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Thinking the unthinkable

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Rarely has a Pulse survey attracted such widespread coverage – and rarely has it prompted such intense debate.

In a story we published yesterday, we reported that in a poll of some 440 GPs, 51% said they would support charging a small fee for GP appointments. Some 36% said they would not support charging, with the rest ‘don’t knows’.

It was a striking finding – not least because in a similar poll we conducted last September, only 34% of GPs said they would support charging – and it’s been covered widely in the national press today, on the front page of the Daily Express and ‘I’, and in the Guardian, Independent and the Times among others.

Much of the reaction has been very hostile, as you would expect. Any suggestion that patients could be charged for access to the NHS is a hugely controversial one; any suggestion that it could be GPs who do the charging doubly so. Many have been disbelieving that so many GPs could support such an idea, and there have been the usual misguided attacks on ‘greedy GPs’ as a result.

Yet read the comments from those who responded to our survey – or indeed the comments that have been left since we published the story – and it is clear that many grassroots GPs do believe that it may now be time to introduce a charge. Not to make money or unfairly penalise patients, simply to help manage demand and help general practice cope with an unsustainable workload.

Peverley – our award-winning columnist, and the weary voice of a profession if ever there was one – put the case eloquently but robustly in a piece he wrote this time last year: ‘Free at the point of abuse

This profession deeply depresses me at times, and it always comes back to the fact that our services are free at the point of use (or abuse, if you will).

Some 90% of my time, or rather 100% on the day of supposed industrial action, is taken up by about 5% of our patients, and there is no evidence to suggest that they are the 5% that need it most…

The patients we are actually here for cannot get easily accessible appointments because of the tedious minority who spend far too much of our time indulging their hobby of free, self-indulgent self-aggrandisement.

I honestly believe that the time for free access to medical care is over; ruined by the selfish few.

So does that mean GPs as a profession really want to charge patients? No. Many are vehemently opposed, believing that any kind of charge would irrevocably damage the doctor-patient relationship and would be the first step on a slippery slope towards privatisation.

I would also argue that no matter how they responded to the survey, the vast majority of GPs fervently believe in the principle of an NHS which is free at the point of delivery, and if they now support charges do so only with the greatest reluctance. There are all kinds of problems – practical, moral, ethical – with charging patients. Ministers have already firmly said they have no plans to do any such thing, but I’d hazard a bet that if Jeremy Hunt were to turn around tomorrow and try to introduce a charge, the profession as one would rise up in opposition.

No, what this survey result shows is that general practice is now creaking under intense, unprecedented pressure, with a backdrop of rising patient demand matched by a huge increase in GPs’ workload over the past year, thanks largely to commissioning and the imposed GP contract. While some of today’s headlines are inevitably negative, it can only be a good thing that this pressure, workload and the stress GPs face are being discussed more widely in the national media.

Charging may not be the answer, but the views of GPs expressed in this poll should serve as a wake-up call to both politicians and the public. Politicians must realise that GPs are now stretched to breaking point. And the public must realise that while it’s all very well bashing GPs for thinking the unthinkable, how a cash-strapped NHS copes with rising demand is a debate we’re all going to have to take part in over the next few years.


On methodology

Finally, a quick word about the survey’s methology. The survey – and indeed Pulse itself – has come in for some pretty harsh criticism online from those who oppose charging, who believe it is flawed and therefore not representative of the views of the wider GP population. (Dr AnneMarie Cunningham has very thoroughly summarised some of the concerns here).

We ran the survey through SurveyMonkey, asking a series of questions covering multiple GP topics to avoid selection bias. It was advertised to all of our readers through our website and email newsletters, and we offered the incentive of a Kindle Fire which will be awarded to one randomly chosen respondent.

We received several hundred responses from readers across the UK. As part of the questionnaire respondents were asked to provide their job title. We then screened out a small number non-GPs to analyse the results for this question.

Such a survey is obviously not a scientific study, and was not weighted in any way. However it was conducted in exactly the same way as we always conduct surveys and from past experience the results we get from readers closely match the wider views of the profession. This survey, for instance, accurately predicted the poor turnout in last year’s pensions industrial action, while our findings in January on what GPs were doing to prepare for the contract imposition were echoed by medical accountants. The current survey also covered a wide range of topics and its findings on NHS 111 seem to reflect polls elsewhere, while an unpublished finding that between 53% and 72% of GPs have signed up to the new DESs seems similar to what official figures from local area teams show).

