the reasons why it costs so much in the US.

I’m originally from a high tax city in a high tax state, which means the total percentage of tax I pay in the UK (for income tax and national insurance) is pretty much equal to what I paid in the US -- the major difference being my healthcare is covered by the NHS, which I think is a bloody bargain. When I left the US, I was paying another $800-$1000 a year for health insurance through my employer and that was 10 years ago.

Regarding ten minute consultations, it appears the British Medical Association (the professional association and registered trade union for doctors in the UK) agrees with you Superman. They said last June:

"The progressive movement of complex and chronic care into the community has made the 10 minute GP consultation totally outdated, wholly inadequate and failing the needs of patients, and demands that there should be a deliberate workforce strategy for requisite GP numbers to enable longer consultations with patients."

http://www.pulsetoday.co.uk/home/finance-and-practice-life-news/ten-minute-appointments-are-an-anachronism-doctors-agree/20003445.article#.VC6KOPnMR8F

It seems the Royal College of General Practitioners (the professional body for general (medical) practitioners) agrees. RCGP honorary secretary Professor Amanda Howe said:

"It may be that we need to be making the case, within the workload planning, for quarter of an hour or even half-hour appointments – like an outpatient appointment would be – if you have a complex patient, to do them justice."

http://www.pulsetoday.co.uk/half-hour-gp-appointments-should-be-the-norm-says-rcgp/14442135.article#.VC6MHfnMR8E

For myself, the NHS system works fine (I was born and raised in the UK). I don't have any ongoing medical conditions and so far I've never needed any extended care (I was treated for a broken ankle at A&E when I was 12, but other than that, I've never had an operation, never had a referral, never seen a specialist, never stayed in hospital).

All I need from my NHS GP is a repeat prescription every 6-12 months and that's pretty much it. So, the 10-minute appointment suits me fine - I just need to go in, ask for a new prescription and then leave again .

When I go to the doctor, I don't want to be kept waiting around for ages, I don't need any tests, and I don't want a chatty doctor.... I just want to be able to make an appointment, show up, see the doctor and leave again in the space of 30 minutes or less. My record, I think, has been about 15 minutes from leaving the house, seeing the doctor and arriving home again.

Other than repeat prescriptions, in the last few years, I have only been to the GP for travel vaccinations, a blood test to see if I was anaemic (I'm not), my 3-yearly PAP test with the nurse and a chest infection.

Perhaps if I had needed operations/referrals or had a chronic condition, or had to stay in hospital, I might have had a different experience with the NHS (long wait times, for example), but so far, I'm completely happy with it.

Basically, it's kind of a bare-bones service to give everyone in the UK the essential access to healthcare that they need, whenever they need it - it's not like the US, where the hospitals and doctors and insurance companies are out to make as much money as they can, by ordering lots of tests, keeping you for ages, charging you for every little thing.

The NHS is on a budget, paid for out of our taxes. They are in debt, so they need to save money when and where they can. They can't necessarily afford longer appointments, or multiple tests, or full regular check-ups. They tend to treat only the symptoms you tell them about and don't tend to look for others (some GPs restrict you to one medical issue per appointment - you can't go in for your 10-minute appointment with 4 different things for them to treat... you need to book double/multiple appointments to cover them all). In a way, that can be a good thing, because you aren't being 'treated' or checked for things that you might not even have, but in a way it's not so good because it can mean some things aren't necessarily caught as early as they could have been.

There are pros and cons to the NHS, of course, but having been raised in the NHS system and having also lived in the US twice, I would take the NHS over US healthcare any day... in fact, it was one of the reasons I decided to move back to the UK.

