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CAMHS won't see you now

79% of people think Government should charge for missed GP appointments

Around eight in ten people believe the Government should consider charging patients for missed GP appointments as a policy, a major pre-election poll of 20,000 British adults has found.

‘The people, the parties and the NHS’ report by Lord Ashcroft Polls found that ‘anger’ about misuse of services meant 79% of respondents believed charging for DNAs would be an effective route to raise extra funding.

Though some pointed out that the time cost in recovering fines would likely hinder implementation of the scheme, there was widespread support, particularly amongst those who have had difficulty in arranging an appointment.

The report states: ‘As well as concern about the numbers of people apparently using the NHS without having helped to pay for it, there was anger about those who abused the service, particularly by failing to turn up for GP appointments.

‘The poll found nearly four-fifths (79%) saying the Government should consider charging people for missed appointments as a way of raising extra funding.’

Pulse reported before Christmas that GPs in Northern Ireland were increasingly deploying a ‘three strikes and you’re out’ rule to curb the 10,000 DNAs they experience each week.

And the DNA rate has also been used as evidence against seven day working, after a study of missed appointments in hospital outpatient clinics found the rate doubled at weekends.

Readers' comments (15)

  • Vinci Ho

    See , the rate of DNAs is doubled in weekends . Until that is ironed out , stop talking 7 days opening for everything !
    The penalty fee acquired for DNAs must be reused in NHS , not to plug holes of deficits elswhere!

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  • Great idea, completely unworkable in practice.

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  • A good example of the public saying yes to something unworkable, without having to put a shred of thought into the mechanics of it.
    How are you going to charge the DNAs? And if they don't pay send the bailiffs? Refuse to treat them again until they pay, that's a moral minefield. Get into raging arguments with them claiming they did cancel, that they tried to but the phones were always engaged, that their elderly mother had been rushed into hospital etc etc etc.

    The idea sounds fine if you apply an IQ less than 100 to it. Meanwhile in the real world it is bonkers and unworkable.

    However there is a workable and perfect solution. Charge everyone some amount say £20 to book an appointment. Non-refundable under any circumstances. That way you have already collected the DNA fee before they DNA, and demand for appts each day will drop enough that pressure will be taken off all practices so that those who do need to see the doctor can actually get an appointment.

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  • I agree with practice Manager 2.06. Bravo my friend.

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  • That idea still wont work as most of my attenders will be in exempted group - >65, <18, chronic disase, unemployed etc etc. The only people who will be paying will be those that work - majority of whom don't tend to DNA as they know it'llbe difficult to get time off to attend again.

    Far more workable is the credit system- annual attendance allowance of x3 GP visit/year, x1 AED visit/year. Beyond which they will be refused medical treatment unless upfront payment is made or it is immediately life threatening problem.

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  • "Anonymous | GP Partner | 14 January 2015 2:55pm
    That idea still wont work as most of my attenders will be in exempted group - >65, <18, chronic disase, unemployed etc etc. "

    Who said there would be an exempted group? I wouldn't allow any exemptions, period. Make the charge to suit, say £5 or £10. Just enough to make people think, "do I really need to see the doc or would a 20p pack of paracetamol from tesco do the job?"

    And while we are at it, make everyone pay for prescriptions, no exemptions. Minimal charge same for everyone, say £1. It would not only raise far more money than is done now, but it would completely and utterly end prescription payment fraud. It would mostly stop the stockpiling of untaken medicines which many people collect month after month simply because it is free.

    Many of the NHS problems could be solved overnight if the British people could undergo therapy to liberate them from their brainwashed cult religion of the "free" NHS.

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  • "Anonymous | GP Partner | 14 January 2015 2:55pm

    Far more workable is the credit system- annual attendance allowance of x3 GP visit/year, x1 AED visit/year. Beyond which they will be refused medical treatment unless upfront payment is made or it is immediately life threatening problem."

    Unworkable. Someone has to keep a count of their attendances, so there's a cost and a bureaucracy. People attend A&E in different locations while away for the day, while on hols, while visiting relatives etc so you are going to need a single central massive database. What about counting GP attendances if they present as T/R somewhere, change GP etc etc. Think through the hard, fine details of how any scheme would work and most don't. Making people pay hard cash, there on the spot, needs no new bureaucracy.

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  • so why don't those who are entitled to NHS treatment, have to carry a card proving this. this card would also hold at least basic medical info & the number of allocated 'credits' already used, on a chip. if you book an appt without a card - you have to pay..... Everyone gets issued a NI card - surely it is no more difficult / expensive?

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  • "Anonymous | Sessional/Locum GP | 14 January 2015 7:08pm
    so why don't those who are entitled to NHS treatment, have to carry a card proving this. this card would also hold at least basic medical info & the number of allocated 'credits' already used, on a chip. if you book an appt without a card - you have to pay..... Everyone gets issued a NI card - surely it is no more difficult / expensive?"

    Because there's a huge cost setting that up and running it, probably tens or hundreds of millions £. Because people will lose/forget the card and need to see a doctor now and get into raging arguments in reception. Because computer errors happen and some people will deny they have used their credit and another raging argument happens in reception.

    Cash, now, or no appointment booked, no exceptions. Simple, infallible, cheap.

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  • In realistic world- no way u can charge DNAers, ethically/logistics
    In this day and age when nothing is freein this world and current changes in NHS are moving towards privatisation, answer to above dilemma Is a small fee to see ur GP. I bet £1-£5 upfront to make an app will be enough for offenders to think 10 times before making any app. And this nominal fee is quite justified in comparison to other health systems in world. Though moaners are going to moan about this as well despite their spending of more than £5 on a ciggeret box everyday.

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  • Cash upfront! Say a tenner? That'd mean 4-5k in the practice at 6pm when the masked men come in!
    Why not paint a target on the door saying 'rob us' whilst we throw away a founding principle of the NHS.

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  • I think almost all patients feel that GP surgeries should be charged / penalized if they are not given an appointment when requested.

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  • I work in AQP pay per visit GPSI service. If patient DNAs I don't get paid. It makes me utterly furious. This can happen repeatedly and the service apparently can't ban repeat offenders. They should pay. Dentists can work this scheme I'm sure we can.

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  • If everybody paid £5 on initial consultation then free if the GP needed to review for the presenting complaint. Make the first appointment 20 mins the 10 mins for review. We could then have an additional GP in the premises with the money received per annum.

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  • DNA's … if you miss one appointment, prevent any further pre booking, make the patient turn up on the day and wait to see a duty doctor … if DNA patients change practice, make sure their records records highlight they are on a DNA list so the same rule applies.
    Making folk pay may mean some folk stop taking medication and end up in A&E, especially the vulnerable.
    Stop issuing medication on scripts that can be purchase OTC if it cost less than £10.

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