Mark Smith: I now use a private GP and dentist. Is this the future?

I do not blame him for doing this. The British Dental Association says rising costs and inadequate fees can leave dentists carrying out NHS treatments at a loss, which is unsustainable. And while the Scottish Government has made some changes, the tinkering hasn’t fixed the underlying problems. Obviously, dentists going private makes things worse on the face of it, but it’s understandable. Would you keep working at a loss?

A similar situation applies to GPs. There aren’t enough of them, the number of doctors getting out of the job is rising, and there’s increasing pressure from the patients, who are getting older and sicker and fatter. The BMA did a survey of GPs in Scotland recently which revealed that just five per cent of them believe their practice is in a long-term sustainable position. Five per cent. Blimey.

If you don’t believe it, try phoning one, like I did a few weeks ago. Could I have an appointment please? Is it an emergency? No but I would like to see someone quickly. We are entirely booked out for a month. OK, could I have an appointment after a month? No, you will have to call back later in the month when the appointments reopen. When will that be? We don’t know, call back at some point in the future and find out. I put the phone down and reached for my copy of Kafka for a possible explanation.

What I did then, I’m afraid, was I phoned up a private GP and got an appointment immediately; there’s also a subscription service which means I can see the doctor, in person or remotely, swiftly and easily. Like it used to be in the 90s. Remember it? Phoning up the surgery and getting an appointment without really thinking about it? The last ten years or so have erased all that.

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But there’s some hope at least. Keir Starmer is starting to talk about reform and most importantly, he’s no longer relying on the idea that the system can be fixed with more money alone; and some more; and more; more please. The new report on the NHS in England which Starmer commissioned says recent investment in hospitals has led to a 17% increase in the workforce since 2019 and yet treatment has collapsed. It also says it’s implausible that more cash will improve performance i.e. money doesn’t necessarily mean better.

I’m also pleased to see Starmer appears to be leading the way on what kind of reform is needed, and there will be lessons for Scotland. The plan appears to be that investment will move from hospitals to communities and we know why: a large number of NHS beds, in England and Scotland, are occupied by people waiting for social care support or care at home. It is the crux of the problem.

There’s already been talk of tackling this in Scotland, and there have been attempts at integrating health and social care, but there certainly hasn’t been the kind of wholesale shift towards care at home and in the community that the UK Government’s report says is necessary. Indeed, as the report demonstrates, there’s still a culture of care centred round hospitals, which means they get most of the money. It’s one of the reasons the care we receive in the community – at the dentist or the GP surgery – is in such a poor way.

(Image: Dentists are under pressure)

The hope now is that Starmer sees all of this and that in England (with Scotland following forthwith hopefully) a greater proportion of the budget will be spent on GPs, social care, community services and preventative care. But as the PM himself acknowledged, the change will take years not months and that’s not great news for the people who are on waiting lists now. Or people trying to get an appointment with their GP. Or people trying to find an NHS dentist.

Which means, I think, that more people will do what I did and go private. Was it an easy decision to make? In some ways no. Ideally, I’d like to use the NHS, which I help pay for in taxes. Anyone who goes private also needs to acknowledge that not everyone is able to take the paid option.

On the other hand, there’s an argument, which makes some sense, that patients who go private take a bit of the strain off the NHS, even though, if we’re honest, that’s probably just an attempt to make the decision appear selfless which it isn’t. A better way to describe it would be, if not selfish, then certainly self-centred. I couldn’t get the service I wanted and if I paid for it, I could, so I did. Part of me wants to apologise for that but only part. The other part feels like I’ve done the right thing. Take a look out there. Can you really blame me?