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Gold, incentives and meh

GP leaders to vote on whether to support patient charges for appointments

Exclusive GP leaders are set to vote on whether the GPC should ‘explore national charging for GP services’ at the LMCs Conference later this month.

The motion, put to conference by the agenda committee and set to be proposed by Wiltshire LMC on the day, suggests general practice is ‘unsustainable in its current format’ and that ‘it is no longer viable for general practice to provide all patients with all NHS services free at the point of delivery’.

The motion concludes: ‘That conference… calls on GPC to explore national charging for general practice services with the UK governments.’

A Pulse survey of 440 GPs last July showed that just over half of GPs are in favour of the NHS charging a small fee for routine appointments, with many believing it is the only way of managing their workload and curbing rising patient demand.

Other topics scheduled for debate at the annual policy meeting, set to be held 22-23 May in York, include whether or not CCGs should commission primary care, with several LMCs arguing that this will ‘fatally damage relations between CCGs and their constituents’.

However, in a counter motion, Merton, Sutton and Wandsworth LMCs will argue in favour of CCGs commissioning primary care. This comes as NHS England invited CCGs to bid to commission primary care last week.

GP leaders will also be voting on a motion to ‘reject the concept of routine general practice care 8-8 seven days a week’, a concept that has been heavily pushed by Prime Minister David Cameron over the past six months and which is likely to form part of Conservative policy ahead of next year’s general election.

The agenda document also highlighted LMC concerns over the Government’s care.data scheme, which is now set for a delayed rollout in the autumn. An agenda committee motion, to be proposed by Bedfordshire LMC will say that ‘the introduction of care.data has been nothing short of a disaster’ and call for a patient ‘opt-in’ system to replace the current process of patients having to opt out if they disapprove of their records being shared.

The motion says: ‘That conference believes the introduction of care.data has been nothing short of a disaster and.. asserts that extraction should only take place with the explicit and informed consent of patients opting-in.’

The conference will also see LMCs debating the ‘unsustainable workload in general practice’; deplore ‘the CQC’s plans for a simplistic rating system for practices’; and condemn the ‘disorganised mess’ resulting from the NHS reorganisation, including delayed payments to GP practices.

Highlights from the 2014 LMC conference agenda

AGENDA COMMITTEE to be proposed by WILTSHIRE That conference:
(i) believes that general practice is unsustainable in its current format
(ii) believes that it is no longer viable for general practice to provide all patients with all NHS services free at the point of delivery
(iii) urges the UK governments to define the services that can and cannot be accessed in the NHS
(iv) calls on GPC to consider alternative funding mechanisms for general practice
(v) calls on GPC to explore national charging for general practice services with the UK governments.

AGENDA COMMITTEE to be proposed by NOTTINGHAMSHIRE: That conference views with alarm proposals contained in NHS England’s (NHSE) interim response to the ‘call for action for general practice’ to make CCGs co-commissioners of GP contracts and
(i) believes that this will fatally damage relations between CCGs and their constituents
(ii) warns that this will undermine CCGs’ chances of success in other areas of commissioning
(iii) predicts this will undermine the credibility of CCGs
(iv) asserts that conflicts of interests would be unacceptable
(v) insists that GP core contracts should not be held by CCGs.

AGENDA COMMITTEE to be proposed by WIRRAL That conference:
(i) rejects the concept of routine general practice care 8-8 seven days a week
(ii) believes that GPs will only provide routine planned care 8-8 seven days a week if resources are provided to the satisfaction of the profession
(iii) commends GPs for already providing unscheduled general practice care for 24 hours every day, seven days every week.

Source: BMA

Readers' comments (57)

  • The focus should be on how demand can be controlled, especially looking at inappropriate attendances. Tis should be government led, not primary care led as it is a public health issue not each local practice problem.

    The government will only do this if a political or financial pressure is applied. As we know bma is pants at applying political pressure, the only way is to put financial pressure without involving patients.

    I quite agree we should be paid per time spent on appointment (10 min tariff, 15 min tariff etc). That way government will have to cough up the money if they don't address the demand, patients are not charged and we get paid fair amount and able to spend decent time with patients!

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  • problems with the proposed charging system -

    1. the very group of patients who cause high demand will be exempt from charging i.e. it won't curtail demand.
    2. those patients who are already working and paying tax who may only use the service occasionally will be unfairly penalized.
    3. the public will assume that the money will be going into the GPs pocket and resent GPs even more.

    a better method would be

    1. leave the NHS contract
    2. set up independent private practices
    3. only see patients who are part of a health plan (work based, government 'nhs', employer, private) or as an emergency encounter or who are willing to pay directly. The health plan will specify what patients are entitled to i.e. it will not be unlimited.
    4, have a doctor patient contract which sets outs rights and responsibilities for both parties
    5. charge per activity / encounter / time

    Each GP can then decide what ratio of private to government work they will do. Demand will be curtailed as patients will have to pay or will have to justify their attendance to their plan provider. This will put an end to abuse of the system and will ensure 'vulnerable' groups are represented as they will be covered by the government plan.

