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Should GPs charge for non-NHS services?

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I am writing this on a train up to Edinburgh for the LMCs Conference. I am reading the agenda for this annual meeting of medical leaders as the sheep and the fields rush by.

The agenda will set the policy direction for the next year for the BMA and contains the usual mix of the earnest and the absurd - lots of mentions of ‘disappointment’, ‘concern’ and ‘demands’ for change. There is a whole angry debate on the inadequacies of the GP Forward View - alongside a call for an apology from the GPC for the rescue package. 

It is not likely to top the drama of last year’s vote for mass resignation, although that did not turn out exactly as planned in the end. But there is yet another ‘no confidence’ vote on the CQC and a call for GPs to stop prescribing OTC medications.

But one debate is causing controversy. There are a series of calls for GPs to be able to charge their patients for non-NHS treatment, and this has already caused some national attention.

I have no idea how this vote will go. There seems to have been a big increase in companies offering fully private GP services and LMCs individually have recently been looking closely at how practices could get a piece of this action by charging their own patients for non-core work.

But the regulations are a minefield in this area (see here for a quick run-down) and proposals for wider GP charging have been rejected by previous LMCs Conferences, despite there being some support for it within the profession.

And no doubt there will be strong views on either side. Those voting for will argue that practice closures are at record levels and something has to be done to make general practice more sustainable. All businesses seek to diversify their income streams to ensure that they can survive.

On the other side, it will be portrayed as resulting in a two-tier service adversely affecting the most vulnerable, a retreat from the principle that the NHS should be ‘free at the point of use’ and perhaps even worse, will be a powerful new weapon for the Daily Mail to beat the profession over the head with.

Extending patient charging is a politically charged issue at the best of times, but having such a vote during an general election could be potentially explosive for the profession.  

I predict a lively debate at the conference tomorrow, I urge members to vote very carefully.

Nigel Praities is editor of Pulse

This motion was passed at the conference on Thursday - see the full story here

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Readers' comments (4)

  • X.Ray

    I find it utterly stupid that a consultant can remove big bits of you on either the NHS or privately but as a GP I cant remove an asymptomatic skin tag on the NHS or privately.

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  • Can we have an end to the cliché "2 tier health service " I have been hearing it since the 1980s.

    Food is essential

    When I consult my hungry stomach on a Friday night, must I go to Macdonalds....no! I begin to survey the multi-tiers of my culinary options at home at supermarket takeaway restaurant

    Two tier is good. Multitiered options even better. Anything else is COMMUNISM

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  • Of course we should and if we don't someone else will.

    General practice is on its last legs. The politicians don't care. The patients don't care until it affects them. The only people remaining to save us is GPs themselves.

    What is happening now is privatisation by default. As surgeries close, on-line GPs will step in to fill the demand. Services will be patchy as they were before 1948. The most vulnerable patients will be left to rot.

    Sacrificing GPs for political ideology is not on. Patients will loose out from it. We need to be realistic and do what the rest of the Europe somehow manages without having a 'two tier' service - regulated co-payment. The alternative is disorderly domino collapse of the NHS and a USA style free for all.

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  • GP is officially dead if Mrs May gets into power, RIP British general practice, whoever has advised her on health has only one agenda and that is the whole destruction of the NHS as we have known it, vote for it my English friends and weep, we have no effective say on the debate as we have been politically disenfranchised in the other uk nations and must do what the English electorate decide, gp is dead, democracy is dead, soon it will be thousands of unmet patient needs which will render them dead also,

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