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£10 charge for GP appointments would raise the NHS £1.2bn, study finds

Charging patients £10 a time to visit their GP would raise an extra £1.2bn a year in England, a new report has claimed.

The think tank Reform’s study of 31 developed countries found that 22 countries require patients to pay for an appointment with a GP, ranging from 85p in France to £17 in Sweden. If the Government introduced a £10 fee in England, this would equate to £1.2bn increase in funding, the report concluded.

The finding comes after a Pulse survey published in July prompted a national debate when it revealed that about half of GPs in the UK favour charging patients a small fee for routine appointments.

Reform’s calculations are based on adopting fees in the same way that other developed countries do. Its report argues that extra cash could also be raised through increasing prescription prices, charging patients a £10 ‘hotel charge’ for every overnight stay, and £10 for missing a hospital outpatient appointment.

Overall, these measures would bring in £3bn for the NHS, it concluded.

Thomas Cawston, research director at Reform, said: ‘Few will want to debate higher NHS charges, but the funding outlook for the service makes it unavoidable.’

‘Prescription charges are the easiest route to new revenue, with exemptions for people on low incomes.’

Pulse’s survey found that over half of GPs are in favour of the NHS charging a small fee for routine appointments, with many believing it is the only way of managing their workload and curbing rising patient demand.

Of the 440 GPs polled in the survey, which covered a wide range of different topics, 51% said they would support charging a small fee for GP appointments, compared with 36% who would not. 

That represented a significant increase on the 34% of GPs who said they would support charging for appointments in a similar poll in September 2012.

The GPC and RCGP have said they are strongly opposed to introducing charges for patients, and ministers have also ruled out the idea. But Dr Paul Charlson, a GP in Yorkshire and vice chair of Conservative Health, said there were merits to charging for appointments.

He said: ‘I think it’s a good idea in principle because it would reduce the number of inappropriate visits to GPs. We would need to make sure that there are exemptions for people on low incomes.’

However, he added: ‘There would be drawbacks of this charging. It would be political suicide for a party to introduce this. They could only really do it if there was a feeling in the country that health services were falling apart. It could be time-consuming to monitor payments, bank them, and chase up non-payment – and there would be a cost to all that.’


Readers' comments (42)

  • Germany recently got rid of the 10 Euro charge it had introduced as charging did nothing to deter patients from attending and the health of patients with chronic disease deteriorated as a result of the charges.

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  • I think I agree with most comments-we may compromise a bit consultation £5-DNA £10-non concordance £20-using A&E inappropriately £20--but has the government got the guts --no way they can only slash GP pay

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  • i can gaurentee the 1.2 billion saved will be .6 bn in a years time and half that again in you know why?it is obvious.

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  • He said: ‘I think it’s a good idea in principle because it would reduce the number of inappropriate visits to GPs. We would need to make sure that there are exemptions for people on low incomes.’

    Hardly anyone would pay, as with the current nhs prescription charge fiasco. Of the 6,000 items dispensed monthly less than 300 of those items are actually paid for by patients. The other 5,700 items are covered under one exemption or another.

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  • hey you know something?the current benefit rates are based upon free the government will have to increase their benefits to take into account the 10pound

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  • One pound fee for everyone including those on benefits, for both GP, MIU, walk in and A and E attendances and all visits, I guarantee the attendance rates will drop in half. The government has caused this by raising patient expectations. We must charge everyone so that there will be a real impact.

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  • Dear Anon at 3.11pm, how do you reckon GPs should be responsible for drug wastage by patients? If the patient is getting scripts at the appropriate time interval and states on medication review they are compliant, GPs have done nothing wrong. Would you like us to supervise every patient taking every medication to avoid waste? Most patients seem to be ordering through the pharmacy now anyway - and, as I understand it, pharmacists contact the patient first to ask what items are required. We cannot be held responsible for actions of others but when asked to audit the pharmacists actions previously we found that patients were being asked appropriately what was required. In an ideal world we would make no mistakes but we are all human (apart from you it would seem) and do our best for our patients. You enjoy your evening and relax.

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  • Germany had introduced a practice charge of 10 Euros per visit a few years ago and scrapped it last year as it cost more to collect than it generated and did not deter anybody.

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  • My goodness, I thought my finger had slipped and I was reading the comments section of the Daily Mail!

    Why penalise people for poor health and/or poor education and self care skills? Why not penalise for a complete lack of personal responsibility and inability to appreciate that actions have consequences?

    Charging for DNA's in hospitals could be a start, and if successful, rolled out to GPs.

    Having a national prescribing policy regarding otc meds would be another. The mind boggles as to why it requires someone with a medical degree to merely be a scribe for someone's calpol or senna.

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  • Finally some common sense in the debate about NHS finding. I'd say £30/consultation would be more appropriate with a concessionary rate say £7.50 to those on benefits. We could also cross subsidize special appointments such as diabetes, children under 10 and cancer care to keep core practice 'free'. We could also cap charges for those with long term conditions.

    Loading extra onto prescriptions is just a tax on the working class and penalizes those with long term conditions who don't necessarily need to see a doctor. A+E minors should charge extra (say £50) to encourage appropriate GP use. The NHS is in such dire straights at the moment that charges are inevitable just to control the surge in demand so it's far better to plan this properly than to wait until the inevitable happens. By the way, my boiler-man charged £70h for a call out the other day, so I still think we offer pretty good value.

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  • The problem with this is 'fairness'

    A large proportion of the patients we see are not employed and will likely be exempted from paying which will not make any difference for demand. They will likely be exempted from DNAs as well.

