Money: A policy on private practices

ANYONE who's ever tried to see their GP and still get to work on time will know the frustration of dealing with the NHS. Many surgeries seem to be set up for the convenience of patients who don't work and have all day to see the doctor. Plus there's the problem that millions of people, especially in London and the South-east, live miles from their workplace. A visit to the GP will mean a morning or afternoon off work.

The people who first set up drop-in private GP surgeries, called Medicentres, have taken it one step further. They believe that some workers are so fed up with the problems of accessing their family doctor at a time convenient to them that they will pay for medical insurance covering trips to see a private GP.

The GP First insurance package is a joint venture between Norwich Union healthcare and Sinclair Montrose, which runs the Medicentres. The insurance goes on sale tomorrow. A flat fee of pounds 120 a year (pounds 54 per child) will buy you four consultations with a GP at one of nine Medicentres. Insured customers will be able to drop in for a 15-minute consultation with a GP, have a health screening (only free in the first year), and get advice over the phone from GPs on call 24 hours a day.

That's pretty much all you get for pounds 10 a month, but Norwich Union Healthcare is confident there'll be plenty of demand. And they're aiming it squarely at young professionals: 65 per cent of Medicentre's existing customers are between 20 and 39 and pay pounds 38 per visit. About three in 10 of these people always use the Medicentre GP instead of an NHS doctor. These figures seem to confirm the view that there are many people willing to pay for a service we can all get free.

The insurance is restricted to people who live near a Medicentre. Four are in London, and others are in Sheffield, Gateshead, Solihull and Dudley. There should be 15 more within the next 18 months. The insurance also offers you home visits from a doctor if you live within 20 miles of a centre - but it will cost you pounds 45 per visit.

The British Medical Association is not impressed with GP First. Dr Peter Holden, a GP and member of the BMA Council, says that patients who visit a private GP must accept that they will have to pay the full cost of prescribed drugs; a private prescription doesn't allow you to buy NHS-subsidised drugs.

He says: "The public don't realise how restrictive this is. You can't just flit in and out of the NHS. People who turn up at a GP surgery with prescriptions from private dentists for painkillers don't get their prescriptions converted to an FP10 (the NHS prescription). I'm not prepared to be a free prescription service."

The doctor who examines you is the one who has to make the decision to issue a prescription or not - NHS GPs aren't obliged to re-examine patients who have already been seen elsewhere and have a private prescription. "That's a misuse of NHS resources," Dr Holden says.

Dr Holden is very concerned that Medicentres will break the continuity of care that we get in the NHS. At the moment, GPs keep all patients' entire medical history on record. Medicentre GPs won't have access to patients' histories - and the scheme doesn't oblige private GPs to pass notes back to NHS practices. Half of Medicare's existing patients expressly ask the private doctors to keep their notes secret from their NHS doctor. The BMA says it is extremely concerned by this practice.

If you're busy enough to use Medicare centres, then this insurance may be a good deal. Medicentres employ GPs, rather than taking locums on contract, so it's possible to build up a relationship with the doctor. But pounds 120 a year for four GP consultations isn't much use to most of us, especially if you have to pay for any drugs prescribed. You can get a wider range of primary care cover elsewhere - even on budget insurance plans.

Cashplans were set up before the NHS started and pay you a cash sum for each night you stay in hospital. With the increase in daycare surgery this isn't so useful, but modern schemes also help you with the cost of "grey" primary care areas where the NHS doesn't offer free treatment: opticians', dentists' and chiropodists' fees.

WPA's Health & Sickness cashplan offers all this for pounds 95.76 a year and reimburses up to pounds 100 a year in alternative practitioners' fee (including osteopaths and acupuncture).

The cost of boosting your health cover

q NHS cashplan: WPA Health & Sickness, pounds 95.76 a year for a single person, pounds 191.52 for a couple. Children under 18 are covered free on joint policies (half-cover for children named on single adult policies). Reimburses up to pounds 50 year for opticians, pounds 50 for dental fees, pounds 100 private consultant's fees, pounds 50 chiropody, pounds 100 alternative practitioners and two free NHS prescriptions (pounds 5.75 each). Also pays cash if you have to go to hospital. Call WPA: 0500 414243.

q Private GP insurance : GP First, pounds 120 a year adults (pounds 54 children). Buys you four private health consultations, access to a 24-hour GP helpline and a free health screen (worth pounds 65) in the first year. But you will have to bear the full cost of any prescribed drugs, without an NHS subsidy. Call Norwich Union: 0800 056 2591.

q Budget private medical insurance: Legal & General Lifetime Essentials, single person aged 35: pounds 176.52 a year, couple aged 35: pounds 353.04 a year. Offers a full refund of in-patient hospital costs (including day surgery) and follow up out-patient treatment within three months. pounds 50 per procedure towards GP surgery costs. Call 0500 66966.