Breaking down the UK’s private health boom

So the headline figures say more people are getting private health insurance than ever. The consultancy firm, Broadstone, tells us that since 2020, those with private insurance have risen from 6.7 to 7.6 million. 14% of the population now have private health insurance. Yes, population growth in those five years will have to be accounted for as well. But it seems we can’t escape the increasing prevalence of private care.

Prices, however, vary massively. As with most insurance, fancy algorithms drive actuarial pricing. The more likely the firm is to reach into its pocket to pay a claim, the more it expects you to pay monthly. These algorithms take every relevant factor (your postcode, medical history, and current state of health) and match it with your desired level of cover.

So it’s time we spoke numbers. Sarah Coles from the investment platform Hargreaves Lansdown says elderly people, who are more likely to fall ill, are likely paying close to £200 a month for comprehensive cover.

If you used a government site like MoneyHelper for an estimate, they would tell you that to insure a typical family of two adults in their forties and two children under 10, you would be paying between £700 and £1800 a year. The Times tried to find a figure for someone aged 50 living in London with a £100 excess, and the smallest figure they could find was £2000 a year.

But behind these financial decisions lies psychology. A father who watched his parents struggle with the worst effects of an illness will sleep much better knowing his own family is protected. Another father might look at his budgeting spreadsheet and wonder how he could ever afford those premiums. For many who have the means, private insurance is bought for peace of mind rather than actuarial rationality.

Perhaps the most fascinating aspect, however, is that 14% of the country with private cover. Is this group representative of the general population? Clearly not. They are disproportionately young, healthy, and wealthy. In other words, they are the people least likely to actually need health insurance, especially when compared to the elderly, the chronically ill, and those living in working-class postcodes.

There is, however, one major confounder explaining why this 14% leans so young and healthy: corporate health policies. It wouldn’t be accurate to assume this surge is driven entirely by anxious individuals buying policies out of pocket. Instead, much of it is fueled by employers offering health cover as a corporate perk.

But let's not view this ‘perk’ the same as one would view free lunches. Companies view this as a solid investment; it ensures their workforce can bypass long NHS waiting lists and get back to work faster.

Ultimately, this surge in private health insurance reveals a silent, structural shift in our healthcare system. Businesses are looking at the climate of healthcare and realising they need a defensive shield against long waiting lists. The result is this paradoxical situation where the young and wealthy are offered quick access to care, whilst the ones who need it most are left on long waiting lists.

Even NHS England Don’t Want You To Rely on Payroll

Joking about the likelihood of a payroll error has almost become a rite of passage for medics. Listen, are we being a bit harsh? Perhaps. The NHS is one of the biggest employers in the entire world, and most of its clinical staff rotating on the same day all across the country must make for chaos in the admin departments.

The thing is, NHS England knows all too well that these payroll errors occur and they aren’t infrequent either. Take their own 10-point plan on how to improve resident doctors’ lives. In it, they set a target to reduce payroll errors at rotation time by a minimum of 90%. So even NHS England knows they can’t hide from it.

The responsible thing for us to say at On-Call is to advise you not to just assume that those slips will be correct when they are emailed across to you. There are basic things you should know: What your tax code should be, what the base pay for your grade of doctor is and whether the deductions to your pay fall within the expected range.

On a national level, surely NHS England needs to understand a basic principle: fewer opportunities for error mean fewer actual mistakes. For example, instead of making doctors pay for course and exam fees out of pocket and wait for reimbursement, why doesn't the NHS simply pay them upfront?

They could also look to expand the "Lead Employer Model," which is already working well across the entire Northern Deanery. Under this system, doctors' pay is managed by a single entity, with Northumbria acting as the Lead Employer Trust, no matter where they move within the region. Whether you rotate through Newcastle, Durham, Sunderland, Teesside, or Northumbria itself, you remain under one employer. It’s a simple structural change that massively reduces the likelihood of payroll errors every time we rotate. Good on the Northerners!

Another dinner surrounded by high achievers and what to take from it

You look up from your overpriced cacio e pepe at the guests around the dinner table you've been invited to. Third dinner out this month, you tell yourself. This time it’s the turn of one of your medic friends from university to have their birthday, and the table is populated by doctors working at NHS trusts across the country.

At least you'll never run out of small talk with these people, you tell yourself. The girl to your left tells you about her day job; she's an Academic Clinical Fellow in Orthopaedics. You take a second to wonder since when the ortho bros started doing research before finally asking: “How's that going?” "Yeah, not too bad, just trying to balance PhD grant applications with trying to skill up surgically."

Before you've even managed to nod like you understand what a grant application involves, the doctor on your right leans in. "Oh no way, I'm two years into my DPhil at Oxford, it doesn't get any better, let me tell you. Ethical approval for my RCT alone took ten months."

