This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

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.

    Unsuitable or offensive? Report this comment

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

    Unsuitable or offensive? Report this comment

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

    Unsuitable or offensive? Report this comment

  • 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

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

  • 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 .

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

  • 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

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

  • 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 ?

    Unsuitable or offensive? Report this comment

  • @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.

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

  • 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?

    Unsuitable or offensive? Report this comment

  • >>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?

    Unsuitable or offensive? Report this comment

  • 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?

    Unsuitable or offensive? Report this comment

  • 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

    Unsuitable or offensive? Report this comment

  • 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?

    Unsuitable or offensive? Report this comment

  • Paul Shenton is right for all the reasons he states above. Charging is a bad idea. - beware what you ask for. This would not be money to GPs. It would be a treasury tax collected by GPs, equivalent to a prescription charge, and would add to practice bureaucracy. It would also be a green light to the medical insurance industry. The way to deal with GP demand is to massively reduce bureaucracy on practices, invest in GP infrastructure and staff, and on the right services in the community for those that should have them. A mass media health literaqcy/ education campaign from NHSE/S/W/NI and DH on how to use and how not to use the NHS would also be the right thing to do, but that would require ministers taking risks, which of course they hate. But above all, someone needs to nuke the DM. Any takers?

    Unsuitable or offensive? Report this comment

  • 1.02 There is a difference between charging and privatization. It doesn't matter if the nominal fee goes to the treasury - so long as we are paid a bit to collect the money. I agree charging is no panacea and community services particularly district nursing are struggling but a charge would help stymie some of the excess demand and return much needed revenue to the exchequer - this works in Europe. The government also desperately need to reform the medico-legal industry (too few winners) and sort out the other bottlenecks like residential care. It will be impossible to change the culture of consumerism in the world of 24 hour supermarkets and internet shopping so the best option is to charge extra for premium usage like out of hours and A+E and transfer this money to more cost effective services.

    Unsuitable or offensive? Report this comment

  • At last some sanity! Point of entry should never be free: Free / Cheap is rightly seen by public as Cheap / low value. The principle: Free doctors are bad doctors ... if they were any good / in demand they would have charged. Ask £10 per 10 min. visit: End of the day... GP have £200 in pocket ... but better GP (who saw 60 patients) has £600. Those patients without money get £10 cash voucher from JSP / DWP. Those that want to chat to GP for 30 min pay £30. Simples

    Unsuitable or offensive? Report this comment

  • Has anyone polled the poor old end users, seems to me a bit of horse before the cart.

    Unsuitable or offensive? Report this comment

  • @ Pieter Jooste

    Patients with multiple complex health conditions don't 'want' to spend 30 minutes with their GP, they wish they were well and able to stay away from the place!

    A £/min scheme is the worst of all worlds - if the GP extends the appointment because they feel there is a clinical need to do so (or because they have identified their own opportunity for learning) does the patient still pay for the extra minutes?

    Unsuitable or offensive? Report this comment

  • Unfortunately those out of work would probably not have to pay anyway and they make up the majority of who I see. Once again the working middle class would get shafted with any kind of payment scheme. Pity the daily wailers don't realise this

    Unsuitable or offensive? Report this comment

  • 3.40 Those on benefits could pay a much reduced fee as could minimum wagers. Its the sharp elbowed 'worried well' middle classes that we need to filter out. Those coming in for Chronic disease management appointments could be exempt for these although one would expect those appointments to follow disease demographics ie mainly go to the poorest in society. This would be better than the current system where those with most need compete for appointments on an even basis with those who have minor complaints - this is intrinsically unfair.

    Unsuitable or offensive? Report this comment

  • 4:30 yes there would be ways round it and every surgeries population are different. Where I work yes the worried well take up appointments but these worried well are all on benefits with too much time on their hands. I agree that if this system were to go ahead that even on benefits u should have to pay some kind off fee so it's fair all round.

    Unsuitable or offensive? Report this comment

  • 'HALF OF GPS' in favour of charging?
    Sample size 440
    So about 0.5% of GPs favour charging
    Why feed the Daily Mail with headlines like this?

    Unsuitable or offensive? Report this comment

  • User charges are a classic policy zombie (an idea that, however often killed off by research evidence, refuses to die). Please see https://sites.google.com/a/york.ac.uk/york-health-policy-group/blog19july2013 for a summary of relevant evidence and many reasons why this is a terrible idea.

