Former health secretary backs £20 fee for GP appointments

The NHS should introduce a £20 fee for GPs appointments, a paper backed by former health secretary Sir Sajid Javid has recommended.

The Government should consider shifting to an insurance-based system for the NHS, combined with the introduction of charges and co-payments, according to think tank Policy Exchange.

Sir Sajid, who backed the paper, said that a ‘serious conversation’ with taxpayers about how we continue funding the NHS is ‘long overdue’.

The report said that there should be ‘a fee payable for visiting a GP’, with exemption for low-income groups.

It also proposed the idea of leaving GP visits ‘free during core hours’ but to give GP surgeries ‘the option to charge for evening or weekend appointments’.

The think tank argued that potential savings resulting from charging patients for some NHS services could be just over £11bn per annum, but that the greatest saving for the NHS would come from charging to see a GP.

It added: ‘This calculation assumes that the GP charge is set at £20. It that were raised to £50 then the total amount raised would increase by £7bn to £18bn.’

According to the paper, the introduction of a charge would also reduce the demand for GP appointments and cut back the number of missed appointments so ‘the total gain could be considerably greater’.  

Sir Sajid, who was health secretary in 2021 and 2022 under Boris Johnson, had already backed the idea that patients should pay a fee to see their GP to reduce demand in 2023, when he said the NHS could not ‘survive much longer’ without substantial change, including some fee payments to see GPs and emergency departments.

In a foreword to the Policy Exchange paper, Sir Sajid said: ‘We’ve come to a crossroads. A serious conversation with taxpayers about how we continue funding their favourite national institution is long overdue. We have two options.

‘The first is to make an active choice to continue putting more and more money into healthcare, funded by yearly tax rises and by diverting essential investment into everything from education to defence towards the NHS.

‘The second is reforming how we do healthcare. What we cannot afford to do is to bury our heads in the sand. While some of the new government’s interventions have been very welcome – particularly Wes Streeting’s focus on patient outcomes – they will not change the long-term viability of a model which does very little to adjust almost unlimited demand to the finite resources we have for healthcare provision.’

The report argued that there are several ways in which patients could be made to make payments towards the cost of NHS provided services, with the ‘most obvious option’ being to charge people for GP appointments.

It added: ‘There is clearly much room for debate about the amount to charge per appointment. £50 might seem a plausible sum, while still being below the full cost.

‘However, a charge this large would surely cause widespread consternation. Perhaps it would be wiser to start by charging £20 and then to gradually increase the charge over the years to £50.

‘In the year to March 2025, there were an estimated 370 million GP appointments made, although only 331million were actually attended.

‘If there were a £50 charge for each of these appointments, this would raise approximately £18.5 billion, or £7.4 bn if the charge were £20 per appointment.’

The think tank recognised that there would ‘undoubtedly’ be ‘widespread public resentment’ if people were made to pay for GP appointments.

But it added: ‘Doubtless they would get used to it as they have had to do with prescription charges and payments for dental services.

‘And some European countries have grasped this nettle, although there is a wide variety of charging practice across different European countries.’

The paper argued that the NHS should move from the current entirely socialised model to a ‘hybrid model’ with a ‘significant’ social insurance component, but that under no circumstances should the UK consider the American model.

It added: ‘This reformed healthcare system would ensure universal, affordable coverage, subsidise the cost of the care for those under the age of eighteen, those on low incomes and those with long term conditions, employ a blend of insurance premiums, annual excesses, tax contributions and copayments, and would ensure a high minimum standard of provision as well as greater choice for individuals over their healthcare.

‘For all its faults, the presently structured NHS is far preferable to the American system. Under
no circumstances should the UK consider moving towards the US model.’

In 2023, another former Tory health secretary, Ken Clarke, argued that wealthier patients should pay a fee to see their GP as a way to increase funds for the NHS.

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