I know who should pay for their GP appointments:
the people who don’t turn up for them

It happens with hotels, restaurants and plane tickets. Three missed appointments and you should be dumped and have to seek care elsewhere.

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If we value the NHS so much, why didn’t we turn up for 12 million GP appointments last year? Costing £162m that the service can ill afford. Nearly seven million hospital appointments were also blighted by no-shows, at an average cost of £108.

The NHS does an amazing job, in spite of being burdened by red tape, top-heavy administration and dysfunctional IT, with an ageing population placing huge demands on the system. Being free at the point of delivery is a core value – one that makes us proud to be British – but is it sustainable? If you value something, then treat it with respect. Otherwise it will disappear.

This week, GPs debated whether to ask the Government if they could impose charges for appointments. A sliding scale of between £10 and £25, to deal with critical shortages in funding. The motion failed, but it raised key issues that none of us can ignore.

Another part of the proposal, urging the Government “to define services that can and cannot be accessed on the NHS”, was carried. One GP said that charging would lead to “survival of the richest, not treatment of the sickest”. Others said charges were “toxic” and worried that GPs would become “tax collectors for the Government”.

GPs all agreed that the service was in crisis. Appointments often have to be booked ages in advance. Time spent with patients is too short, and there are the people who turn up (about 10 a day at local surgeries) simply because they are lonely.

The pressure on doctors has led to a crisis in A&E, with a new two-tier system being proposed, as well as more walk-in centres, staffed by nurses. There are 39 at present, open outside office hours, and they attract far more young people than regular health centres. Up to 30 per cent of admissions at A&E – 6.5 million people – could be treated by doctors, ambulance staff or nurses. They are not emergencies at all.

A two-tier system might be a solution at GP practices too, because at least a third of patients are elderly or people suffering from long-term conditions. Surely they could be assigned a special practitioner (and counsellors or nurses), freeing up the other doctors to deal with new conditions or the stuff that doesn’t warrant a trip to casualty.

I also favour health centres taking our bank or credit card details, and fining us if we don’t show. It happens with hotels, restaurants and plane tickets, so why not a trip to the doctor? Three missed appointments and you should be dumped and have to seek care elsewhere.

Loneliness is a real problem among the elderly, and health centres need more group therapies involving volunteers and trainee counsellors who can earn the hours needed for their qualifications by talking and encouraging social interaction.

When people say they are prepared to pay to see the doctor, they already have that option. It’s called private healthcare. If you can afford it, then there’s nothing to stop you. What people also want are longer appointments, but that can happen only if doctors have their case-loads halved, and stuff that can be treated by a nurse or a pharmacist identified before a patient is sitting on the other side of their desk.

I’m always annoyed that I can’t talk to my GP online, as I’m sure that would save a load of his time. I can’t get the results of blood tests online, and have to call a busy receptionist. There are plenty of ways the current system could be improved. Charging is appealing, but I prefer a short sharp shock – implementing fines. Charging would be swamped in paperwork. There would be endless exceptions (the elderly, etc) and so it would never work.

At the moment, 90 per cent of the prescriptions dispensed on the NHS are free. Are they all really necessary? Why not have a fundamental drugs audit, do some ruthless pruning, and I expect quite a few hundred million would be saved. Charging introduces a class system into the NHS, one of the few institutions in the UK that’s relatively democratic.

Shrill male critics are deaf to soprano’s real beauty

The way male critics have attacked the female opera star in Glyndebourne’s new production of Der Rosenkavalier for not conforming to their idea of beauty is outrageous. Have you ever seen a picture of Rupert Christiansen of The Daily Telegraph (who called her “dumpy”), or Quentin Letts of the Mail (“she has the figure and the face of a goodish pork pie”)? In the baying pack was Richard Morrison of The Times, who chucked in “unsightly”, and Andrew Clark of the Financial Times couldn’t resist calling her “a chubby bundle of puppy fat”.

Soprano Tara Erraught is 27 years old, hardly a bouncing toddler. She’s won international awards, toured the US and is regarded as a huge talent. Let’s shoot the costume designer for Der Rosenkavalier, and the director, not the woman who is just a professional, singing sublimely.

Years ago, I produced a television documentary in which Peter Ustinov interviewed Luciano Pavarotti. Half the encounter took place in the kitchen, where they ate huge bowls of pasta. The rest of the film was shot in the swimming pool, where the mountains of blubber stood and chatted, with water obscuring their torsos. You can guess which footage we used

Some of us will need our tools wrenched from lifeless hands

I managed to avoid Philip Roth’s two-part telly “retirement” extravaganza last week, which featured his best buddy Alan Yentob asking obsequious questions on bended knee. Have you noticed how retirement means something different to famous people? At 81, Roth says there’ll be no more writing or telly and stage appearances. At least that’s what he’s saying now, but successful artists and writers are very likely to change their minds when boredom sets in, and they have one more good idea and need to publicise it.

Lily Allen “retired” to have children – but is back partying and promoting her new album. Sinead O’Connor retired, but is singing beautifully. Prince retired and shunned the world but he’s currently touring the UK and even says he wants to live here. At 79, Sophia Loren hasn’t retired – she’s just become more selective, appearing at Cannes to promote her son’s new film, in which she stars (naturally).

A new survey shows that more than half of us worry that we can’t afford a retirement of 25 years, and a quarter of us say we will be working until we’re 70 – unless we write a hit song or a best-seller, that is. I’m not genetically programmed to retire. You’ll have to prise the laptop from my claws when you tip me in the soil.

Happiness is enjoying heavenly Harrogate

Harrogate has been voted the happiest town in Great Britain – not that you’d know reading the local paper, in which dozens of letters complain about the threat of new superstores, new housing estates and a potential rise in crime if street lights are dimmed. The town has an elderly population which gets anxious, but also an extremely wealthy middle class, plenty of swanky shops and restaurants, and the divine Betty’s Tea Rooms, where I celebrated one of my weddings.

Harrogate is lovely because of the Stray – that vast sumptuous expanse of grass that gives the centre of the town such a sense of calm. Badges like “happy” are pretty meaningless, but Harrogate is a special place because the council doesn’t skimp on parks or flowers. There are plenty of benches to sit on and gorgeous hanging baskets. Stuff everyone can enjoy for nought.

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