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GP leaders to vote on whether to support patient charges for appointments

Exclusive GP leaders are set to vote on whether the GPC should ‘explore national charging for GP services’ at the LMCs Conference later this month.

The motion, put to conference by the agenda committee and set to be proposed by Wiltshire LMC on the day, suggests general practice is ‘unsustainable in its current format’ and that ‘it is no longer viable for general practice to provide all patients with all NHS services free at the point of delivery’.

The motion concludes: ‘That conference… calls on GPC to explore national charging for general practice services with the UK governments.’

A Pulse survey of 440 GPs last July showed that 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.

Other topics scheduled for debate at the annual policy meeting, set to be held 22-23 May in York, include whether or not CCGs should commission primary care, with several LMCs arguing that this will ‘fatally damage relations between CCGs and their constituents’.

However, in a counter motion, Merton, Sutton and Wandsworth LMCs will argue in favour of CCGs commissioning primary care. This comes as NHS England invited CCGs to bid to commission primary care last week.

GP leaders will also be voting on a motion to ‘reject the concept of routine general practice care 8-8 seven days a week’, a concept that has been heavily pushed by Prime Minister David Cameron over the past six months and which is likely to form part of Conservative policy ahead of next year’s general election.

The agenda document also highlighted LMC concerns over the Government’s care.data scheme, which is now set for a delayed rollout in the autumn. An agenda committee motion, to be proposed by Bedfordshire LMC will say that ‘the introduction of care.data has been nothing short of a disaster’ and call for a patient ‘opt-in’ system to replace the current process of patients having to opt out if they disapprove of their records being shared.

The motion says: ‘That conference believes the introduction of care.data has been nothing short of a disaster and.. asserts that extraction should only take place with the explicit and informed consent of patients opting-in.’

The conference will also see LMCs debating the ‘unsustainable workload in general practice’; deplore ‘the CQC’s plans for a simplistic rating system for practices’; and condemn the ‘disorganised mess’ resulting from the NHS reorganisation, including delayed payments to GP practices.

Highlights from the 2014 LMC conference agenda

AGENDA COMMITTEE to be proposed by WILTSHIRE That conference:
(i) believes that general practice is unsustainable in its current format
(ii) believes that it is no longer viable for general practice to provide all patients with all NHS services free at the point of delivery
(iii) urges the UK governments to define the services that can and cannot be accessed in the NHS
(iv) calls on GPC to consider alternative funding mechanisms for general practice
(v) calls on GPC to explore national charging for general practice services with the UK governments.

AGENDA COMMITTEE to be proposed by NOTTINGHAMSHIRE: That conference views with alarm proposals contained in NHS England’s (NHSE) interim response to the ‘call for action for general practice’ to make CCGs co-commissioners of GP contracts and
(i) believes that this will fatally damage relations between CCGs and their constituents
(ii) warns that this will undermine CCGs’ chances of success in other areas of commissioning
(iii) predicts this will undermine the credibility of CCGs
(iv) asserts that conflicts of interests would be unacceptable
(v) insists that GP core contracts should not be held by CCGs.

AGENDA COMMITTEE to be proposed by WIRRAL That conference:
(i) rejects the concept of routine general practice care 8-8 seven days a week
(ii) believes that GPs will only provide routine planned care 8-8 seven days a week if resources are provided to the satisfaction of the profession
(iii) commends GPs for already providing unscheduled general practice care for 24 hours every day, seven days every week.

Source: BMA

Readers' comments (57)

  • In reply to some of the above:
    To stop A+E becoming overburdened A+E minors should attract a higher charge than a GP. A properly funded GP could take on much more minor injury work.
    GPs are reaching a point where the option is to close shop or introduce realistic funding. It doesn't matter at this stage what the public think because we have a moral responsibility to ensure the system is stabilized unlike the politicians who are just trying to get voted back in.
    Of douse GPs currently have no authority to bring in charges, but as a group we could force the end of the GMS contract. The government would be left with no choice but to allow us to operate in a real market rather than the present abusive monopoly employer situation.
    The cost of a consultation needs to be set at what encourages those on median incomes to consider if their use of the service is sensible. We should offer concessionary rates and reduce the cost of medicines for long term conditions which cost more if not managed appropriately.
    It is absolutely up to the doctors to have some input into the process of their payment because they are the ones offering their skills and labor, this is the same way the rest of the workforce operates.
    You cannot compare St Lucia to the UK as they are chalk and cheese. A fair comparison would be any European or Antiopdean nation and they all have some up front charges.
    It is fairly obvious that GPs could bring in charges even if this requires a change in the law - the dentists have already provided the model for this.
    We have to start the funding debate somewhere in a country with £1trillion debt and a demographic crisis. The LMC are getting the ball rolling. The current politicians refusal to consider alternatives is dishonest and likely to hurt more people if the NHS collapses into a disorderly mess.

