A recent Pulse survey of 400 GPs indicated a bare majority would now support patient charges. This has generated a revealing cross-section of medical and public views.
Charging most patients a nominal fee to see their GP would promote more responsible use of the NHS; doesn’t the public value a service more when it has to be paid for? As for the technical challenges of processing such payments, they have already been met worldwide.
These fees, like prescription charges, should be a source of NHS revenue, and not destined to reward GPs directly. They should only be introduced in an integrated way – if walk-in centres and A&E departments remained free to access, it is easy to imagine the skewed patient behaviour that would result.
Appointment fees could encourage greater self-care, and reduce the ‘just in case’ or ‘it’s my right’ attitudes that influence some patients.
Certain groups would need to be exempted from such fees, but with so many candidate groups, it would be important to prevent the fees becoming another ‘middle-class tax’, potentially fostering the emergence of private general practice and a two-tier service.
One GP expressed concern that patients would demand ‘their money’s worth’ if they had paid – but surely this is what GPs would most like to deliver. The chance to devote more time to our patients and provide healthcare both reactively and proactively: a true NHS primary care health promotion service.
Charging a fee could help manage the level of demand that is bringing the profession to its knees and putting GPs under such pressure that they struggle to offer the quality of consultation they want to provide and that patients deserve.
If NHS treatment is to remain affordable and sustainable in the future, there are some difficult choices ahead.
Dr Julius Parker is a GP in Slough, chair of Kingston and Richmond LMC and chief executive of Surrey and Sussex LMCs