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Half of GPs in favour of charging for routine appointments



Exclusive: Just 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, a Pulse survey has found.

Of the 440 GPs polled in the survey, 51% said they would support charging a small fee for GP appointments, compared with 36% who would not.  

That represents a significant increase on the 34% of GPs who said they would support charging for appointments in a similar poll last September, and suggests many GPs are willing to consider more drastic solutions to reduce their growing workload.

The survey results come at a time when GPs have been reporting growing workload due to the imposed 2013 contract deal, with some willing to take a pay cut rather than bid for new work under four new DESs being offered this year, and worrying levels of GP burnout.

The majority of doctors who called for charging to be introduced specified an amount between £5 and £25 per appointment. One GP suggested means-testing, saying: ‘£10 for poor, £25 for others, £100 for professionals and politicians and £150 for solicitors and accountants.’

A report by the Deloitte Centre for Health Solutions last year concluded that demand for face-to-face consultations with GPs is likely to double in the next two decades, with 433 million practice consultations predicted annually by 2035, including 180 million for people aged 65 and over.

But the option of charging patients is likely to be prove politically unpalatable; health secretary Jeremy Hunt was recently forced to deny that he was considering Conservative Health Forum proposals to include a cap on the number of appointments patients can make with a GP.

Dr Stephen McMinn, a GP in Bangor, Northern Ireland, said he was in favour of charging patients for appointments. He said: ‘[It] has been shown to work in other countries. There needs to be some pressure to decrease patient demand and expectation.’

Dr Shailendra Bhatt, a GP in Hemel Hempstead in Hertfordshire, said: ‘I work in a walk-in centre. The amount of people who come through the door for practically no reason at all and say “I was out and saw this sign for a walk-in centre where one can see a doctor, so I came in”… People don’t value the things if they get it cheap, worse still if they get it for nothing.’

But other GPs argued that against charging. Dr Sheila Pietersen, a GP in Bristol, said it could deter some patients with a genuine need from seeking help and ‘may hinder the doctor-patient relationship’.

She added: ‘The costs of administering fees would be huge and chasing people for non-payment would be difficult and time-consuming.’

Dr Edmond Ferdinandus, a GP in Wakefield, West Yorkshire, said: ‘A small fee will make patients feel they have a large entitlement – if we do this, I predict the extra income will be entirely cancelled out by extra prescriptions, investigations or referrals.’

The GPC said it was not in favour of such a policy. Dr Chaand Nagpaul, GPC chair, said: ‘The NHS should be free at point of delivery and it is not LMC policy to support charging patients.

‘Charging patients would have adverse effects and would fundamentally be to the detriment of GP-patient relationships. We need to preserve trust between patients and their GPs.’

A Pulse survey last year showed three-quarters of GPs were in favour of charging for ‘did not attend’ appointments, while a report from The King’s Fund found that the public would also be in favour of such a proposal.

Would you support charging a small fee for all GP appointments?

Yes – 51%

No – 36%

Don’t know – 13%

Source: Pulse survey of 440 GPs