Regarding 'a better way...an interesting comparison, perhaps...in our vet practice you can pay for your pet's routine healthcare (vaccines, worms, flea treatment at a discounted rate) and you then have the option of paying a bit more in monthly instalments, and you get free vet consultations (should you be worried about your pet being poorly), unlimited through the year.
We had worries that they would be abused by people coming all the time for trifling matters, but it very rarely is...the novelty wears off, I guess.
What we are trying to create is that NHS-style feeling of 'free access' so we get to see problems early and efficiently rather than overly late, but which time they are generally unnecessarily smelly and trickier to resolve.
We also actively promote pet insurance.
We're a fee paying service, but in that sense we are trying to move more towards a 'free at the point of use' feeling to encourage clients to come in. It's true that other than those consultations, we are gain income by the volume of work we do, so attracting more clients/more pets is in our business interests, but in contrast to an NHS GP system, we aren't paid a 'headage', we are paid by the item of work done. I know GPS also get seperate payments for things like probing BJ's arse, but frankly that's not a route I'd like to go down (badumm-ting)
We do also have a surgical referral service, open to other practices as well, which is basically me, my grey hair, my scalpel and a team of lovely nurses. Clients sometimes mistake my grey hair for some sort of expertise and push towards seeing me with their tricky little problems that require lots of time and clever thinking to diagnose and resolve, whilst I much prefer to see pets with blatantly obvious problems like broken legs swinging in the breeze that require very little thinking at all, but do tend to be rather urgent.
This led to a bit of a build up and some missed coffee breaks for yours truly, so we introduced a system where clients couldn't just book in to see old grey beard, they had to be referred after seeing one of the other practice vets, as a filter, and to spread out the tricky thinking amongst the rest of my colleagues. My colleagues got wise to that quite swiftly, and so would see the case, and within a miraculous few seconds decide that the touch of old grey beard was required, and march them straight back to the desk to book in with me...then return to their coffee.
Next step we introduced was a bit of a premium consultation fee to pay to see me, and that didn't work either...clients seemed actually to relish it in a Stella Artois 'reassuringly expensive' kind of way. Return to build up of cases, missed coffee, heavy thinking, still urgent fractures and spines coming anyway, late finishes and rather a desperate situation for our hero where all these tricky cases rather became a bit of a burden.
Fortunately, we now have a solution in a sternly regulated booking system by two secretaries who are the loveliest of ladies to me, but will not tolerate any bollocks from the great unwashed, combined with a superficially protective demeanour of 'cynical arsehole' from me, towards any colleague looking to spin their tricky thinking cases my way.
So, the upshot is, in the area of our business that is oversubscribed and non-expandable (me) we've kind of created an NHS receptionist and service model, largely as a defence mechanism. It's grown in throughput by 60% in two years, with some expansion of support staff, but mainly through streamlining cases I do see into just the 'monkey see, monkey do' surgical cases, rather than the head-scratch and client-pander time consuming cases. I am a director of the business, so I am paid to a degree according to the volume of work I do, and I do work bloody hard and often very late...but y streamlining my caseload into cases that do really need me, and that my expertise is most appropriate to, we've increased my productivity greatly.
However, in the area of our business reliant on custom and fully expandable (our first-opinion practice has doubled in size in five years) we have very much a service industry model, welcoming clients in with as few barriers to coming in to see us as possible.
If the staff of the NHS got paid according to the volume of work they did, rather than by a headage/registered client fee, or just for turning up (or not turning up and phoning in sick) then you could well find that the capacity of the NHS increased markedly. It's amazing what people are capable of when they are paid piecework- suitably regulated and supervised-rather than a flat appearance fee. It may well be uncool to say so, as the dogma is that all clinical staff in all fields work at their very best for the love of their profession...but they don't. Everyone likes to earn a bonus, and everyone has the capacity to trundle along in second gear or to press forward in fourth gear, however worthy our tasks are.