> I don't follow you. GPs go through specialist training and assessment (general practice is, perhaps paradoxically, a specialism).

You spend 20 years prescribing paracetamol and homeopathy to old ladies and you eventually stop being a real doctor, like somebody who takes a PhD in computer science and then spend 20 years replacing hard disks in a call center.

> I'm not sure I understand your complaint. Do you expect to have direct access to pediatricians and gynaecologists without referral?

Yes, in Italy that is the norm and it sounds silly that you think it’s a weird expectation. That’s probably one of the reasons why the British infant mortality rate is 50% higher than the Italian.

> Fair enough.... so, that itch you get occasionally, or that nagging ache... are you going to visit the neurologist, or the rheumatologist, or the radiologist, or....?

I’m not a hypochondriac, so I don’t go to random doctors on a weekly basis. But given the taxes I pay to fund it, I’m expecting a Western European healthcare system and not this thing that would be below par in a middle-income country.

> I've literally never heard a GP mention budgets to me as a patient. Or are you referring to GP representation in the media?

Sure, that’s what my GP said, she didn’t have a budget for that. I’ve left out the part where I said that it didn’t matter because I had a private insurance and the NHS wouldn’t have to pay for my treatment. At that point she totally lost it and started yelling that the Tories are privatising the NHS and insurance companies are their accomplices or some other crazy thing like that.

> You say that GPs will knowingly experiment on their patients to save money. Are you sure that's what's happening?

Rather than referring my partner to a gynaecologist, the GP kept making up pseudorandom diagnoses for roughly 3 month, until my girlfriend gave up on him and decided to go to a private doctor (it’s not the same person that hates private insurances and at the time I didn’t have an insurance). The private gynaecologist identified the issue in 20’ and prescribed a 3 day treatment that fixed the problem. 3 months of randomness vs 20’ of professionalism.

So, to answer your question, I was being sarcastic: the GP wasn’t experimenting, in the sense that he knew what he was doing, he was just making stuff up to not spend his budget on referrals.

> Is that actually the reason they gave? Or something you've inferred? Did they, perhaps, want to provide your girlfriend with the service she requested, using what they had at their disposal?

My girlfriend had been using a pill for years, after testing a few under the supervision of a gynaecologist (again, that’s the norm in Italy, GPs don’t come up with birth control pill suggestions). Then she moved to the UK and the British GP told her that she should change the pill, because it was too expensive. My girlfriend said she was fine paying for a more expensive pill (in Italy you have to pay for it). Then the doctor went on explaining that the NHS would have to pay for it and that she should use too much public money. I eventually had to intervene, because my partner’s assertiveness is below 0 and the doctor was putting her health at risk to save 5£ per month.