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Charge patients for missed GP appointments, says report

Charging patients for missing a GP appointment or going to A&E unnecessarily would have public support, concludes a report published today.

The King’s Fund study found although the public did not want to change the basic funding structure of the NHS, where care is free at the point of delivery, there was some support for charges in certain circumstances.

In a report published today, the think-tank looked at the result of focus groups discussing NHS charges. They found support for charging for those with ‘self-inflicted’ illnesses, such as obesity or lung cancer.

The study participants also supported the introduction of fees to attend walk-in clinics - because the increased flexibility they offer made them a ‘commodity’ - and procedures such as cosmetic surgery or elective caesarean sections. They also supported charges for missing appointments.

The report said: ‘When thinking about who should pay, and for what, many participants discussed those who are perceived to “abuse” the system. Discouraging or penalising this was seen as important. Almost all groups mentioned drunks in A&E departments at weekends.’

‘Another category of people mentioned was those whose illnesses are self-inflicted, such as those who do not exercise or control their diet and, as a consequence, are obese, or those who smoke and have lung cancer. Many thought these people should be responsible for the consequences of their decisions.’

‘Others mentioned people who miss planned hospital and GP appointments and those who do not make good use of the system, for example, those who go to the A&E department when they should be going to their GP first.

‘To prevent this from happening, some thought investing time and effort in educating people on how to use the health service appropriately would save money in the long term.’

But the researchers opened up for a wider range of services to become subject to fees as long as they were introduced ‘incrementally’. They concluded that people were more likely to support fees for services they already have to pay for, such as opticians and dentists appointments.

The report said: ‘For example, small charges could be introduced for some services that are seen to be discretionary, such as walk-in centres. As acceptability of this grows, those charges could then be increased or extended to other services.’

Anna Dixon, The King’s Fund policy director, said: ‘Although difficult choices lie ahead, politicians have been reluctant to discuss the future funding challenge facing the NHS. This research shows that people want to engage with these issues.’

‘With pressures to spend more on health care growing and the public finances likely to be under considerable strain for the foreseeable future, it is time for an informed public debate about how much we should spend on the NHS and how this should be funded.’

GPC deputy chair Dr Richard Vautrey commented: ‘There are already many charges within the NHS, for instance dental charges, opticians and prescription charges but it would be a dangerous slippery slope to introduce further charges, particularly if they acted as barriers to patients seeking appropriate access to healthcare.

‘We don’t want to go back to the pre-NHS days, or move to a US style of healthcare, where large numbers of people can no longer get the healthcare they need because they can’t afford it or cannot get or afford insurance.’

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Readers' comments (17)

  • I am entirely in favour of charging for self inflicted illness and injury. How much should I charge the chap with sore knees this morning from too much running & football. How much should we charge weekend footballers when they break a leg?? Should we force all hang gliders who sustain spinal injuries to sell their homes to pay for their care?? How much should we charge THIN people who do not exercise or control their diet?? Should we force all recreational cyclists to insure themselves against personal injury??
    NO you say, yet ALL of these are SELF INFLICTED!!
    Shame on the authors and all of you who have not even commented on this gross and perverted suggestion!

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  • I can see why GPs like DNAs, but please don't make excuses for these people because they are 'poor' - relative wealth should be irrelevant to good manners and consideration of others who struggle to get an appointment because poor (sic) Chardonay has difficulty getting out of bed before noon.

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  • I think what some posters don't realize is, this is about changing the attitude and culture of Britain.

    Currently it's "free" to make an appointment and fail to attend. That "missed" appointment is paid for by the tax payers. So it's not free after all - just free to the person that's missed it. If you calculate the number of these wated money, it will allow NHS to do more - or at least prevent cutting some services.

    Unless there is an incentive or penalty to stop the wastage, people will not change their attitude. And relative wealth should not be an excuse for their ability to attend an appointment. Yes, poor may have chaotic lifestyle but how does that justify wasting public funds? If the nation wants better health care, I suggest they start looking at their attitudes towards it, not just shout "gimme gimme gimme"

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  • The King's Fund is biased in favour of competition and privatisation. What they found with this study is that people are strongly in favour of maintaining the fundamental principles underpinning the NHS: taxpayer funded and free at the point of service.

    If you go to their website and look at the language they use to describe this finding (e.g., people are "wedded" to this concept) you can see the bias. The policy implication they take from their study results is that change will have to be incremental if people are to accept it.

    The NHS is under financial pressure primarily due to the reorganisation of the NHS to facilitate competition and the use of the private, for-profit sector to provide services. This necessarily results in fragmentation and greater inefficiency and bureaucracy. The reorg is being funded by the "efficiency" savings forced on the health service. Once the quality of the service declines, the argument is made that individuals must top up the funding with fees. The way you get individuals to buy into this is to set them against each other: some illnesses are worthy of free at the point of service care, some are self-inflicted and therefore not worthy.

    Rather than impose fees, the health service needs to move away from market forces, competition and profit. This unfortunately will be down to the next government.

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  • It won't work. Most of these DNAs are by people who receive benefits and as they don't have to pay anything, they will continue to ignore things like this. DNAs will come down if harsh decisions are taken. Perhaps by asking them to find another practice if they DNA 3 times. People who DNA must be harshly punished as they are causin problems for those who are looking for genuine problems

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  • Whilst I have long believed that what is free at the point of use is not properly valued this wont wash UNLESS we drastically reduce our bookings and run to time!

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  • Our PRG group voted for us to reduce the number of DNA before letters are sent- I get so much abuse from recipients- they have rights. I ask what gives them the right to prevent other people getting appointments that they need and would use, no one has ever been able to answer that one. They also get invited to come and discsuss it at PRG no one takes that offer up either.

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