I would definitely give it more time before making a final judgement. 
I do have a chronic, autoimmune condition and I <3 the NHS.  I have been in A&E, hospital, and also have routine and regular appointments (with the 1 specialist in a 12,300 square mile radius), who never, ever rushes me and always takes the time to listen, yet his appointments are always on time as well (he must deliberately book 15 minute slots or something, but he's an amazing specialist and I don't know what I would do without him). I'm in Scotland, so I get free prescriptions, which is great too and I get my once a year free eye health check.
I went to my GP's surgery yesterday. There are two doctor's there that I always like to see and one there that I loathe and the others are fine if that's who I need to see.  There is one I loathe, because she's condescending and always acts like I have some nerve making an appointment to see her. So she’s scratched off my list.  There’s one male one I enjoy seeing, because he’s super professional.  Gives you enough time and is pleasant, but doesn’t sit and waste time with small talk.  Perfect.    The other one I enjoy seeing is just hilarious. She’s very funny, cracking jokes and putting you at ease in a very friendly way. She’s the kind you’d bring your kids to see. 
My practice is a teaching practise, so there are often medical students about and they also employ GP Registrars (early in their careers and not full GPs yet). We’ve got the practice nurse and health care assistants as well.  They also have video conferencing to partner with the more rural and remote places.  (Our health board is one of the largest and most sparsely populated Health Boards in the UK).  All of health records are electronic and this also links into the hospital system.   The surgery is quite happy to refer me to specialists if needed (I had a problem with my foot a while back and I got referred for x-rays and to an NHS podiatrist, which was very helpful), but they will also not waste time on unnecessary tests.
I had a doctor in the US who was always behind on time, rude, and was actually taking the piss on medical tests (because I had very good insurance once I started working, but I never did growing up).  I hadn’t realised it at first, as I was thinking, “oh that’s got to be good, because he was checking x, y, z – (and not having much insurance growing up, didn’t realise that he was doing unnecessary testing) but I started to get suspicious – I went in for a very simple strep throat, and he ended up taking vials of blood for to check for mononucleosis “just in case” (I had no mono symptoms, just the strep throat ones). Then I went in to get them to sign off my medical form showing I had my vaccines (I gave him the copies of medical records showing all my shots were done) when I was newly enrolled for a master’s degree and he decided he needed to do a complete examination –blood work-chest x-rays- just because.  So I ran away from that practice as far as I could!!   Except that was not good either, because the next one I went to decided that I needed antibiotics for every.little.thing (very bad practice to do!!!)
My GPs never ever-ever do that and I never feel like my health is suffering!!! 
As far as dentists, well you’re very lucky to get an NHS dentist.  I just got an NHS dentist last year after being here 6 years.   
I actually broke the cost down for visit at my private dentist over time:
 1/year: Should be 2 times a year, but I’d only been going one a year due to cost.
 Check up: £80
Cleaning: £75
X-rays, £130/each x 2 = £260
Filling replacements due to cracks/decay aging of old ones  £95 x 3 = £285
Total = £700
 
NHS Dentist Visit (Check up, X-rays, cleaning)
Check up: £0
X-rays, £2.22 each so £4.44
Cleaning: £10.20
 Total = £14.64
 Fillings cost £6.92 each.
 
Both dentists (private and NHS) were shocked at the number of fillings-crowns I had in my mouth because my teeth are in really good shape- (clean -no plaque, no gum issues, etc).  I haven't had any new fillings put in since I moved to Scotland and they’ve only had to repair US ones.  (Again, had good dental insurance, once I started working on my own)  So, I am very convinced that my US dentists put in fillings, did root canals, etc for the sake of it, because that's what pays them the big bucks and they could get away with it, I didn’t know any better.
The US spends a huge amount on health care every single year, one of the highest spends in the world/per capita. Yet, their health rankings are lower.  Spending more does not mean better care or outcomes! See these articles:
http://www.bloomberg.com/visual-data/best-and-worst/most-efficient-health-care-2014-countries
http://www.theatlantic.com/health/archive/2013/01/new-health-rankings-of-17-nations-us-is-dead-last/267045/
http://www.huffingtonpost.com/2013/08/29/most-efficient-healthcare_n_3825477.html
http://academyhealth.org/files/2013/sunday/bradley.pdf
Anyways,that was extremely long winded, but just saying, give the NHS more time! You may grow to like it! 

I think you need to consider how much pressure the NHS is under.  Working in pharma, I  have attended various seminars on the NHS, and how it's changing, and what some of this means in terms of patient care.  It has been really insightful, and there are some really fantastic people working in the system. However, it's a very LARGE organisation, (with limited funding) and with that it can be a bit disjointed in its approaches sometimes. But they are working to harmonise things with the overall aim of improving the patient care and the patient's experience overall.

