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CAMHS won't see you now

Four in 10 GPs in favour of charging patients for appointments

Exclusive Four in 10 GPs would welcome being able to charge patients for appointments, a Pulse survey has found. 

The survey of 948 GPs found that 41% are in favour of the NHS charging a fee for appointments, as it could help tackle workload and allow a better use of their time. 

This is a decrease from 2013, when just over half of 440 GPs who were surveyed by Pulse said they were in favour of charging a small fee for routine appointments, compared with 36% who would not.

Under the new five-year contract, negotiated by the BMA and NHS England in January, general practice will receive billions of funding alongside a raft of changes, including financial incentives to join primary care networks and a new state-backed indemnity scheme paid for out of the global sum.

Despite NHS England chief executive Simon Stevens saying the deal 'unarguably represents the biggest boost to primary care in more than 15 years', only 45% of GPs said they would have voted for the contract if it had been put to ballot, with some arguing against the little increase in funding

In Pulse's latest survey, the 387 GPs in favour of introducing a fee for appointments argued this could help drive demand down and tackle the increased pressures.

One GP said: 'Although I have previously opposed this, I now genuinely think that people don't value health care services, either hospital or general practice. We get numerous DNAs, as do the hospital.

'Charging 5p for a carrier bag has reduced the number of unnecessary carrier bags as people think twice. A nominal fee that makes people think about whether an appointment is genuinely needed or if they can access appropriate information in an alternate way might improve unnecessary workload.'

Echoing their comment, one respondent said: 'A small, nominal fee that can be claimed back if on low income. It would make people realise that primary care is a privilege and not unlimited, while not restricting access for those who need it.'

Another GP said: 'I cannot think of any other way of stemming increasing and unreasonable demand other than some form of financial barrier.'

The survey also showed that 41% of respondents are against the practice of charging patients, pointing out it would be 'appalling' and likely to deepen the divide between the rich and poor.

One GP said: 'This would create further health inequalities, drive the inverse care law and create increased, unreasonable expectations. A potential consequence of this would be an increase in investigations, referrals and prescriptions.'

Another GP commented: 'Public support for the NHS is already precarious. We already charge people for their NHS care, through taxes. To charge again would be appalling. The poorest would get sicker.' 

Leading doctors have previously rejected calls for the BMA to consider charging patients for GP appointments in order to fund the NHS, saying co-payments are 'a tax on sickness' and 'clearly not right'.

The issue was also debated at the 2017's LMCs conference in Edinburgh, when GP leaders tasked the BMA GPC with creating a list of the charging options available and their potential positives and negatives despite warnings that passing the motion would send the wrong message. 

Meanwhile, a 2015 YouGov poll revealed that almost a quarter of British people would be willing to pay for GP appointments


Readers' comments (29)

  • If you make something free people from all walks of life will crap on it and reduce its value. It's an obvious economic consequence.

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  • doctordog.

    We all know this is a non- starter.
    Unenforceable . Who gets the money? Patients will want their money’s worth.
    Would cost more to collect than make in profit. Unless profit is not the intention, and the idea is to punish those who use the service most frequently .

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  • Long overdue. Raise extra funds for the NHS and encourage more responsible use of services. Reward Doctors who see patients rather than those who have huge lists but no appointments.

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  • Ivan Benett

    More don’t. Charging people for appointments undermines the very principles of the NHS and would penalise the poor, the least assertive and the very ones who need to see a doctor. It is an appalling idea in every sense and will worsen current inequalities

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  • NHS. Free at the point of exploitation.

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  • I'm against billing the patient - but the three medical systems that lie geographically nearest to us - all charge for a primary care contact. (France, Ireland and the Channel Islands).

    Charges vary between about 18 and about 50 pounds. There are exemptions (in Ireland), refunds (in France) or a state contribution (in the Channel Islands).

    It is my impression that access to all three of the above primary care systems is generally rather better than in the UK.

    I note though that all three areas - like the UK - have recruitment problems. The situation in France - where the charge is lowest - is helped by the excellence of the hospital system.

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  • I am one of those 40% who thinks charging would be the only thing that could save NHS GP as well as the vast majority of patients from a future dangerous third rate service.
    The net £60-70 / patient/ year income GPs get after expenses could be doubled. That income together with the decreased demand would allow for consultations to be 2-3 X longer.
    The extra staff needed to allow that sort of lengthened consultation would come from GPs and other Practitioners encouraged by a much more pleasant work situation from leaving the service in one way or another.
    Yes, on average patients would have to pay about £60 a year to get this quality potentially life saving service. They would be issued with a card from a DOH intermediate organization that they simply scan at the Practice desk for co-payment and the organization bills the patient but pays the GP. If the patient truely cannot afford the amount they can make a representation to DOH/intermediate for it to be waived.
    That was easy!

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  • My question to Dcotrs who oppose charging patients is what solution they have to reduce demand and how they plan to reduce DNA rates and avoid patients booking unnecessary appointments. And please don't say "patient education " . I would like to some real practical sloution/answer

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  • In the UK, there exists a profound cognitive dissonance between the population’s claim of valuation of healthcare and what they are willing to pay for it.
    Just put a commercial price on healthcare and the population/electorate and their representatives can sort out the billing system (seems to work fine for mobile phone contracts, which generally are much more expensive).

