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GPs buried under trusts' workload dump

NHS users should pay £10 a month, says former health minister

Patients in the UK should start paying a £10-a-month NHS ‘membership charge’ to save it from its funding crisis and help pay for annual MoT checks for everyone, a former Labour health minister has urged.

Lord Warner, who served under Tony Blair, warns that the NHS will become unsustainable without new sources of funding and painful changes, and recommends that everyone who is eligible for prescription charges should have to pay the £10-a-month charge.

This report followed a Pulse survey last year that showed more than half of GPs were in favour of charging for appointments.

The report, co-authored with Jack O’Sullivan, an expert in new thinking in health and social care, for the think-tank Reform said dramatic action was needed as the NHS faces an expected £30bn-a-year gap by 2020 between the demand for healthcare and its ability to respond.

It said: ‘A membership fee of £10 a month for all adults, with similar exemptions to those for prescription charges, would leave about 23 million people paying an annual fee. This would raise over £2bn a year for local programmes. We think that such a scheme might be popular, if the money went directly to local programmes rather than into central government coffers.’

It added: ‘NHS Membership could entitle more people than now to an annual “Health MOT”, running basic health checks. It would review progress over the previous year, agreeing individualised goals and NHS support for the coming year, with a focus on management of chronic conditions and more support for carers.’

Commenting on the proposals, Dr Ian Wilson, chairman of the BMA’s Representative Body, said: ‘Whilst some of [Lord Warner’s] proposals merit closer examination, resolving under-funding should not be at the expense of the most vulnerable in society nor at the fundamental principle that the NHS needs to be free at the point of use and the BMA firmly believes that charging for patients is not the solution’.

Meanwhile, a recent opinion poll revealed that Britons are overwhelmingly against the introduction of GP charges to help the NHS balance its books.

According to the ComRes poll of 2,039 adults, commissioned by the Whitehouse Consultancy, a Westminster firm specialising in healthcare, one in four people said they would be willing to pay £10 for a GP visit rather than see their practice shutting down, but more than double that – 56% – were against.

The Pulse survey last year found 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.

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.  

This was followed by a separate report from Reform that found that charging patients £10 a time to visit their GP would raise an extra £1.2bn a year in England.

Readers' comments (31)

  • Hmm, and those most in need that are unable to afford this cost and need frequent GP attendances, what do they do?

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  • >what do they do?

    Sorting out the lower end isn't a problem - it's easy to arrange exemptions for those of a certain income, or reduced fees for chronic conditions. There are lots of possibilities.

    Let's not let small things distract us from the overview - £80 per year for unlimited GP care is not sustainable.

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  • Una Coales

    From the comments on BBC news websites and other sites today, the mere thought of paying £10/month is being met with a lot of hostility and entitlement to a totally free NHS. This means NHS GPs you are not going to get any public support or sympathy, and it is a case of each GP look out for yourself as the government continue to drop a pile of s%# on you to force you to leave any way shape or how and that includes making your appraisal as stressful as possible, revalidation as punitive and remediation impossible to keep self funding.

    They will put up huge hurdles and cut off funding to keep state NHS GPs from returning. They have not finished yet. Trainers will be forced to pay the wages of trainees so there will be no trainers of state NHS GPs.

    I am sorry but the only solution now has to be industrial action or a full strike as the last chance to save the NHS GP. The naive public have no idea that when the last NHS GP partnership is dissolved, privatisation will continue and it will not be £10/month for private medical insurance but more like £60/month for basic cover before top ups.

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  • In Sweden a public referendum was held to decide how best to support the Swedish healthcare system which whilst modelled on the NHS, was effectively being bankrupted by public demand (ring any bells?) The choice was: to pay an annual stipend per capita to support health care being free at point of contact or to opt for payment at point of contact for everything outside genuine emergency assessement and treatment. The public voted for the latter, and today have a health system which is efficient, effective and capable of manageing public demand because the public have been educated in the fiscal difference between clinical need and public demand!! Which I may suggest is exactly what needs to happen in the UK

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  • He also said there will be a £30 billion funding gap. If everyone in England paid £10 a month this would only raise £6 billion. Meanwhile Old Etonian Osbourne claims today that we are getting record tax reductions. NHS funding is paying for the tax cuts. If we want good quality NHS care we have to pay for it.