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  • Charging the taxpayer without allowing him to set it against tax is not a good political move.It effectively amounts to double taxation and plays into the hands of those who wish to portray all GPs as lazy greedy money grabbers

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  • The politicos are terrified of bad press . The worst scenario for them is one of overcrowded A+E departments in winter . We have 9 months to plan their demise . Withdraw any work for OOH in February . It will not take the whole month 2 weeks will be enough . Then we can make a deal . No deal loses them the election.

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  • 8:18 Charging for appointments is not double taxation. We already pay surcharges for a whole range of government services. The tax system is not like a savings account, you cannot simply withdraw what you put in. GPs have already been portrayed as greedy money grabbers so it is too late for that argument, besides this does not happen in countries where there is an up front charge for access. In fact if primary care was funded in a sustainable manner then we would probably have to plead for resources less often and money would become less of an issue - we could then get on with the business of looking after the sick.

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  • Despite the attempt that the GPC made, it seemed with initial success, with the 2004 contract to change the method of funding of primary care and deliver increasing resources for increasing work, the politicians have deviously undermined that agreement by portraying us as greedy, overpaid and incompetent ever since. The 'John Wayne' contract lives and breathes, despite rumours of its demise in 2004.

    As a result of political bullying, with the full cooperation of the media, our leaders have been cowed into accepting worsening contractual obligations for GPs every year since 2004. The main problem being ever increasing workload, fuelled by the fantasy propagated by politicians that unlike any other field of human endeavour, an ever increasing, supposedly unlimited in fact, supply of high-quality produce is available within a strictly constrained budget.

    It seems to me that the strategy of shifting the public debate as to how a realistic and sustainable method of funding for primary care can be delivered is now entirely correct.

    On the contrary, the existing strategy of fighting for a reasonable contract without questioning the basic system within which that is delivered (the NHS free at point of delivery etc) has proven disastrous.

    Unfortunately we have played into the hands of politicians by letting them choose their battleground -- the danger being that GPs will now be portrayed as even more greedy because they are asking for payment for item of work done (or at least top up funding per consultation) and thereby undermining the principles of the NHS.

    The 2012 BMA strike to protest against changes to the NHS pension was not just ineffectual and misconceived (it seems that even the legal position had not been clarified in advance) but further undermined our standing in the eyes of the public, rather than engendering their sympathy -- because of what we chose to protest against.

    It must be clear to the public that, if we choose to protest in future, we are not campaigning simply for more money, rather we are campaigning for terms and conditions which permit us to deliver the service to the required standards in a sustainable way.

    Ultimately, the public have to realise that they cannot receive high-quality readily accessible care without the system being adequately funded. The question as to how that system is designed and funded should be opened to democratic debate.

    It seems to me at the moment we have politicians acting like an elected autocracy, certainly with regard to the design of the NHS -- remember the election pledge 'no top down changes' anyone? Maybe the politicians wish to stifle debate, whilst they implement a policy of privatisation by stealth?

    In conclusion, the political leaders of the medical profession in my opinion should advance the argument that the interests of the public and GP's, in securing a system adequately funded to deliver ready accessible and high-quality care, are aligned -- and not necessarily identical to the interests of their political lords and masters, who aspire mainly for their own reelection and quite possibly the piecemeal privatisation of the NHS.

    Privatisation may be inevitable but it should be subjected to public scrutiny and debate before it becomes irreversible.

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  • Please doctors do not vote for this - as this would be the end of the NHS free at the point of delivery - which is the whole ethos of the NHS = Patients currently value their GP more than any other establishment - you will destroy this cherrished place as the patients will never forgive you

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  • Of course, the NHS is not all free at the point of delivery. We pay when we attend a dentist or an optician, for example. We accept having to pay for check-ups, and paying extra for additional services.
    At present, GP practices cannot charge their own patients for any treatment provided. Enabling practices to charge for some extra services - think weekend and evening appointments, minor surgery, acupuncture - would be an incentive to introduce additional services and promote patient choice

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  • There was similar reservations re: dentists - yet they managed it and there hasn't been a collapse of care for vulnerable groups. Can any one recall a negative story about dentists in the last 5 years? or some report stating how uk dental care compares to the rest of the planet? No, neither can I.

    Time to leave the contract.

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  • Yes - and that's why we get dental problems coming through to primary care from time to time. I often decline to treat this but still, it shows the dynamics between money and access.

    I think Germany had a trial a few years ago of introducing 10EUR surcharge for primary care appointments. I understand it didn't curve the demand and increased demand else where in the system so it has now stopped.

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  • The cost and infrastructure for money handling, the effect on the doctor patient relationship, patients wanting their money's worth, no thanks
    Charging for home visits- that would be different, especially the Green argument!

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