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  • Important to charge for A+E as well because if not the 'patients' would just go there.
    I had to attend recently with a metal shard stuck in my cornea and would happily have paid £50 to be seen. Were this charge in place I suspect I would have been seen much faster because half the people there didn't seem to have had either an accident or be an emergency.

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  • Amazingly many other countries around the world seem to have found solutions to the "who gets the money" or "what about those who can't afford it" problems.

    Many of you sound like you've been taking hostage by the NHS and have Stockholm Syndrome.

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  • It works in the rest of the western world apart from the USA, but out leaders are herding the masses down the road of a USA HMO model.This will not bode well well this will inevitably happen and we inherit the worst copayment system in the world by default.

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  • Let's discuss:
    I think there should be a charge for NOT seeing the GP! (or any practice staff)
    Take a deposit, of, say, £ 50, and lose it for a DNA;
    Introduce a fee for email/telephone/internet consultations;
    and a REALISTIC fee for copies of records, notes, or letters!

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  • So what we need now is some objective meaningful validated data.

    Certainly at the meetings I attend,the Irish GP's are on average 100% happier and more professionally satisfied than their British counterparts,clearly that are always also the noisiest table,and the one everyone else wants to join.

    It would be interesting to know how many of those who oppose this proposal also support staying in the EU where this occurs,e.g. France.

    A trip to France,to meet some French GP's,is I think called for,all in the name of professional research

    I feel a booze cruise coming on

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  • Leave this to the BMA

    Not only will they vote out charging pts, they will introduce the charging of GPs to see patients.

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  • Before comparing oranges with apples, note that France/Germany put £20-24bn more per annum into their health services than does UK.

    Charging is for zombies. Costs more to administrate than is recouped (see prescription charges).

    Not a single commentator anywhere ever seems to have noticed, let alone counted/costed/analysed, the proportion of GP time/appointments occupied by forced initiatives from NHSE....all the healthy people on whom we do NHS health checks, 'proactive' appointments, care plans, bloods, reviews etc etc etc.

    No evidence, no analysis.

    My suspicion is that the money doesn't end up covering the extra work and staff required. Same for the new work of PCNs.

    It's time we checked our own backyard properly before blaming and punishing patients.

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  • France and Germany put more money into healthcare; they use insurance and co-payments instead of expecting tax payers to footthe entire bill.

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  • Even in Greece you pay a small fee to see a Gp and the system actually works pretty well. No having to queue up at 8 in the morning outside some freezing sh*thole or having to scramble with hundreds of other callers on the phone first thing in the morning to get a “same day appointment”. What moron came up with this stupid system

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  • David Banner

    5p for a plastic bag

    A nominal charge would significantly reduce use whilst not impeding the poor.

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  • What's this rubbish about it costing more to charge. It costs nothing. £10 please and thank you very much. End of. We charge people for letters etc and it costs nothing just take the money

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  • Nick Mann | Salaried GP10 Oct 2019 5:03pm

    I 100% agree

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  • Imagine going to a car dealership where everything is free, most will want everything and not bother to even wash the car. Just get a new free one since others are paying.
    The NHS is now treating things to do with making a statement, social problems, parental problems and life style and distracted from treating basic diseases.

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  • To the 59% who feel the "all you can eat for free" approach is correct and working… Good luck carrying all the work when the rest are finally broken by the current GP land.

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  • Almost every service in the country involves a charge at some level, healthcare is almost unique in the way it tries to hide costs from the user. Charging has benefits over taxation because it ring-fences money for health, something taxation can never do which is why we end up with feast and famine in the NHS.

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  • It is block contract for poor gps. Why would government change any thing and loose votes. These blogs have appeared many times in past and nothing happened. This time it will be no different..
    Paid .
    Limited number pay limited taxes. Those who don't pay taxes have unlimited access. Any thing free at point of delivery is certain to be misused.

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  • Some quite bizarre answers from those supporting charges... implying the NHS is free and comparing Health services to plastic bags.

    Charging doesn't seem to have put off many in the private sector, but of course poor people can't go there.

    I sense some pejorative attitudes towards patients in these comments. Patients are not time-wasters or commodities. Ditch the zombie narratives and start pushing upwards. Patients are the easy target, but not the right target.

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  • I wonder whether the 40% would still vote for charging patients if they were told that the following would exempt from paying. Or, would they have insisted that no one is exempt.
    Income support
    Income-based Jobseeker’s Allowance
    Income related Employment and Support Allowance
    Pension credits
    War Pension Scheme or in Armed Forces
    Pregnant women and those who have had a baby in last 12 months
    Housing benefits
    Universal Credit
    Disability living allowance
    Attendance allowance
    Carer’s allowance
    Cold weather payment
    Winter fuel payment
    Bus pass
    Tax credits
    Free NHS prescriptions

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  • I'm sad to say I agree.
    Echoing some of the comments above, those who do not agree charging is a good idea need to come up with an alternative suggestion.
    Sadly, in a capitalist society, people only seem to value things when they have a monetary value attached.

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  • There has to be a charge, but the problem is I dont trust ANY politician, born or not unborn to govern this.

    Even a five pound charge will dissuade a lot of pointless GP appointments typically sought by the worried well.

    A lot of people will say they cant afford any fee, but will soon turn up asking for a GP letter detailing the reasons why they have to take their pregabalin on their next foreign holiday.

    I do agree that any fees charged must be similarly enforced at AE.

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