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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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