So, it was a small, unweighted sample, and in no way scientific research. But we’re confident the findings reflect the views of our readers – even if those who support charging are perhaps those least likely to be politically active and make their voice heard.

(You can also read a much better informed analysis of the survey methodology, our reporting of it and potential weaknesses from the Picker Institue’s director of research and policy Chris Graham.)

Steve Nowottny is the editor of Pulse. You can follow him on Twitter @stevenowottny.


Readers' comments (14)

  • I think this survey has done a huge amount of harm to the profession. The press are reporting that 50% of GPs are in favour of charging patients for their services. This on top of the unfavourable reporting of GP pay is all reducing the standing of the profession in the public eye.
    Now as a GP, I know our pay is dropping, I know the headline rate in the Daily Mail is pure fantasy for the vast majority of us and I realise that most of this is due to government spin to keep us in line. However say something enough times and it becomes a fact. 220 responses to a survey are now being held up as proof that we are all in favour of charging patients because we think we work too hard despite getting four times the average national pay. Is this really what we all think? I became a GP because that is what I wanted to be. I didn't go into medicine for money or for an easy life. I knew I would work hard all my working life and retire with the satisfaction of having made a difference in a job that is truly worthwhile. Don't suppose the Daily Mail will publish that though.

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  • the time for charging has come. it's time to change our thinking guys. we worry too much about public perception which is so poor that it's driving our brightest away from the UK. something needs to be done.

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  • "I would also argue that no matter how they responded to the survey, the vast majority of GPs fervently believe in the principle of an NHS which is free at the point of delivery"
    There is no evidence for this statement, in fact free at the point of delivery may well be the cuase of the current harms that are splashed daily over the Red Tops due to unrealistic demands. Anecdotally, I'd say a lot of us are quite fed up with the gradual chipping away of our terms of serivce and would welcome a pay per use model so long as it didn't cause unnecessary hardship.

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  • The question for me is how long to wait for positive change, if it is ever to happen, before taking (very) early retirement. .

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  • The problem is that the patient demand and expectations are increasing significantly, year on year. Working flat-out 12 hour days, without a tea-break, let alone lunch-break, is truly utterly exhausting. I can't keep this up, yet every year it gets worse. There's no way to modulate the demand, and you can guarantee that it'll be even tougher next year, and the year after.
    I too look on my work as a vocation, but I also feel as though I'm drowning in it. We desperately need more GPs to service this work-load, before doctors start going off sick, from shear utter exhaustion.

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  • We are on a loosing spin battle here chaps.

    This morning, I heard my local radio station broadcast this news "to ease increasing workload for GPs", rather then "to ease increasing DEMAND for GPs".

    So it's not about people wanting more, it's all about me wanting an easier life.......

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  • Rather than charge patients, why can't we charge per item of service. That way it would be a lot easier to budget for care provided and would be popular with the public as we could put on surgeries outside normal hours knowing they would be paid for. I suspect Government however would not like this model (even though it is more akin to the Tesco rubbish that is put out), simply because demand would then have to properly funded instead of continually squeezing further our finite resources.

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  • Hey - I have an idea. Let's make up a survey about something really controversial, sample a handful of GPs and then feed the results to the press.

    If we keep doing that our magazine will always be in the limelight and attract more advertisers.

    Who is the winner here???

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  • Charging a nominal fee cannot come too soon - we are being worked into the grave! The question is when not if.

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  • This magazine is one of the worst bits of media I've read in a long time. I'm astounded, knowing the discussion that has gone on behind the scenes and the editor admitting the survey was meaningless, that he has now written this editorial. I will trust that the readers of this article are savvy to the situation he finds himself in, in not being able to apologise and withdraw such a flawed, damaging and inaccurate article. Thank goodness I've had the opportunity to talk to so many GPs to get the true perspective on this matter.

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  • Thanks for the comment.

    I certainly haven't said that the survey is meaningless, and I'm not sure where you got that impression from - the points above on methodology are simply to be absolutely clear on how we went about the survey, in response to questions I've had from GPs. As I mention above, you can read a very fair-minded and entirely independent analysis of the survey's methodology from the expert Picker Institute here:

    Their analysis is well worth reading in full, but to summarise, it concludes that while some of the survey's findings may have been exaggerated in coverage from other publications, 'the article in Pulse seems to give a reasonable and balanced description of the results of the poll'. It also suggests that the survey resulted in 'an interesting and challenging finding, and one that merits further investigation'.

    Steve Nowottny
    Editor, Pulse

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