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Appointment charges undermine principles of NHS, say GP leaders

The RCGP has said charges for GP appointments to be introduced would ‘fundamentally change’ a founding principle of general practice, after a motion was proposed for the 2014 LMCs conference.

Pulse revealed yesterday that LMC leaders would vote on whether to charge for appointments, after a motion from Wiltshire LMC called on ‘GPC to explore national charging for general practice services with the UK governments.’

But the proposal has attracted criticism by the profession’s leaders, with GPC deputy chair Dr Richard Vautrey taking to the social media site Twitter to say charging patients was ‘not the answer’ to the workload crisis.

A Pulse survey from last year found that just over half of GPs were in favour of charging a small fee for routine appointments.

The RCGP’s honorary treasurer, Dr Helen Stokes-Lampard, said: ‘Introducing a charge for appointments would fundamentally change one of the founding principles of general practice – that healthcare is free at the point of need.

‘Asking patients to pay would undoubtedly deter many people from seeking medical help in the early stages of illness when they can be dealt with cost-effectively and efficiently in primary care, rather than requiring expensive specialist care and increasing admissions to emergency departments.’

Dr Vautrey said on Twitter: ‘Charging patients for [NHS] care is not the answer to GP workload crisis. Increased funding from [NHS England and the Department of Health] certainly is.’

The motion, which is to be debated at the LMCs conference in York at the end of this month, read: ‘[This conference] believes that it is no longer viable for general practice to provide all patients with all NHS services free at the point of delivery.’

Readers' comments (25)

  • Charging is one way forward if not the only answer. Patients should be charged at time of booking and be refunded when they turn up. Same with hospital appointments! Evey one as a choice in life - if you can spend money on cigarettes knowing that it is harmful to you then you would have to face the consequence of bad health and pay to see doctors to help you choice of lifestyle. Everything is about choice!

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  • Vinci Ho

    At the end of the day , the only demon here is the government which would absolutely loves to see GPs unilaterally ask for a charge or even privatising general practice .Because it can then fund even less and less in the service or pack it in altogether .
    Current form of NHS is non sustainable , fact . Is that the fault of doctors ? Is that the fault of people ?
    It is more interested in cutting corporation tax further to lure more foreign power to come to this country than carrying on funding any public sector . So we can turn ourselves into the demonic slaves of this government .
    Yes. Charge a fee can help only on conditions including patients can really afford . How do we know whether a patient can afford? That is the catch.
    If a government really has a will to get it right, you really think it cannot find a way ? I do not believe it....

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  • Vinci Ho

    When the days are cold
    And the cards all fold
    And the saints we see
    Are all made of gold

    When your dreams all fail
    And the ones we hail
    Are the worst of all
    And the blood’s run stale

    I wanna hide the truth
    I wanna shelter you
    But with the beast inside
    There’s nowhere we can hide

    No matter what we breed
    We still are made of greed
    This is my kingdom come
    This is my kingdom come

    When you feel my heat
    Look into my eyes
    It’s where my demons hide
    It’s where my demons hide
    Don’t get too close
    It’s dark inside
    It’s where my demons hide
    It’s where my demons hide

    At the curtain’s call
    It's the last of all
    When the lights fade out
    All the sinners crawl

    So they dug your grave
    And the masquerade
    Will come calling out
    At the mess you made

    Don't wanna let you down
    But I am hell bound
    Though this is all for you
    Don't wanna hide the truth

    No matter what we breed
    We still are made of greed
    This is my kingdom come
    This is my kingdom come

    When you feel my heat
    Look into my eyes
    It’s where my demons hide
    It’s where my demons hide
    Don’t get too close
    It’s dark inside
    It’s where my demons hide
    It’s where my demons hide

    They say it's what you make
    I say it's up to fate
    It's woven in my soul
    I need to let you go

    Your eyes, they shine so bright
    I wanna save that light
    I can't escape this now
    Unless you show me how

    When you feel my heat
    Look into my eyes
    It’s where my demons hide
    It’s where my demons hide
    Don’t get too close
    It’s dark inside
    It’s where my demons hide
    It’s where my demons hide

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  • Charging a small fee (co-payment) for those who are not on benefits is the only way forward.
    I think this has potential to SAVE and modernise the NHS.
    This is the only way to increase funding and bring some PATIENT RESPONSIBILITY back in.