    Unsuitable or offensive? Report this comment

  • So what are really the choices ?? of course we would all like to have a service which was free at point of contact and could manage the demands placed on it . Unfortunately this does not exist. Politicians are only against this because it would be unpopular with voters. The actaul concept would be supported to try and decrease the misuse but the practicalities needed to initiate this ,as all too often , would be smudged or blamed on someone else. In reply to the person who wanted to know about QOF- this box ticking exercise has gone way beyond any of the professionsals delivering it expectations. I feel that treating patients in the way we were all trained to do -in a timely manner would likley result in outcomes at least as good- if not better. Preventative medicine could be delivered in a different manner to present and charging could be considered and discussed. Again if seem to have a value then even simple comon sense advice advice would be taken more serioulsy.
    We can of course continue on the present path which will undoubtedly result in privatisation , cherry picking of services , decrease of availability of the cinderalla services and the very situation that the people who want no change are suggesting is ridiculous. Change is inevitable , it is necessary

    Unsuitable or offensive? Report this comment

  • Charging is much preferable to unregulated privatization. The simple solution is to charge for those things the NHS currently considers undesirable such as going to A&E with flu and subsidize those services which are proven to prevent disease (eg hypertension clinics) or for people who have chronic serious conditions. There is obviously a wide spectrum of activity in between but if we can mange something as complex as QOF I'm sure this would not prove insurmountable. The alternative is that the NHS goes bust within 10 years as the boomers get sick or the system becomes so unresponsive that it is utterly useless at caring. Sleepwalking into this will prove an unmitigated disaster.

    Unsuitable or offensive? Report this comment

  • Charging in my opinion will help control demand
    by "encouraging " self management of minor/trivia.
    Evidence is what we should go on
    They charge in Ireland and many other
    European countries ... What we want to know
    are their health outcomes better or worse?
    We do not do the patients any favours by supporting
    A system that tries to cram in as many patients
    like a production line trying to manage more and more
    Complex medical needs in 10 minute apts trying
    To spot the serious from the minor !
    Lest have the debate and the evidence
    Not just the ideological dogma

    Unsuitable or offensive? Report this comment

  • Just illustrates how out of touch the lefties, running the GPC and RCGP, are!

    Unsuitable or offensive? Report this comment

  • Have never been in favour of charging but something has to be done to increase the income coming into GP and serve as a brake on demand. Increased taxation is unlikely, as is secondary care money being diverted to primary care. The BMA and RCGP have no plan of action other than moaning and seeing GPs looking to retire or burnout. GP consultations are estimated to double in the next 10 years so charging seems inevitable unless we are willing to double our workload as income falls.

    Unsuitable or offensive? Report this comment

  • One thing cheap and easy that would help massively is to drop revalidation. It's a huge waste of time money and effort for unproven gain.

    Unsuitable or offensive? Report this comment

  • We need to get paid much more as well. The aging 2004 deal is a pittance one you take off all the deductions. I'm sick of being denigrated in the press and not being able to house and educate my kids well. It's now time to charge market rates.

    Unsuitable or offensive? Report this comment

  • Unbelievable how out of touch doctors are at a time when patients and their children are forced to line up at foodbanks in a dire state of poverty.....


    "We need to get paid much more as well. The aging 2004 deal is a pittance one you take off all the deductions. I'm sick of being denigrated in the press and not being able to house and educate my kids well. It's now time to charge market rates."

    "Those on benefits should be made to pay some amount of co-payment albeit at a reduced level."

    Unsuitable or offensive? Report this comment

  • Re anonymous at 8.43pm 25 th July----- GPS have been blamed for everything going wrong in this country but it is not our fault if "people are living in poverty and cannot feed themselves. We are professionals who have taken yrs os studying and hard work at huge expense to get to where are & deserve to be well remunerated. The plumber charges £50.00 for just being called out before other charges. That is a lot more than I earn. The govt should stop the £75.00 per patients per year that we are given and let people pay for their treatment at source. GPS in countries where this happens are treating with a lot more respect and their time used appropriately.. It would reduce the current unattainable demand & attendant GP burnout and illness. A lot of GP colleagues are so stressed and have lost the joy of caring for people which does not even argue well for the patients. There is only so much a person can take. We are not super humans capable of working 24/7 . We are just mortals not everyone else.

    Patients want to see a go any odd hours at their behest but we are not supermarkets employing non skilled staff. The manpower is just not available to provide what people are asking for. We also have families who would like to see us and have "quality time " with, we need rest and time for other activities just like the rest of the populace.
    Stop being selfish and self centred and only ask of others what u can also give if you we're wearing their shoes.

