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Former health secretary calls for GP appointment fees

Former health secretary calls for GP appointment fees

Wealthier patients should pay a fee to see their GP as a way to increase funds for the NHS, a former Tory health secretary has said.

Ken Clarke, who was in the post under Prime Minister Margaret Thatcher, from 1988 to 1990, said that the Government should not rule out asking wealthier NHS patients to pay for their treatment.

But the BMA said doctors have repeatedly dismissed the idea of co-payments or charging for care.

It comes after GPs urged the Government to put in place ‘radical’ solutions to ease pressure on general practice and urgent care.

Earlier this week current health secretary Steve Barclay unveiled plans to tackle increased pressures via additional funding for early discharge services and the setting up of modular hubs outside A&E departments. 

The plans also included reducing CQC inspections so that NHS staff can focus on essential services, but some GPs believe the measures were ‘too little too late.’

Lord Clarke said that charging a ‘flat level’ fee for a GP would have to be means-tested but worth considering as a way to raise more money, and it could include charging a small fee for ‘routine procedures.’

Speaking to Times Radio on Monday (9 January), Lord Clarke said: ‘I do think, and I would have reacted to this ferociously at any time until the current crisis, we may have to look at some means of the better-off patients making some modest contribution to their treatment, which we have always had in the case of prescription charges.

‘We do pay [for prescriptions] until you become a pensioner, however well off you are as a pensioner, which is an anomaly. We may have to look for other small payments.

‘It’s just possible, I’ve not converted yet, but I do understand why people are saying that. Those who say they just want to go to a wholly insurance-based system, I’m still as flatly opposed to that as ever.’

But Dr David Wrigley, BMA England GP committee deputy chair, said that rather than discussing patients paying for a care, politicians should be pressing the Government to fund services adequately.

Dr Wrigley told Pulse that the BMA has dismissed the idea of charging for care on multiple occasions and that the public ‘should not be punished for misguided political choices.’

He said: ‘The BMA supports the founding principles of the NHS: a health service that is free at the point of use, publicly funded and publicly provided, which provides care based on need, not on the ability to pay.

‘The idea of co-payments or charging for care has been repeatedly dismissed by both BMA and LMC conferences.

‘Rather than discussing patients paying for appointments or for other care, politicians should be pressing the Government to fund services adequately so that they can meet the needs of the population, while recruiting and retaining enough staff to protect the future of the NHS for our patients.’

In today’s Prime Minister’s Questions, Labour leader Sir Keir Starmer accused the Government of having ‘broken the NHS’, leaving it ‘without a minimum level of service any day’ and Prime Minister Rishi Sunak signalled that he has no interest in wholesale reorganisation of general practice in England.

In September, NHS England asked integrated care boards (ICBs) to identify where to allocate potential winter support funding to GP practices and PCNs, focusing on areas with deprivation and recruitment challenges and some practices in the South East of England are offering £15,000 as well as support in relocating.



Please note, only GPs are permitted to add comments to articles

Ian Jacobs 12 January, 2023 10:23 am

Many of us will remember Ken Clarke and 2 well recognised mutterings that he made . GP’s ” reaching for their wallets ” ( well – it was in the late 80’s) but then saying he didn’t mind if GP’s drove around in Rolls Royces if they deserved one due to their hard work and entrepreneurship.

This proposal would lead to an even wider disparity of access to primary health care than exists already . Who knows where he would draw the ” financial line ” – and would it be based on income , capital assets , both + accumulated pension entitlements etc etc . Those that were deemed eligible to pay are likely to feel even more entitled to their GP’s time, skills and expertise if they are paying for a consultation. And would a paying patient also be able to jump the appointments queue ?

However- the overriding issue is the overseeing of payments. It would add a whole new layer of administration for those practices with many high net worth patients whereas some practices would hardly be effected at all . ie more division and divisiveness. The richer practices are likely to get even richer – and the poorer non-paying patients at those practices would find increasing difficulty getting access. Would these ” private patient type payments ” be pensionable ?. It might tip some practices ( the wealthier ones ) into having to register for VAT due to their non-NHS income being pushed over the VAT threshold(s).

GP’s and primary care practices already face daily difficulties with patients feeling entitled to whatever service they want- creating a sub-class of patients who are likely to feel even more entitled ( because their paying something ) is a recipe for disaster. ie even more disaster.

Cameron Wilson 12 January, 2023 10:30 am

And that’s exactly why the BMA hasn’t got it’s priorities right! By being dogmatic that charging patients isn’t an option there’s no Plan B hence no negotiation credibility, never mind losing the workforce as collateral!
Also, to reduce demand all patients should pay up front and then any groups exempt get central reimbursement! This might be anathema to some but I am afraid thinking that any government is going to be able to fund an unlimited health want/need service is not dealing with reality.

Turn out The Lights 12 January, 2023 11:19 am

Spot on CW

Guy Wilkinson 12 January, 2023 12:02 pm

Totally agree CW

The socialised model for health is dying. FATPOA is killing it . We need to move to copayments in an Australian model.

SUBHASH BHATT 12 January, 2023 1:42 pm

Why every one is after well off people. They pay nearly half of their earning in taxes to fund services including nhs. Lots of them pay for private insurance and save money to nhs.. they also send children to private schools.
nhs expense is bottomless pit. One need to find alternative which is fair to poor and rich ..offer tax incentive for private health insurance.
Being rich is not a crime.

Matthew Shaw 17 January, 2023 9:46 am

Totally agree with CW – the BMA are typically leftist and populist on this. Think of the 5p plastic bag charge and how it changed behaviour. In countries where they pay to see a GP [we’re talking Ireland and France not the USA here] the consultation rates are as much as 75% lower. Which tells you what we all know but the BMA doesn’t want to admit – that a lot of what we see is a waste of time or worse, causing dependency.