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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)

  • 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

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  • 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.

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  • 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

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

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  • 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.

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  • 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.

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  • 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.

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  • 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."

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  • 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.

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

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