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Gold, incentives and meh

Large majority of GPs vote against charging patients for appointments

A significant majority of GPs at the LMCs Conference has voted against the proposal to back patient charging for GP appointments.

In all, 224 delegates voted against the motion, which received intense media coverage after first being covered in Pulse earlier this month. But in the end, only 59 delegates voted in favour, while four abstained.

Proposing the motion, Wiltshire LMC’s Dr Helena McKeown said the time has come to ‘put a true value on general practice’. However, the GPC led a host of delegates in opposing the motion, which was branded as ‘mistaken and dangerous’.

Dr McKeown said: ‘The time has come to lead our profession in putting a true price on the value of general practice. Currently, the Government both commissions, and controls, completely the funding of general practice. They dictate both what they want, what they will pay for, and indeed how much they will pay for it. We are left rationing care both in CCGs and in our consulting rooms.’

‘A fee for services, for some people, would sustain us whilst we build up a workforce that wants to join us and make general practice more attractive than retirement or general practice abroad. We need an honest Government to say who and what will be completely covered by general practice as an NHS service. A fixed fee, for some services, for some patients, wil emphasize our value.’

But the number of GPs wanting to speak against the motion vastly outstripped those speaking in favour. Among those queueing to make their opinion heard was former GPC chair Dr Laurence Buckman. Welcomed to applause, Dr Buckman, who stepped down as GPC chair last year, said the motion was both ‘mistaken and dangerous’.

He said: ‘You do not control demand by making patients pay. You then get survival of the richest, not treatment of the sickest.’

He added: ‘It is not for GPC to consider alternative funding mechanisms, unless the NHS is threatened with closure. Although we know that all the main political parties want a private health services, and some parts of the Treasury would love to get rid of the NHS, the vast majority of the public of all political views would prefer to keep it. GPC will be offering to privatise as a way out by doing it to ourselves and our patients, as well as another opportunity to bash greedy GPs. That we already have some co-payments in the NHS is regrettable. To introduce it for UK general practice would appal most of the public and the profession.’

‘Conference, I don’t think most of us became GPs to collect taxes for the Government, but that is what [this motion] would do.’

Commenting on the outcome of the vote, GPC chair Dr Chaand Nagpaul said: ‘In this climate, it is understandable that the LMCs Conference wanted to debate the need for extra funding for overstretched GP services. But introducing a charge for services would be a tax on illness, hit the most vulnerable the hardest and threaten to undermine the principle of an NHS free at the point of delivery.’

‘Introducing a financial transaction would undermine the trust between doctor and patient. If patients are deterred from seeing their GP due to an additional cost this could result in their illness deteriorating and costing the NHS even more.’

‘GPs have today sent a resounding message that charging patients is not the solution to the financial crisis facing the NHS. The BMA is committed to a health service that is free at the point of need and accessible to all and we should proud to have an NHS GP service where no one has to pay to get the treatment they need.’

Live blog: LMCs Conference 2014

The motion in full:


That conference:
(i) believes that general practice is unsustainable in its current format - CARRIED
(ii) believes that it is no longer viable for general practice to provide all patients with all NHS services free at the
point of delivery - NOT CARRIED
(iii) urges the UK governments to define the services that can and cannot be accessed in the NHS - CARRIED
(iv) calls on GPC to consider alternative funding mechanisms for general practice - NOT CARRIED
(v) calls on GPC to explore national charging for general practice services with the UK governments. - NOT CARRIED

Readers' comments (29)

  • A "private NHS" is only the Goal of Jeremy Hunt and his media chums like THE DAILY MAIL who cunningly manipulate public anxieties to support their master Jeremy Hunt. They owe him.....he supports no press regulation or any kind of controls on media lunacy.

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  • The solution to a dangerously underfunded and grossly overworked GP service-is more funding. FOR THE PATIENTS. Thing is The Daily Mail could not care less about the general public-this "greedy" newspaper only cares about money, money, money

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  • Since every other civilised and rich country makes people pay to see the GP, I find it odd that our GPs continue with this cult religion of the "free at the point of abuse" system. Every reason they come up with for keeping it "free" is destroyed by the experience in every other civilised country. Why on earth does the GPC cling like devotees to this awful discredited politicised ideology instead of doing its job of looking after its members?

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  • Totally agree with the above.

    Ironically those so fond of the NHS free at the point of abuse system are actually partly to blame for the impending demise of the service. Pretending that we don't have to charge will mean that we can never have an honest conversation about how much health care actually costs.

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  • I, personally, am chronically in fear of the public these days so could not face challenging their rage. But this is all silly-we don't decide anyway!! JEREMY HUNT CALLS THE SHOTS.

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  • Vinci Ho

    Remember a political problem needs a political solution . If this result was the other way round, we would have shot ourselves in the foot giving agent Hunt et al the political 'convenience' to go ahead with his secret agenda of destroying NHS once and for all.
    This vote result is more about game of politics than actually answering what is right or wrong . The pressure needs to be forced back to this government which is losing trust and credibility fast and furious . Where does the funding come from? The answer is coming from those running the state NOT from us who have suffered enough and been turned into working zombies , demons and slaves by politicians .

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  • I feel strongly that patients should be charged when they do not turn up for appointments. Whilst I accept it may be difficult to enforce it would at least send out a clear message that abuse of the NHS is not acceptable and will not be tolerated.
    I work in a Practice in a deprived area which serves a diverse ethnic population. In this area patients regularly DNA both GP and Practice Nurse appointments. These appointments are often lengthy, for example lung function tests/health checks etc. We have implemented a wide range of DNA avoidance strategies but ultimately a large percentage of patients just take the view that it is fine to just not turn up for an appointment as they can always rebook when the fancy takes them etc.
    Additionally we regularly book Interpreters only for the patients not to turn up again. Once again the NHS foots the bill for this abuse without question.
    The widespread abuse of the NHS needs to be tackled.

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  • Well done commissars, keep building nice shiney red tractors ,with no petrol, to keep the collective going.

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  • I doubt the GPs at the LMC conference are particularly representative of the grass roots because they tend to be more senior doctors who are wedded to the old ways they have worked for decades. A financial transaction does not undermine trust, I still trust my accountant, my solicitor and my dentist. If this is really how the profession feels then I am seriously worried about the future of UK primary care when our leaders cannot accept the overwhelming evidence from the rest of the western world (with the exception of America) that a co-payment system gets better results no matter what marker of quality you look at. Put simply it is unethical for us to sleepwalk into a future of catastrophic NHS collapse because we are too arrogant to accept what the rest of the world came to terms with years ago.

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  • A missed opportunity.
    Charging for surgery attendees- ridiculous ,
    Charging for home visits- why not?
    Home visits are one of the biggest barriers to patient care.

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