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  • I really dont think the British public is as reasonable as the Swedish.....this is all going to be very painful for GPS as Una quite rightly points out

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  • Lord Warner and the thinktank Reform are involved with the private health business, so they are not in any way "independent". Even so do their proposals have any merit? Not in my opinion. Bringing in additional income streams will undermine the basis of the NHS and cause harm to the poorest in our society. If more money is required for the NHS then it must come from taxation.

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  • Before we charge UK residents. How about ensuring people from abroad pay for any care given when they are not residents of the UK. Currently, hospitals and community services have a 'duty of care' to all who require medical care and once the care is complete the patient disappears back home and the bill for care remains unpaid. Sort this first then reassess.

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  • I find it deeply concerning that there is talk of charging anything for access to any service provided under the NHS which is supposed to be FREE at the point of contact. This would be the thin end of the wedge, leading to charging for A&E attendance, referrals to Consultants and other parts of the NHS, all talk of payment from patients for the services of the NHS should be stopped before the current Government get their way and fully install a 2 tier Health Service.

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  • I'll go to A&E for free thanks!
    For someone like myself (I rearely see a GP) I can get private care for the same amount - or will the price of this then skyrocket!
    Will this be an enforceable tax like the tv licence fee?
    Who gets the monety the DH who then sign it over to the treasury to patch over Osbornes deficit holes?

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  • I didnt think I was paying enough national insurance and tax so another £10 a month will solve that problem!!!

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  • Lord Warner is a well known Thinker Without A Thought.

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  • Anon 1203 - Why does George Osborne's school have anything to do with it? Get the chip off your socialist shoulder.

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  • OK. I am reasonably fit, take regular exercise and thankfully very rarely see my GP so would it be right that I should pay the same as some McDonalds loving smoking obese couch potato who probably has several diseases purely brought on but their own lifestyle. Would it be right that I should have to subsidise them? Sorry, make that subsidise them even more! Payment per appointment is the way to go.

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  • Dr Mustapha Tahir

    A GPs only constituents are his Patients. GPs should therefore listen and support the views of the Patient's Association in this debate. Politicians have never been and will never be on the side of GPs.

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  • Payment per appointment has not been down to reduce burden on primary care. Germany tested similar model and referred back to free at point of care as it did not work.

    I believe the answer is the other way round. Patients will have health credit each year (say free 3 GP appointments and one AED/year, initiated by patient. Appointment initiated by GP is free) after which they are chargeable. Referral to secondary care is chargeable except for cancer. Patients with chronic disease will have to apply for exemption via social care funding and these will be reflected back in our global sum. We don't directly get involved in taking money from patients so no conflict of interest. And each patient would have electronic NHS card with central credit record, so it will solve the problem of eligibility to NHS treatment as well.

    Only problem? It won't be cheap to implement :-)

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  • There is nothing to debate here.
    80 or so for the eat all your like buffet is n't adequate.
    Isolating primary care from the NHS: it's cheap, effective and good enough. Even pension 'pot' is in credit.
    We just need to stop the investment falling and restore balance to primary care by correcting the previous centrally engineered cuts, then a world leading primary care service will race ahead once more.

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  • Vinci Ho

    This debate will go on forever as expected.
    If any politician has some guts, propose a referendum!!

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  • It's strange that people think the NHS is free - it's not. We're already paying taxes which pay for the NHS. Just put up taxation or switch funds raised by taxation away from something else and into the NHS, and make sure no one evades or avoids tax so that the rich pay more and the poorer pay less.