Personally, I have had mixed experiences with the NHS.  But one in particular has changed my view completely.  I knew something was wrong with me, but my GP couldn't get me in for an appointment until 2 weeks later.  I tried a Walk-In clinic, but they had seen the maximum number of patients for the day.  Frustrated, but knowing deep down that something was wrong, I went to A&E. 

They took my pain seriously, and ended up admitting me for overnight observation.  I did have a life-threatening condition, and they acted as quickly as they could to diagnose me fully.  I required regular follow ups and blood tests-- every other day for what ended up being a total of 3 months (Same day tests do exist when deemed necessary).  The staff I worked with helped me through one of the worst experiences of my life, when I was most vulnerable, and gave me all the time I needed to ask questions, help me understand and make informed decisions about my options, etc.  After doing my own research, there was one treatment option I thought would work in my case (I had access to a wide range of medical journals at the time). It wasn't something they were in the habit of administering, but agreed to try it given my strong argument (backed by clinical evidence) for that type of treatment in circumstances such as mine.  It did work for me, and saved me from undergoing potentially unnecessary surgery.

Until you are in a position of need, I don't think you will really understand the value of the NHS.  I know I didn't. My experiences in the US have been that they ask for your insurance card before even being triaged.  My experience here is that the patient actually does come first.  If it's a life/death situation, you don't have to worry about going bankrupt.  At the same time as my ordeal, I found out I would be losing my job -- so the pressures associated with paying for my healthcare and fears I couldn't afford it -- were nonexistent.  What would have cost tens of thousands in the US was absolutely free through the NHS.

The NHS knows that people are "unimpressed" with their service, but the system has struggled since its formation, because there is such great NEED for it across the country.  They are making changes, and the effects will gradually become more noticeable to the general public, but it's really not a simple solution, and I think you need to better understand some of the challenges it faces before making a final judgement on it.  You might be waiting a week for your routine cholesterol results, but that's because it's likely  less of a priority than someone else's test for cancer tumor markers.  They do the best they can with the limited resources they have.

While I agree that the facilities can seem a bit dingy or outdated, I personally prefer that they're spending on as many staff as they can, rather than redecoration and moving facilities to more convenient locations.  Yes, it's disjointed and doesn't necessarily make sense, but they can't exactly shutdown while renovations happen either. 

Until you are in a position of need, I don't think you will really understand the value of the NHS.  I know I didn't. My experiences in the US have been that they ask for your insurance card before even being triaged.  My experience here is that the patient actually does come first.  If it's a life/death situation, you don't have to worry about going bankrupt.  At the same time as my ordeal, I found out I would be losing my job -- so the pressures associated with paying for my healthcare and fears I couldn't afford it -- were nonexistent.  What would have cost tens of thousands in the US was absolutely free through the NHS.

That sums it up nicely - the NHS is very strictly triaged by need, to keep it within budget (as a fraction of national wealth, spending on health in the UK is about two thirds of what it is in the US). That means the convenience is often not that great (your rapid, bare bones GP appointment, or in my case waiting an average of 2 hours every time I had an appointment about my broken collarbone last year), and they do everything they can to avoid unnecessary treatment (e.g. caesarian rates are VERY much lower in the UK than the US, since they are normally done as a last resort). However, when something genuinely serious crops up they are very good indeed - far, far better than any private hospital in the UK.

It is also very strongly based on the QALY (Quality Adjusted Life Year) when deciding funding - how much they're willing to spend on treatment is dependent on how many years of good-quality life it will give you. For children, that means they essentially have a blank cheque - something reflected in the fact that infant mortality in the UK is ~20% lower than in the US. I have two friends whose children have been extremely sick and who got absolutely first-class care, as good as it would have been anywhere in the world.
When it comes to care of the elderly, however, things aren't as good - something brought up again and again in the US healthcare debate. In the US, the elderly often have large savings built up over a lifetime and can afford the best care. In the UK, they tend to be a lower priority because they will often have multiple conditions and spending huge amounts on cancer treatment may well be a bad deal when they'll die in 3 months of dementia anyway. My sister and sister-in-law are both NHS doctors in hospital, and while the stories they tell about the way old people are cared for aren't great it's far from clear that more money for the NHS would really help. The NHS is frequently used to warehouse people who should really be in nursing homes for instance, and "granny dumping" is so common as to be a frequent term - at Christmas or during holidays, family will turn up in A&E or call an ambulance for an elderly relative, saying that they're sick. Further examination will make it clear that there is nothing wrong beyond say dementia which has been there for months - the family are just using the NHS as a babysitting service. However, they are typically pretty obstructive and it takes days to discharge them in most cases (although there is much gloating when they can check them out and send them home again straight away!).