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  • Aren't GPC leaders supposed to be reflecting us GPs?!!! Before they decide what should or shouldn't happen why don't they ask the GPs they represent! This is why we are in this awful mess. The BMA and RCGP don't ask what grassroots GPs really want in order to represent us!

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  • – that healthcare is free at the point of need.
    Need seems to becoming increasingly rare in comparison to "want" in day to day general practice.
    Wait for the implosion of general practice if charging is not introduced.
    When did the GPC / RCGP last survey primary care Drs for an opinion on charges? As far as my 5 partners are concerned they seem to be pressing ahead with a minority opinion.

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  • Healthcare is only free in the uk and Cuba the NASTY TORYS wish to destroy the socialist NHS and they are succeeding our leaders are inept the only way forward is payments at the point of use.I have worked in Australia and New Zealand where patients pay and the doctor patient dynamic is much better unlike the arrogant paternalism we see in the NHS from doctors.We have a system that was designed in the 1940s we live in a capitalist democracy not the USSR times have changed as a profession we will do well out of this move on!

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  • RCGP statement: "It is true that GPs are struggling to deal with increasing demand whilst receiving a record low share of the NHS budget, but charging our patients for appointments is absolutely not the solution. What we need is more investment into general practice so that we can provide more services to our patients and the care that they need and deserve."

    RCGP can bleat on about government requests for increasing investment- it isn't going to happen!

    As far as "providing the services to our patients and the care they deserve"- there are too many worried well patients that need reassurance at the detriment of the sick- they show NO responsibility for anyone else but themselves! Where is the collective responsibility for the care of the vulnerable- it can't come just from GPs. The RCGP is deluded if it thinks that statements like this is actually going to help sustain NHS general practice. GPs have had enough and are leaving the profession and are not being replaced.

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  • @Anonymous | GP Partner | 07 May 2014 7:27pm
    who wrote "Charging a small fee (co-payment) for those who are not on benefits is the only way forward"

    Spoken like a true marxist.Why not impose a small token co-payment.If they can afford a pack of fags surely they can pay a couple of quid.Perhaps my American colleague was right when he described Britain as a nation of bums.

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  • Thanks to the Daily Mail we are already unpopular enough without voting for charging patients.
    This subject is to be debated in a proper forum and those who wish to make their feelings clear should lobby their LMC Reps. This is not primarily a BMA or RCGP matter.

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  • We need more investment in General practice . Our leaders suggest restoring the 11% share . This is completely lacking in ambition . Give us 20 % now for 90% of the work dump the internal market and watch us restore the NATIONAL health service . To beg for scraps from the table is pathetic , a waste of time and ultimately doomed . Give us the enhanced funding now or watch general practice perish and that right soon.

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  • Is there any other publically funded service that the population can access without charge as many times as they want for what ever reason that comes to mind (no questions asked) and are actively encouraged to do so by weasel politicians looking for popularity votes? Can you demand to see a teacher when ever you want as often as you want for whatever reason you can think of? ..no! Can you demand to see a politician whenever you want as often as you want for whatever reason you can think of?..no!...can you demand to see a bin man when ever you want as often as you want for whatever reason you can think of?...no!...can you demand to see ANYONE as often as you want for for whatever reason you can dream up other than a GP ...and feel entitled to complain if you can't see them within 48 hours? ...uuuur no I don't think so. Without SOME KIND of control , in the face of ever increasing expectations about 24 hour access to excellence and a friendly smile to attend to any concern anyone might have remotely connected to a sense of personal, emotional or physical well being...it's a no brainer ...we'll be (and currently are) completely over whelmed. If we're not going to charge what ARE we going to do to make people think before 'just checking' with their friendly highly trained attentive affirming GP??

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  • As a UK GP now working in Australia, I am used to charging a co-payment or Gap to patients who can afford it. And patients appear to value your service more for it. It does say take some responsibility for yourself and for your minor illness.

