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Should the NHS charge patients for GP appointments? No

The very idea of it is against the ethos of the health service, says Dr Kailash Chand

Dr Kailash Chand 2 Neil O Connor

Dr Kailash Chand

In the current economic climate it is not hard to see why the old spectre of ‘NHS fees’ has raised its head again. But despite the idea’s renewed fashionable status, its supporters have still not managed to address its fundamental flaws.

The most obvious of those is that charging would be an administrative nightmare. Charging for appointments would require yet another bureaucratic machine to collect payments, pay them to the Treasury and deal with the inevitable paperwork and appeals. How much would this cost to set up?

More importantly, there is a clear moral dilemma. Fees are quite simply against the ethos of an NHS designed to give free, high-quality healthcare to all UK citizens no matter what their economic status. Charges would inevitably result in many people not visiting their GP when they need to, especially those on low incomes.

The growing band of people in our society who need food banks to feed their families could not afford a £10 visit to their GP. I particularly fear that patients would not come forward with those niggles and aches that, while appearing trivial, signify the early onset of life-threatening diseases. A question for proponents of charges, therefore, is how much ‘extra’ illness would be acceptable?

However much patient fees are dressed up as promoting self-care or deterring time-wasters, the fact is they are a tax on the sick and would reposition our NHS as one where the depth of a patient’s pockets determines access to care.

GPs are in a testing period, under pressure from rising demand and budget cuts. We need to address, head-on, how to cope with these challenges but the answer will not be to introduce an expensive new tax system that divides GP access between the haves and the have-nots.

Dr Kailash Chand is the deputy chair of the BMA and a retired GP

Readers' comments (22)

  • I fully agree, even those patients on welfare benefits find the monies for new mobile phones, designer clothes, Sky TV, Internet, Cigarettes, alcohol, so a minimal charge would prioritise their thoughts! All under 21's should be free, covering those in education and leaving those youngsters who are working not to be penalised due to Minimum wage. It would also stop the continuing worried well blocking up the surgeries with their weekly worries. Though if they worked for the Daily Mail they would probably need to go private due to the breakdown of patient - doctor relationship!

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  • The attendance fee of 10 Euros has just been scrapped in Germany as it was a bureaucratic nightmare, did not generate more fnds and did not deter trivial attenders.

    Interestingly, since 2006 no OTC medicines in Germany are available on prescriptions paid for by the health system (with the under 12s and other narrow exceptions). I think this might deter a lot more unnecessary attendances and prescription requests.

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  • I thought GP's didn't have enough appointments to go round so how does charging resolve that problem?
    GP's have got greedy and over book patients onto their register, patient numbers should be capped to ensure demand can be reasonably met. Patients on benefits would not have to pay and they tend to make up a large number of appointment slots.
    The real solution would be to cap the number of patients GP's can claim a fee for, a maximum number of patients per GP in ration with the number of appointment slots available.

    Should patients pay to see a doctor, we already do, via NI Contributions that nobody gave us the choice of opting out of!

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  • We provide free NHS care for folk that haven't contributed a penny into the system, e.g. those that have never worked and those coming into the country for economic reasons.

    The rest of us already pay via our taxes, we pay when we attend hospital via car parking fees e.g. £2.50 minimum, even if you are only parked fro twenty minutes. Many folk pay for prescriptions, often for items that could be bought cheaper OTC.

    Charging patients should only apply where cosmetic surgery is being sought, or for other care that would not normally be available via the GP.

    GP's have enough to contend with and whatever this government wants to try and force them to do, and this would be just another bit of paperwork.

    It is real shame that practice managers cannot relive GP's of some of this work, so one does wonder what they actually do with their time?

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  • The Tories (old Irish word Meaning thieving vagabond) have always wanted to privatise the NHS . This is one step closer on their agenda .

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  • @Anonymous 9:13am - Do you belive in Santa Clause and Fairies along with this claptrap you read in the Daily Mail?

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  • I like the idea of no OTC medicines on prescription - a packet of Ibuprofen costs 37p in supermarket - imagine the cost of GP visit and prescription handling against that? Agree that charging for GP visits is wrong and against the ethos of the NHS.

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  • Please - not another survey on this. We were pilloried by the Daily Hate Mail and others after the last one which was widely interpreted as a proper balanced view of GP opinion rather than an opportunity for self selected angry people [like me] to have a swipe at the system!

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  • Creeping privatisation is already visible. The top-heavy management structure (and associated costs and micromanagement) of the NHS has crippled what was once a system that I was proud to be working within.

    Now, the mismanagement of funds (CEOs on >£200k pa in a public body) and the sheer incompetence of the senior management of the NHS has brought it to its knees. The Francis report highlights what was presaged by running the NHS as if it is a shop, with 'customers' who need to be serviced on the same basis... i.e. we have your money now go away.

    Free healthcare at the point of service is the defining hallmark of the NHS and a civilised country. Please do not take it away. The USA has approximately 60% of its vast population who cannot afford healthcare. We should not follow the example of our American cousins.

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  • Hazel Drury

    Anon at 0913. Slightly confused. Most of us would be happy to have lists limited, but who is going to see the rest of the ones who are removed from me to have my "limit"? AFAIK there are very few GPs sat around with a deficit of patients on their lists? which patients do you remove? Not exactly in the spirit of "patient choice" is it?

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