SARAH VINE: What my GP's demand for £20 (in cash!) reveals about our broken NHS... and doctors' lucrative side-hustle

A few weeks ago, my teenage son, who has never displayed the slightest whiff of being allergic to anything (apart from broccoli and hanging up wet towels) had a very nasty reaction to something.

Being a nocturnal teenager, this happened in the middle of the night while I was asleep. It took him several attempts to rouse me, by which point his eyes had swelled up like proverbial footballs, his throat felt tight, he was vomiting and struggling to breathe.

I immediately shoved a load of antihistamine down him, which seemed to calm things down a bit, and then sat up with him until satisfied that the reaction had subsided.

The next day I logged on to our GP surgery's website (there's no point phoning these days) and emailed pictures of the afflicted child, along with an explanation of the circumstances.

A couple of days later, with their usual sclerotic sense of urgency, the receptionist called to arrange a phone consultation for the end of the week.

At the appointed hour, a doctor did indeed call, prescribed a couple of EpiPens – the rapid injection device that delivers anti-allergy medication – and said that Will needed an allergy screening – but it would be several months before he'd get an appointment. I explained that like many people, I had recently taken out private health insurance, and that perhaps we could go via that route. The GP agreed – and said he'd prepare a referral letter.

What I didn't realise, until I collected the letter from the surgery, was that it would cost £20. When I asked why, I was told that a charge is made for referrals for an insurance claim. Fair enough, I thought, until told they only accepted cash.

Like most people these days, I rarely carry cash. I only had my phone so couldn't go to a cashpoint. I asked if I could take a photo of the letter, to email to the insurer, and come back with the money later. Nope. No lolly, no letter. The receptionist dropped it back into her drawer and slammed it shut. Was this normal, I wondered?

When I got home, I checked the British Medical Association website. It turns out that NHS GPs can charge for a variety of services, including private referrals, sick notes and 'freedom from infection' certificates. In fact, such services appear to be a lucrative side-hustle for GPs.

No mention of cash only, though. The only other business I know that insists on cash only are the local crack dealers.

Joking aside, is this part of the reason why millions of people are waiting weeks, sometimes months, for a GP appointment?

With more and more patients taking out health insurance – over half a million extra since the start of this year alone – out of exasperation with the lack of NHS care, does it make better financial sense for GPs to spend their days dispensing letters at £20 a pop (in cash) than tending to NHS patients?

Perhaps. What's certain, though, is that with the latest round of junior doctor strikes due to kick off on Wednesday, isn't it time we finally faced the truth? That the NHS, in its current form, is unsustainable – for patients and doctors – and that radical reform is urgently needed?

The only people profiting from the current chaos are private insurance companies – Bupa, Aviva and so on – who are making a fortune from new subscribers who feel they cannot rely on the NHS.

As one of those people, I'd far rather my monthly premium went to an NHS partnership than private shareholders, as happens in many other countries which have very successful, means-assessed, private-public systems (indeed, in the case of Italy, which is a complete basket case generally, their healthcare is one of the world's best). But there isn't that option in the UK.

There are two reasons. First, as we've seen from months of strikes, our health service is run by political ideologues who care less about providing the best care for patients and more about preserving some romantic socialist fantasy. And, second, no politician has the courage to do what needs to be done, and institute radical reform.

The result: doctors aren't happy, patients aren't happy, and no one is getting what they need or want.

Meanwhile, the NHS is dying. Worse, people are dying.

As someone who can afford to contribute more, I would be very happy to do so. Not just so I and my family can get the healthcare we need, but also so the extra money might go back into the NHS and help improve services overall.

There's a reason why insurance companies have such healthy profits: most of us pay in far more than we ever take out. If the NHS had a piece of that action, it could return to being the world-class health service it once was. Until then, it's just more cash for referrals.

It's quite understandable why people are upset by the BBC axeing A Question Of Sport. Not everything should be about ratings. Otherwise there wouldn't be delightful, gentle shows such as Young Chorister Of The Year. Can't BBC bosses see that's what makes the Corporation special? Take that away and it's just a budget Netflix.

My tip? Go to the pub

The ever-delectable Nigella Lawson's tips for Christmas dinner include ensuring plates are hot, and not striving for perfection. Wise words. But I've a better idea: eliminate all stress by going to the pub on Christmas Day. 

I've done that for the past few years and it's much more fun. Granted, the food can be hit and miss – but still: no cooking, no washing up. This year it's my local George IV pub. Packet of dry roasted and half a shandy, please – and hold the cranberry sauce.

I sincerely hope Rishi Sunak is considering a ban on under-16s using social media. Eight years ago, my suggestion that smartphones should be restricted to over-16s was met with derision. But now the detrimental long-term effects on young minds are plain to see. Especially since the platforms refuse to accept any responsibility or duty of care. 

A recent case: a friend's 13-year-old daughter was victimised by bullies on TikTok. From being outgoing and carefree, she became scared and stopped wanting to go to school. Her mother asked TikTok to intervene but was met with a wall of silence. Whatever Sunak decides, all platforms that host under-16s must be legally obliged to respond to worried parents – or face big fines. After all, there's no point appealing to their sense of morality as only money focuses their minds. 

It's boom-time for drug rats

At the risk of seeming unsympathetic to those less fortunate, a property on my road is now a halfway house for recovering addicts.

Except they're not so much recovering as thriving. What used to be middle-class 'wine o'clock' is more like 'meth o'clock', when they emerge at dusk in search of supplies. This has resulted in a) an increase in the number of men in balaclavas delivering unspecified packages on scooters and b) a man in stained tracksuit bottoms who ambushes pedestrians for money.

None of these people are homeless – living in a property worth about £1.5million. But why bother working hard to buy your own home when you can live in one for free while being a nuisance to others?

An Italian restaurant in London has stopped serving carbonara because too many customers demand it's made with cream, mushrooms and chicken. 

A proper carbonara contains none of those. Carbonara loosely means 'burnt' or 'scorched', from 'carbone' ('coal') and refers to the crispy fried pork that's the base of the dish. Creaminess comes from egg yolks, which cook in the heat of the freshly drained, hot pasta. But we mustn't be too snobbish. 

If we applied the Italians' rule of not drinking cappuccino after 11am, half of Britain's high streets would go out of business. 

Super trouper Amy!

And the award for Trouper Of The Year goes to… Strictly pro dancer Amy Dowden, left. The day before her honeymoon in May, she discovered a lump, which turned out to be grade three breast cancer, leading to a mastectomy. After chemotherapy, she got sepsis and then a blood clot in her lung. 

Previously, she'd been living with Crohn's disease. Any one of those might have crushed a less determined person, but this tough, 33-year-old Caerphilly chick simply carried on, and performed in the opening dance for last night's final.