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  • The problem is that there is not the political or public will to increase funding for the NHS as a whole. And if NHSE puts more money into primary care then they will have to take money from a different part of the NHS so some other service will be affected.

    The other problem is future funding - even if by some miracle more funding was available - demand will again outstrip supply and you will end up asking for more and more funding. Estimates are for very high future contribution of GDP (?14-20%) which the country can not afford. So asking for more money from the state is not a viable long term approach.

    So if there is no more funding then one has to be more bold and look at other ideas to create a viable service including charging or even leaving the NHS contract.

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  • You all seem obsessed with how the public perceive you. Why?

    I don't particularly like my accountant or my lawyer, but I'm happy to pay their fees for the quality service that they provide.

    Do you somehow think that the current, rather acopic, generation will suddenly stop seeing you? Of course not, they'll still want you to see their sore throat after two hours - with charging they might at least try and self manage it...

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  • We should be concerned with public's view - after all we are publically funded service and we treat that very public as our job. I'm sure it's not an coincidence rates of GPs being taken to court has risen alongside the smear campaign by the media.

    That's not to say we shouldn't act - but we need to weigh up the risk and benefit carefully

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  • I don't know whether charging is the answer, but we should get one thing clear. The NHS is not free at the point of treatment (unless you are exempt from prescription charges), so this really would not represent a sea-change.

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  • If, like me, you are a staunch support of the NHS values of the same excellent standards of care for rich and poor alike, then you would be against any form of charging.

    However, it is increasingly feeling like delivery of the same poor standards for rich and poor alike, with mortality rates still much higher for social classes 4 and 5. This makes me wonder if we are doing it right.

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  • "I'm sure it's not an coincidence rates of GPs being taken to court has risen alongside the smear campaign by the media."

    I'm afraid this also illustrates the opposite. Referrals to the GMC have risen, but with no drop in standards as far as the GMC are concerned - see Pulse previously. Patients don't understand the constraints, don't understand what fantastic value their £80/yr is and would quite happily have you chained to your desk 24h per day if it was convenient for them.

    It's time to be honest about healthcare. Most modern countries across the world have some form of payment/co-payment. The current system is NOT sustainable and defending the NHS at all costs is likely to 1) lead to burn out for increasingly overworked staff and 2) ironically lead to it's demise quicker as it implodes with little warning.

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  • I wonder if it's even ethical not to charge now because there seems to be overwhelming evidence that countries which have up front costs achieve better health outcomes and more satisfied patients. 'Free at the point of delivery', is more a political ideology than science and I think it's time this dogma, no matter how admirable in its intent, was questioned. We should have the courage to not mind what people think of us but to ensure that doctors do not burn out and that primary care is appropriately resourced and can stand on its own feet rather than having its bones picked at by the private HMOs.

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  • GP leaders? Says who? They are members of an academic body and they certainly do not lead me as a GP. Who elected them to represent our views?
    Either way it is good that they are opposed to the idea as I would like to see it introduced and the best way to achieve this is to tell our contrary Government that we don't want it!

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  • All we need is one change in the next GP contract - I hope the GPC can slide it in under the radar.
    Practices need to be able to provide private care to their own patients.
    Then we can have a two tier system like the dentists - a private one for those that can pay and a basic service for nhs patients. That should give the nhs the death that politicians want to see.

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  • If charges for seeing a GP carried the same exemptions as prescription charges then 90% of consultations would be exempted in any case?

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  • "90% of consultations would be exempted in any case?"

    I'm sure we could find a more sensible list of execptions. Again, as has been stated previously, other countries seem to manage this.

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  • In Southend the CCG is made up of many GP's but who looks after their patients whilst they attend endless meetings? A 'service' is provided by one or more GP's who have set up a private company in an attempt to fore all GP's to use this service because they claim hospital referrals are not completed properly by GP's (or so we are told) ... but nobody asks the patients consent to give this company confidential information, no consent forms signed, so perhaps there is some truth in that 'the devil looks after its own'!
    As for charging patients, I feel we need to take better care of our GPs before start introducing yet more new systems. There are too many changes when the foundation has been put in place. Get the GP numbers up to scratch then build on that, nothing can last without a solid foundation!

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