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  • "GPs should therefore listen and support the views of the Patient's Association"
    --

    You must be joking. The patient's association are always at the front of the queue when it comes to NHS bashing (well ok - just behind the Daily Mail).

    And they are largely funded by private companies - impartial they are not...

    http://www.patients-association.com/Default.aspx?tabid=78

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  • Peter Swinyard

    interesting comment from Anonymous | 31 March 2014 12:21pm about getting in to hospitals the fees they should get from foreign nationals. The only way to do this is a credit card swipe from all entering hospitals - no charge to the entitled and a reasonable chance of recovery from those not entitled. The recovery rate of income managed by some hospital trusts is truly pitiful.

    On the 3.27pm comment, the Patients Association is an interesting beast - will not divulge how many members they have - one suspects not many. I debated "the end of GPs as we know it" with a representative of the patients association a week ago yesterday on Radio 5 Live (don't worry if you missed it...). They put up a retired GP who wanted to tell me that he and his partner used to have a list of 8000 patients and the two of them looked after them round the clock and he thinks modern GPs are slackers and moaners. I ventured to say that the day job is immensely more complex than it was in the "good old days".

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  • Took Early Retirement

    I think many of those who looked after lists of 4000 in the "good old days" are deluding themselves. the standard of care was often pretty abysmal from what one hears.
    A former partner at my place (now dead) used to consult at 2.5 minute intervals- yes, dear reader, 150 seconds and was heard to say "my patients are either well, or in hospital".

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  • Took Early Retirement

    Funny how the Noble Lord changes his tune once no longer in a Labour Govt!

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  • Bob Hodges

    I love the boys and their 'in my day anecdotes'.

    They could manage a list of thousands all by themselves, and still fit in more rounds of golf in an average working week than I manage trips to the toilet.

    Shame everyone died prematurely.

    The average person now has a better life expectancy than their GP.

    Priceless.

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  • let's forget worrying about support of anybody, bad press etc..... it is time to be radical, for the sake of our profession, our health and, oddly enough, for the ultimate good of our patients! No pain, no gain, but without a significant upheaval, nothing will change, and general practice will continue to die - we're being pushed out, and I'm not looking to stay much longer, as I see no satisfaction dealing with consumers who think they know better than highly trained professionals and contribute so little to sustaining the NHS!

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  • Quit en masse, government will lose next election. Simple. Shame as a profession we have no cahoonies to do so.......im in oz! 30'something ex-gp partner

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  • well said, 10.30am.....only growing a real pair and taking such action will things change, but oh well, ain't gonna happen during my career, so Oz beckons, or private practice and other fun things!

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  • In many ways I love my job.
    i am able to establish a caring relationship with patients and their families over many years which allow them to trust me to put their care ahead any monetary need.
    I am saddened to see that most politicians (and the daily Wail) fail to grasp that GPs care about their patients.
    We need politicians with balls to stand up for the true needs of patients, continuity of care with good access and no political interference.

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  • He suggests £10 a month, as an incentive to get people to live healthier?? That is just another tax!!
    If patients had to pay £10 for each Dr contact, and start putting some value on the service they get, they might start to think - can I treat this myself, what could I have doen to prevent this? That is the onyl way forward a co-payment for a pay as you use service.

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  • the only way forward is to leave the NHS contract and have a system of direct payments (fairer) based on time/activity like almost all other services e.g. solicitors, barristers, dentists, accountants, etc.

    Indirect payments (insurance and government backed schemes preferably pre-paid vouchers) could also exist.

    Such a system is fairer and will still provide a safety net (government backed) for the poor but we would not be held hostage to unlimited demand for a fixed fee. It will solve supply/demand issues.

    Hard working GPs will be rewarded and could expand to cope with demand as they will have the resources coming in and best of all such a system will be free of NHSE interference and incompetence as income will be direct from the patient.

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  • We do pay every month, it is called a national Insurance contribution!

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