The NHS has TONS to do!  Give it a bit longer, see how it works.  I don't mind the short visits when I have a quick problem.  If you are still unsure, go private.

Or find a firm that offers private healthcare as part of the package?

I agree about waiting to see how it goes with the NHS as it realy is under a huge stress at the moment and it will all have to change as will other services. The population has increased by about 20% in a decade. Already we are seeing treatments that were free in 90s and before, no longer free on the NHS or even if it is free,the budget doesn't cover everyone (called a lottery postcode). The last government suggested everyone should pay a flat fee each time they visit a GP to make those who use it more, pay more. It will have to change.

Plus the healthtcare system was never built to vet the people who use it for free, when they shouldn't be i.e. visitors, those with a visa of less than 6 months, Brits residing abroad, EU nationals who aren't working in the UK at the time when they want treatment, dependants of EU nationals when their EU citizen isn't working in the UK at the time they want treatment etc.

It's been a long haul to alter the tax system to real time (completed in the tax year 2013) to have an up to date list every week/month of who really is working in the UK. While also bringing through the healthcare changes under the new immigation law, to make it easier to bill people or refuse treament if they can't prove they can pay. Changes too are being brought in to make it easier to bill other EU countries for their citizens healthcare if their citizens used the British national healthcare system when they are not allowed to use it to free (they weren't working that week/month). It takes governments time to do all this.

The private companies were a lot quicker of course as they have already set up special Comprehensive Sickness Insurance policies in reaction to EU and UK laws, for people to buy if they are resident in the UK but are not allowed free NHS.

A former NHS nurse once told me that the NHS is exceptionally good at the really serious cases (cancer, heart attacks and so on).  They pull out all the plugs to treat such patients (especially youngsters).  And then there's the fact that you don't have to worry about the cost, deductibles, co-pays and so on when you're feeling wiped out by the diagnosis. 

I agree with those who have commented on the tendency of US medics to order tests and treatments which are perhaps not needed simply because your insurance will cover it.  I saw recently (AARP magazine) that it is advisable to opt for screenings over yearly physical exams -- and it seems to me that that is how the NHS operates.  They will "invite" you for various screenings according to your age and gender. 

The NHS is not about "impressing" anyone -- they are trying to provide the best service for everyone with very limited resources.

A former NHS nurse once told me that the NHS is exceptionally good at the really serious cases (cancer, heart attacks and so on).

 

Unless they are elderly cancer patients as they don't have unlimited budgets and choices have to be made.

They pull out all the plugs to treat such patients (especially youngsters).  

Except some treatments they can no longer offer, even to youngsters. That's why you see campaigns to raise money for a child to have treatment the parents can't afford to buy.

The NHS does not cover everything, especially if the drugs are expensive. What they have just started doing is to buy the expensive drug as one now, as the NHS, to get better discounts from the drug companies. Before, each trust brought separately from the drug companies.

Except some treatments they can no longer offer, even to youngsters. That's why you see campaigns to raise money for a child to have treatment the parents can't afford to buy.

At least for children, the reason for this is usually that there is no evidence that the treatment they're fund-raising for actually works. That's at the heart of the whole Ashya King story - the NHS wouldn't fund the treatment the parents wanted because for his particular cancer the treatment they wanted offered no benefits over the (very much cheaper) radiotherapy they could provide. If you take a proper look at what they're fundraising for, it's frequently quackery or at least of very dubious benefit. They're frequently peddling hope rather than a cure.

Good article on it here: http://www.theguardian.com/uk-news/2014/sep/10/ashya-king-proton-beam-treatment-cure-children-conventional-radiotherapy