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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)

  • I would:
    Vote for a connection between practice income and practice appointments per 1000 patients and each year adjust the recommended number of appointments based on the pay increment (chuckling inside), inflation and expenses. The adjusted number should be made by the BMA (not the government), Any extras forwarded to A+E.

    If you really want attach a caveat that charging for appointments might be a way to help the situation.

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  • It is not up to us to decide if we need to start charging patients. Government has got to come up with a plan on how to do this as we do not legally have the right to do this.
    If we decide we want to do this, what the government's response will be is- ' We gave the GPs the budget, they misused it and now they want to charge you. We will protect you from them and pass a law strictly prohibiting any GP from charging.'
    I agree with charging patients but it is not up to us to initiate.

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  • Let GPs charge whatever the market will bear yet retain the right to refer to NHS services and NHS scripts:

    http://libertarianhome.co.uk/2014/04/your-nhs-gp-is-a-libertarian-but-doesnt-know-it/

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  • I have worked in systems where the patient pays for a consultation. And no it was not not somewhere like Australia or Europe, but a mission hospital in St Lucia where people would pay a week's wages to see a dr. It didn't reduce work load, but it did did change the dynamics of the consultation. It led to increased investigations, longer consultations, more demand as a right by patients, and people would continue bringing their children even if you had seen them only a day or so earlier for the same self limiting conditions that you had tried to educate them to self treat.
    So no, not a good idea, not a safe idea, and not a cost effective idea.

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  • I don't understand how a GP CAN charge for a consultation - don't you provide the consultation as part of your contract with the NHS? In which case, you are simple the service provider and not the author of the service ergo if the government says free at point of delivery, then it will stay free - the only thing a GP can do is refuse to provide the service - and so lose their contract for all GP services. It seems someone has spent a lot of time and effort on something you can't actually implement without government support - and, I would hazard, a change in the statutes

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  • @ Mr Eggleston : just to say obvious that GPs are asking for contract change! Is there any problem doing that? what do you mean by 'simple service provider'? Like in your contract you charge by every prescription you dispense, similarly GPs are asking for fairness, if they see more patients they will be paid more (per patient or slot basis) , simple ! At the moment this is being paid as block payment, in other word bottomless contract where it is unlimited minutes for fixed bill (by the way - phone company is clever enough to put small print as 'fair usage' but not our negotiator colleagues) !

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  • If you charge patients, then would you also be eligible for MPIG or NHS money, surely you cann't get paid twice for same service

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  • 06 May 2014 5:35pm

    Have read suggested link - good stuff !

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  • I think we are talking about NHS getting the money, not individual GP practice.

    I quite agree with the medical student this is a double edged sword and our hapless leaders are yet again being out maneuvered into voting for unpopular move which will direct the wrath of the nation at our feet. They should have had the intelligence and the tenacity to force government into starting this debate but alas no - they are too naive to be paying a political game.

    We should be paid per consultation now - all secondary care are, why can we not have the same?

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  • The important message is that the debate on different care models has started whether or not it is fair to charge or not it is worth exploring the issue.

    Hopefully we will end up with a better and more sustainable health care model in the end.

    What is clear is that the current NHS model is not sustainable and doing nothing or hoping for government funding is not an option.

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