    Unsuitable or offensive? Report this comment

  • Those on benefits are often the biggest offenders when it comes to presenting with trivia. Sad but true.

    Unsuitable or offensive? Report this comment

  • 8.43 The increased use of food-banks is disturbing but really only accounts for a tiny minority of our patients. No-one is suggesting charging such people. Charges for access are standard in almost all western countries many of whom look after their poor much better than us. In fact I'm surprised the EU competition laws haven't forced us to bring in a charge yet as 'free access' represents a massive subsidy to UK business and please explain exactly why I shouldn't be paid market rates for my labor?

    Unsuitable or offensive? Report this comment

  • What does everyone think about charging for DNAs at least? Patients are always complaining that they cannot get in; maybe they should pay a fine for not turning up- whatever their income. A lot of people who don't pay taxes as they do not work and therefore do not contribute to the NHS.

    Unsuitable or offensive? Report this comment

  • @9:45

    Many other countries train and employ a far greater number of doctors at lower rates of pay (eg. European nations, Cuba etc). As a self-employed person, you have the choice of taking a paycut and taking on another member of staff.

    Meeting patient needs by increasing the supply of doctors at a lower rate of pay (as achieved in Europe) would solve the problem of not only patient needs but also of unmanageable workloads , but Pulse doesn't seem to be too keen to report on that solution.

    The idea that a doctor earning on average 4-5x the national salary claims he/she can't "school" and "house" his/her children suggests that doctor is completely out of touch with the reality of patients' struggles, as apparently are many of the doctors commenting on here.

    Unsuitable or offensive? Report this comment

  • 11.06 Not out of touch, just aspirational like many of our patients. We know people on low pay struggle, this is why our surgery pays a living wage. I have also done minimum wage summer jobs to support myself as a student. Doctors study for years taking endless exams and rack up huge university debts which have to be paid back. They then don't start earning until their mid 20s so you have to make up time in the game of life. In fact a lot of my colleagues who started work earlier than us have done better by getting mortgages before the housing market went out of control. GPs pay £7000/y to insure themselves, this magnitude of risk demands an equivalent salary. Even if you wanted to employ more doctors they aren't there to appoint. We work in a globalized competitive society and if you don't pay the going rate, you cannot recruit, hence the current mess.

    Unsuitable or offensive? Report this comment

  • 11.06

    If you pay doctors 4x the average salary but they end up working 2x the average week then you must consider how well you are really rewarding them. The public may have been hoodwinked about remuneration but we are not. We know we are working like dogs for perhaps twice the average hourly rate.

    If you are a mother trying to find chlidcare and having to pay for an unusually long day then it does not take long for it to be uneconomic to continue at these unsustainable rates.

    Unsuitable or offensive? Report this comment

  • I would be completely against this for a number of reasons. It is first of all uninforceable, it would stop preventative medicine dead on it's tract , it would lead to patients presenting late to doctors with potentially fatal illneses and it would worsen doctor / patient relationship more that it is already.. It is a Dum idea

    Unsuitable or offensive? Report this comment

  • No. This is a crap idea.

    Fodder for the ghastly Sophie Borland at the Daily Mail.

    What were you guys thinking?

    Unsuitable or offensive? Report this comment

  • Carlos Knorr
    I respect your concerns but are they founded
    On good evidence from other Europian countries
    That have some form of charge?
    Is our health care so good and our out comes
    so good that this piece of work should not be
    Considered?
    Is our model sustainable?

    Unsuitable or offensive? Report this comment

  • 11.01 Easy to enforce - we already do this with prescriptions. Preventative medicine would still exist as we would funnel resources generated from charging back to these clinics which would be targeted at those who need it most. Charges are not required to stop all demand, just unnecessary demand. Remember the rest of the would does it this way (not just the USA) and so many countries do medicine better!

    Unsuitable or offensive? Report this comment

  • "One GP suggested means-testing, saying: ‘£10 for poor, £25 for others, £100 for professionals and politicians and £150 for solicitors and accountants".

    This suggests a truly worrying lack of insight into the value of £10 to someone who is 'poor'. For a pensioner dependent on the state pension this is unaffordable. It’s shocking that a GP didn’t understand this.

    The NHS is there for the health of the country. If it’s not working, fix it - don’t smash it up in a fit of self-centred bad temper. It’s time GPs used their power as a group to stop the final dismantling of the NHS.

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say