    Those that will have to pay will be the ones working who are already paying a lot of tax , having in their view poor access, and having to take time off work to attend appointments. Many can't afford to take time off work due to pressure by employers or financial concerns. They often then turn up at walk in centers after work. I don't think it is fair to ask them to pay twice for what they view as a poor service.

    A fairer way would be for GPs to pull out of the NHS and all become private like dentists, give back a proportion of the NI contribution back to patients and let ALL of them pay the GP directly. There would still be a mechanism for the government to cover the costs of healthcare for those who can't pay e.g. redeemable vouchers which could be reimbursed by the GP. It may make people think more about the cost of their care and may encourage more positive views to their own health.

    It would ensure competition as patients could choose which GP they want to see. Demand would be controlled by market forces (as in all other sectors). Society will then have to decide what it wants to pay for. The pressure will be on Society to make those decisions rather than pushing all the responsibility onto GPs. we can then spend the time caring for the patients we see rather than chasing our tails to trying to deal with insurmountable (and rising) demand .

    Some of you may think I'm being unfair but a lot of my surgery is taken up by the public with the following issues 'aggression issues', workshy, after prescription medication, worried well, lonely, have a chronic illness but are not motivated to do anything about even though I've gone through the benefits the umpteen time, want referrals but DNA then turn up wanting another referral etc... The categories of cases I've listed are not poorly educated or vulnerable - they know exactly what they are doing. Many are manipulative and know the system better than us.

    I just don't think it is fair on the genuine hard working members of the public who pay their tax and when they want to get a GP appointment they cant get one (I'm definitely not blaming GPs it is a demand issue), if they then get an appointment they
    have only 10 minutes with the doctor who tells them to come back if they are no better.

    We need to think big on this and start to look at alternative models.

    those GPs that just want to see NHS patients could in this model still opt to do so.

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  • Err...who is going to cover the cost of the administration of getting the money out of the patients? Our receptionists are already snowed under. The Practice Managers don't have time to deal with the complaints that will result in patients whinging on about how they paid for a doctors time but the doctor misdiagnosed the problem or refused to give them antibiotics....blah blah blah. I can just hear it now!
    Why should it only be working people who have to pay....good god, how much more can we be responsibel for?. And we've got all the bulgarians coming in soon - are we expected to cover their costs too?
    However, YES...I do think we should charge for DNA's at the surgery and at hospital. Afterall, you would have to pay if you missed your dental or beautician appnt.

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  • Stop benefits and give them vouchers for food,electricity and other basic needs. Working people are the laughing stocks for many. Alcoholic gets benefit money and goes to bargain booze !!! People get meds for free and sell them on streets. Who pays for all these the poor working lot.....system is doomed to fail...Sooner the better for next generation at least....otherwise it will 100% on free medicines from current 91% need to work! Hurray

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  • Sally Griffiths | 21 November 2013 10:35pm

    Err...who is going to cover the cost of the administration of getting the money out of the patients?

    good point but the money collected should go back to primary care to cover such costs and pay for more staff so we can provide more appointment slots as the public say it wants.

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  • Maybe patients could pay an annual fee of £10 to their GP practice. This would not be as draconian as payment for each appointment. Elderly or those on benefits could be exempt if they wish to be.

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  • why not go further and pull out of the NHS

    have direct payment at say £30 per consultation + extra for paperwork, visits and so on. emergencies can go to a&e as usual. we can give back society the 7-10% of NHS funds that we greedily take to fund our lavish champagne lifestyles and let society worry about the 90% or so face to face consultations that we do. We will no longer be a drain on the taxpayer. The public can then use the money they save from primary care to see a GP of their choice and the true cost of care will be passed to the individual. This is a win-win for everyone?

    the media (right and left wing) will be happy as they have finally got rid of the cause of all that is wrong with the UK and got GPs off the public payroll - as if it weren't for greedy GPs the NHS would be providing perfect healthcare with 0% mortality and no mistakes and a&e would be running smoothly !

    Politicians will be happy as they have saved 10% of the NHS budget.

    Joe Public will be happy as their tax money won't be lining their doctors pockets i.e. the person that actually provides the service.

    The grassroots should be happy as with direct payment there will be no need for QOF etc as you are cutting out the middle man who handles the payment (NHS England). It will simply be a matter of keeping your patient happy.

    The BMA can negotiate a fair rate and the RCGP and GMC can maintain standards.

    everyone wins?

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  • Here's an idea. We could ask everybody who is working to contribute a small amount of their income every month. Then we could use some of that money to pay doctors to look after us when we need medical care. We could call that monthly payment "National Insurance".

    Or another idea is to charge an extra amount for cigarettes and alcohol. Then we could use some of that money to treat people when they get cancer, cirrhosis, heart disease etc. We could call it "excise duty".

    Or we could just tax people on their income and use some of that money to pay for medical care? We could call it "income tax".

    No wait, these are are all STUPID ideas. It will be much better to spend a few billion pounds to collect a couple of billion. Well done Reform and hurrah to the Tories.

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  • If it's free it's abused not valued and demand for
    a Rolls Royce service.
    I want a Porsche but have to settle for a fiat
    But if it was free we would all demand a premium
    That's the problem we want it now for whatever
    and also want it 24/7.
    Reason free at the point of delivery

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  • Charging patients to see GP is a tax on the sick - and will mean GPs in poorer areas receive less money to deliver care to those that need it. Better to tax those that can afford £100 more per year and sort out supply led demand

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  • @ 10:03- Poor is a relative term. Who is poor ??? - joe public who slogs to earn national avg salary and has to think about each penny he spends or
    Someone who hasn't contributed to the society at all gets everything provided for !!!!!

    We can keep on subsiding for the so called poor and you will be doing it for ever till society disintegrates ..... Time for a culture change !

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