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A faulty production line

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)

  • 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?

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  • 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.

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  • @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.

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  • 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.

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  • 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.

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  • 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

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  • No. This is a crap idea.

    Fodder for the ghastly Sophie Borland at the Daily Mail.

    What were you guys thinking?

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  • 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
    Is our model sustainable?

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  • 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!

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  • "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.

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