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GPs should be able to charge their own patients for providing a private referral and

for any treatment not available locally on the NHS, LMCs

decided.

Representatives voted to instruct the GPC to negotiate a widening of the limited list of activities for which GPs can charge their own patients.

But the motion on private referrals was passed by just one vote after a debate revealed huge differences in opinion.

LMCs also rejected calls to widen the list to include out-of-hours services where the practice has opted out and

minor surgery at weekends.

Proposing the motion, Dr Raffi Assadourian, vice-chair of North East Hampshire LMC, said widening the list was about increasing choice for patients and doctors.

He said the present contract forced patients into the arms of private practices.

'If my patients want their own doctor to perform minor operations over the weekend, they have no choice.

'Even if they are prepared to pay for this they have no choice.'

He added: 'It is only fair that we should be able to charge for these costs rather than subsidising private care from our own pockets.'

Dr Greg Place, Nottinghamshire LMC chair, said patients ought to have the right to get services from their local GP that were not necessarily commissioned through the NHS.

He said: 'Patient choice is good, what about doctor choice as well?'

But other GPs warned that the moves would create a two-tier system.

Dr Ian Harper, chair of Merton, Sutton and Wands-worth LMC, said: 'These changes are limited, but

they would diminish the

trust and respect of our

patients.'

Dr Mike Griffiths, Gwent LMC member, said if GPs believed services were inadequate they should negotiate for more funding, not charge the patients.

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