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Charge patients for missed GP appointments, says report

Charging patients for missing a GP appointment or going to A&E unnecessarily would have public support, concludes a report published today.

The King’s Fund study found although the public did not want to change the basic funding structure of the NHS, where care is free at the point of delivery, there was some support for charges in certain circumstances.

In a report published today, the think-tank looked at the result of focus groups discussing NHS charges. They found support for charging for those with ‘self-inflicted’ illnesses, such as obesity or lung cancer.

The study participants also supported the introduction of fees to attend walk-in clinics - because the increased flexibility they offer made them a ‘commodity’ - and procedures such as cosmetic surgery or elective caesarean sections. They also supported charges for missing appointments.

The report said: ‘When thinking about who should pay, and for what, many participants discussed those who are perceived to “abuse” the system. Discouraging or penalising this was seen as important. Almost all groups mentioned drunks in A&E departments at weekends.’

‘Another category of people mentioned was those whose illnesses are self-inflicted, such as those who do not exercise or control their diet and, as a consequence, are obese, or those who smoke and have lung cancer. Many thought these people should be responsible for the consequences of their decisions.’

‘Others mentioned people who miss planned hospital and GP appointments and those who do not make good use of the system, for example, those who go to the A&E department when they should be going to their GP first.

‘To prevent this from happening, some thought investing time and effort in educating people on how to use the health service appropriately would save money in the long term.’

But the researchers opened up for a wider range of services to become subject to fees as long as they were introduced ‘incrementally’. They concluded that people were more likely to support fees for services they already have to pay for, such as opticians and dentists appointments.

The report said: ‘For example, small charges could be introduced for some services that are seen to be discretionary, such as walk-in centres. As acceptability of this grows, those charges could then be increased or extended to other services.’

Anna Dixon, The King’s Fund policy director, said: ‘Although difficult choices lie ahead, politicians have been reluctant to discuss the future funding challenge facing the NHS. This research shows that people want to engage with these issues.’

‘With pressures to spend more on health care growing and the public finances likely to be under considerable strain for the foreseeable future, it is time for an informed public debate about how much we should spend on the NHS and how this should be funded.’

GPC deputy chair Dr Richard Vautrey commented: ‘There are already many charges within the NHS, for instance dental charges, opticians and prescription charges but it would be a dangerous slippery slope to introduce further charges, particularly if they acted as barriers to patients seeking appropriate access to healthcare.

‘We don’t want to go back to the pre-NHS days, or move to a US style of healthcare, where large numbers of people can no longer get the healthcare they need because they can’t afford it or cannot get or afford insurance.’

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Readers' comments (17)

  • Vinci Ho

    There are two distinct concepts in here:
    (1) it is perhaps justified to 'penalise' DNAs if the appointments were just ignored by patients ( not necessarily the case ALL the time)
    (2) it is contentious to label 'self influcted' illnesses and charged patients for treatments . I don't think you can use the word penalty here.
    It is rather 'suspicious' about the motive behind this study. We are all quite aware of the stance of King's Fund and its studies from time to time........

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  • Bornjovial

    We have a system to send a reminder letter to patients if they miss THREE OR MORE appointments a year! This was actually voted for by the patient participation group. Unfortunately some patients feel so angry to get these letters! Wonder what would happen if we start charging for DNA. I support charging for DNA. That said hospitals should aim to send a txt before appointments where possible to ensure patients have received their appointment letter. If there is no proof that patient received an appointment letter (unless they booked the appointment themselves via C&B) one cannot legitimately charge for DNA.
    Can PULSE do a quick opinion poll on how many doctors support this.
    As with Vinci Ho, charging for inappropriate visits to A&E and "self inflicted diseases" would be morally wrong and difficult to define in the first place.

    Also does Kings Fund suggest we fine 111 service if they advise a patient to go to A&E unnecessarily or call an ambulance unnecessarily!!!

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  • Simple idea. Good idea.

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  • The problem is a lot of my DNAs are my poorest and most vulnerable patients. I think there is a real risk of targeting the people who are the hardest to reach with financial punishments (which might also impact on QOF achievement). Those people are likely to be the least able to pay which is not really what medicine should be about no matter how annoying DNAs are. I can usually use the time productively anyway either as catch up slots or doing paperwork and we always end up bolting on slots so it evens out in the end. Likewise most so called self inflicted conditions are usually of greater prevalence amongst the poor and its surely grossly harsh to demonize smokers with cancer and the obese who have little knowledge about or access to nutritional food. Whats self inflicted anyway? A skiing injury? It's too hard to know where to draw the line and anyway a lot of people who we might consider 'badly behaved' are real people who are loved and valued for the other contributions they make to society. Would you want to discourage your teenager from seeking emergency help if he was injured whilst out drunk? The Kings fund proposal is masking a fairly obvious hidden agenda. Beware!

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  • Just rearranging the chairs on the Titanic folks.You've got to make the British people accountable for their actions and that cannot happen under a state run enterprise like the NHS where the politicians have strong vested interests to continue with the status quo.

    Personally i don't get riled up when patients miss appointments as i get a well deserved break in my busy scedule.If they want to attend A/E that's the government's problem not mine.When you have a complete disconnect between supply and demand in any free at point of delivery service this is what happens.

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  • This is a crazy idea. Why would we want to collect money on behalf of the govt?

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  • I don't think deprivation has anything to do with DNAs. If you don't DNA, you don't get charged. no money lost, doesn't matter how poor you are. Simple.

    I agree, at some point we need to ask the public to be responsible for their own action. We cannot continue to provide free health care for everyone indefinitely and at some point we need to start asking people look after their own health, or face the consequences.

    But I agree with Vinci, AED and self inflicted is contentious. We should blanket charge everyone from start of 2020, tell the public to start getting themselves from now.

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  • Anon, 9.05. Because the govt pay you on behalf of the people? Incredible......

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  • 09.41 Deprivation is fairly obviously related to DNAs - just go and do a locum in an inner city practice and you'll see what I mean. Poor people often lead chaotic lives for a large number of complex interrelated reasons and therefore miss appointments. Judging them may make you feel a little better but doesn't actually help that much. General practice is a place for more carrot and less stick.

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  • What do they mean get patients used to paying. For what en exactly.

    Look if people want to charge patients. Fine, no problem, go and setup private practice. Do not ruin the nhs for greed. It is a good and honest top quality institution.

    Free at the point of delivery is a central principle of the nhs. These are the same people that recommend practice sizes of 35000. They are a lost organisation. Total has beens. They used to be respected, but they have been rejected but I know feel that hey are rejected by the clinical community.

    - anonymous salaried!

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