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CAMHS won't see you now

Half of GPs in favour of charging for routine appointments

Exclusive: 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, a Pulse survey has found.

Of the 440 GPs polled in the survey, 51% said they would support charging a small fee for GP appointments, compared with 36% who would not.  

That represents a significant increase on the 34% of GPs who said they would support charging for appointments in a similar poll last September, and suggests many GPs are willing to consider more drastic solutions to reduce their growing workload.

The survey results come at a time when GPs have been reporting growing workload due to the imposed 2013 contract deal, with some willing to take a pay cut rather than bid for new work under four new DESs being offered this year, and worrying levels of GP burnout.

The majority of doctors who called for charging to be introduced specified an amount between £5 and £25 per appointment. One GP suggested means-testing, saying: ‘£10 for poor, £25 for others, £100 for professionals and politicians and £150 for solicitors and accountants.’

A report by the Deloitte Centre for Health Solutions last year concluded that demand for face-to-face consultations with GPs is likely to double in the next two decades, with 433 million practice consultations predicted annually by 2035, including 180 million for people aged 65 and over.

But the option of charging patients is likely to be prove politically unpalatable; health secretary Jeremy Hunt was recently forced to deny that he was considering Conservative Health Forum proposals to include a cap on the number of appointments patients can make with a GP.

Dr Stephen McMinn, a GP in Bangor, Northern Ireland, said he was in favour of charging patients for appointments. He said: ‘[It] has been shown to work in other countries. There needs to be some pressure to decrease patient demand and expectation.’

Dr Shailendra Bhatt, a GP in Hemel Hempstead in Hertfordshire, said: ‘I work in a walk-in centre. The amount of people who come through the door for practically no reason at all and say “I was out and saw this sign for a walk-in centre where one can see a doctor, so I came in”… People don’t value the things if they get it cheap, worse still if they get it for nothing.’

But other GPs argued that against charging. Dr Sheila Pietersen, a GP in Bristol, said it could deter some patients with a genuine need from seeking help and ‘may hinder the doctor-patient relationship’.

She added: ‘The costs of administering fees would be huge and chasing people for non-payment would be difficult and time-consuming.’

Dr Edmond Ferdinandus, a GP in Wakefield, West Yorkshire, said: ‘A small fee will make patients feel they have a large entitlement - if we do this, I predict the extra income will be entirely cancelled out by extra prescriptions, investigations or referrals.’

The GPC said it was not in favour of such a policy. Dr Chaand Nagpaul, GPC chair, said: ‘The NHS should be free at point of delivery and it is not LMC policy to support charging patients.

‘Charging patients would have adverse effects and would fundamentally be to the detriment of GP-patient relationships. We need to preserve trust between patients and their GPs.’

A Pulse survey last year showed three-quarters of GPs were in favour of charging for ‘did not attend’ appointments, while a report from The King’s Fund found that the public would also be in favour of such a proposal.

Would you support charging a small fee for all GP appointments?

Yes - 51%

No - 36%

Don’t know - 13%

Source: Pulse survey of 440 GPs

 

Readers' comments (79)

  • I find the belief that charging will put patients off seeking help when needed nonsense when health outcomes in many countries that charge are better than the UK.

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  • Re the suggested charging scale, how about £200 for GPs?

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  • Will hospitals also able to charge for attending A&E? Because that's where the patients will come. What a ridiculous idea.

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  • absolutely unbelievable, the NHS was fundamentally set up to provide healthcare for all not for those who could afford it, and indirectly all working people pay already for those appointments through their tax and superannuation etc, any more of this and we will be back to the era of education and healthcare for the upper class and never mind the lower class

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  • Stupid idea - no evidence that it would manage demand at all, all political parties are against it and the vey people in genuine need would bounce around the system as previous comment says i.e UCC/MIU/WIC/UCC. You want to manage demand then reduce choice - close all the WIC's, front all ED's with UCC's who redirect Johnny Junior with ear wax at 3pm back to practices and reinvest the money in a breeding programme for practice nurses 7 days a week primary care 7am-7pm thus giving the patient 2 choices which we had 30 years ago - if you are dying or injured go to ED otherwise see your GP. The current choices have bred a neurotic public fuelled by political promises and have put back GP education to patients by some 30 years.

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  • Charging would destroy a large part of preventative medicine - something that is helping the most needy to live longer. Makes more sense to charge for attending A&E - maybe if not accompanied by a note from a doctor, nurse or paramedic or if not referred by 111 (the last could be contentious!)
    Wopuld encourage more rational use of the service.