The room starts to close in a little. You're doing the thing again… measuring yourself against the table. You think about missing the MSRA cut-off for your speciality this year, and even though you know, in your better moments, that this is just a part of the road, sitting here feels less like a setback and more like proof you don’t belong at this table. You know you are worth more than an MSRA score, but deep down, you know it fractured your ego, and you never confronted those feelings.

Because here's the thing about our profession: it is genuinely full of remarkable people. People pushing medicine forward using the scientific method. People with a clinical intuition you just can't teach. People who are relentlessly, unfairly good at anything remotely procedural. People who out-work everyone else in the room without even seeming to notice they're doing it. Medicine needs all of them. It would be worse off without every single one.

But none of that answers the actual question sitting in front of you: what are you supposed to do at a birthday dinner where engaging in the small talk requires a PhD just to keep up?

What you do is, you ask questions. You ask the DPhil student about his RCT, and he tells you the truth.

“Well, getting ethical approval took ten months, and it was an absolute slog. I had a supervisor who kept changing his mind and sending forms back. For that whole summer, I can’t remember doing anything else. It wasn’t glamorous, I’ll tell you that.”

And for a moment, you feel a bit better about yourself. It hasn’t changed your opinion on how high-achieving this individual must be, but it reminds you that life is rarely the highlight reel people introduce themselves with. You did miss an exam cut-off; that’s real, and it’s allowed to sting, but comparing your behind-the-scenes struggles to the dinner-party versions of your peers is always going to be a losing game. You shouldn’t measure yourself against someone who compresses a brutal, exhausting year of difficulty into two minutes of small talk about running an RCT.

Just finish the pasta. You paid a lot of money for it, and it’s getting cold.

“Was stung by the “Nice Patient Law” again this weekend. For those who haven’t seen it before: The nicer the patient, the worse the pathology.”

“‘It was a pleasure to meet this gentleman in clinic today’ aka ‘I have never met this person before in my life and this is the safest way of opening my letter’"

“The doctor on the front row of my CST induction prefaced his questions by acknowledging that it may be a stupid one. If only he knew that practically all of the questions he asked were ones I had in mind. He saved me the time I’d be spending sending emails right now. The person asking the “stupid questions” is so often doing everyone in the room a favour.”

“Twice in one week I’ve rang pathology to chase a blood result that I hadn’t even requested. Different person answering me each time at least. Saved me my hospital cred.”

What’s on your mind? Email us!

Some things to review when you’re off the ward…

Former European Society of Cardiology president, Emeritus professor at Imperial College, and at one time, cardiologist to the late Queen, Prof Kim Fox is Cardiology royalty. Imagine then that the BMJ has published an investigation into Prof Fox, accusing him of a conflict of interest of monstrous proportions.

To keep it short, between 2006 and 2015 Fox pulled in more than £50 million through his contract research company, much of it running trials of the drug iIabradine. At the same time, Fox was chairing the ESC that wrote 2006 guidelines recommending Ivabradine for certain angina patients who couldn’t tolerate other treatments. The whole story is wild, with Fox maintaining that no rules were broken and his declarations were always clear. Here’s the BMJ’s full article.

Last week’s poll:

If a new colleague described themselves as a 'medfluencer' and left it at that, would you assume their non-clinical activities were a good thing or a bad thing?

…and whilst you’re here, can we please take a quick history from you?

Something you’d like to know in our next poll? Let us know!

The prospect of surgery is perhaps the most anxiety-inducing moment someone could have bestowed upon them. From the cocktail of drugs the anaesthetist has waiting for you to the surgery and post-operative care that awaits, it is no small psychological and physical feat to ask of someone.

We, therefore, expect our clinicians to make every possible effort to minimise the requirement for surgery.

Before imaging, we couldn’t afford to take risks. We asked some questions, prodded the abdomen and took some bloods, but ultimately the uncertainty steered many patients towards surgeries that were eventually shown to be unnecessary.

Imaging has changed medicine. Just consider that we have access to a non-invasive way of viewing every corner of our anatomy, in three dimensions, with a good resolution, whilst our patient is lying awake on the table.

Is it any wonder that the Radiology registrar’s phone is never silent? In fact, when we begin to stack up the huge risks associated with going under the scalpel, the number of instances where avoiding a scan begins to shrink.

Imagine we use a scoring tool for appendicitis like the Alvarado score, and it tells us the likelihood of our patient having appendicitis is 95%. That means 5% (or 1 in 20) patients in similar circumstances to our patient will undergo an unnecessary laparotomy. Can this ever be acceptable in an era where CT scans are so readily available?