    The days of unlimited care are over.

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  • I fail to see what is so great about the NHS ethos of 'free at the point of delivery' when ultimately someone pays(usually the middle class) and the quality of the service is being degraded because we insist on hiding the true costs of excellent care. The poor will be offered concessionary rates and the wealthy will go privately as they do now. The idea that patients will never forgive us if we bring charges in is utter nonsense, you don't get all the GP bashing stories in New Zealand or Australia. I believe that charging might paradoxically make us more popular because we would have the resources available to manage people in a time effective appropriate manner. Papering over the cracks of the NHS as 'gatekeepers' makes patients resent us because we are lumbered with the politicians dirty work of how to ration care fairly. The German experiment did not work well because they weren't charging enough to cover the costs of the changes, we need to charge at least £30/consultation to sustain primary care and £100 for A+E attendance to prevent a flood into other parts of the system. This is still less than the cost of taxing your car and is unlikely to bankrupt those on middle incomes whereas the collapse of the NHS could easily lead to financial hardship for he majority of the population.

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  • We all pay the tube... even if you don't use it...
    We all pay for rail... even if you don't use it...
    We all pay for the police... even if you are able to use them.. ( i.e. they wont come)
    We all pay for bus service.. despite not using it.
    We all pay for benefits all 210 billion of it... despite not using it. (btw the NHS budge is 110 billion)
    9 billion used by GPs although we see 1 million patients every 36 hours... or the entire population every 86 days...

    Don't compare Gp's to dentists look at peoples teeth in england!

    Point being... national insurance pays for the service to exist... if you need a 46000£ you get it for your effort... if you need 100000£ in chemo you get it...

    it should be universal... just like a script... pay per use.. 10 pounds a visit... is 2 billion a year for improvements on patient care... at the same time reducing demand.

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  • 1.43 We can still curtail excessive demand from people who are exempt from the full charge by putting in concessionary rates at an appropriate level say £5. People who are working and paying tax may feel penalized but such is the nature of taxation. It is likely they will need the NHS to be there for them one day no matter how fit they are at present and I suspect their children are already using it anyway. The public won't resent GPs for collecting fees because it is human nature to value that which you pay for - you don't hate your hairdresser or local garage! The mixed health economy model is undoubtedly the best which is why the rest of the western world use it! No tax system will ever be able to support infinite demand for healthcare in an ageing world.

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  • GP registrar | 07 May 2014 2:33pm

    the bottom line is this - how to we create a sustainable healthcare model in the face of rising demand and falling funding/supply whilst increasing the quality of care?

    many think it is impossible to do and something will have to give i.e. funding/supply will have to increase, demand will have to curtailed (?loss of universal care or unlimited care), or expectations on quality will have to change.

    no conscientious doctor wants the NHS to fail or for us to lose universal free at the point of use care but sadly it may come to it if these issues are not addressed and looking at different options may help focus the public/politicians into action i.e. if we don't raise the issue don't expect politicians to.

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  • Absolutely don't charge the patient they will all just rock up at A&E total chaos - what a disaster!!

    If you pay at a GPs then you need balance with charging at A&E and that will never happen - political suicide for any government! Let's take the NHS out of the hands of the politicians then maybe just maybe something good might happen!!!

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  • There is no reason that charges for A+E minors should not be introduced if a better value alternative in primary care is made available. There are of course a lot of GPs who would like to walk away from GMS so we can be in control of our own destiny rather than jumping through the hoop of the week at the whim of politicians. Ultimately patients still trust their GP more than their MP and if we make it clear that the current arrangements will end in chaos then the penny will finally drop.

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  • I feel charging patients for an appointment will make patients expect and demand more.
    I have worked all my life and paid my dues so I have already paid my share.

    What will happen when someone dies because they couldn't afford an appointment, however small the cost?

    what about script costs, £8 for a bottle of 75 mg aspirins than cost pence?

    When things go wrong, it will be the GP that is blamed!
    DNA's should be fined and barred from pre booking, that would make more appointments available for those that really need them.

    NHS equipment should demand a deposit as many items end up in boot sales!

    There are plenty of ways of saving money without charging patients for appointments, but whatever happens, it will be the overworked GP that sits in the firing line!

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  • So ashamed of Wiltshire for proposing this. It will backfire.

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