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A faulty production line

This LMC vote does not mean GPs support co-payments

Letter from Dr Naomi Beer, Tower Hamlets, east London

The LMC conference has just passed a motion instructing the GPC ‘to produce a discussion paper outlining alternative funding options for general practice, including co-payments’.

Let me first make something clear. This was never intended to be a motion primarily about co-payments. The way it became so was problematic and disappointing. It was a motion drafted by the agenda committee following a discussion involving about 50-60 GPs on whether care could and should be rationed. As might be expected, they held widely differing views and the chair had the difficult task of trying to represent those views in the form of a binary motion that was later presented to the whole of conference for a vote. We did not get the chance to agree the motion in the actual discussion forum as it was drafted later.

I was very unhappy with the wording of the motion because singling out co-payments for a special mention implied two things: firstly that co-payments should be part of the solution to the underfunding of primary care; and secondly, that it was the preferred option of those who took part in the parallel discussion which formed the basis of the motion (later drafted by the agenda committee). Neither of these is true.

I and many others who took part in the parallel discussion have no desire whatsoever to see co-payments as part of any proposed solution to the problems of general practice. Patients, particularly sick and disadvantaged ones, should not be made to pay to bail us out of problems caused entirely by a government bent on dismantling our universal health service free at the point of use by means of needless reorganisation and savage cuts. Any form of charging will exactly penalise those who most need the service we provide. There is a wealth of evidence to support this opinion and further evidence around the effectiveness and outcomes for different models of care. The whole point of the group requesting a discussion paper was to ensure that options people are already talking about can be explained and examined properly, using evidence and information already available.

Never the less there are colleagues who, in the face of an intransigent and reckless government, still seem to believe that making patients pay for ills caused by government and NHS England is a potential solution. They talk of charging and co-payments and believe it is possible to safety-net in such a way that no one who is vulnerable will be disadvantaged. There were such opinions expressed in the discussion. However, there were others who gave evidence of current successful working alternatives that made any need for co-payments entirely unnecessary.

It was my hope that an informed discussion paper based on thorough research could examine the options and potential consequences or outcomes of those options where evidence for them exists.

In the end there was no debate where reservations could be expressed despite agreement with the main point of the motion: the only speaker allowed was the Proposer, who turned a motion intended to call for evidence into a platform for his own enthusiasm for co-payments.

No sensational headlines please. GPs have not voted for co-payments!


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Readers' comments (4)

  • Vinci Ho

    I would only question the political wisdom of having this motion three weeks before a general election.
    Know the rules of the game , play by the rules . Don't shoot oneself in the foot......

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  • In case you have not been paying attention we already have a co-payment system in the form of prescriptions. This has not led to a collapse of healthcare for the poor because they do not pay. I have come across people (JAMs) who have not collected their meds until their pay cheque arrives but on those occasions it has been a personal choice between their meds and another lifestyle factor which they prioritise. They are making a resource based decision for themselves - it just happens to be with a different lens to mine. The wealth of evidence (i.e. the rest of the world) shows that a system which allows patients to supplement a basic healthcare provision works better than the NHS (although is less resource efficient). Co-payments are a way of increasing patient choice and effectively increase the private spend that goes into a country's healthcare. As a profession we have a responsibility to call time on a health service which is not serving our patients and start looking for long term sustainable models. The obvious thing to do is look at another country that is managing better and see if we can mirror that here. All options need to be on the table - we must not cling on to blinkered ideology if it is not working. Co-payments can be means tested and that protects those who cannot afford them.

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  • Vinci Ho

    "The pessimist looks down &hits his head. The optimist looks up & loses his footing. The realist looks straight ahead & adjusts his plan."
    Walking Dead season 7 ep 2

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  • I'm really sorry Naomi - I have immense respect for you, but I am going to have to disagree with your version of events here.

    I, too, was present at this themed debate. Everyone in the room had their say and both facilitators did their best to try and encapsulate the diverse views.

    Both motions which came out of this debate were discussed with the group and approved by the group.

    I agree that the motion itself was only proposed and opposed by two speakers but this as due to time pressures.

    I, personally, do not wish to see a co-payment system but neither do I wish to shut down debate. There are numerous countries in the western world (including Europe)who seem to have an excellent health care system but it is not the NHS. Why is it such a sin to look at some of these other systems and perform a really good analysis of their pros and cons?

    I'm afraid there is a lot of scare mongering amongst those who vehemently oppose this motion that the elderly and poor with be dying on the streets. We all know this not to be true in countries which adopt a co-payment system.

    I will say it again - a nationalised health service is the most efficient way of running things and doesn't line the pockets of multi-million pound insurance companies. But if it is severely and chronically underfunded, then it may actually cause harm to both patients and employees.

    No matter how hard we campaign, the NHS will not be funded the way it should be under this government's watch. Do we die with it or look at all our options?

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