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CAMHS won't see you now

Should the NHS charge patients for GP appointments? Yes

Charging patients to see a GP could ease the workload crisis and promote better care, argues Dr Julius Parker

Dr Julius Parker

A recent Pulse survey of 400 GPs indicated a bare majority would now support patient charges. This has generated a revealing cross-section of medical and public views.

Charging most patients a nominal fee to see their GP would promote more responsible use of the NHS; doesn’t the public value a service more when it has to be paid for? As for the technical challenges of processing such payments, they have already been met worldwide.

These fees, like prescription charges, should be a source of NHS revenue, and not destined to reward GPs directly. They should only be introduced in an integrated way – if walk-in centres and A&E departments remained free to access, it is easy to imagine the skewed patient behaviour that would result.

Appointment fees could encourage greater self-care, and reduce the ‘just in case’ or ‘it’s my right’ attitudes that influence some patients.

Certain groups would need to be exempted from such fees, but with so many candidate groups, it would be important to prevent the fees becoming another ‘middle-class tax’, potentially fostering the emergence of private general practice and a two-tier service.

One GP expressed concern that patients would demand ‘their money’s worth’ if they had paid – but surely this is what GPs would most like to deliver. The chance to devote more time to our patients and provide healthcare both reactively and proactively: a true NHS primary care health promotion service.

Charging a fee could help manage the level of demand that is bringing the profession to its knees and putting GPs under such pressure that they struggle to offer the quality of consultation they want to provide and that patients deserve.

If NHS treatment is to remain affordable and sustainable in the future, there are some difficult choices ahead.

Dr Julius Parker is a GP in Slough, chair of Kingston and Richmond LMC and chief executive of Surrey and Sussex LMCs

Readers' comments (27)

  • 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 GPs are causing my extra appointments as there is always problems with transfers & referrals which is positively dangerous .This is very upsetting when the stress actually contributed to cardiac arrest never having been referred to a cardiologist[ weekly visits re symptons] .Should they pay me for wasting my time unreasonably .If they had taken the hippocratic oath this would not be happening.

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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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  • Charging could solve the NHS problems and deliver the quality service patients expect. GP practices receive on average after expenses just £60 per patient per annum. In our Practice we have 6-8 contacts per patient per year . Assuming a charge of £10 per contact Practice income could be doubled. However expect also that demand would drop by 25% hopefully mainly by the patients who come in unnecessarily. The extra income can be put back into good patient care and extra resources i.e. appointments could be extended to 20 minutes and even 30 minutes for complex problems. GPs would be less stressed, patients would be better sorted which in turn would result in far fewer emergency hospital attendances. If patients were unable to pay, Practice staff could have a very low discretionary threshold for waiving the fee....

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  • I see the chair of richmond lmc agrees with charging, I wonder why.............££

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  • £10 per consultation - Watch out this is a precursor to privatisation . Why are practice boundaries being scrapped ? So that private companies can cherry pick worried well workers and charge £60 for the "convenience" .

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  • Why not I have to pay to see the dentist !!!!!!

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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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  • Absolutely, 10£ visits, 20£ DNA without cancellation. Free to kids and pensioners.

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  • If you are charging a patient, people on benefits should not be exempt. In my surgery , middle class patients and patients who work hardly bother us . The ones who are always in the surgery are the ones on benefits and elderly. We cannot charge the elderly either. Hence it should be for everybody under the age of 65. I am sure everybody in this country can afford £10 for their health. Evidence has shown that people on lower socio economic strata spend more money on alcohol and cigarettes. It then proves that they can push their money to buy cigarettes; if so they should be able to spend it for their health as well.
    This needs to be applicable for A/E and walk in centres. The consuntation time should be increased to 20 mts as well.

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