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GPs buried under trusts' workload dump

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)

  • Paul Shenton is right for all the reasons he states above. Charging is a bad idea. - beware what you ask for. This would not be money to GPs. It would be a treasury tax collected by GPs, equivalent to a prescription charge, and would add to practice bureaucracy. It would also be a green light to the medical insurance industry. The way to deal with GP demand is to massively reduce bureaucracy on practices, invest in GP infrastructure and staff, and on the right services in the community for those that should have them. A mass media health literaqcy/ education campaign from NHSE/S/W/NI and DH on how to use and how not to use the NHS would also be the right thing to do, but that would require ministers taking risks, which of course they hate. But above all, someone needs to nuke the DM. Any takers?

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  • 1.02 There is a difference between charging and privatization. It doesn't matter if the nominal fee goes to the treasury - so long as we are paid a bit to collect the money. I agree charging is no panacea and community services particularly district nursing are struggling but a charge would help stymie some of the excess demand and return much needed revenue to the exchequer - this works in Europe. The government also desperately need to reform the medico-legal industry (too few winners) and sort out the other bottlenecks like residential care. It will be impossible to change the culture of consumerism in the world of 24 hour supermarkets and internet shopping so the best option is to charge extra for premium usage like out of hours and A+E and transfer this money to more cost effective services.

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  • At last some sanity! Point of entry should never be free: Free / Cheap is rightly seen by public as Cheap / low value. The principle: Free doctors are bad doctors ... if they were any good / in demand they would have charged. Ask £10 per 10 min. visit: End of the day... GP have £200 in pocket ... but better GP (who saw 60 patients) has £600. Those patients without money get £10 cash voucher from JSP / DWP. Those that want to chat to GP for 30 min pay £30. Simples

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  • Has anyone polled the poor old end users, seems to me a bit of horse before the cart.

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  • @ Pieter Jooste

    Patients with multiple complex health conditions don't 'want' to spend 30 minutes with their GP, they wish they were well and able to stay away from the place!

    A £/min scheme is the worst of all worlds - if the GP extends the appointment because they feel there is a clinical need to do so (or because they have identified their own opportunity for learning) does the patient still pay for the extra minutes?

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  • Unfortunately those out of work would probably not have to pay anyway and they make up the majority of who I see. Once again the working middle class would get shafted with any kind of payment scheme. Pity the daily wailers don't realise this

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  • 3.40 Those on benefits could pay a much reduced fee as could minimum wagers. Its the sharp elbowed 'worried well' middle classes that we need to filter out. Those coming in for Chronic disease management appointments could be exempt for these although one would expect those appointments to follow disease demographics ie mainly go to the poorest in society. This would be better than the current system where those with most need compete for appointments on an even basis with those who have minor complaints - this is intrinsically unfair.

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  • 4:30 yes there would be ways round it and every surgeries population are different. Where I work yes the worried well take up appointments but these worried well are all on benefits with too much time on their hands. I agree that if this system were to go ahead that even on benefits u should have to pay some kind off fee so it's fair all round.

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  • 'HALF OF GPS' in favour of charging?
    Sample size 440
    So about 0.5% of GPs favour charging
    Why feed the Daily Mail with headlines like this?

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  • User charges are a classic policy zombie (an idea that, however often killed off by research evidence, refuses to die). Please see https://sites.google.com/a/york.ac.uk/york-health-policy-group/blog19july2013 for a summary of relevant evidence and many reasons why this is a terrible idea.

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