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  • This won`t work. Using evidence- there are 3 main main drivers for behaviour- romantic, financial and moral/ethical. A study in the states showed that when parents picking up kids late from school were charges- it was then found that more parents picked up later- as the moral driver was removed- the fact that they paid removed any guilt. A minimal charge will likely justify several complaints and wants as they are then paying for it. ( Yes I know they are already via tax etc- but that is "hidden").
    What`s worrying is that it`s the first step towards doing as the Dentists did when their contract was unfair. I know Dentists that earn £9000 for a 2 day week( and yes there are a few poor dentists - ((just as there a few ethical daily wail jounrnalists, well probably there are!)).
    I do wonder if thae current agenda is to push us the same way as the Dentists, by either design or incompetance.
    However Gp`s on the whole are usually not as motivated by money as some of the trolls on this site and the Saily Wail think- if wanted money we,d already be in private practice.
    P.S. Whilst i believe in balance, This is a proffesion`s blog and sounding board, Pulse, I do wish you would help loweer GP`s blood Pressures, by ensuring it`s only target proffesionals who can comment, Most of the replies are "Dear anon at 1240 please be informed that you are talking rubbish , and cluless over blah blah". I agree with balance, but if i want to become depressed I read a certain papers blogs and despair .

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  • Sudheer Surapaneni

    GP charges must be refunded back. By asking for money upfront some abusers of the system can be nudged to change their behaviour. As the money is refunded back, it does not cost any one.
    Genuinely needed will not be put off.

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  • How will charging impact on QOF? Patients just will not turn up. It could be a good thing as will be the end of GPES it will starve the government of data for monitoring patients every move.

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  • I believe in charging- anything that is free has no value. I have seen patients that attend every week- usual complaints- rash of 1 hr duration/cough of 1 hour duration, runny nose of 1 hour duration. They comes to the reception first thing in the morning make a different complaint so they are seen as urgent - only to discover their condition are relatively minor and could be managed at home.

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  • charging must be introduced.amongst many others i have one patient who made 116 appoints in a 12month period.we tried many many avenues of reducing them,and guess what happened?she went and complained to the ombudsman.what a joke

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  • If you're going to charge, charge properly i.e. the market cost of a GP appointment not a nominal fee. Some patients will demand even more from their payment. I take home less than 4 quid per consultation, if i didn't believe in the NHS as a civilising organisation I would be walking away. 200k in Australia. I agree with reducing options to make an appointment more 'valued.' Part of the hidden costs in the NHS is the freedom for patients to book a GP appointment for a verruca because they do not feel that telling a receptionist what they want. Time to start saying no.

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  • And what happens when the GP asks to see the patient ? For example when the patient is asked to make a "routine appointment" for a non-urgent, but nonertheless, abnormal blood test result ? Or when the patient is asked to make a "routine appointment" for a review of medication ?

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  • @Anonymous | 25 July 2013 10:55am "If you're going to charge, charge properly i.e. the market cost of a GP appointment not a nominal fee."
    But patients already pay for their appointments - it's part of the taxation system in the UK, our taxes pay for the NHS. A nominal fee as when we see dentists, yes, but not the full fee unless we scrap the part of our taxes which goes to the NHS and adopt a private insurance system.

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  • What about all the appointments where GPs are calling patients in for their own benefit - eg. chasing QOF? Should patients be charged for these appointments?

    A stupid idea.

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  • Its becoming blindingly obvious we need to charge for routine appointments ASAP because it will be far worse if the system fails in a crisis, something that mathematically looks inevitable. Charges should be £70/appt comparable to the dentists. QOF and recall appointments should remain free so chronic disease management is protected and prescriptions that keep you out of hopsital should be free (long term condition prescription charges has been an unethical mess for some time now). Those on benefits would get concessionary rates but still pay enough to prevent trivial demand. A+E minors should charge £140 to keep people in primary care, majors remain free. The NHS will still be providing fantastic value for money for the taxes paid. I honestly don't know why the politicians have so many hang-ups about this, they'll get more votes if the system speeds up. Comparable economies all charge at the point of access and often get better outcomes. What makes us think we are so special we can do differently to the rest of the world?

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  • >>But patients already pay for their appointments - it's part of the taxation system in the UK, our taxes pay for the NHS
    ----

    A fair point. Patients should be refunded the £70-80 per year that goes to their GP practice and then they should be made to pay per appointment. Now how far do you think the £70-80 would go?

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  • as many have said - a ridiculous idea. If demand is a problem, then the first solution is to diversify the types of interaction GPs offer to manage that demand. The current system of seeing everyone for 7 minutes or whatever regardless of their complaint is a massive factor in the problem. Online consultations, phone consultations - much cheaper, faster, more convenient and probably appropriate and effective for a large number of complaints. Start there maybe?

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  • Online and phone consultations can be tricky- they can triage out- which most of us are doing already- but you can`t diagnose a lot of things on the phone completely. I don`t know of any Gp`s having 7 min appts anymore.
    Ps again please can the comments be submitted by GP`s/practice staff

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  • How many GPs would be keen on charges for appointments if the money was then put into the NHS as a whole and not kept in their practice. Or are they proposing that NHS funding is cut as part of the practice income now comes from the patient?

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